Zaher Nazzal

An-Najah National University · Faculty of Medicine and Health Sciences

Background: The exposure to chemicals in detergent factories, as some studies have shown, has a negative impact the health of workers’ respiratory systems. The aim of the study was to assess the lung function parameters of detergent factory workers and compare it with those of a group of non-chemical workers using spirometry. Methods: A comparative...

Purpose This study aimed to examine the association between renal impairment and polypharmacy among older Palestinian patients visiting primary healthcare centers and to examine potentially inappropriate medications among older patients. Methods A cross-sectional study was conducted among PHC clinic attendees aged 65 and older. We used medical rec...

Introduction Kidney failure is rapidly rising in Palestine, as the number of patients receiving maintenance dialysis has quadrupled in the last 15 years. In this study, we share an overview of our experience growing a peritoneal dialysis (PD) program from zero to 178 patients in 5 years at An-Najah National University Hospital in Palestine, present...

This cross-sectional study aims to find the prevalence of chronic pain and its correlation with the quality of life and vitamin D levels among hemodialysis patients in Palestine. We used the brief pain inventory, the medical outcomes study 36-item short-form health survey, and Serum 25-hydroxyvitamin D to assess chronic pain, quality of life, and v...

Background: The emergence of several SARS-CoV-2 variants may necessitate an annual COVID-19 booster vaccine. This study aimed to evaluate healthcare workers' (HCWs) acceptance of a COVID-19 yearly booster vaccine, if recommended, and its association with their attitudes and burnout levels. Methods: We used an online self-administered questionnaire...

Objectives: This scoping review is to investigate the existing literature on the mental health of Healthcare workers, including stress or distress, anxiety, depression, burnout, insomnia, and fear or phobia within the different countries in the Eastern Mediterranean region (EMR) during the COVID-19 pandemic. Methods: We systematically searched to c...

Patients on maintenance dialysis therapy are especially vulnerable to COVID-19 and its complications. This study aimed to assess the incidence, epidemiological characteristics, and mortality rate of COVID-19 among maintenance dialysis patients. This retrospective observational chart review study included 548 patients from all dialysis units in the...

Background: The purpose of this study was to determine the prevalence of anxiety and depression symptoms among adolescent students in the West Bank region of Palestine, focusing on the effect of using electronic devices on their mental health. Methods: This cross-sectional study included 1,140 adolescents. Data on sociodemographic characteristics,...

Tinnitus is a common complaint with potentially negative impact on quality of life. Prevalence of tinnitus ranges from 5 to 43% worldwide. This variation could be due to the heterogeneity of tinnitus assessment. This has limited the progress in understanding tinnitus. Therefore, we employed a standardized and a validated assessment method to determ...

The acute COVID-19 presentation is well described in the literature, but the long-term effect is unclear. This study aims to find the incidence of long-COVID symptoms and the associated risk factors among COVID-19 patients. A prospective cohort study in Palestine included 669 confirmed COVID-19 patients. Sociodemographic and clinical data were extr...

Introduction: Kidney failure is rapidly rising in Palestine, as the number of patients receiving maintenance dialysis has quadrupled in the last 15 years. In this study, we share an overview of our experience growing a peritoneal dialysis (PD) program from zero to 178 patients in five years at An-Najah National University Hospital in Palestine, pre...

Introduction: Kidney failure is rapidly rising in Palestine, as the number of patients receiving maintenance dialysis has quadrupled in the last 15 years. In this study, we share an overview of our experience growing a peritoneal dialysis (PD) program from zero to 178 patients in five years at An-Najah National University Hospital in Palestine, pre...

Background: Depression and anxiety are common mental health disorders among the elderly worldwide. In this study, we estimated the prevalence of depression and anxiety and related risk factor among elderly attending PHC centers in Palestine. Methods: A cross-sectional study was conducted on a sample size of 380 participants aged ≥60 attending PHC c...

Background: The emergence of several SARS-CoV-2 variants may necessitate an annual COVID-19 booster vaccine. This study aimed to evaluate healthcare workers (HCWs) acceptance of an annual COVID-19 booster vaccine, if recommended, and its association with their attitudes and burnout levels. Methods: We used an online self-administered questionnaire...

Purpose: This study aimed to estimate the prevalence of renal impairment among primary health care (PHC) elderly, its association with polypharmacy, and the most frequent potentially inappropriate prescription (PIP) in renal impairment patients. Methods: A cross-sectional study was conducted among PHC clinic attendees aged 65 and older. We used me...

The exposure to chemicals in cleaning factories and companies, as some studies have shown negatively affect the health of their respiratory system. The aim of the study was to determine the effect of chemical substances on lung function of the factories' workers. Spirometry parameters were compared between chemical factories workers and non-workers...

