Effects of novel anemia nurse manager program on hemodialysis: a retrospective study from Qatar.

INTRODUCTION: Anemia management in dialysis is challenging. Keeping hemoglobin levels within a tight range is difficult. A new program (anemia nurse manager [ANM]) was started for better anemia management. This study aimed to compare traditional anemia management with the new ANM model regarding the achievement of better hemoglobin targets (range, 10-12 g/dL), avoidance of extreme hemoglobin levels ( < 9 or >13 g/dL), and evaluation of the cost-effectiveness of the new model. METHODS: This retrospective observational study compared traditional anemia management with management involving our new ANM model. Patients on hemodialysis in all ambulatory dialysis clinics in Qatar were included. The study included three phases: phase 1 (observation): June 2015 to August 2015, 460 patients; phase 2 (pilot): September 2015 to May 2016, 211 patients; and phase 3 (expansion in two phases): June 2016 to February 2017 and October 2017 to June 2018, 610 patients. Hemoglobin, iron saturation, and ferritin were evaluated according to the protocol. RESULTS: In this study, 55% of the patients achieved the target hemoglobin in phase 1 compared with 75% in phase 2 (p = 0.0007). The hemoglobin level within the target range was sustained at 72% ± 5% of patients in phase 3. The achievement rate of the target hemoglobin level increased from 56% (May 2015) to 72% (July 2018) (p < 0.001). The proportion of patients with extreme hemoglobin declined from 10.7% in phase 1 to 6.4% in phase 2 and sustained at 8% afterward. Reducing the doses of erythropoietin stimulating agents, owing to the use of the ANM model, saved costs by approximately 11%. CONCLUSIONS: The ANM model was able to achieve and maintain hemoglobin levels within the target range and decrease extreme hemoglobin levels. These outcomes improved patient care by avoiding high hemoglobin (increase thrombosis, cancer recurrence, stroke, and death) and low hemoglobin (weakness, poor quality of life, and need for transfusion) levels. The ANM model was cost effective even after including the salaries of nurses. This model can be considered in other aspects of patient care in dialysis.

Fe(II)-Catalyzed Transformation of Organic Matter-Ferrihydrite Coprecipitates: A Closer Look Using Fe Isotopes.

Ferrihydrite is a common Fe mineral in soils and sediments that rapidly transforms to secondary minerals in the presence of Fe(II). Both the rate and products of Fe(II)-catalyzed ferrihydrite transformation have been shown to be significantly influenced by natural organic matter (NOM). Here, we used enriched Fe isotope experiments and 57Fe Mössbauer spectroscopy to track the formation of secondary minerals, as well as electron transfer and Fe mixing between aqueous Fe(II) and ferrihydrite coprecipitated with several types of NOM. Ferrihydrite coprecipitated with humic acids transformed primarily to goethite after reaction with Fe(II). In contrast, ferrihydrite coprecipitated with fulvic acids and Suwannee River NOM (SRNOM) resulted in no measurable formation of secondary minerals. Despite no secondary mineral transformation, Mössbauer spectra indicated electron transfer still occurred between Fe(II) and ferrihydrite coprecipitated with fulvic acid and SRNOM. In addition, isotope tracer experiments revealed that a significant fraction of structural Fe in the ferrihydrite mixed with the aqueous phase Fe(II) (∼85%). After reaction with Fe(II), Mössbauer spectroscopy indicated some subtle changes in the crystallinity, particle size, or particle interactions in the coprecipitate. Our observations suggest that ferrihydrite coprecipitated with fulvic acid and SRNOM remains a highly dynamic phase even without ferrihydrite transformation.

Disposition kinetics of omeprazole in healthy female volunteers in Faisalabad.

