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In baseline trachoma prevalence surveys, six districts in two governorates of Yemen were identified as requiring interventions. We set out to estimate the prevalence of trachoma 6−12 months after one round of antibiotic mass drug administration (MDA) and implementation of measures to encourage facial cleanliness. A population-based prevalence survey was conducted in each of the four evaluation units in October 2019. Contemporary World Health Organization recommendations for trachoma surveys were followed. Participants were selected using a two-stage cluster sampling process. The prevalence of inflammatory and late-stage trachoma was measured through eye examination. Water, sanitation, and hygiene facility access among visited households was estimated. The prevalence of trachomatous inflammation—,follicular (TF) in 1–9-year-olds per EU was

Kamal M Al-Shami,1,2,* Wesam S Ahmed,3,* Karem H Alzoubi1 1Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan; 2Faculty of Biosciences, University of Heidelberg, Heidelberg, 69120, Germany; 3College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar*These authors contributed equally to this workCorrespondence: Wesam S Ahmed, Email wisamyejo@yahoo.com; wahmed@hbku.edu.qaPurpose: Biospecimen repositories and big data generated from clinical research are critically important in advancing patient-centered healthcare. However, ethical considerations arising from reusing clinical samples and health records for subsequent research pose a hurdle for big-data health research. This study aims to assess the public’s opinions in Jordan toward providing blanket consent for using biospecimens and health records in research.Participants and Methods: A cross-sectional study utilizing a self-reported questionnaire was carried out in different cities in Jordan, targeting adult participants. Outcome variables included awareness of clinical research, participation in clinical research, and opinions toward providing open access to clinical samples and records for research purposes. Descriptive analysis was utilized for reporting the outcome as frequency (percentages) out of the total responses. Univariate and multivariate logistic regression were used to investigate the association between independent variables and the outcome of interest.Results: A total of 1033 eligible participants completed the questionnaire. Although the majority (90%) were aware of clinical research, only 24% have ever participated in this type of research. About half (51%) agreed on providing blanket consent for the use of clinical samples, while a lower percentage (43%) agreed on providing open access to their health records. Privacy concerns and lack of trust in the researcher were cited as major barriers to providing blanket consent. Participation in clinical research and having health insurance were predictors for providing open access to clinical samples and records.Conclusion: The lack of public trust in Jordan toward data privacy is evident from this study. Therefore, a governance framework is needed to raise and maintain the public’s trust in big-data research that warrants the future reuse of clinical samples and records. As such, the current study provides valuable insights that will inform the design of effective consent protocols required in data-intensive health research.Keywords: biospecimens, health records, Jordan, open access, blanket consent, clinical research

Abdallah Damin Abukhalil, Tala Al Sheikh,* Sandra Muallem,* Ni’meh Al-Shami, Hani A Naseef Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine*These authors contributed equally to this workCorrespondence: Abdallah Damin Abukhalil; Ni’meh Al-Shami, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine, Tel/Fax +970-2-2982017, Email Adkhalil@birzeit.edu; nemaashami86@gmail.comBackground: Proton pump inhibitors (PPIs) are commonly prescribed medications that are thought to increase the risk of cardiovascular events because they reduce the effectiveness of clopidogrel via shared hepatic pathways.Objective: This study examined the prevalence of concomitant prescribing of clopidogrel/PPI among patients diagnosed with acute coronary syndrome and the adverse cardiovascular event associated with this interaction.Methods: A retrospective cohort study was conducted by retrieving patient data from the Nat Health Insurance claims processor database in Palestine. Adults diagnosed with Acute Coronary Syndrome (ACS) from 2019 through 2021 who were prescribed clopidogrel or clopidogrel in combination with a PPI were included in the study. Endpoints were adverse cardiac events, including readmission for revascularization during the first year of treatment.Results: The study included 443 patients; the prevalence of prescribing concomitant clopidogrel with a PPI was 74.7%, whereas 49.2% were prescribed interacting PPI (omeprazole, esomeprazole, and lansoprazole). 59 (13.3%) of participants experienced a cardiovascular event within 1 year of starting therapy, including 27 (12.4%) patients who had a cardiovascular event while taking an interacting PPI. No significant association was found between PPI administration and increased CV event risk in patients receiving concomitant clopidogrel and PPIs therapy (p = 0.579).Conclusion: In this study, we observed a high prevalence of prescribing a PPI in combination with clopidogrel, regardless of the FDA recommendations. No significant increase in cardiovascular events was observed in patients receiving concomitant clopidogrel and PPI therapy.Keywords: clopidogrel, PPI, proton pump inhibitors, cardiovascular disease, cardiovascular event, drug-drug interaction, PPIs interactions, clopidogrel PPI combinations

