Childhood poisoning represents a major public health risk in low- and middle-income countries (LMICs), including Palestine. Easy access to toxic substances in the household and limited preventive awareness contribute substantially to this burden. Therefore, this study assessed healthcare providers’ knowledge, practices, and training related to childhood poisoning prevention and management and identified areas that require improvement. A cross-sectional survey was conducted from May to July 2025, including 328 healthcare providers working in governmental and private healthcare facilities in the northern West Bank. Data were collected using a structured questionnaire developed based on previously published instruments, expert review, and pilot testing. The questionnaire assessed participants’ demographic characteristics, knowledge of childhood poisoning risks, knowledge of poisoning treatment and management, preparedness, previous training, and awareness of poisoning management guidelines. We used descriptive statistics, the Mann–Whitney U test, the Kruskal–Wallis test, and Spearman’s rank correlation for the bivariate analyses. Multivariable linear regression analysis was conducted to identify factors associated with higher knowledge scores. A total of 328 healthcare providers, with a median age of 27 years, participated in the study, and 56.7

The use of androgenic–anabolic steroids (AASs) has increased in recent years, especially among athletes, due to their effect on body shape and performance. These agents could have serious side effects on this highly susceptible population, which tends to use these substances frequently to promote muscle growth and physical performance. Therefore, this study aimed to evaluate the knowledge and attitudes toward the use of anabolic androgenic steroids among physical education university students in Palestine. A cross-sectional study of physical education students from November 2020 to January 2021 was conducted using an electronic questionnaire. The main outcome was to measure the level of knowledge and use of the AAS. A total of 380 students were included. The mean age of the students was 21 years (SD = 4.2), and the study participants were distributed almost equally according to sex. Approximately a quarter of the students were smokers. Eighty percent (80%) of the study participants were from the West Bank, while the remaining 20% were from Jerusalem and 48 territories. Furthermore, most of the students lived with their families; half lived in cities, approximately 152 (40%) lived in villages, and only 29 (8%) lived in camps. The average level of knowledge of the AAS was 2.95 out of 8 (37/100), with a median of three. Furthermore, only 36 (10%) of the participants had satisfactory knowledge, scoring 80% or more. Regarding the use of AAS, 11 (2.9%) participants, all males, confirmed that they were currently using AAS. Additionally, approximately 28 (7%) had previously used them, while 30 (8%) planned to try them in the future. Overall, 221 (58%) patients were confirmed to use vitamins and minerals. Our study showed that most of the participants had a substantial lack of information on the potential side effects of AAS, while the level of use was comparable with that of other populations.

Nomophobia (NO MObile PHone Phobia) is a psychological condition in which people are anxious of being cut off from their mobile phones and been associated with adverse consequences to physical and psychosocial health. The objective of this study was to measure the impact of nomophobia on musculoskeletal problems in the upper extremity among adults. The Nomophobia scale (NMP-Q) was used to measure addiction to smartphone use among 5,087 Middle Eastern adults. A snowball sampling approach was used to recruit the participants between March and June 2021. Results showed that nomophobia was evident in 1,119 participants (22%) with a mean NMP-Q score of 114.1 (SD 11.1). A total of 3,396 upper extremity symptoms were reported among our participants. The binomial logistic regression showed that NMP-Q score is a significant predictor of symptoms to the thumb only (β = 0.01, p = .026). This study has provided evidence of the negative physical consequences of addiction to smartphone use. Participants with thumb-related symptoms were more prone to sustain other concurrent upper extremity symptoms, probably due to their maladaptive habits of using the phone. Thus, it is important to increase awareness about the risks associated with the use of smartphones. Implications for occupational therapy are presented.

