Challenges in conducting qualitative research among nurse educators.

OBJECTIVE: To explore the perspectives of nurse educators regarding challenges in conducting qualitative research. METHODS: The qualitative descriptive study was conducted from August 2021 to January 2022 at three private nursing colleges of Peshawar, Pakistan, including the Rufaidah Nursing College, the North West Institute of Health Sciences, and the Rehman College of Nursing. Nurse educators of either gender with at least one year of experience who were able to speak Urdu and English and had a minimum qualification of bachelor's degree in nursing were Included. Data was collected through semi-structured interviews using an interview guide. Braun and Clark 6-step method was used for analysis. RESULTS: Of the 26 nurse educators, 13(50%) each were males and females. Three main themes were developed; concept of qualitative research, challenges in qualitative research, and suggestions to promote qualitative research. Participants reported that conducting qualitative research was a challenging task that needed resourses and collaboration. CONCLUSIONS: Qualitative research is a complex process which requires commitment, support and skills at individual and organisational levels.

Experiences regarding internship among Bachelor of Science in nursing students in Peshawar: A qualitative study.

OBJECTIVE: To explore the experiences of new nursing graduates during their internship in a tertiary care setting. METHODS: The qualitative phenomenological descriptive study was conducted from September2020 to May2021 at three private hospitals of Peshawar, Pakistan, namely the Kuwait Teaching Hospital, the Mercy Teaching Hospital and the Prime Teaching Hospital. New nursing graduates of either gender were enrolled. Data was collected through semi-structured interviews using an interview guide and probing questions. Data was analysed using the 6-step Braun and Clarke method. RESULTS: Of the 11 subjects, 6(54.5%) were males and 5(45.5%) were females. Data led to the generation of four main themes; challenges, coping strategies, improved knowledge, and need for improvement in internship programme. The participants said certain types of individuals and organisational challenges affected them both personally and socially in their daily routines. Coping strategies varied among the subjects. CONCLUSIONS: New nursing graduates faced both individual and organisational challenges which is a matter of concern. Policies and their proper implementation should be planned to counter such challenges.

Evaluation of hematological parameters as an indicator of disease severity in Covid-19 patients: Pakistan's experience.

BACKGROUND: The severity of COVID-19 could be evaluated by examining several blood parameters mainly white blood cell (WBC) count, granulocytes, platelet, and novel hemocytometric markers neutrophils to lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), and lymphocyte to monocyte ratio (LMR). The current study was conducted to investigate alteration in blood parameters and their association with the severity and mortality of COVID-19 patients. METHODOLOGY: An observational cross-sectional study was conducted retrospectively, a total of 101 COVID-19 positive patients were examined: 52 were mild, 24 were moderate, 09 were severe, and 16 were critically diseased patients. We also recorded 16 deaths associated with the critical group. The overall mean age observed in our study was 48.94 years, where the mean age for critical individuals was 62.12 ± 14.35 years. RESULTS: A significant association between the disease severity and elevation in blood parameters were observed. The WBC's and granulocyte count were significantly increased (p value <0.001) while the mean platelet count (165.0 × 109 /L) and red blood cell volume distribution width (RDW) were decreased in the critical group (57.86%) compared to mild group's patients (177.3%) (p = 0.83). The lymphocytes count was decreased in critical patients (1.40 × 109 /L) compared to mild patients (1.92 × 109 /L) (p = 0.28). A significant association was observed in platelet-lymphocyte ratio (p < 0.001), Neutrophil-Lymphocyte ratio (p = <0.001), and Lymphocyte-Monocyte ratio (0.011). CONCLUSION: These blood parameters could be used as a suitable biomarker for the prognosis and severity of COVID-19. Evaluating novel hemograms NLR, PLR, and LMR can aid clinicians to identify potentially severe cases at early stages, initiate effective management in time, and conduct early triage which may reduce the overall mortality of COVID-19 patients.

Challenges experienced by post coronary artery bypass grafting patients: A qualitative study from Peshawar, Khyber Pakhtunkhwa, Pakistan.