Omeprazole (OMP) a proton pump inhibitor is widely used to suppress gastric acid secretions of parietal cells of stomach and metabolized predominantly by CYP2C19. The objective of the present study was to investigate the pharmacokinetics and dosage regimen of OMP, after its single oral administration in eight healthy adult female subjects. Blood samples were collected at different time intervals after oral administration and their pH was measured. Plasma concentration of OMP was determined by high performance liquid chromatography (HPLC) system equipped with UV-visible Detector. The concentration versus time data was used to compute the pharmacokinetic parameters with the help of computer software programme MW/PHRAM APO version 3.02.Peak plasma concentration was (Cmax) 0.38±0.04 µg/ml achieved at 2.07±0.22 hrs. The elimination half-life (t1/2 ß) was1.82 ± 0.42 hrs. Volume of distribution (Vd) in the present study was 0.40 ± 0.07 l/kg with total body clearance (ClB) 0.19 ± 0.02 l/hr/kg and area under the curve (AUC) 1.89 ± 0.23 µg.hr/ml.The pharmacokinetic properties which are different from the literature after oral administration of 20 mg OMP in eight healthy female volunteers may be due to the variations of environment and genetic variation between Pakistan and drug manufacturing of foreign countries.

Renal clearance and urinary excretion of omeprazole in healthy female volunteers in Pakistan.

Omeprazole is a widely prescribed proton pump inhibitor to treat various gastric acid hyper secretion disorders. The present study was designed to evaluate the renal clearance and urinary excretion of omeprazole in eight healthy female volunteers to increase the understanding of the contributing factors such as demographics variability in the renal clearance and urinary excretion of omeprazole under indigenous conditions. The urine and blood samples were collected 0.5, 1, 1.5, 2, 3, 4, 6, 8 hours after oral administration of enteric coated omeprazole (20 mg) and drug concentration in the samples was determined by High Performance Liquid Chromatography (HPLC) with C18 column and UV detector. Urinary excretion and renal clearance of omeprazole was calculated and data was statistically analyzed by using regression/correlation technique. Endogenous creatinine was also measured by reagent kit available in the market. The results indicate that mean diuresis was 0.0172±0.0029 ml/min/kg. While the mean values of renal clearance of creatinine and omeprazole were 1.315±0.103 and 0.066±0.0042 ml/min. kg, respectively. Whereas, clearance ratio was 0.055±0.007 which indicates back diffusion. The cumulative percentage of dose excreted was 6.71±0.358. A significant (p<0.05) negative correlation (r= -0.457) between clearance ratio and urine pH of omeprazole reflecting glomerular filtration reabsorption of drug at kidney tubular level while significant (p<0.05) negative correlation (r= -0.681) between clearance ratio and plasma concentration of omeprazole indicates the involvement of active tubular secretion of drug. It can be concluded that during glomerular filtration, omeprazole diffuse back/reabsorption. Therefore, Urinary excretion of omeprazole in indigenous healthy female subjects was observed to be lower than given in the literature values.

Chemical composition, antioxidant, antitumor, anticancer and cytotoxic effects of Psidium guajava leaf extracts.

Context Psidium guajava L. (Myrtaceae) leaves are used in traditional medicines for the treatment of cancer, inflammation and other ailments. Objective The current study explores scientific validation for this traditional medication. Materials and methods We used ferric-reducing antioxidant power (FRAP) and 2,2-diphenyl-1-picryl hydrazil (DPPH) assays to estimate antioxidant activity of P. guajava leaf extracts (methanol, hexane and chloroform). Antitumour and in vivo cytotoxic activities were determined using potato disc assay (PDA) and brine shrimp lethality assay, respectively. Three human carcinoma cell lines (KBM5, SCC4 and U266) were incubated with different doses (10-100 µg/mL) of extracts and the anticancer activity was estimated by MTT assay. NF-κB suppressing activity was determined using electrophoretic mobility shift assay (EMSA). Chemical composition of the three extracts was identified by GC-MS. Total phenolic and flavonoid contents were measured by colorimetric assays. Results and discussions The order of antioxidant activity of three extracts was methanol > chloroform > hexane. The IC50 values ranged from 22.73 to 51.65 µg/mL for KBM5; 22.82 to 70.25 µg/mL for SCC4 and 20.97 to 89.55 µg/mL for U266 cells. The hexane extract exhibited potent antitumour (IC50 value = 65.02 µg/mL) and cytotoxic (LC50 value = 32.18 µg/mL) activities. This extract also completely inhibited the TNF-α induced NF-κB activation in KBM5 cells. GC-MS results showed that pyrogallol, palmitic acid and vitamin E were the major components of methanol, chloroform and hexane extracts. We observed significant (p < 0.05) difference in total phenolic and flavonoid contents of different solvent extracts. Conclusion The present study demonstrates that P. guajava leaf extracts play a substantial role against cancer and down-modulate inflammatory nuclear factor kB.