Objectives: Polypharmacy has emerged as a standard clinical practice in treating psychiatric disorders. This study investigates the prevalence of polypharmacy among patients treated for common psychiatric disorders and the factors associated with this practice. Methods: The current cross-sectional study included all the prescriptions that were issued over the period between October 2018 and January 2019 for patients diagnosed with anxiety, depression, schizophrenia, schizoaffective and bipolar disorders in an outpatient psychiatry clinic in the north of West Bank, Palestine. Results: A total of 1045 prescriptions were analyzed. The mean age of the patients for whom the prescriptions were made was 47.3 years (SD= 13.6); half were between 36 and 55 years old, and one-third were females. Half of the cases were diagnosed with schizophrenia, while the rest were diagnosed with bipolar, depression, schizoaffective, or anxiety. Polypharmacy was found in 877 prescriptions (84%). One-third of the patients have been prescribed two drugs, while one-third received three, and the rest received four or more. Patients with schizophrenia, schizoaffective and bipolar disorders have a higher rate of polypharmacy than patients with anxiety and depression (p=0.000). Patients aged 36 and 55 were more likely to have polypharmacy than younger or older ones (p=0.001). The rate of polypharmacy was not different according to gender. Multi-class, adjunctive, and same-class polypharmacy was found in 81%, 50%, and 32% of the prescriptions. Conclusions: Our results suggest that polypharmacy among psychiatric patients is common in Palestine. Age and diagnosis should pay more attention to selected patients to avoid harmful drug-drug interactions.

(1) Background: ESports is a new trend of sports, which has gained considerable popularity worldwide. There is a scarcity of evidence that focuses on the lifestyle of ESports players (eSP) particularly on symptoms of nomophobia, level of anxiety, sleep quality, food consumption and physical activity. (2) Objective: to determine the prevalence and relationship between symptoms of nomophobia, psychological aspects, insomnia and physical activity of eSP in Saudi Arabia. (3) Methods: A cross-sectional study was conducted between March and April 2021 using a convenient self-selection adult sample. A total of 893 (216 eSP vs. 677 non-eSP (NeSP)) participants aged over 18 years were included. All participants answered a seven-part validated questionnaire that included: (i) sociodemographic questions; (ii) a symptoms of nomophobia questionnaire; (iii) general anxiety disorder questions, (iv) an insomnia severity index, (v) an Internet addiction scale, (vi) the Yale food addiction scale 2.0 short form and (vii) an international physical activity questionnaire. (4) Results: Among the entire population, the prevalence of moderate to severe nomophobia, anxiety, insomnia, Internet addiction and low physical activity were 29.8%, 13.9%, 63.3%, 27% and 2.8%, respectively. The eSP and NeSP differed significantly in nomophobia scale, anxiety and insomnia values. Compared to NeSP, eSP had a higher level of severe nomophobia p = 0.003, a severe level of anxiety p = 0.025 and symptoms of insomnia p = 0.018. Except for food addiction and physical activity, a positive correlation was identified between symptoms of nomophobia, anxiety and insomnia among eSP. (5) Conclusion: This study reported high prevalence of nomophobia, anxiety and insomnia among eSP compared to NeSP.

Background: Psychotropic polypharmacy is particularly common, which puts psychiatric patients at high risk for developing drug-drug interactions. Objective: We aimed to study potential interactions between psychotropic medications prescribed within the outpatient psychiatry setting. Method: This was an audit study, which targeted a sample of outpatient prescriptions ordered within the outpatient clinics of the main psychiatry hospital in Bahrain over 2017. We studied the grades and correlates of interactions between psychotropic drugs. Results: The total number of prescriptions in our sample was 992 (56.1% males, 43.9% females). Psychotropic polypharmacy was detected in 842 prescriptions (84.9%). Potential interactions between psychotropic drugs were observed in 550 prescriptions (56.4%). The degree of interaction was minor in 43 prescriptions (7.8%), significant in 419 prescriptions (76.2%), and serious in 88 prescriptions (16%). Schizoaffective disorder subjects were the most likely to suffer from interactions (64.6%), whereas prescriptions issued for those who had schizophrenia contained the least number of interactions (51.6%). The total number of interactions was strongly associated with polypharmacy (p < .001) and gender (p < .01), but not with age (p > .05) or diagnosis (p > .05). Conclusion: High prevalence of polypharmacy and interactions between psychotropic medications were observed in our sample, particularly of the significant grade.

