Background Chronic kidney disease is considered as a global health problem. Hemodialysis (HD), following renal transplantation, is the most common form of renal replacement therapy. However, HD may impact the quality of life (QOL). Pain is a frequent complaint among this population that also affects their QOL. The purposes of this study were to assess pain and QOL among end-stage renal disease (ESRD) patients on HD and to examine their association. Methods This was a multicenter, cross-sectional study that occurred in Palestine between August and November 2018. Brief Pain Inventory and European Quality of Life scale 5 dimensions (EQ-5D) scale, including its European Quality of Life visual analogue scale (EQ-VAS) component, were used to assess pain and QOL, respectively. Results A total of 300 participants were included in the final study. The average age of the subjects was 54 ± 16 years. Their median EQ-5D score was 0.68 [0.54–0.88], whereas their median EQ-VAS score was 60 [40–75]. A statistically significant association of pain severity score with EQ-5D score was found (r = − 0.783, p < 0.001). The association between pain interference score and EQ-5D score was also found to be statistically significant (r = − 0.868, p < 0.001). Similarly, pain severity score was significantly assocsiated with EQ-VAS score (r = − 0.590, p < 0.001), the same as was the pain interference score (r = − 0.647, p < 0.001). Moreover, age, gender, BMI, employment, educational level, income level, dialysis vintage, previous kidney transplantation, and chronic medication use were all significantly correlated with QOL. Regression analysis showed that patients aged < 60 years (p < 0.001), those with lower pain severity scores (p = 0.003), and those with lower pain interference scores (p < 0.001) had significantly higher QOL scores. Conclusions Pain has a significant negative impact on QOL in ESRD patients undergoing HD. The subgroups that were at higher risk included elderly patients, females, those with higher BMI, those without a formal education, those unemployed, those living with low monthly income, smokers, those who have multiple comorbidities, and patients with longer dialysis vintage. Our findings provide reliable data for educators and clinicians working with HD patients.

Background Accurate knowledge and good pain evaluation and documentation practices should be present for efficient pain management. In this study, we aimed to assess the knowledge and practices of nurses relating to the management of cancer pain in Palestine, and to determine the barriers to efficient pain control in cancer patients. Methods A cross-sectional survey took place at 8 hospitals across Northern West Bank. A convenience sample of 220 Nurses working in governmental and private hospitals in West Bank/Palestine was studied. For that purpose, a questionnaire was developed to assess knowledge, practices, perceived barriers, and delaying processes relating to cancer pain management (CPM). Results In total, 220 questionnaires were completed with a response rate of 88%. Participants’ mean age was 30.34 years. Overall, 69.5% worked in governmental hospitals, 26.8% worked in the private sector and the remainder worked in both governmental and private sectors. The correct response rate to questions that assess knowledge relating to cancer pain control was calculated and a mean knowledge score was found to be 5.1 with a standard deviation of 2.1. A relationship between the knowledge score and the sample characteristics was made and showed that males scored significantly higher ( p = 0.001) than females with median scores of 6 [4–7] and 5 [3–6] for males and females, respectively. Inadequate pain assessment (76.8%), insufficient knowledge of pain control (70.5%) and strict regulation on opioid use (69.5%) were the most frequently perceived barriers. Nurses reported that they would assess pain on every round and check all items related to pain assessment. Contacting the physician for the prescription of opioids was cited as the main delaying process by 56.4% of participants. Conclusions This study allowed us to recognise the knowledge deficit and the barriers to effective management. On the other hand, the analysis has shown good pain documentation practices among nurses. Those knowledge deficits demonstrate the need for more education about CPM. The improvement of coordination and communication between physicians and nurses seems to play a crucial role in CPM, as contacting physicians was cited as the most delaying process in CPM by nurses. Electronic supplementary material The online version of this article (10.1186/s12909-019-1613-z) contains supplementary material, which is available to authorized users.