Why do nurses leave their jobs? Understanding person-related hostility in the healthcare sector of Pakistan.

Nursing is considered indigent and oppressed because of uneven organizational hierarchies and unsatisfactory work environments. This study aimed to highlight the critical aspects of organizational culture in the nursing profession and, in general, those propagating hostile behaviours among female nursing staff that result in dissatisfaction and intention to leave the organization. A quantitative research approach was applied and a survey research strategy was used to collect the data. Convenience sampling was applied and data were collected from female nurses who were easily accessible and willing to participate in the research. A total of 707 questionnaires were collected from 14 hospitals and the data was analyzed using SmartPLS 4. Lack of administrative support and gender discrimination positively affected person-related hostility. In contrast, person-related hostility mediated the relationship between gender discrimination and lack of administrative support with the intention to leave. Direct or indirect person-related hostility factors can severely damage organizational reputation and quality and may cause the loss of employees with specific organizational knowledge and exposure. Losing an experienced employee to a newer one cannot replace the costs incurred on hiring, training, and providing knowledge to older employees. HR managers in organizations should devise strategies and policies that allow for the timely resolution of issues of nursing staff based on fair work performance.

Integration of virtual screening of phytoecdysteroids as androgen receptor inhibitors by 3D-QSAR Model, CoMFA, molecular docking and ADMET analysis: An extensive and interactive machine learning.

Ecdysteroids, a class of naturally isolated polyhydroxylated sterols, stands at a very good place in the pharmaceutical industry from their medicinal point of views like anti-inflammatory, neuroprotective, anti-microbial, anti-diabetic, antioxidant, and anti-tumor effects. Due to their excellent antioxidant and anti-microbial potential, ecdysteroids have extensive use in skin products, especially derma creams. To monitor the best anti-acne phytoecdysteroids, here made use of different computational approaches, by using the rapid, easy, cost-effective and high throughput method to screen and identify ecdysteroids as androgen receptor inhibitors. 3D-QSAR study was carried out on a dataset of ecdysteroids by using comparative molecular field analysis (CoMFA) to determine the factors responsible for the activity of compounds. Statistically a cross-validated (q2) 0.1457 and regression coefficient (r2) 0.9713 indicated the best model. Contour map results showed the influence of steric effect to enhance activity. A molecular docking analysis was done to further find out the binding sites and their anti-acne potential against three crystal structured macromolecules (PDB ID: 2REQ, 2BAC, 4EM0). Docking results were further evaluated by prime MM-GBSA analysis and findings confirmed the accuracy. Toxicity by ADMET assessment was carried out and M2 was found as lead druglike with best anti-acne activity against Propionium acnes GehA lipase bacteria after passing all filters. This research study is novel because it is representing first effort to explore ecdysteroids class for their high therapeutic output as androgen receptor inhibitor by using computational tools and expectedly led to novel scaffold for androgen receptor inhibitor. This is a novel and new approach to investigate the ecdysteroids for first time for their practical applications.

Effects of stress and self-efficacy on quality of life of mothers with autistic children: Covariance-Based Structural Equation Modeling (CB-SEM) approach.

Background: Mothers who have children with autism encounter significant difficulties in caring for their autistic youngsters, leading to higher stress levels and a reduced overall quality of life. External or internal factors can cause and respond to stress, affecting an individual's physical, psychological, and emotional health. Thus, it is crucial to examine the quality of life of mothers with autistic children. Objectives: This study aimed to investigate the relationships between stress, self-efficacy, and quality of life (QoL) in mothers of children with autism. Methods: A cross-sectional study design was used. Self-administered questionnaires were distributed from October to November 2019 to mothers with autistic children using cluster sampling techniques to capture their demographics and perceptions of stress, self-efficacy, and QoL. The data analysis was performed using covariance-based structural equation modeling (CB-SEM). Results: Of the 290 questionnaires distributed, 238 (response rate of 82%) sets were returned, but only 181 questionnaires were usable for further analysis. The findings demonstrated a notable impact of stress and self-efficacy on quality of life and an adverse effect of stress on self-efficacy. Self-efficacy serves as an intermediary in the relationship between stress and quality of life. Conclusion: In general, mothers of autistic children typically face moderate stress levels, but they have low levels of self-efficacy and quality of life. Mothers of children with autism need assistance and support from healthcare professionals, such as doctors, nurses, and psychiatrists, so that they can bear the challenges of raising children with special needs and enjoy a higher standard of living with less emotional and physical strain.