Background The practice patterns of psychiatrists have changed over the last two decades. Objectives This study describes the pattern of prescribing psychotropic drugs in treating common psychiatric disorders, and investigates the rate of polypharmacy and potential drug-drug interactions. Setting Psychiatry governmental outpatient clinic in the north of West Bank, Palestine. Methods Cross-sectional study that included all prescriptions which were issued over the period October 2018 to January 2019, for patients diagnosed with schizophrenia, depression, anxiety, bipolar disorder and schizoaffective disorders, and checked for the presence and the grade of potential drug-drug interactions using “Medscape drug interactions checker". Main outcome measure Prescribing patterns of psychotropic drugs. Results A total of 1045 prescriptions were examined. The mean age of the patients was 47.3 years (SD = 13.6), two-thirds of the patients (64.5%) were males. Fifty-two percent of the patients were diagnosed with schizophrenia while 15.2% were diagnosed with depression. The later third was diagnosed with bipolar disorder, schizoaffective and anxiety disorders (15.8%, 11.1% and 5.1% respectively). The most commonly prescribed drugs were typical antipsychotics for schizophrenia, bipolar and schizoaffective disorders, selective serotonin reuptake inhibitors for depression and tricyclic anti-depressants for anxiety. Polypharmacy was found in 877 prescriptions (84%), and drug-drug interactions (DDIs) were identified in 823 (94%) prescriptions. The DDIs were classified as minor (4, 0.5%), significant (418, 50.8%) and serious (401, 48.7%). Conclusions Our results suggest that the pharmacotherapy of psychiatric disorders in Palestine may not be in accordance to international guidelines and the incidence of polypharmacy and DDIs is high.

Background: Antimicrobial resistance has become a worldwide issue as the number of multidrug-resistant (MDR) bacteria has risen considerably. The irrational use of antibiotics contributes significantly to this issue. Methods: A prospective study was conducted over three months at a teaching hospital in surgical and medical intensive care units (SICU, MICU) in Palestine. Antimicrobial consumption data were recorded and analyzed using the antimi-crobial consumption tool. Microorganisms and their resistance patterns were obtained from the microbiology laboratory. Results: One hundred patients with a median age of 50 years were included in this study (65% males). More than half of the patients were admitted to the MICU (55 patients). Vancomycin, piperacillin-tazobactam, and fluconazole were the most highly consumed antimicrobials, in terms of defined daily dose(DDD)/100-bed day, in the SICU (37, 31, and 27, respectively). On the other hand, meropenem, vancomycin, and levofloxacin were the most commonly consumed antimicrobials in the MICU (49, 35, and 26, respectively). The most frequent organisms were Coagulase-negative Staphylococci spe-cies, Escherichia coli, and Enterococcus faecalis (15%, 12%, and 9%, respectively). There were two Vancomycin-resistant Enterococcus faecium (VRE) cases in each ICU. Methicillin-resistant Staphylococcus aureus (MRSA) was common in the MICUs (five isolates). In both ICUs, A. baumannii, Escherichia coli, P. aeruginosa, and Klebsiella pneumonia showed ex-tensive resistance to the tested antibiotics. The isolated Enterococcus faecium from both ICUs were highly resistant to the commonly used antibiotics. Conclusion: This study revealed high consumption of the most potent antibiotics and the prevalence of multidrug-resistant or-ganisms (MDRO) in the tested ICUs. This highlights the need to adhere to the antibiotic stew-ardship policy to use antibiotics appropriately and reduce the presence of these MDROs.

Man used various natural materials as a remedy for the treatment of various diseases and recently witnessed a vastly growing and renewed interest in herbal medicine globally. In Pal-estinian folk medicine, Crataegus aronia is used as diuretics and for the treatment of hyper-tension. This study aimed to evaluate the diuretic effect of the aqueous extracts of this plant in mice after intraperitonial administration. It is an experimental trial applied to mice (n=12 male, CD-1, weight range: [ 25-30] g), which are divided into three groups (4 in each): first group administered with the plant extract (500 mg/kg), the second with normal saline as nega-tive control group and the third with furosemide (10 mg/kg) as positive control. Then, urine output and electrolyte contents were quantified up to 6 hours for the three groups and then compared. Results were analyzed using SPSS program. The aqueous extract of C. aronia produced significant diuresis (p'Äâ<'Äâ0.05). Moreover, aqueous extracts had an acidic PH (6.5125). The aqueous extracts of C. aronia tended an increase in sodium loss compared to the negative control group, but the results were not significant statistically for sodium (P-value 0.068). Our investigations significantly revealed that C. aronia aqueous extract had a potential diuretic effect which can be utilized for the treatment of hypertension and other dis-eases related to diuresis and also for manufacturing natural and safe diuretic drugs.