We aimed to synthesize evidence from published clinical trials on the efficacy and safety of tranexamic acid (TXA) administration in patients with aneurysmal subarachnoid hemorrhage (aSAH). We followed the standard methods of the Cochrane Handbook of Systematic Reviews for interventions and the PRISMA statement guidelines 2020 when conducting and reporting this study. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until 1 January 2022. We selected observational studies and clinical trials comparing TXA versus no TXA in aSAH patients. Data of all outcomes were pooled as the risk ratio (RR) with the corresponding 95% confidence intervals in the meta-analysis models. Thirteen studies with a total of 2991 patients were included in the analysis. TXA could significantly cut the risk of rebleeding (RR 0.56, 95% CI 0.44 to 0.72) and mortality from rebleeding (RR 0.60, 95% CI 0.39 to 0.92, p = 0.02). However, TXA did not significantly improve the overall mortality, neurological outcome, delayed cerebral ischemia, or hydrocephalus (all p > 0.05). In terms of safety, no significant adverse events were reported. No statistical heterogeneity or publication bias was found in all outcomes. In patients with aSAH, TXA significantly reduces the incidence of rebleeding and mortality from rebleeding. However, current evidence does not support any benefits in overall mortality, neurological outcome, delayed cerebral ischemia, or hydrocephalus.

Vitamin D deficiency (VDD) is a global health concern. This study aimed to determine the prevalence of vitamin D deficiency and its associated comorbidities in Palestine, such as diabetes mellitus, hypertension, hyperlipidemia, and cardiovascular and autoimmune diseases.A retrospective, descriptive study retrieved medical data from the Nat Health insurance processor database from 2014 to 2020. Patient information included age, sex, vitamin D laboratory order, symptoms, and comorbidities. This study included patients prescribed vitamin D at a dose of 50000IU for vitamin D deficiency confirmed by a serum vitamin D laboratory test. The collected data were analyzed using IBM SPSS. In addition, a chi-square test was conducted to assess the association between vitamin D deficiency, symptoms, and comorbidities.Data of 3011 patients were collected; 639 patients were diagnosed with osteoporosis, and 39 patients prescribed vitamin D without a laboratory test were excluded. Approximately, 1837 (78%) participants had vitamin D deficiency. A total of 1330 women (81.3%) were significantly more likely to have vitamin D deficiency than males, 507 (72.7%; P0.001). Joint pain, back pain, and cervicalgia were significantly associated with vitamin D deficiency (P0.001). Asymptomatic participants (2.1%) were significantly less likely to have vitamin D deficiency than symptomatic participants (9.5%, p0.001). Hypothyroidism is significantly associated with vitamin D deficiency (p = 0.048).In this retrospective study, the prevalence of vitamin D was high and alarming. There was a significant association between VDD, patients who presented with back pain, arthritis, and cervicalgia symptoms, and patients diagnosed with hypothyroidism. Therefore, health initiative programs are warranted to increase awareness regarding screening, prevention, and treatment. Further studies are needed to confirm the relationship between vitamin D supplementation and the reduced risk of comorbid diseases.

Hani Naseef *, Dana Joza’, Ahlam Awawdeh, Alaa Hasan, Abdallah Damin Abukhalil *, Ni’meh Al-Shami, Abdullah Rabba Pharmacy Department, Birzeit University, Birzeit, State of Palestine*These authors contributed equally to this workCorrespondence: Hani Naseef, Tel +970-598903449, Fax +970-2-2982017, Email hshtaya@birzeit.eduBackground: Antibiotics are highly effective medications and essential in curing infectious diseases; however, their inappropriate use, such as self-medication, is a significant factor in developing antimicrobial resistance.Objective: This study aimed to evaluate the level of antibiotic self-medication among patients who visited primary care clinics in Palestine.Methods: Data were collected via a self-administered questionnaire, either printed or electronically, using google forms (Google Inc., USA). The sample size needed to provide a 95% confidence level and 5% margin error and assuming a prevalence of 50% of SM with antibiotics was 377 patients. A total of 700 questionnaires were randomly distributed to patients aged 18 years or older. However, 87 were excluded due to duplication, incomplete responses, or participants under 18 years old. Finally, 423 patients were included in this study, with 254 patients completing the electronic Google Forms and 181 completing the written survey. The questionnaire consists of patients’ demographics, antibiotics knowledge, and self-medication behavior. In addition, descriptive statistics and knowledge scales were performed using SPSS 22 IBM to measure and assess the scope of the problem and find the association between self-medication demographics, education, and socioeconomic status.Results: Approximately 50% of participants reported self-medication with antibiotics, with a very high use among participants with medical knowledge. Most people have adequate awareness of antibiotics, whereas out of 423 respondents, (40.2%, n = 170) had GKL, (50.4%, n= 213) had AKL, and only (9.5%, n=40) presented PKL. The primary source for self-treatment with antibiotics was community pharmacies (87.1%, n=223), whereas (14.1%, n=36) got antibiotics from family and friends. Convenience, easy access, and experience with community pharmacists contributed to self-medications. The most commonly used antibiotic for self-medication was amoxicillin/clavulanic acid.Conclusion: Self-medication with antibiotics is a common practice in Palestine, regardless of socioeconomic or educational status. Patients’ educations about complications from inappropriate use and the possibility of side effects are essential steps to decrease patients’ demands for antibiotics. Furthermore, compliance and adherence of community pharmacists in dispensing antibiotics only with a prescription is necessary.Keywords: self-medication, antibiotics, primary care clinics, self-treatment behaviors, knowledge, Palestine