Discriminatory practices and poor job performance: A study of person-related hostility among nursing staff.

This study highlights the organisational-level factors that become the reason for propagating hostile behaviours among female nurses. Freire's theory of oppression has been used as an underpinning theory for developing the conceptual framework. This study empirically verifies the conceptual framework of the study that gender discrimination and lack of administrative support are the antecedents of person-related hostility, which is the reason for poor job performance in the healthcare sector. We applied a quantitative research approach, using questionnaires to collect data. Total of 707 survey forms were collected from female nurses working in public sector hospitals in four main cities of Pakistan. The software SPSS 20 and SmartPLS 3 were used for the final data analysis. All hypotheses regarding the direct and indirect relationship of variables were accepted. Gender discrimination and lack of administrative support were positively associated with person-related hostility. Moreover, person-related hostility also mediated the relationship between independent variables (gender discrimination, lack of administrative support) and dependent variable (poor job performance). Future research is directed to study person-related hostility among nursing staff of semi-urban areas and small towns with low literacy rates, considering other dependent variables like burnout, mental well-being, and mental health. HR strategies and policies for fair performance evaluation and timely promotions of nursing professionals are proposed in the study for building an overall healthy environment.

Exploring the anti-SARS-CoV-2 main protease potential of FDA approved marine drugs using integrated machine learning templates as predictive tools.

Since the inception of COVID-19 pandemic in December 2019, socio-economic crisis begins to rise globally and SARS-CoV-2 was responsible for this outbreak. With this outbreak, currently, world is in need of effective and safe eradication of COVID-19. Hence, in this study anti-SAR-Co-2 potential of FDA approved marine drugs (Biological macromolecules) data set is explored computationally using machine learning algorithm of Flare by Cresset Group, Field template, 3D-QSAR and activity Atlas model was generated against FDA approved M-pro SARS-CoV-2 repurposed drugs including Nafamostat, Hydroxyprogesterone caporate, and Camostat mesylate. Data sets were categorized into active and inactive molecules on the basis of their structural and biological resemblance with repurposed COVID-19 drugs. Then these active compounds were docked against the five different M-pro proteins co-crystal structures. Highest LF VS score of Holichondrin B against all main protease co-crystal structures ranked it as lead drug. Finally, this new technique of drug repurposing remained efficient to explore the anti-SARS-CoV-2 potential of FDA approved marine drugs.

Antitumour and antioxidant potential of some selected Pakistani honeys.

Antitumour potential of honey is attributed to its excellent antioxidant activity which in turn depends on the geographical origin. The present study focuses on exploration of antioxidant and antitumour potential as well as total phenolic contents (TPC) of 58 Pakistani honeys involving spectrochemical techniques and potato disk assay. Agrobacterium tumefaciens was used to induce tumours in potato disks. All analysed honey samples exhibited 1.33±0.00-155.16±0.98mg/100g of TPC, 50% 2,2-diphenyl picryl hydrazyl (DPPH) inhibition, ⩾7.36±0.43-39.86±2.34mg/100g qurecitin equivalent antioxidant contents, ⩾13.69±0.91-65.50±1.37mg/100g ascorbic acid equivalent antioxidant contents, 64.65±0.43-1780.74±11.79mM ferric reducing antioxidant power and 60% peroxide inhibition. Antitumour activity observed for 43 natural and 10 commercial samples was ⩾20%. Two samples from Faisalabad region showed 87.50±5.50% and 79.00±5.56% antitumour activity which were reference standard. It was concluded that Pakistani honeys possessed excellent antioxidant and antitumour potential overall.