Objectives: The current article was designed to review the main clinical and pharmacological data on the currently approved immunosuppressants used for the prevention and treatment of kidney transplant rejection. Design: A narrative review manuscript Settings: A comprehensive search for the available literature on renal transplant pharmacotherapy on PubMed, Google, Medline Scopus and clinicalTrials.gov . Subjects: Key related articles published until May 2020 Intervention: Non-interventional Main outcome measures: The induction therapy should be started with high doses of immunosuppressants immediately after transplantation, followed by gradual dosage reduction in maintenance therapy. It commonly involves thymoglobulin or alemtuzumab. Basiliximab is also approved as an induction agent, especially in recipients with low risk of rejection. Results: Thymoglobulin is superior in patients on a steroid-free maintenance regimen. The maintenance therapy should be started early after transplantation or even before. It can be made up of different combinations of calcineurin inhibitors (CNIs) like cyclosporine A / tacrolimus, mycophenolate mofetil (MMF), mTOR inhibitors (sirolimus/everolimus) and corticosteroids. Tacrolimus is considered a first-line agent in maintenance therapy and it is associated with a better allograft function. MMF is a major drug in the current maintenance therapy in combination with CNIs, and a main part in CNI-free regimens. Corticosteroids are still a main component in immunosuppressive regimens, despite the current interest in avoiding them due to their various long-term side effects. The rates of transplant loss are still unacceptably high, mainly due to dose-limiting toxicities. Conclusion: New drugs are being developed to improve the efficacy and safety profile of maintenance therapy. Some of them showed promising results.

Renal transplantation is the ultimate therapeutic option for end-stage renal failure. A major challenge that often leads to the loss of the renal graft is the immune-mediated organ rejection, of which there are three types; hyperacute, acute and chronic rejection. This necessitates a proper use of immunosuppressants in the form of short-term induction therapy, as prophylaxis against early acute rejection, and a life-long maintenance therapy against chronic rejection. However, the suppression of the immune system would also compromise the ability of the immune system to eradicate the pathogens and early cancer cells, which increases the risk for various types of serious infections and malignancies. Some of these drugs are also associated with hematologic, metabolic, cardiovascular and renal toxicities. This manuscript thoroughly reviews the available clinical data on the currently approved drugs that are used for both the induction and maintenance therapy, with some focus on their pharmacology. It also discusses the current guidelines and covers, in some details, the new drug classes that are still under clinical investigations.

Background Co-existence of depression and anxiety can be associated with severe detrimental consequences to the physical, mental and social wellbeing of the affected populations. This study was conducted to determine prevalence of depressive and anxiety symptoms among Palestinian medical students and to investigate associations between sociodemographic factors of the students with depressive and anxiety symptoms. Methods This study was conducted in a cross-sectional observational design using a questionnaire in the period between September 2018 and April 2019 in a major university in the West Bank of Palestine. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) and anxiety symptoms were assessed using the Beck Anxiety Inventory (BAI). The questionnaire also collected the sociodemographic characteristics of the students. Reliability of the questionnaire was tested using the test re-test method. A total of 425 medical students were invited to participate in the study. Results Of those invited, 286 students completed the questionnaire, giving a response rate of 67.3%. More than half (56.6%) of the students had minimal depression, 20.3% had mild depression, 14.0% had moderate depression, 9.1% had severe depression, 23.4% had no anxiety, 29.7% had mild to moderate anxiety, 25.5% had moderate to severe anxiety, and 21.3% had severe anxiety. Multiple linear regression analysis showed that academic stage ( p -value < 0.01), Grade Point Average ( p -value < 0.01), mental health status ( p -value < 0.001), ever attempted suicide ( p -value < 0.05), and religious commitment ( p -value < 0.01) were predictors of BDI-II scores. Multiple linear regression analysis showed that academic stage ( p -value < 0.05) and mental health status ( p -value < 0.001) were predictors of BAI scores. Conclusions Depressive and anxiety symptoms were prevalent among Palestinian medical students in a major university in the West Bank of Palestine. Interventions might be designed to improve self-rated mental health of medical students in their academic years, ameliorate study conditions, and provision of counseling services to improve spirituality might be effective in reducing symptoms of depression and anxiety among medical students in Palestine. Future studies are still needed to investigate if these interventions could be useful in reducing depressive and anxiety symptoms among Palestinian medical students.