Purpose to determine COVID-19 vaccination coverage among pregnant women and investigate the factors affecting vaccine uptake. Design Analytical cross-sectional study. Setting Palestinian health care facilities. Between October and November 2021 – eight months after the country’s first COVID-19 vaccination. Sample We needed 820 people to estimate...

Background Pain is a common complaint among hemodialysis patients. End-stage renal disease patients are at high risk of vitamin D deficiency and poor Quality of life (QoL). This study aims to find the prevalence of chronic pain and its correlation with QoL and vitamin D level among hemodialysis patients in Palestine. Methods This cross-sectional s...

This study aims to explore pregnant women's attitudes to COVID-19 vaccination and determinants of vaccine acceptance. We conducted a cross-sectional study among pregnant women attending PHC clinics and hospitals in the West-bank of Palestine. We used an interviewer-administered questionnaire based on Health Belief Model. The study's primary outcome...

AimThis study aimed to assess weight control behaviors and their relationship with body weight and image perceptions among female university students.Subject and methodsA cross-sectional study was conducted among female students. The study included 420 female students aged 17–27 years using a convenient sample. Students were invited from all facult...

Background: In our clinical practice, conventional radial access has been employed routinely for coronary procedures. The distal radial artery (DRA) access site has recently emerged as a novel technique in cardiac procedures. Objectives: This study compares distal radial access to standard forearm radial access (FRA) in terms of feasibility, out...

Background Objectives: To determine the prevalence of different psychostimulants and cognitive enhancers among Palestinian university students and their association with of metabolic syndrome (MetS) Methods A cross-sectional study was conducted in 2020 among university students aged 18-25 years at An-Najah National University in the West Bank. MetS...

Background Chronic kidney disease (CKD) is a worldwide public health problem because of high morbidity and mortality and high costs of treatment. Diabetes is a major risk factor for development and progression of CKD. In this study, we aimed to assess the prevalence of CKD among patients with type 2 diabetes treated in primary health care (PHC) cen...

Background Digital health interventions have been shown to improve data quality and health services in low- and middle-income countries (LMICs). Nonetheless, in LMICs, systematic assessments of time saved with the use of digital tools are rare. We ran a set of cluster-randomized controlled trials as part of the implementation of a digital maternal...

Background In response to this extraordinary outbreak, many countries and companies rush to develop an effective vaccine, authorize, and deliver it to all people across the world. Despite these extensive efforts, curbing this pandemic relies highly upon vaccination coverage. This study aimed to determine SARS-COV-2 vaccine uptake among Palestinian...

Purpose: Due to geopolitical and socioeconomic challenges, the Family Medicine (FM) speciality in Palestine is in early stages of development. Volunteer British General Practitioner (BGP) trainers worked with FM faculty to develop an online tutorial program (OTP) and a novel evaluation framework E-QUaL (Evaluation-Quality, Utilization and Learning...

Background In the light of recent years, an increase in the number of life-threatening infections due to various fungi has been observed, especially in tertiary care centres. With Amphotericin B labelled as the first choice in treating these infections, one of its common side effects, nephrotoxicity, along with hypokalemia, were studied to determin...

Background: Chronic kidney disease associated-pruritus (CKD-aP) is a common cutaneous complication and an important prognostic factor in patients with chronic kidney disease. The mechanism of Pruritus in those patients is poorly understood. This study aims to assess the burden of CKD-aP among patients receiving dialysis and the role of interleukin...

Introduction: Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are the principal causes of maternal morbidity and mortality. The maternal morbidity and mortality burden for Palestinian women is relatively high, suggesting a substandard quality of care. Therefore, an early diagnosis of GDM and gestational hypertensio...

Introduction: Despite discovery of effective vaccines, healthy behaviors and good practices remain the cornerstone of the prevention and control of COVID-19 and the mitigation of adverse impacts. This study aimed to assess the Palestinian population's COVID-19 prevention measures and correlate them with their knowledge, attitude, and background ch...

Introduction: Acute kidney injury (AKI) remains a critical issue for cancer patients despite recent treatment improvements. This study aimed to assess the incidence of AKI in cancer patients and its related risk factors. Methods: A Retrospective cohort study was conducted at tertiary hospitals in the period 2016-2018. A data abstraction sheet wa...

Background: In the light of recent years, an increase in the number of life-threatening infections due to various fungi has been observed, especially in tertiary care centers. With Amphotericin B labelled as the first choice in treating these infections, one of its common side effects, nephrotoxicity, along with hypokalemia, were studied to determi...

