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There is paucity of studies focused on the enablers and barriers to community pharmacists’ readiness to deprescribe inappropriate medications for older adults in developing settings. The current study assessed the enablers and barriers to community pharmacists’ readiness to implement deprescribing of inappropriate medications for older adults. A cross-sectional survey of 252 community pharmacists was conducted in Qatar with a pre-tested 24-item questionnaire developed with the theory of domain framework. Information about perceived enablers and barriers were elicited with a 5-point Likert-type scale. The response rate was 79.4% (200/252). The majority of the community pharmacists were females (54.5%), within the age range of 20–40 years (88.0%), had BSc / BPharm as the highest educational qualification (70.5%), were full-time employee (97.0%). The top-ranked enablers of community pharmacists’ readiness to implement deprescribing were exposure to CPD on the use of deprescribing toolkits and algorithm (66%), interprofessional collaboration with physicians (60.5%) and shared electronic patient record (59.5%), and improved remuneration / re-imbursement 58%). The top-ranked barriers were lack of access to patient records (70.5%), ineffective collaboration with physicians (66.5%), lack of time due to heavy workload (65%), regulatory framework that limit expansion of clinical roles (51%) and intense focus on sales target (49%). The top-ranked enablers of community pharmacists’ readiness to implement deprescribing were exposure to CPD on the use of deprescribing toolkits and algorithm, interprofessional collaboration with physicians and shared electronic patient record. These findings bode well for the implementation of community pharmacists-led deprescribing of inappropriate medications for older adults in Qatar. However, a number of critical barriers were identified, and these will require institutional, regulatory and organizational interventions to improve readiness.

Objective: To evaluate the correlation between dental anxiety and different demographic factors and to determine level of dental anxiety using Modified Dental Anxiety Scale. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Multan Institute of Medical Sciences Dental College, Multan Pakistan, from Sep to Dec 2022. Methodology: We evaluated the level of dental anxiety using the Modified Dental Anxiety Scale questionnaire. We enrolled a sample size of 290 individuals from Outpatient Department using a non-probability convenience sampling technique after obtaining relevant permission from the Ethics Review Board of our institution. Results: We found dental anxiety to be influenced by a variety of demographic factors, including gender, age, education and prior dental experiences. As per Modified Dental Anxiety Scale scoring, 112(38.6%) individuals had low levels of anxiety, 103(35.5%) had moderate levels of anxiety while 75(25.86%) had high levels of dental anxiety. The overall Modified Dental Anxiety Scale score was 1.87. Anxiety was most frequent among young patients with males found to have higher dental anxiety than females (p <0.0001). Among the many dental treatment methods, local anesthetic injections were discovered to be associated with the highest level of anxiety. No significant association was found between education and previous dental experience. Conclusion: Dental anxiety was influenced by multiple demographic factors, including gender, age, education and prior dental experiences.

Background Bacterial wilt disease caused by the soilborne bacterium Ralstonia solanacearum is a serious threat to flue-cured tobacco production. In this study, an indigenous disease suppressive Bacillus strain was isolated from the rhizosphere soil of healthy tobacco plants, and its biocontrol and plant growth promoting (PGP) potential were evaluated in in-vivo and in-vitro assays. Results Through isolation and screening of 250 isolates, WS-10 was found to be the best candidate antagonistic strain against R. solanacearum (WS-001). In-vitro assays revealed that the isolated strain WS-10 ( Bacillus amyloliquefaciens ) showed an effective antagonistic activity against R. solanacearum WS-001 and several plant-pathogenic fungi. As promising PGP rhizobacteria, WS-10 had the ability of nitrogen fixation, solubilization of inorganic potassium and phosphate, and biosynthesis of indole-3-acetic. In a co-culture assay, it significantly inhibits the growth of WS-001. Our greenhouse experiments showed that the soil physicochemical properties and accumulation of dry matter contents in different plant parts (roots, stems, and leaves) were significantly increased in the presence of B. amyloliquefaciens WS-10. The soil treated with B. amyloliquefaciens WS-10 displayed significantly higher values of the average well color development index, the utilization ability of 6 types of carbon sources by rhizosphere microorganisms, and the diversity indices of the rhizosphere microbial communities. In planta assay, B. amyloliquefaciens WS-10 significantly reduced tobacco bacterial wilt disease incidence by up to 73.36, 43.82, and 86.82% under three different treatments by improving the functional diversity and biological activity of the soil microbial community. Conclusions Obtained findings suggested that B. amyloliquefaciens WS-10 had an excellent potential as a growth-promoting and biocontrol agent of tobacco bacterial wilt disease due to its multiple beneficial traits of nutrient solubilization and disease suppression. Thus, we conclude that  B. amyloliquefaciens WS-10 was a high potential PGP and biocontrol strain for healthy production of tobacco crop.