We examined the outpatient prescription pattern of psychotropic drugs used for the treatment of five major psychiatric diseases in Bahrain. Setting outpatient department of the main psychiatric hospital in Bahrain. Methods This was a retrospective, cross-sectional study in which we targeted randomly selected prescriptions (n = 992, 56.1% males, 43.9% females) from 1st of January until 31st of December, 2017. Main outcome measure the types of outpatient psychotropic drugs prescribed by the physicians. Results The pharmacotherapy of schizophrenia consisted of atypical anti-psychotics (92.8%), or typical anti-psychotics (17.8%). The anti-depressants used were: Selective-serotonin reuptake inhibiters (SSRIs) (41.6%), Serotonin-norepinephrine reuptake inhibiters (SNRIs) (34.5%), tricyclic anti-depressants (TCAs) (12.8%), and atypical anti-depressants (10.6%). Combination anti-depressants was employed in (12.4%) of cases. The pharmacotherapy for anxiety disorders was composed of benzodiazepines (59.5%), atypical anti-psychotics (45.2%), SSRIs (40.5%), SNRIs (28.6%), TCAs (14.3%), and anti-convulsants (16.7%) and atypical anti-psychotics (7.1). The medications prescribed for bipolar disorder were atypical anti-psychotics (78.6%), anti-convulsants (66.5%), benzodiazepines (27.7%), typical anti-psychotics (8.9%) and lithium (6.7%). Schizoaffective disorder patients received atypical anti-psychotics (97.3%), anti-convulsants (47.8%), benzodiazepines (27.4%), SNRIs (25.7%), SSRIs (15%), typical anti-psychotics (10.6%), atypical anti-depressants (10.6%) and TCAs (6.2%). A combination of antipsychotics and anti-depressants was employed in 33.6% and 4.7% of all subjects regardless of the diagnosis, respectively. Conclusions With a few exceptions, the pharmacotherapy of psychiatric diseases in Bahrain was in line with the latest recommendations. However, psychotropic polypharmacy was observed and calls for immediate attention.

Many people nowadays seek the health information they need online, as an alternative to professional medical consultation. The current manuscript aims to evaluate the quality of the online information on oral contraceptive pills in Arabic websites. In this cross-sectional study, the term "oral contraceptive pills" in the Arabic language was fed to popular search engines. A list of 45 websites was evaluated in terms of accuracy/completeness, credibility and usability. The analyzed data demonstrated that most websites provide incomplete infor-mation about important issues, like efficacy, safety, instruction for administration, and when to use backup methods, which might result in the delivery of misinformation and the conse-quent occurrence of unwanted pregnancy. In the majority of the websites, the articles were prepared by anonymous authors with unknown qualifications and expertise, and without providing any citations, which questions the reliability and correctness of the provided in-formation. Moreover, most websites did not declare the source of their funding and the or-ganization behind the websites, which opens the door for a possibility of a conflict of interest and the exploitation of the websites for marketing purposes. On the other hand, most web-sites fairly fulfilled the usability criteria, as they were designed with a clear, consistent and legible layout of information, with easy navigation and information finding. In conclusion, the majority of the websites in the Arabic language provide information on oral contraceptive pills, which is inadequate, none reliable, none credible and seriously vulnerable to inaccuracy and conflict of interest.

