A chromosome-scale assembly for 'd'Anjou' pear.

Cultivated pear consists of several Pyrus species with Pyrus communis (European pear) representing a large fraction of worldwide production. As a relatively recently domesticated crop and perennial tree, pear can benefit from genome-assisted breeding. Additionally, comparative genomics within Rosaceae promises greater understanding of evolution within this economically important family. Here, we generate a fully phased chromosome-scale genome assembly of P. communis 'd'Anjou.' Using PacBio HiFi and Dovetail Omni-C reads, the genome is resolved into the expected 17 chromosomes, with each haplotype totaling nearly 540 Megabases and a contig N50 of nearly 14 Mb. Both haplotypes are highly syntenic to each other and to the Malus domestica 'Honeycrisp' apple genome. Nearly 45,000 genes were annotated in each haplotype, over 90% of which have direct RNA-seq expression evidence. We detect signatures of the known whole-genome duplication shared between apple and pear, and we estimate 57% of d'Anjou genes are retained in duplicate derived from this event. This genome highlights the value of generating phased diploid assemblies for recovering the full allelic complement in highly heterozygous crop species.

Effectiveness of community pharmacist-led interventions in osteoarthritis pain management: A cluster-randomized trial.

BACKGROUND: Community pharmacists contribute in osteoarthritis management via evidence-based pain management services. However, their roles and impacts on osteoarthritis management in low- and middle-income countries have yet to be explored. OBJECTIVE: This study aims to evaluate the effectiveness of community pharmacist-led educational intervention and medication review among osteoarthritis patients. METHODS: A 6-month cluster-randomized controlled study was conducted in 22 community pharmacies of Nepal. Patients clinically diagnosed with osteoarthritis, aged 18 years and above, with a poor knowledge level of osteoarthritis and pain management were enrolled in the study. The intervention groups were educated on osteoarthritis and pain management, and had their medications reviewed while control group received usual care. Primary outcomes evaluated for the study were the change in pain levels, knowledge, and physical functional scores at 3 and 6 months. Repeated analyses of covariance were performed to examine the outcomes. RESULTS: A total of 158 participants were recruited for the study. The intervention group reported improvements in pain score (mean difference 0.473, 95 % CI 0.047 to 0.900) at 3 months and the end of the study (mean difference 0.469, 95 % CI 0.047 to 0.891) as compared to control. Similarly, improvement in knowledge scores were observed in the intervention group at 3 months (mean difference 5.320, 95 % CI 4.982 to 5.658) and 6 months (mean difference 5.411, 95 % CI 5.086 to 5.735). No differences were observed in other outcomes, including physical functional score, depression, and quality of life. CONCLUSION: Community pharmacist-led intervention improved patients' knowledge of osteoarthritis and pain management. While pain scores improved, physical functional score, depression, and quality of life score remained unchanged. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05337709.

RD29A and RD29B rearrange genetic and epigenetic markers in priming systemic defense responses against drought and salinity.

Drought has become the most important limiting factor to crop productions. Research thus far has been devoted to identifying drought-responsive genes (DRGs) via breeding and engineering approaches. Still, these efforts have not resulted in a solution to combat drought's effects because the ectopic expression of most DRGs causes adverse effects that reduce plant growth and yields. Lately, we discovered that two DRGs, Response to Desiccation (RD)29A and RD29B, induced by Paenibacillus polymyxa CR1, a plant growth-promoting rhizobacterium capable of priming drought tolerance and concurrently stimulating plant growth, play pivotal roles in defense responses against drought. In this study, we employ the ChlP and qRT-PCR analyses and further clarify that P. polymyxa CR1 reformats the chromatin/transcriptional memory of RD29s, positioned as upstream controllers that fine-tune the temporal dynamic of stress-regulating transcription factors (TFs) in elaborating induced systemic drought tolerance without growth penalties. Two genes coordinate the upregulation of NAC TFs, while feedback inhibiting CBF TFs, which regulate downstream DRG expressions. This supports that RD29s are unique, feasible transgene candidates for improving plants' survival capacity in both optimal and drought conditions. However, the mode of action of RD29A and RD29B are partly independent, exerting distinct roles in disparate ecological states. When subjected to increasing NaCl concentrations, the KO mutant of RD29A (rd29a) displayed enhanced tolerance compared to WT and rd29b plants, proposing that RD29B, but not RD29A, a key player in conferring WT-like tolerance to salinity stress; further studies will be needed to optimize/maximize their applications in engineering for-profit drought and/or broad-spectrum stress tolerant crops.

Managing Pain in Low Resource Settings: Healthcare Professionals' Knowledge, Attitude and Practice Regarding Pain Management in Western Nepal.

