Background The Pfizer BioNTech COVID-19 vaccine was the first to receive emergency authorization and approval from the FDA. Therefore, it is preferred by most recipients; however, many people are concerned about the vaccine’s side effects. At the time of the study, December 2021, Palestine lacked a national reporting system for monitoring adverse vaccine effects. Therefore, this study investigates the post-vaccine adverse events following the Pfizer/BioNTech COVID-19 Vaccine administration in Palestine and identifies the occurrence, extent, and severity among university staff, employees, and students at Birzeit University. Method A questionnaire-based retrospective cross-sectional study was conducted using a university website (Ritaj), social media platforms (e.g., Facebook and Telegram), and in-person interviews. The Chi-square, Fisher’s exact, and McNemar’s tests were used to investigate significant relationships. Data were analyzed using SPSS version 22. Results In total, 1137 participants completed the questionnaire, 33.2% were males, and the mean age was 21.163 years. All participants received at least one dose of the Pfizer-BioNTech COVID-19 vaccine. Approximately one-third of participants reported no adverse effects after receiving the first, second, or third doses (34%, 33.6%, and 32.5%, respectively). The most commonly reported adverse events were fever, chills, headache, fatigue, pain and swelling at the injection site, muscle pain, and joint pain. Allergic reactions were reported by 12.7% of the participants; furthermore, participants with a history of allergy or anaphylaxis before vaccination had a significantly higher tendency for post-vaccination allergic reactions. Eight participants reported rare side effects, including 7 (0.6%) cases of thrombocytopenia and one (0.1%) case of myocarditis. Males aged less than 20 years and smokers were significantly less likely to complain of adverse events. The number of reported side effects was significantly higher after the second vaccine dose than after the first dose. Finally, participants infected with COVID-19 before vaccination was significantly associated with side effects such as fever, chills, shortness of breath, and persistent cough. Conclusion In this study, the most common post- BNT162b2 Vaccination reported self-limiting side effects similar to those reported by Pfizer/BioNTech Company. However, higher rates of allergic reactions were reported in this sample. Rare side effects, such as thrombocytopenia and myocarditis, were reported by 8 participants. COVID vaccines have been developed at an accelerated pace, and vaccine safety is a top priority; therefore, standard monitoring through a national adverse event reporting system is necessary for safety assurance. Continuous monitoring and long-term studies are required to ensure vaccine safety.

Background 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.

Background: The American Geriatric Society Beers criteria comprise a screening tool to identify potentially inappropriate medications (PIMs) and guide healthcare providers (HCPs) in prescribing, dispensing, and recommending appropriate medications. The extent of awareness about PIMs and geriatric medicine among HCPs needs to be assessed. Therefore, this study aimed to examine the level of awareness regarding PIMs and Beers criteria among HCPs in Palestine. Method: This was a cross-sectional study conducted using a self-administered 20-item questionnaire involving physicians and pharmacists in Palestine. Ten clinical vignettes presenting different medical statuses in the elderly necessitating appropriate prescription advice were used to assess awareness on geriatric medication. Results: A total of 306 participants, including 116 physicians and 190 pharmacists, participated in the study. 34.0% of the participants had poor awareness, 30.1% had average and 23.2% participants had good awareness about PIMs in the elderly. Only a small percentage of participants had very poor or very good awareness (6.9% vs. 5.9%, respectively) with no difference in the results in terms of profession. There was a significant relationship between the familiarity with Beers criteria and the level of awareness. Finally, participants perceived drug-drug interactions as a major barrier to appropriate prescribing. Conclusion:The majority of participating HCPs had a low level of awareness, and a close proportion had moderate awareness on PIMs and Beers criteria. Consequently, there is a need to increase HCP's awareness of medication use in the elderly. Continued education and training in geriatric pharmacotherapy may be valuable.

Background: Coronavirus Disease 2019 (COVID-19) rapid manifestation and spread have disrupted world norms and affected people's daily activities and life. Many ministries chose mass lockdown protocol as a way to control the virus spread. Though this protocol has shown to be effective in limiting the Virus transmission, it might have a negative impact on the population's psychological status, such as boredom, confusion, psychological stress, anxiety, depression, and physical effects. Objective: This study aimed to find the impact of the COVID-19 pandemic on the Palestinian adults' psychological status by assessing the participant's practices, reports of anxiety and depression during the pandemics Methods: An observational descriptive cross-sectional study was conducted among Palestinian adults in the West Bank, at the occupied Palestinian territories, between July and September 2020. The questionnaire was structured into two domains: the first domain includes nine questions about sociodemographic data. The second consisted of 33 (yes and no) questions evaluating the participant's psychological status. Results: 739 participants with a mean age of 31.76, filled the online questionnaire. Around one-third of respondents revealed having many signs of anxiety, and around 42% of respondents expressed having many signs of depression. Females were significantly more likely to have signs of depression, whereas front-line COVID-19 health care workers were significantly the least likely to have signs of depression and no signs of depression were found among participants with high incomes. Conclusion: COVID-19 pandemic has a negative effect on mental status; most participants have signs of anxiety and depression.