Background Females are often more hesitant to get vaccinated than males, even among health care workers (HCWs). The purpose of this study was to assess female HCWs' COVID-19 vaccination coverage and their anti-vaccination attitudes. Methods We conducted a cross-sectional study using an online questionnaire. It included HCWs from various profession...

Background Headache is one of the most disturbing complaints worldwide, negatively impacting social and regular life activities. In the background of stressful life in medical schools, adding to the stressful situation in Palestine, a developing country under occupation, this study investigated the prevalence and clinical characteristics of migrain...

Ocular complications are common in patients with end-stage renal disease treated with hemodialysis. Disability due to visual impairment in these patients represents a global public health problem. The study aimed to estimate the hemodialysis effect on intraocular pressure (IOP) fluctuation and related factors. A cross-sectional study of 60 patients...

Background Uncertainty about vaccination among nurses are major barriers to managing the ongoing COVID-19 pandemic worldwide. Purpose To explore nurseś perceptions about receiving the SARS CoV-2 vaccine to inform the upcoming Palestinian Ministry of Health (MOH) vaccination efforts. Methods Four focus groups were conducted with nurses between Jan...

Background: Hypomagnesemia has been shown to have a significant impact on both glycemic control and diabetes complications in type 2 Diabetes Mellitus (T2DM) patients. This study aims to assess the prevalence of hypomagnesemia in T2DM patients and find the association between serum magnesium levels and outcomes relevant to glycemic control and diab...

Background University students are at a higher risk of using cognitive enhancers and psychoactive substances. Depression is associated with a noticeable decline in academic performance and can increase the risk of substance use. Due to sociopolitical issues, the use of cognitive enhancers and psychoactive substances among Palestinians has spread in...

BACKGROUND Digital health interventions have been shown to improve data quality and health services in low- and middle-income countries (LMICs). Nonetheless, in LMICs, systematic assessments of time saved with the use of digital tools are rare. We ran a set of cluster-randomized controlled trials as part of the implementation of a digital maternal...

Introduction: Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are the principal causes of maternal morbidity and mortality. The maternal morbidity and mortality burden for Palestinian women is relatively high, suggesting a substandard quality of care. Therefore, an early diagnosis of GDM and gestational hypertensio...

Background Breast cancer affects women's lives worldwide, yet early detection is an effective strategy for reducing mortality. The participation of women in mammography screening is linked to their knowledge, attitudes and perceived barriers. Objectives Our study aims to assess mammography screening uptake and barriers among women attending primar...

This study aimed to assess the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) total antibodies in the north, middle, and south regions of West Bank and the prevalence of SARS-CoV-2 specific antibodies (IgA, IgM, and IgG) in the Palestinian population. This was a cross-sectional study. The serological and epidemiological...

Introduction: Due to their stressful lives, Palestinian refugees are prone to use cognitive enhancers (CE) and psychostimulant substances (PS). Recognising health problems associated with CE/PS use can indicate how preventive programs should be directed towards adolescents. Unfortunately, research has not thoroughly investigated the health problem...

Introduction: About 14% of COVID-19 patients experience severe symptoms and require hospitalization. Managing these patients could be challenging for limited-resource countries, such as Palestine. This study aimed to evaluate hospitalized severe COVID-19 patients' treatment outcomes managed with supportive care and steroids. Methodology: This wa...

COVID-19 was characterized by cytokine storm and endothelial dysfunction in severely ill patients. As the severity of the infection was corelated with ethnicity, this study aimed to assess the correlation of proinflammatory cytokine serum level and COVID-19 symptoms within the Palestinian population. In cross-sectional study, serum samples of 27 no...

Background Due to the long waiting time for kidney transplantation, most End-Stage renal disease patients are commenced on either hemodialysis or peritoneal dialysis. Reusable fistulas have the lowest risk for death, cardiovascular events, and infections among all vascular accesses. This study aims to report the outcomes of the arteriovenous fistul...

Background Headache is one of the most disturbing complaints worldwide, negatively impacting social and regular life activities.In the background of stressful life in medical schools, adding to the stressful situation in Palestine, a developing country under occupation, this study investigated the prevalence and clinical characteristics of migraine...

Background Retinitis pigmentosa (RP) is a heterogeneous group of inherited ocular diseases that result in progressive retinal degeneration. This study aims to describe different Swept-source Optical Coherence Tomographic (SS-OCT) changes in Palestinian RP patients and to explore possible correlations with Visual Acuity (VA). Methods A cross-sectio...