OBJECTIVE: To explore the experiences of post-coronary artery bypass grafting patients in Pakistan. METHODS: The qualitative, descriptive, phenomenological study was conducted at the Lady Reading Hospital, Peshawar, Pakistan, from May 2018 to April 2019, and comprised patients having undergone coronary artery bypass grafting. Data was collected through semi-structured interviews that included probing questions. Codes, categories and themes were framed through extensive thematic analysis. RESULTS: Of the 14 patients, 11(78.6%) were male with a mean age of 50.81±5.61 years and 3(21.4%) were female with a mean age of 63.33±6.02 years. Four main themes were generated; challenges, perceptions about coronary artery bypass grafting, coping with the challenges, and perceptions about nurses and doctors. The subjects were of the view that they were affected with certain types of physical, psychological and financial challenges. These encounters affected the patients post-procedure in almost every aspect of their lives and made it difficult for them to carry out activities on a daily basis. Further, coping strategies varied from individual to individual. CONCLUSIONS: Patients after coronary artery bypass grafting were found to encounter issues related to physical, psychological and social spheres. Care for such patients must be planned in a way to avoid such challenges.

Association of arg16gly and gln27glu, b2-adrenergic receptor gene polymorphism with asthma. A systematic review and meta-analysis of case control studies.

The study was planned to assimilate quantitatively the available evidences on association of Arg16Gly and Glu27Gln with asthma and to produce more precise results. All case-control studies conducted on adults were searched on Medline, Embase, PubMed, Wiley online library according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The strength of association was measured by odds ratios with 95% confidence interval. A total of 17 case-control studies were included in the meta-analysis and there was no significant association of asthma with Arg16Gly (odds ratio = 1.19; 95% confidence interval = 0.75-1.50, p=0.459) and Glu27Gln of ADRb2 polymorphism (odds ratio=0.87, 95% confidence interval =0.44-1.71, p=0.683). Moreover, neither Gly16 allele (odds ratio = 0.98; 95% confidence interval = 0.70-1.38, p=0.867) nor Glu27 allele (odds ratio = 0.67, 95% confidence interval = 0.38-1.19, p=0.169) contributed to asthma susceptibility. There was also no significant association between haplotypes of both single nucleotide polymorphisms and asthma (p>0.05). Data indicated that adrenergic receptor b2 did not contribute markedly to susceptibility to asthma (p>0.05).

Adipokine Serum visfatin level in pregnancy induced hypertension and uncomplicated pregnancy.

BACKGROUND AND OBJECTIVES: Hypertensive disorder in pregnancy is the significant disease that badly affects the maternal and fetal prognosis and lead to higher mortality and morbidity in the prenatal period. Visfatin, potentially a new adipokine has emerged having high contribution in pathogenesis of pre-eclampsia. The objective of the study was to find the level of Visfatin in pregnancy induced hypertension and normal pregnant women. METHODS: This study was carried out in tertiary care hospitals, Peshawar from March-October 2014. A total of 234 pregnant women (gestational age >20 weeks) were included in the study with distribution as Preeclampsia (PE=86), Eclampsia (E=74) and control (N=74). Blood was taken for measuring Visfatin level by Enzyme Linked Immunosorbent Assay (ELISA) technique. SPSS version 19 was used for statistical analysis. Student's t test was performed to evaluate the mean differences in patients and control. RESULTS: Serum level of visfatin was significantly higher in pregnancy induced hypertension when compared with control (P value<0.001).: Comparisons of mean value of visfatin with age group of 21-40 years, body mass index (BMI), primary parous and parity 2-4, gestational age of >36 weeks and both systolic and diastolic blood pressure were highly significant in pregnancy induced hypertension when compared with control (p value<0.001). CONCLUSION: Pregnancy induced hypertensive women showed increased level of serum Visfatin than normal pregnant women.

The genetic cause of neurodevelopmental disorders in 30 consanguineous families.