Background: Elderly patients suffer from chronic diseases and are prone to polypharmacy and potentially inappropriate prescribing (PIP). This study aimed to identify potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among elderly patients in a tertiary care hospital setting and to estimate the prevalence of polypharmacy. Methods: This multicenter retrospective observational study reviewed patient data from two major Palestinian hospitals. The collected data included patient demographics, comorbidities, and medications administered during hospitalization and discharge. The study included 247 patients aged ≥ 65 years hospitalized between January 2019 and December 2019. The STOPP/START criteria version 2 was used to identify the prevalence of PIMs and PPOs. Clinical pharmacists verified the data, and SPSS was used for data analysis. Descriptive statistics, one-tailed bivariate correlations, and Pearson's test were applied to the variables of interest to examine their association with the STOPP/START criteria. Results: A total of 247 patients were included in the study, and 50.2% were females. As a result, 165 (66.8%) participants were identified with PIPs, including 30 patients with PPOs, 91 with PIMs, and 44 with both. Furthermore, the prevalence of PIP during hospitalization and discharge was 56.29% and 64.39%, respectively. Polypharmacy (5-9 medications) was 44.5% and 52.1% during hospitalization and discharge, respectively, and excessive polypharmacy (ten medications or more) was 33.6% and 16.4% during hospitalization and discharge, respectively. Moreover, 47.3% of the patients had a comorbidity index of ≥ 5. Conclusion:This study identified a high prevalence of PIPs among elderly patients during hospital admission and discharge. In addition, more than half of the geriatric patients in this study had PIP and a high prevalence of polypharmacy. Therefore, this study emphasizes the importance of adapting evidence-based tools, such as the STOPP/START criteria, to optimize patient medication therapy and guide prescribers in identifying and resolving PIMs and PPOs.

Background Mucormycosis is a fulminant and rapidly progressing fungal infection associated with a high mortality rate. Mucormycosis is primarily seen in immunocompromised patients, especially those with uncontrolled diabetes mellitus (DM), and recently in coronavirus disease 2019 (COVID-19) patients. Case Presentation In this case report, we present a rare case of fatal mucormycosis in Palestine. A 34-year-old Palestinian female patient presented to the emergency department one-month post-COVID-19 infection with left facial pain. During her hospital stay, she deteriorated, with a random blood sugar level of 400 mg/dl and a hemoglobin A1c of 18% with metabolic acidosis and the appearance of swelling and black eschar on her left side of her face. Finally, she was diagnosed with mucormycosis and expired two days later. Conclusion In this unfortunate case report of mucormycosis, severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection, delayed diagnosis, misuse of corticosteroids, inappropriate use of antibiotics, and uncontrolled diabetes with ketoacidosis contributed to patient mortality and fatality. Therefore, appropriate patient assessment, rapid diagnosis, and selection of appropriate treatment are important and lifesaving.

Background: Diagnosis of co-infections with multiple pathogens among hospitalized coronavirus disease 2019 (COVID-19) patients can be jointly challenging and essential for appropriate treatment, shortening hospital stays and preventing antimicrobial resistance. This study proposes to investigate the burden of bacterial and fungal co-infections outcomes on COVID-19 patients. It is a single center cross-sectional study of hospitalized COVID-19 patients at Beit-Jala hospital in Palestine. Methods: The study included 321 hospitalized patients admitted to the ICU between June 2020 and March 2021 aged ≥20 years, with a confirmed diagnosis of COVID-19 via reverse transcriptase-polymerase chain reaction assay conducted on a nasopharyngeal swab. The patient's information was gathered using graded data forms from electronic medical reports. Results: The diagnosis of bacterial and fungal infection was proved through the patient’s clinical presentation and positive blood or sputum culture results. All cases had received empirical antimicrobial therapy before the intensive care unit (ICU) admission, and different regimens during the ICU stay. The rate of bacterial co-infection was 51.1%, mainly from gram-negative isolates (Enterobacter species and K.pneumoniae). The rate of fungal co-infection caused by A.fumigatus was 48.9%, and the mortality rate was 8.1%. However, it is unclear if it had been attributed to SARS-CoV-2 or coincidental. Conclusions: Bacterial and fungal co-infection is common among COVID-19 patients at the ICU in Palestine, but it is not obvious if these cases are attributed to SARS-CoV-2 or coincidental, because little data is available to compare it with the rates of secondary infection in local ICU departments before the pandemic. Comprehensively, those conclusions present data supporting a conservative antibiotic administration for severely unwell COVID-19 infected patients. Our examination regarding the impacts of employing antifungals to manage COVID-19 patients can work as a successful reference for future COVID-19 therapy.

Background Breast cancer (BC) is the most common cancer among women. Studies have shown that cancer patients can develop depression impacting their quality of life, treatment outcomes, and survival rates. This study aimed to determine the risk factors, severity and prevalence of depression among females diagnosed with BC in multiple hospitals across Palestine. Methods A cross-sectional study was conducted at different cancer treatment centers in Palestine using a previously developed questionnaire consisting of 23 questions to assess the severity of major depressive disorder among females diagnosed with breast cancer. The Patient Health Questionnaire-9 (PHQ-9) was included in the questionnaire. Results Out of 223 respondents, 79 (35.4%) have developed moderate to severe depression. Chi-square results revealed that the risk of developing moderate to severe depression was higher among females who suffer from side-effects related to BC treatment (P < 0.011), females who knew the BC stage at the diagnosis step (P < 0.031), and negative implications on BC patients in Palestine (P < 0.009). Conclusion Breast cancer patients have an increased risk of developing major depressive disorder. Patient assessment and treatment for depression at the time of BC diagnosis, during the treatment journey, and monitoring after treatment completion is essential for patient quality of life and BC treatment outcomes.