Background Teaching Complementary and alternative medicine (CAM) in medical schools is becoming prevalent worldwide. Few studies have been conducted to evaluate medical students’ knowledge and attitude toward CAM. Therefore, this study was designed to assess CAM knowledge, attitudes, and beliefs among Palestinian medical students. Methods This study was developed in a cross-sectional design. It targeted medical students at An-Najah National University, between January and April of 2018. We gathered the data from students using a questionnaire printed as a hard copy. Medical students of both sexes in their 4th, 5th, or 6th year of studies were included in the survey. The questionnaire consisted of 3 sections: demographic characteristics and detailed practices of the participants, their attitude and held beliefs towards CAM, and their knowledge on CAM. Mann-Whitney U Test and Kruskal-Wallis Test were used to test if there were differences between knowledge about CAM and the characteristics of the participants. Results Of the 300 medical students who were offered the questionnaire, 251 students (43.8% male and 56.2% female) were included in the final analysis. Out of a maximum of 8 points, the mean knowledge score of the participants was 2.0 ± 1.6. The Kruskal-Wallis test showed a statistically significant difference in overall knowledge score among students of different year groups, with students at lower levels obtaining higher scores ( P < 0.001). Additionally, the highest knowledge scores were found in students with low income, and students who came from the Palestinian refugee camps ( P < 0.001). Students frequently recommended CAM modalities, with herbal medicine being the most recognized and used CAM modality and Ayurvedic medicine being the least recognized and recommended one. Social media was the most popular source of information about CAM, cited by 72.9% of the participants. Participants generally had a good attitude towards CAM but held varying beliefs about it. Conclusions In the current study, a knowledge gap regarding CAM was found among medical students in our sample, despite their good attitude towards the subject. Also, there was a general acceptance to include materials on CAM within the curriculum of medical students. Electronic supplementary material The online version of this article (10.1186/s12906-019-2492-x) contains supplementary material, which is available to authorized users.

Wolfram syndrome is a rare multisystem disorder caused by mutations in WFS1 or CISD2 genes leading to brain structural abnormalities and neurological symptoms. These abnormalities appear in early stages of the disease. The pathogenesis of Wolfram syndrome involves abnormalities in the endoplasmic reticulum (ER) and mitochondrial dynamics, which are common features in several other neurodegenerative disorders. Mutations in WFS1 are responsible for the majority of Wolfram syndrome cases. WFS1 encodes for an endoplasmic reticulum (ER) protein, wolframin. It is proposed that wolframin deficiency triggers the unfolded protein response (UPR) pathway resulting in an increased ER stress-mediated neuronal loss. Recent neuroimaging studies showed marked alteration in early brain development, primarily characterized by abnormal white matter myelination. Interestingly, ER stress and the UPR pathway are implicated in the pathogenesis of some inherited myelin disorders like Pelizaeus-Merzbacher disease, and Vanishing White Matter disease. In addition, exploratory gene-expression network-based analyses suggest that WFS1 expression occurs preferentially in oligodendrocytes during early brain development. Therefore, we propose that Wolfram syndrome could belong to a category of neurodevelopmental disorders characterized by ER stress-mediated myelination impairment. Further studies of myelination and oligodendrocyte function in Wolfram syndrome could provide new insights into the underlying mechanisms of the Wolfram syndrome-associated brain changes and identify potential connections between neurodevelopmental disorders and neurodegeneration.

Background: Patients on hemodialysis (HD) commonly suffer from poor sleep quality which in turn compromises their quality of life and well as their mortality risk according to many studies. In Palestine however, no single study had emphasized the association and prevalence of sleep quality and daytime sleepiness among hemodialysis patients (HDP). Therefore, we conducted this study to determine the relationship between regular HD and the situation regarding sleep quality and daytime sleepiness in HDP. Methods: In this cross-sectional survey, we targeted HDP at one HD center in An-Najah National University Hospital. Sleep problems were assessed by both the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), which are considered as standardized tools for the assessment of sleep quality and daytime sleepiness, respectively. Results: Of the 192 dialysis patients who were interviewed, 167 were included in the final analysis of this study, with a response rate of 87%. The mean age of the participants was 57.6 ± 12.9. Fifty-two percent were males, and an equal percentage of the participants were 60 years old or older. The median ESS of the participants was 7 [4-11] and 43.1% of the participants had 9 or more ESS score, indicating excessive daytime sleepiness. The median PSQI score was 8 [6-12] and 76.65% of the participants scored more than 5 points on the PSQI, indicating poor sleep quality. Neither the ESS score nor the PSQI score were significantly associated with any particular category of participants, based on their demographic or clinical characteristics. Conclusions: In conclusion, we found that dialysis patients had poor sleep quality, evident by their high median PSQI score, though their excessive daytime sleepiness was less evident by their median ESS score in the high normal values. Additionally, we found a high prevalence of poor sleep quality among HDP, whereas excessive daytime sleepiness was less prevalent. Finally, no significant association was found between either of the two scores and the participants' demographic or clinical characteristics surveyed in this study.