Objective: This study aims to clinically and genetically assess 30 unrelated consanguineous Pakistani families from various ethnic backgrounds, all exhibiting features of neurodevelopmental disorders (NDDs). Methods: We conducted clinical, genetic, biochemical, and molecular analyses on 30 consanguineous families with NDDs enrolled from various regions of Pakistan. The likely molecular causes of primary microcephaly and NDDs were identified. Detailed clinical investigations and molecular diagnoses were performed using whole exome sequencing (WES) of the proband, followed by Sanger sequencing for validation and segregation in the available family members of the affected families. Results: WES identified likely disease-causing homozygous variants in 30 unrelated consanguineous families. Six families presented newly described variants in known NDD-related genes: ABAT (c.1439 T > G; p.Phe480Cys) [OMIM613163], SLC12A6 (c.2865_2865insT; p.Glu955Asnfs*5) [OMIM 218000], SHANK3 (c.1305-3_1,305-2delTT; p.Gln29-_Gly305del) [OMIM 606232], BCKDK (c.356_356insC; p.Gly119Alafs*24) [OMIM 614923], DDHD2 (c.2065G > T; p.Asp689Tyr) [OMIM 615033], ERCC2 (c.1255G > A; p.Glu419Lys) [OMIM 610756]. Additionally, 12 families had previously reported disease-causing variants associated with different types of NDDs: ATRX (c.109C > T; p.Arg37*) [OMIM 309580], GPR56 [ADGRG1] (c.1423C > T; p.Arg475*) [OMIM 606854], NAGLU (c.1694G > A; p.Arg565Gln) [OMIM 252920], DOLK (c.3G > A; p.Met1Ile) [OMIM 610768], GPT2 (c.815C > T; p.Ser272Leu) [OMIM 616281], DYNC1I2 (c.607 + 1G > A; p.?) [OMIM 618492], FBXL3 (c.885delT; p.Leu295Phefs25*) [OMIM 606220], LINGO1 (c.869G > A; p.Arg290His) [OMIM 618103], and ASPM (c.3978G > A; Trp1326*, c.9557C > G; p.Ser3186*, c.6994C > T; p.Arg2332*) [OMIM 608716]. All the identified variants showed segregation compatible with autosomal recessive inheritance. Conclusion: In the present study, we observed a high frequency of ASPM variants in the genetic analysis of 30 consanguineous families exhibiting features of NDDs, particularly those associated with autosomal recessive primary microcephaly. These findings contribute to studies on genotype-phenotype correlation, genetic counseling for families, and a deeper understanding of human brain function and development.

Relationship Of Serum Visfatin Levels With Serum Electrolytes, Liver Profile, Hepatic Enzymes And Anthropometric Parameters In Pregnant Women With Preeclampsia And Eclampsia During 3rd Trimester.

BACKGROUND: Eclampsia and preeclampsia are among the serious complications of gestation and threaten the lives of both mother and foetus. A protein called visfatin, one of these adipokines, is evaluated for its effects on serum electrolytes, lipid profile and hepatic enzymes in preeclamptic and eclamptic patients. METHODS: A sum of 234 pregnant women were enrolled in this crosssectional study and divided in to 2 main groups, i.e., Group A (eclamptic/preeclamptic) Group B (control) pregnant women respectively. Serum visfatin levels (ng/mL), serum electrolytes and liver enzymes were determined for every patient, using relative diagnostic kits. Anthropometric measurements were also noted. RESULTS: A total of 234 women (cases; n=160, controls; n=74) with gestation age of ≥20 weeks participated in this study. Group A had 86 (36.75%) women with preeclampsia and 74 (31.62%) women with eclampsia whereas Group B had 74 (31.62%) normotensive pregnant women. A strong significantly positive association was recorded for systolic (R2=78.78; p-value <0.000) and diastolic blood pressure (BP) (R2=78.52; p-value <0.000). Similar result was obtained for serum sodium ions (R2=3.09; p-value <0.002) and chloride ions (R2=7.36; p-value <0.000). Alkaline phosphatases (ALP) (R2=63.47; p-value <0.000) had also shown a strong positive and statistically significant association with visfatin levels. CONCLUSIONS: Serum visfatin significantly decreased the sodium and chloride levels whereas the levels of potassium remained unaffected. A very strong and positive association of visfatin levels with levels of bilirubin and alkaline phosphatases was also observed (ALP) but it found no effect on aspartate transferases (AST).

Ballodiolic Acid A and B: Two New ROS, (•OH), (ONOO-) Scavenging and Potent Antimicrobial Constituents Isolated from Ballota pseudodictamnus (L.) Benth.