Background: Pain is a public health problem and affects millions of people globally. Effective pain management is possible through comprehensive pain management guidelines, adequate facilities, and trained healthcare professionals. Therefore, this study aims to analyze the healthcare professionals' knowledge, attitude, and practice regarding pain management in Western Nepal. Methods: A cross-sectional study was carried out in hospitals of Pokhara, Nepal. Healthcare professionals, including doctors, pharmacists, and nurses, were enrolled. Tools for the study were "The Knowledge and Attitudes Survey Regarding Pain (KASRP)" and a validated practice-based questionnaire. Frequencies and descriptive statistics were used to describe the outcomes. Kruskal-Wallis H-test and Mann-Whitney U-test were used to analyze the association between the mean rank of KASRP score and sample characteristics. A p-value of <0.05 was considered significant for all statistical tests. Results: A total of 336 healthcare professionals were enrolled in this study (108 medical doctors, 150 nurses, and 78 pharmacists). The mean KASRP scores (% ± SD) obtained by doctors, pharmacists, and nurses were 58.48±8.98, 53.01±7.80, and 52.26±6.39, respectively. A significant difference was found between the KASRP score and sample characteristics (p<0.001). The pain assessment tool is used by 96 (29%) healthcare professionals every time they meet the patients. Doctors and nurses used it more frequently as compared to pharmacists. Many of the pharmacists, 40 (51%), reported that they counsel the patients on the prescribed medicine (analgesics, NSAIDs, and opioids) every time. As only few participants had already attended a training on pain management, most healthcare professionals, 110 (33%), agreed and 198 (59%) strongly agreed that training related to pain management is needed in Nepal. Conclusion: Adequate training and support are required to enhance the knowledge, attitude and ultimately better practice for healthcare professionals regarding pain management in Nepal.

Impact of pharmacist services on economic, clinical, and humanistic outcome (ECHO) of South Asian patients: a systematic review.

BACKGROUND: Pharmacists in high-income countries routinely provide efficient pharmacy or pharmaceutical care services that are known to improve clinical, economic, and humanistic outcomes (ECHO) of patients. However, pharmacy services in low- and middle-income countries, mainly South Asia, are still evolving and limited to providing traditional pharmacy services such as dispensing prescription medicines. This systematic review aims to assess and evaluate the impact of pharmacists' services on the ECHO of patients in South Asian countries. METHODS: We searched PubMed/Medline, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 20th September 2021. Original studies (only randomised controlled trials) conducted in South Asian countries (published only in the English language) and investigating the economic, clinical (therapeutic and medication safety), and humanistic impact (health-related quality of life) of pharmacists' services, from both hospital and community settings, were included. RESULTS: The electronic search yielded 430 studies, of which 20 relevant ones were included in this review. Most studies were conducted in India (9/20), followed by Pakistan (6/20), Nepal (4/20) and Sri Lanka (1/20). One study showed a low risk of bias (RoB), 12 studies showed some concern, and seven studies showed a high RoB. Follow-up duration ranged from 2 to 36 months. Therapeutic outcomes such as HbA1c value and blood pressure (systolic blood pressure and diastolic blood pressure) studied in fourteen studies were found to be reduced. Seventeen studies reported humanistic outcomes such as medication adherence, knowledge and health-related quality of life, which were found to be improved. One study reported safety and economic outcomes each. Most interventions delivered by the pharmacists were related to education and counselling of patients including disease monitoring, treatment optimisation, medication adherence, diet, nutrition, and lifestyle. CONCLUSION: This systematic review suggests that pharmacists have essential roles in improving patients' ECHO in South Asian countries via patient education and counselling; however, further rigorous studies with appropriate study design with proper randomisation of intervention and control groups are anticipated.

Pharmacist-led intervention on chronic pain management: A systematic review and meta-analysis.

AIMS: Pharmacists have been contributing to the management of chronic pain, ensuring the quality use of medicine. However, there is diversity in the interventions provided by pharmacists and their impact. METHODS: Six electronic databases were searched from inception until June 2020 for articles published in English examining the intervention provided by the pharmacist in chronic pain management. Studies investigating the impact of pharmacist intervention individually or multidisciplinary teams including pharmacists for chronic pain management were included. RESULTS: Fourteen studies (2365 participants) were included in the current review. Six studies were randomized controlled trials while the remainder were observational studies in which pharmacists provided intervention individually or in collaboration with other healthcare professionals. Medication review was the most common intervention provided by the pharmacist. The pooled analysis found that pharmacist-led interventions reduced the pain intensity (-0.22; 95% confidence interval [CI]: -0.35 to -0.09; moderate certainty) among participants with chronic pain. Opiate stewardship provided by pharmacists was effective; however, mixed results were noted on the impact of the intervention on physical functioning, anxiety, depression and quality of life. Pharmacist intervention was more expensive than treatment as usual. CONCLUSIONS: Pharmacists contribute substantially to chronic pain management, ensuring the quality use of medicine, resulting in reduced pain intensity. Further studies with rigorous design are needed to measure the impact of pharmacist-provided intervention individually or in a multidisciplinary team on the economic benefit and other health outcomes.