Introduction: Throughout history, therapeutically active plant products have received substantial attention due to their valuable role in the discoveries of specific medications. The aim of this study was to assess, for the first time, the antimicrobial, antioxidant, antilipase, anti-alpha-amylase and cytotoxic properties of four fractions derived from Anchusa ovata Lehm. (AO) leaves. Methods: Antioxidant, antilipase and anti-amylase potentials of (AO) were established using DPPH (1,1-diphenyl-2-picrylhydrazyl), p-nitrophenyl butyrate and dinitro-salicylic acid procedures, respectively, while antimicrobial activity was conducted using broth microdilution assay against eight Gram-positive, Gram-negative bacterial strains in addition to one fungal strain. Moreover, the MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3 carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] cytotoxic assay was utilized against cervical cancer cells (HeLa). Results: The methanol fraction of AO showed potential antioxidant, antilipase, and a-amylase inhibitory activities with IC50, values of 9.55 +/- 0.13, 53.7 +/- 0.41 and 16.55 +/- 1.84 mu g/ml, respectively compared with the positive controls Trolox, Orlistat and Acarbose that had IC50, values of 3.23 +/- 0.92, 12.3 +/- 0.35 and 28.18 +/- 1.22 mu g/ml, respectively. Moreover, the hexane, acetone, and methanol fractions had wide ranges of antimicrobial potential. In addition, the cytotoxic activity outcomes which showed the best activity was for the aqueous followed by acetone, hexane and methanol fractions with IC(50)( )values of 1.04, 2.72, 3.96 and 17.67 mg/ml, respectively. Conclusion: Our data demonstrate a wide range of biological characteristics for each AO plant fraction. This profiling information about the methanol fraction provided important data for further research and pharmaceutical applications.

Background: Gundelia (G.) tournefortii is one of the most famous plants used in Palestine for its traditional curative and nutritive properties. We evaluated effects of Gundelia (G.) tournefortii aqueous-extract in an ex-vivo and in in-vivo animal model of hepatocellular carcinoma (HCC). Methods: HCC cell-line (Hep3B) were injected in the back of male mice on NOD.CB17-Prkdc-scid/NCrHsD background. Tumor size, serum a-fetoprotein (αFP) and Glypican-3 (GPC3) were assessed at day 2 following HCC injections till day-12. G. tournifortii extracts were injected i.p at day 10 in HCC mice. Liver histology, hepatic-p53, p-Akt and p-PI3K expressions were evaluated. Primary-hepatocytes from HCC mice were ex-vivo treated with G. tournifortii and investigated for perturbation of the DNA cell cycle using propidium iodide (PI) staining assay, while apoptosis was estimated by staining with Annexin-V and PI by the flow cytometry. Results: Tumor mass increase in animals with HCC and was associated with elevated aFP and GPC3 (P<0.05). Mice receiving G. tournefortii extracts s howed a significant decrease in tumor at days 12 with decreased hepatic-p53 and phosphorylated Akt/PI3K signaling pathway (p=0.001). Histology H&E staining showed remarkable reduction in inflammatory lesions in HCC livers receiving G. tournifortii extracts in line with delay in G2-M phase of HCC-primary-hepatocytes to 1.39-folds. Moreover, apoptotic activity was mostly enhanced by the 200mg/ml G. tournifortii extracts while a reduction of HCC necrosis to 2.4 fold (P<0.01). Conclusions: Our results explored an anti-cancer, anti-proliferative and apoptotic effects of G. tournifortii in an HCC mice model and in an ex-vivo setting. G. tournifortii could be a promising future cancer remedy.

The Internet has become a major source of health information. However, the accuracy and quality of this information might be questionable. The aim of this study was to evaluate the quality of online information on type-2 diabetes on Arabic websites. In this cross-sectional study, the term “type-2 diabetes” in the Arabic language was fed to popular search engines. The first 25 hits from each engine were considered. A list of 50 websites was evalu-ated in terms of formal quality, usability and accuracy of the information provided by the website. The average percentage of quality standards (QS) achievement of the evaluated websites was 31.6% (min=7 (15.9%) and max=28 (63.6%)). The author was identified in 40% of the websites; however the percentage of showing his/her affiliation, expertise and credentials were 18, 10 and 10% respectively. Only 12% of the websites provided infor-mation written by healthcare providers. Only half of the websites described the disease, and only 22% discussed the treatment options. This study demonstrates a lack of credibility and low quality for the information on type-2 diabetes mellitus provided by the majority of web-sites in the Arabic language.