Bioassays guided phytochemical investigations on the ethyl acetate-soluble fraction of the root material of Ballota pseudodictamnus (L.) Benth. led to the isolation of two new compounds, ballodiolic acid A (1) and ballodiolic acid B (2), along with three known compounds ballodiolic acid (3), ballotenic acid (4), and ß-amyrin (5), which were also isolated for the first time from this species by using multiple chromatographic techniques. The structures of the compounds (1-5) were determined by modern spectroscopic analysis including 1D and 2D NMR techniques and chemical studies. In three separate experiments, the isolated compounds (1-5) demonstrated potent antioxidant scavenging activity, with IC50 values ranging from 07.22-34.10 µM in the hydroxyl radical (•OH) inhibitory activity test, 58.10-148.55 µM in the total ROS (reactive oxygen species) inhibitory activity test, and 6.23-69.01 µM in the peroxynitrite (ONOO-) scavenging activity test. With IC50 values of (07.22 ± 0.03, 58.10 ± 0.07, 6.23 ± 0.04 µM) for •OH, total ROS, and scavenge ONOO-, respectively, ballodiolic acid B (2) showed the highest scavenging ability. Antibacterial and antifungal behaviors were also exposed to the pure compounds 1-5. In contrast to compounds 4 and 5, compounds 1-3 were active against all bacterial strains studied, with a good zone of inhibition proving these as a potent antibacterial agent. Similarly, compared to compounds 3-5, compounds 1 and 2 with a 47 percent and 45 percent respective inhibition zone were found to be more active against tested fungal strains.

Sofosbuvir Resistance-associated Substitutions in the Palm Domain of HCV-NS5B RNA Dependent RNA Polymerase; Study of two Sofosbuvir non-responders.

OBJECTIVE: In current study we performed sequencing of palm domain of HCV-NS5B gene, its ancestral analysis along with amino acids substitution analysis. These analysis were done to find the molecular basis of the viral resistance against Sofosbuvir drug. METHODS: Blood samples from individuals with chronic Hepatitis C infection that were resistant to Sofosbuvir were collected. The samples were processed for their molecular characterization that included RNA extraction, Complementary DNA (cDNA) synthesize, nested PCR, gel elution, Sequencing, ancestral and 3D structure analysis. RESULTS: Evolutionary analysis revealed that current study sequences (QAU-01, QAU-02) clustered with a previously studied sequence, KY971494.1. Moreover, we reports multiple novel amino acid substitutions in the palm domain of NS5B gene such as Ile116Val, Asn117Gly, Glu246Ala, Val252Ala, Glu258Gln, Cys262Leu, Ser269Arg, Ala272Thr, Ile293Leu, Lys304Arg, Asn307Gly, Ala338Val and Arg345Gly in our query sequence (QAU-01). At 246 and 269 position in (QAU-02), no substitution was observed. CONCLUSIONS: We have noticed that the current sequences are relatively emerging and could have been originated from aforementioned sequence recently. Based on the current results, we suggests that these substitutions could be associated with structural or functional impairment of protein and could also be may be considered as resistance associated substitutions (RAS) to Sofosbuvir drug.

Green Synthesis, Characterization, Enzyme Inhibition, Antimicrobial Potential, and Cytotoxic Activity of Plant Mediated Silver Nanoparticle Using Ricinus communis Leaf and Root Extracts.

The need of non-toxic synthesis protocols for nanoparticles arises developing interest in biogenic approaches. The present project was focused on cost effective, environment congenial synthesis of Ag nanoparticles and their biological applications. Leaf and root extracts of Ricinus communis were used as a reducing and stabilizing agent in synthesis process. A Proposed mechanism in published literature suggested that Indole-3-acetic acid, l-valine, triethyl citrate, and quercetin-3-0-p-d-glucopyranoside phytoconstituents of Ricinus communis act as reducing and capping agents. The synthesized Ag NPs were characterized with a help X-ray diffractometer, Transmission electron microscopy, UV-Vis spectrophotometry and Fourier Transform Infrared Spectroscopy (FTIR). The XRD results inveterate the synthesis of pure nano size crystalline silver particles. The FTIR data revealed the possible functional groups of biomolecules involved in bio reduction and capping for efficient stabilization of silver nanoparticles. TEM analysis confirmed the almost spherical morphology of synthesized particles with mean size 29 and 38 nm for R-Ag-NPs (root) and L-Ag-NPs (leaf), respectively. The stability of synthesized nanoparticles was examined against heat and pH. It was observed that synthesized nanoparticles were stable up to 100 °C temperature and also showed stability in neutral, basic and slightly acidic medium (pH 05-06) for several months while below pH 5 were unstable. The synthesized silver nanoparticles had promising inhibition efficiency in multiple applications, including as bactericidal/fungicidal agents and Urease/Xanthine oxidase enzymes inhibitors. The cytotoxicity of synthesized nanoparticles shows that the concentration under 20 µg/mL were biologically compatible.