Mental morbidities have been widely investigated at Primary Health Care (PHC) worldwide, but no data available in Palestine have discussed these diseases’ burden. This study aimed to assess the prevalence of psychological morbidity among primary health care attendees and related factors. A cross-sectional design was adopted in this research. We col...

Background: Diabetes is one of the most common chronic illnesses worldwide, and it is increasing in prevalence. Urinary incontinence is another worldwide health problem, with a reported prevalence that ranges from 9% to 67%. It decreases quality of life for men and women and has been associated with many poor outcomes, such as longer hospital stay...

Background Many primary health care (PHC) clients come in with medically unexplained complaints, leading to frequent consultations and high usage of services and healthcare costs. This study aimed to determine the prevalence of somatic symptom disorder (SSD) among PHC attendees and explore its relation to other mental conditions and risk factors....

Background: University students, who are at risk of eating disorders (ED), are more liable to use cognitive enhancers and psychostimulants to improve their cognitive functions and lose weight. ED in Palestinian male students is a neglected health issue. We aimed to investigate the prevalence and the association between ED and cognitive enhancers,...

With the planned COVID-19 vaccine, vaccine hesitation is a great challenge, particularly for healthcare professionals. In this study, we examined the acceptance of the COVID-19 vaccine by health care workers, their concerns about it, and the reasons that might prevent them from getting vaccinated. We conducted a cross-sectional study using an anony...

Background: The eRegCom cluster randomized controlled trial assesses the effectiveness of targeted client communication (TCC) via short message service (SMS) to pregnant women, from a digital maternal and child health registry (eRegistry) in Palestine, on improving attendance and quality of care. In this paper, we assess whether this TCC intervent...

Objective: To measure COVID-19 vaccine acceptance and related factors to undercover nurses' concerns and fears. Design: A cross-sectional study. Sample: The study included 639 nurses; 83% were women and 80% under 50 years. Measurement: A self-administered questionnaire was used. It included demographic characteristics, COVID-19-related fears...

Introduction: The level of vitamin D status and its relationship to kidney function and liver function among patients with and without type 2 diabetes were not studied among Palestinian hemodialysis patients before. The aim of this study was to assess the status of vitamin D in hemodialysis patients with and without type 2 diabetes and its determi...

Background: Smoking cessation counseling is not well established in Middle East countries including Palestine. This study assesses the practice of smoking cessation counseling among primary healthcare (PHC) physicians in Palestine and its determinants. Methods: Over the period from April to September 2019, general practitioners, family medicine...

Background This trial evaluates interventions that utilize data entered at point-of-care in the Palestinian maternal and child eRegistry to generate Quality Improvement Dashboards (QID) for healthcare providers and Targeted Client Communication (TCC) via short message service (SMS) to clients. The aim is to assess the effectiveness of the automated...

Background: The high potential risks involved in working in a healthcare setting during a pandemic and the associated fear that may affect health care workers' (HCWs') willingness to work are important to understand to eliminate potential barriers to working. This study aimed to assess Palestinian HCWs' willingness to work and the related factors a...

Background: Many primary health care (PHC) clients come in with medically unexplained complaints, leading to frequent consultations and high usage of services and healthcare costs. This study aimed to determine the prevalence of somatic symptom disorder (SSD) among PHC attendees and explore its relation to other mental conditions and risk factors....

Objectives: Healthcare systems have primary responsibility for treating tobacco dependence. Despite its proven effectiveness, international studies have shown that smoking cessation advice to patients in primary health care is suboptimal. This study aimed at assessing Palestinian PHC physicians' compliance and attitude towards smoking cessation cou...

Background Chronic kidney disease (CKD) is a global public health concern and diabetes is one of the main risk factors for its occurrence and progression. The aim of this research is to determine the prevalence of chronic kidney disease in a cross-sectional population of patients with type 2 diabetes in primary health centers in North West Bank. M...

Background: Retinitis pigmentosa (RP) is a heterogeneous group of inherited ocular diseases that result in progressive retinal degeneration. This study aims to describe different Swept-source Optical Coherence Tomographic (SS-OCT) changes in Palestinian RP patients and to explore possible correlations with Visual Acuity (VA) Methods: A cross-sectio...

Background: Sepsis syndrome is an emerging healthcare problem, especially in critically ill patients, regardless whether it\'s community- or hospital-acquired sepsis. This study evaluates the characteristics of these patients, in addition to the type, source, and outcome of sepsis and septic shock, in a university tertiary hospital in Palestine. It...

Background COVID-19 is thought to be the most significant public health threat the modern world has encountered. Health care workers (HCWs) face enormous pressure due to work overload, negative emotions, exhaustion, lack of contact with their families, and risk of catching the infection and death. Aim This study aims to assess the level of stress...