Abdallah Damin Abukhalil, Motaz Alyan, Woroud AbuAita, Ni’meh Al-Shami, Hani A Naseef Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, PalestineCorrespondence: Abdallah Damin Abukhalil, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine, Tel +970-598204036, Fax +970-2-2982017, Email Adkhalil@birzeit.eduBackground: Diabetes mellitus (D.M.) is a chronic metabolic disease caused by decreased insulin secretion, which increases the risk of cardiovascular diseases. Evidence has shown that statins reduce cardiovascular risk in patients with diabetes; moreover, most clinical guidelines recommend statins.Objective: This study aimed to assess the level and status of adherence to guidelines on statin prescription in patients with diabetes mellitus in a primary care setting in Palestine.Methods: A retrospective cross-sectional descriptive study was conducted at an ambulatory center in Palestine. Data were collected by auditing prescription records and reviewing medical charts of patients with diabetes who visited the clinic from February 15 to March 17, 2021. The collected data included patient characteristics, comorbidities, lipid profiles, and statin prescription. A chi-square test was used to evaluate the appropriateness of the prescribed statins with different demographic and clinical variables. Statistical significance was set at p < 0.05. Statistical Package for Social Sciences (SPSS) version 22 was used to analyze the data.Results: Out Of 262 diabetic patients included in the analysis, 74% were prescribed appropriate statin therapy according to the American Diabetes Association (ADA) guidelines, and 24% of patients had inappropriate statin therapy or needed statins. Furthermore, 82.8% were on high-intensity statins, while 11% were not taking any statins. More than 60% of patients had uncontrolled diabetes and hypertension.Conclusion: Most guidelines recommend statin therapy in diabetic patients owing to its benefits in preventing cardiovascular complications. In this study, most patients were on appropriate STATIN therapy; however, 50% of diabetic patients had LDL of more than 100 mg/dl, and 25% were not prescribed statins, increasing their risk of ASCVD. Therefore, we recommend strict adherence to the established guidelines on statins prescribed to patients with diabetes to prevent cardiovascular complications, save lives, and reduce healthcare costs.Keywords: statin therapy, diabetes type II, hyperlipidemia, uncontrolled diabetes, CV risk

In this work, we initiate the concept of supra soft topological ordered spaces which are consider as an extension of the concept of soft topological ordered spaces. We define and discuss some notions via supra soft topological ordered spaces such as monotone interior, closure and limit operators. Then, we formulate some supra soft separation axioms, namely supra p-soft Ti-ordered spaces These axioms are studied in terms of the ordinary points and the two relations of natural belong and total non-belong. We provide some illustrative examples to show the relationships between them and to investigate the mutual relations between them and their parametric supra topologies. Additionally, we characterize the concepts of supra p-soft Ti-ordered spaces (i = 1, 2), supra p-soft regularly ordered and supra soft normally ordered spaces. Finally, we conclude some findings related to hereditary and topological properties and finite product spaces.

The concepts of almost soft compact (almost soft Lindelöf), approximately soft Lindelöf and mildly soft compact (mildly soft Lindelöf) spaces are initiated and investigated in this work. Their characterizations and main properties are established and the relationships among them are illustrated with the help of examples. The sufficient conditions for the equivalent between almost soft Lindelöf and approximately soft Lindelöf spaces; and for the equivalent among soft Lindelöf, almost soft Lindelöf, approximately soft Lindelöf and mildly soft Lindelöf spaces are given. The image of the introduced types of soft compact and soft Lindelöf spaces under soft continuous mappings are studied; and the mutual relations between them and their parametric topological spaces are probed. Some results which associate soft hyperconnectedness and soft connectedness, respectively with almost soft compactness and mildly soft compactness are verified. This study is concluded by providing an illustrative diagram for the interrelations among the initiated soft compact and soft Lindelöf spaces.

Microcredit financing is considered a crucial vehicle to flourish the socioeconomic conditions of women and women empowerment, especially among those who are from low-income households and ...

Microfinance is widely known as a financial development tool for those deprived of access to financial services, especially women. However, the literature provides conflicting evidence and shows th...

Background: Anemia is a major nutritional health problem throughout the world.Objectives: To determine the prevalence and the factors associated with anemia among Kuwaiti children aged 4–5 years.Design: A sample of 578 Kuwaiti preschool children (4–5 years of age) and their mothers were selected from ongoing Kuwait Nutrition Surveillance System from September 2003 to June 2004. Mothers participated in an interview where demographic; health and nutrition information was collected. Anthropometrical data and blood sample were also collected for children and mothers; anemia was defined as hemoglobin