Anticoagulant Utilization and Cost Analysis among Cardiology Inpatients in a Tertiary Care Teaching Hospital of Western Nepal.

INTRODUCTION: Anticoagulants have a wide spectrum of use and risks associated with their therapy due to their narrow therapeutic range. This study aimed to evaluate the anticoagulant utilization and cost analysis in patients admitted to the cardiology ward of a tertiary care hospital in western Nepal. METHODS: A prospective cohort study was conducted in patients admitted to the cardiology ward of Manipal Teaching Hospital (MTH), Pokhara, Kaski, Nepal, from August to November 2019. All patients (n = 132) aged ≥18 years of either gender receiving anticoagulants for any indication in the cardiology ward were included in the study. Anticoagulant utilization, the average prescribed daily dose (PDD/DDD) and the cost of anticoagulant per patient were calculated. Descriptive statistics were performed using IBM-SPSS 20.0. RESULTS: Acute coronary syndrome (66.67%) was a common indication, unfractionated heparin + enoxaparin (45.45%) and enoxaparin (27.3%) were the most frequently prescribed anticoagulants. The performance of monitoring parameters such as international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (aPTT), and renal function test were consistent with the American College of Chest Physician (ACCP) guidelines. The average prescribed daily dose of anticoagulants was 1.3 (unfractionated heparin), 2.25 (enoxaparin), 0.5 (warfarin), and 1.0 (dabigatran). Heparin was associated with the majority of cases of drug interactions (52 cases). Enoxaparin was the most expensive of all the anticoagulant drug classes. The median (IQR) cost of anticoagulants used per patient was US$79.92 ($46.32). CONCLUSION: Our study suggests that the utilization of unfractionated heparin and enoxaparin and the cost of anticoagulants per patient were higher in the patients admitted to the cardiology ward of the hospital.

Pharmacist Led Intervention on Inhalation Technique among Asthmatic Patients for Improving Quality of Life in a Private Hospital of Nepal.

PURPOSE: Asthma is a chronic disease which cannot be cured but can be controlled. Although drug therapy is used to relieve and prevent symptoms of asthma and treat exacerbations, still a good asthma control and a better quality of life in many patients is suboptimal due to improper use of inhalation technique. Thus, this interventional study was conducted to evaluate the effect of a pharmacist intervention on asthma control, quality of life and inhaler technique in adult asthmatic patients. PATIENTS AND METHODS: A total of 72 patients who met the inclusion criteria and agreed to give written consent were enrolled in the study. These patients were randomly divided into two groups i.e., test group (36) and control group (36) by simple block randomization technique. Test group were the interventional groups. Mini Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Questionnaire (ACQ) and structured questionnaires were used to sort the information like quality of life, asthma control and demographic details. They were counselled by the pharmacist about the asthma management and proper use of inhalers. Out of 72 patients, only forty six patients came for follow up after one month. Data were entered and analyzed using Statistical Package for Social Sciences (SPSS) software version 20. RESULTS: A significant change was observed in the mean score of quality of life (p = 0.001) in test group as well as control group, however change in the mean score of asthma control in the test group (p = 0.001) was more significant as compared to the control group (p = 0.099). Inhalation technique was found to be improved significantly after intervention among patients using the metered dose inhaler and dry powder inhaler. Majority of the patients were prescribed with Methylxanthines (24.5%) followed by combined Beta 2 agonists and Inhaled Corticosteroids (21.7%). CONCLUSION: Pharmacist provided intervention improves the quality of life, asthma control and inhalation technique among asthmatic patients.

Disease proportions and drug prescribing pattern observed in a free health camp organized at Dhorphirdi Village Development Committee of Western Nepal.

BACKGROUND: Health camp is generally organized to provide health care services to the people deprived of health care facilities. The aim of this project was to assess the proportions of disease among attendees of health camp and study the drug prescribing pattern in a free health camp. METHODS: A case study was performed from 1 day health camp to determine the proportions of disease and drug prescribing pattern. Data collection was performed using log book maintained in the health camp and patient's demographic details, disease diagnosed and drug prescribed was obtained from same log book. RESULTS: A total of 317 patients were included in the study. The majority of the patients were in the range of 41-50 years. On the basis of study on ethnicity, Brahmins and Chettris, were found to be predominant ethnic groups with gastrointestinal disorders as the major disease. The total number of medications prescribed was 510, with non-steroidal anti-inflammatory drugs (NSAIDs) and antipeptic ulcer drugs being commonly prescribed. The average number of drugs per prescription and the percentage of antibiotics prescribed were 1.6 and 21.4%, respectively. It was observed that 96.8% of prescription was by generic names. Likewise, 100% of prescription included drugs from essential drug list. CONCLUSION: Majority of the patients were of working age group. Headache and fever were found to be the most prevalent cases and NSAIDs were the most commonly prescribed medications. The drug prescribing pattern of the free health camp complied with WHO recommended prescribing indicators.