Background: BALB/c mice showed easily induced Th2-type responses in several infection models. Certain macrophage phenotypes contribute to liver fibrosis. We characterized changes in macrophages phenotype (M1/M2) during fibrogenesis in liver fibrosis mice model. Methods: Carbon-tetrachloride (CCl 4 ) hepatic-fibrosis was induced in BALB/c mice. Liver macrophages isolated were identified for M1 and M2 by CD80/iNOS and CD273 (programmed death ligand 2 (PDL2)/CD206, respectively. IL-4 were induced i.p along week-2 to week-4 of CCl 4 . Liver proteins were assessed for aSMA expressions, histology and ALT levels. Results: CCl 4 -induced hepatic-fibrosis showed increased CD273 (from 20.1%± 3.1in naïve mice to 27.8%±3.2 in fibrotic mice; P=0.01) while gradual decrease in CD80 (from 12%±6.2 in naïve mice to 1.97%±0.4 in fibrotic mice; P<0.02). The overall data showed decreased M1/M2 ratio. M2-macrophages showed inhibited expressions of IFN-g, IL-12 and vitamin-D-receptor (VDR) while high TGF-b levels. ALT, H&E staining intensities and aSMA showed gradually increased along fibrosis while metabolic markers of serum insulin, vitamin D and VDR decreased. IL-4 inductions while inhibited fibrosis it elevated metabolic markers. Conclusions: M2-macrophages express less IFN-g and IL-12, which might indicate inability differentiation of naive T cells into Th1 cells. IL-4 has an anti-fibrotic effects through antagonize M2-macrophages of TGF-b and ameliorating insulin, vitamin D, VDR and consequently attenuated liver-fibrosis.

Introduction: Cercis siliquastrum (Judas tree) is a traditional medicine with drug discovery potential. The aim of this study was to investigate the antimicrobial and antioxidant activity of Cercis siliquastrum L. flowers and leaves for their effect on the DNA cell cycle (proliferation) in a breast cancer cell line. Methods: Assessment of the DNA cell cycle of breast cancer was conducted using propidiumiodide (PI) while apoptosis activity was estimated by staining with Annexin-V using flow cytometry. The antimicrobial activity was assessed through a broth microdilution method on four bacterial pathogens and one fungal strain. Moreover, the Diphenylpicrylhydrazyl (DPPH) method was utilized to evaluate free radical scavenging efficacy of C. siliquastrum flowers and leaves in four different solvent fractions. Results: The acetone and methanol fractions of C. siliquastrum leaves and flowers showed highest antioxidant potentials with IC50 values of 8.31 +/- 1.36, 4.78 +/- 1.84, 1.75 +/- 2.03 and 3.31 +/- 1.66 mu g/ml, respectively compared with Trolox that had an antioxidant potential of IC50 value of 1.41 +/- 1.05 mu g/ml. The leaf hexane fraction showed potent antibacterial potential versus Staphylococcus aureus, Methicillin-Resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa with MIC values of 0.007, 0.024, 0.048 mg/ml, respectively. Notably, the C. siliquastrum flowers hexane fraction strongly inhibited growth of Staphylococcus aureus, Pseudomonas aeruginosa, MRSA, and Candida albicans with MIC values of 0.009, 0.039, 0.048 and 0.08 mg/ml, respectively. Moreover, C. siliquastrum leaves and flowers hexane fractions caused cell cycle arrest followed by cell death via apoptosis/necrosis due predominantly to defects in the mitotic process. Conclusion: Our data revealed the significant antimicrobial and antioxidant effects of C. siliquastrum that contributed significantly to the cytotoxicity of cancer cells requires further detailed studies.

Throughout history, mankind used various natural materials as a remedy for the treatment of various diseases and recently witnessing a vastly growing and renewed interest in herbal medicine globally. In Palestinian folk medicine, Ephedra alata and Plumbago europaea used as diuretics and for treatment of hypertension. This study aimed to evaluate the diuretic and acute toxicity effects of the aqueous extracts for these two plants in mice following oral administration. Aqueous E. alata and P. europaea extracts (500 mg/kg) were administered orally to adult mice. Urine output and electrolytes were then measured after 4 h of administration and compared with those received furosemide 10 mg/kg (positive control group) and those received normal saline (negative control group). Significant diuresis was noted in those receiving the aqueous extract of E. alata (p < 0.001), while the P. europaea aqueous extract had shown mild diuresis at the end of the forth hour compared to controls. Moreover, both aqueous extracts had an alkaline pH and a mild increase in the electrolyte excretion (Na, K). Our results revealed that E. alata aqueous extract has a potential diuretic effect. Further studies are needed to evaluate this diuretic effect in the relief of diseases characterized by volume overload.