The antibiotic trimethoprim (TMP) is used to treat a variety of Escherichia coli infections, but its efficacy is limited by the rapid emergence of TMP-resistant bacteria. Previous laboratory evolution experiments have identified resistance-conferring mutations in the gene encoding the TMP target, bacterial dihydrofolate reductase (DHFR), in particular mutation L28R. Here, we show that 4’-desmethyltrimethoprim (4’-DTMP) inhibits both DHFR and its L28R variant, and selects against the emergence of TMP-resistant bacteria that carry the L28R mutation in laboratory experiments. Furthermore, antibiotic-sensitive E. coli populations acquire antibiotic resistance at a substantially slower rate when grown in the presence of 4’-DTMP than in the presence of TMP. We find that 4’-DTMP impedes evolution of resistance by selecting against resistant genotypes with the L28R mutation and diverting genetic trajectories to other resistance-conferring DHFR mutations with catalytic deficiencies. Our results demonstrate how a detailed characterization of resistance-conferring mutations in a target enzyme can help identify potential drugs against antibiotic-resistant bacteria, which may ultimately increase long-term efficacy of antimicrobial therapies by modulating evolutionary trajectories that lead to resistance. The efficacy of the antibiotic trimethoprim, which inhibits bacterial dihydrofolate reductase (DHFR), is limited by the rapid emergence of resistant bacteria. Here, Manna et al. show that 4’-desmethyltrimethoprim inhibits DHFR and a common TMP-resistant variant, and impedes evolution of antibiotic resistance by selecting against the emergence of this variant.

Dengue fever is a global public health concern, especially in countries like Bangladesh. This study examines youth perceived dengue risk, and preventive practices, providing valuable insights into their behavior regarding this mosquito-borne disease. A cross-sectional survey was undertaken in various regions of the Dhaka district in Bangladesh. Face-to-face interviews were conducted with 1,358 participants using convenience sampling, spanning the period from September 2 to October 10, 2023. A semi-structured questionnaire covered informed consent, socio-demographic data, and questions about perceived dengue risk scale (12 items), and prevention practice (13 items). Participants’ mean age was 22.02 ± 1.58 years. The average scores for perceived dengue risk, and prevention practices were found to be 51.39 ± 12.01 (out of 96), and 55.57 ± 14.55 (out of 104) respectively. Previous dengue history, history of other vector-borne diseases, gender, educational level, father's educational qualification, employment status, adequate sleep duration, father's occupation, etc. are factors associated with higher risk and prevention practices regarding dengue. The research underscores the importance of tailoring prevention strategies for different demographics, raising awareness, and promoting active engagement in preventive measures. These insights are crucial for developing effective public health policies and campaigns to combat dengue.

Chondroid and osseous metaplasia in a Type II Papillary renal cell carcinoma (PRCC) with extensive solid areas is a complex histological combination that has not been reported before. A 21 years old male presented with a comminuted fracture of right femur. On hematological investigations he was found to have low RBC count and hemoglobin. Radiological examination revealed an incidental, exophytic complex solid and cystic, mass lesion measuring 7 x 6.5 x 4.9 cm with thickened walls, septation and calcification. It was completely replacing upper pole of the left kidney with extension into perinephric fat. Enlarged para aortic and hilar nodes with necrosis were also noted. Radiological diagnosis was infectious processes such as tuberculosis versus malignancy. Surgical intervention comprising left partial nephrectomy was done. Histopathology and immunohistochemical analysis yielded the above diagnosis. Cytogenetic studies did not reveal gain of chromosome 7 and/or 17 or loss of chromosome Y, a characteristic genetic profile of PRCC. This case could be representative of a unique histological variant of PRCC in which the molecular profile yet needs to be unraveled.