International Journal of Basic & Clinical Pharmacology

Osteosarcoma – a rare clinical presentation and management approach

Aarti Talwar — 2025-12-23

Osteosarcomas arise from primitive mesenchymal cells, primarily originating in bone and rarely in soft tissue. If left untreated, they follow an aggressive course, leading to local and metastatic disease progression. Osteosarcoma is an uncommon type of sarcoma characterized by the histological presence of osteoid production linked to malignant mesenchymal cells. It is the third most prevalent cancer in children and adolescents, following lymphomas and brain tumors. The exact causes remain unclear, but its occurrence in the growing population and its typical location at the ends of long bones suggest a link to rapid bone production.

Beyond steroids: clinical outcomes of intralesional low molecular weight heparin in the management of oral lichen planus: a case series

Simran Jeet Sindhu — 2025-12-23

The objective was to assess the clinical efficacy and safety of intralesional enoxaparin in symptomatic oral Lichen planus (OLP) management, coupled with a review of the literature. Ten patients with clinically and histopathologically diagnosed OLP were enrolled and treated with intralesional injections of enoxaparin (3 mg/ml) weekly for a period of eight weeks. Clinical parameters assessed were lesion type, pain according to the visual analogue scale (VAS), lesion severity according to the T-score, and quality of life (QoL) at both the initial visit and follow-up. Of the 10 patients included, the mean age was 40.0±17.78 years, with 60% female distribution, presenting most with erosive and reticular lesions in equal proportions. Outcomes revealed significant symptomatic improvement and clinical resolution, as highlighted by a sharp drop in VAS scores from 8.0 to 0.0, a drop in T-scores from 3.6 to 0.67, and an increase in QoL scores from 4.4 to 10.0, indicating complete resolution in daily functioning; there were no reported side effects. Weekly intralesional injections of enoxaparin are safe and represent an effective treatment modality in symptomatic OLP, improving pain symptoms, leading to resolution of lesions, and enhancing the QoL.

Antibiotics in national essential medicine list: alignment with WHO-AWaRe framework in Bangladesh and South Asian perspectives

Morshed Nasir — 2025-11-14

The list of essential medicines varies between countries due to several important reasons. Different countries have different health priorities. For example, malaria or tuberculosis is a major concern in many African and Asian countries, so antimalarial and antitubercular drugs are essential there, while they are less relevant in countries where malaria is rare. Health system capacity is an important factor to consider as some medicines require special storage (like refrigeration), trained professionals to administer, or advanced diagnostic tools. Countries with limited healthcare infrastructure may not include such medicines on their essential lists. Sometimes economic factors like budget constraints influence what medicines a country can afford to provide widely. Lower-income countries may prioritize low-cost, high-impact drugs over expensive treatments. Local regulations and national health policies, medicine approval processes, import laws vary from country to country. A drug considered essential and approved in one country may not be legally available in another. Moreover, cultural and social factors like public perception, traditional medicine practices, and cultural attitudes toward certain treatments can influence what’s considered essential for that population. Countries with domestic pharmaceutical industries may prioritize medicines they can produce locally, ensuring consistent supply. While countries often refer to the World Health Organisation (WHO) model list of essential medicines, they adapt it to local needs, sometimes adding or omitting drugs based on national contexts.

Pharmacological, behavioral, and sociocultural dimensions of GLP-1 and dual incretin therapies in Saudi Arabia: clinical evidence, misuse patterns, and policy priorities

Lamar K. Aloufi — 2025-12-23

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual incretin therapies, including semaglutide and tirzepatide, have reshaped the management of obesity and type 2 diabetes. Their rapid uptake in Saudi Arabia has created both opportunities and challenges, notably the rise in cosmetic-driven use, socioeconomic disparities, and emerging regulatory concerns. This narrative review synthesizes clinical, mechanistic, sociocultural, and policy-related evidence on GLP-1 and dual incretin therapies in Saudi Arabia, with a particular focus on real-world use patterns, misuse, and implications for Vision 2030 health goals. Evidence was drawn from randomized clinical trials, observational studies, national reports, and Gulf-region literature published between 2016 and 2025. Key thematic areas include pharmacologic mechanisms, efficacy, safety, public behaviour, affordability, off-label misuse, and policy gaps. Tirzepatide demonstrates superior glycemic and weight-loss outcomes compared to semaglutide, largely due to its dual GLP-1/GIP activity and enhanced neurobehavioral effects on appetite regulation. Semaglutide, however, retains proven cardiovascular benefits, while similar outcomes for tirzepatide await results from the ongoing SURPASS-CVOT trial. In Saudi Arabia, off-label and cosmetic use of these agents has proliferated, fueled by social media influence, inequitable access, and unregulated parallel markets. High drug costs and limited insurance coverage continue to restrict access for clinically indicated patients. Clinical audits and qualitative studies further reveal significant misuse among non-obese individuals, contributing to medication shortages and threatening equitable distribution. While GLP-1 and dual incretin therapies hold transformative potential for metabolic health, their misuse, affordability barriers, and sociocultural pressures must be addressed. National strategies involving pricing regulation, controlled prescribing policies, public awareness campaigns, and enhanced pharmacovigilance are urgently needed to optimize clinical impact and safeguard public health.

A review on physicochemical properties and pharmacological activity present in Erythrina variegata plant leaves

Elavarasan S. — 2025-12-23

The morphology, pharmacological activity, and phytochemical screening of Erythrina variegata are the briefly outline in the study. A substitute term for E. variegata is also known as Erythrina indica. The plant is capable of reaching an average height of between fifty and sixty feet. Many phytoconstituents, which includes alkaloid substance, tannins, flavonoids, and other resin, protein, saponins and glycosides, have been identified. Terpenoids, triterpenoids, steroids, and phenols are a few examples of secondary metabolites. According to Soxhlet techniques, there are five unique solvent system: methanol, hexane, ethyl acetate, dichloromethane, chloroform, and aqueous solution. Various parts of this plant have been used in traditional medicinal for their analgesic, nervine-calming, antiseptic, antacid antiepileptic, anti-asthmatic, and anti-inflammatory properties. E. variegata plant parts of leaves are used to treat infections produced by bacteria that inhibit or eradicate Pseudomonas and Escherichia (E. coli) bacteria. Its further block both grammeme-positive and grammeme- negative bacteria. E. variegata leaf bark is the main treatment for various diseases in medical systems like siddha (Ayurveda), Unani medicine, and Homoeopathy.

An algorithmic approach to pharmacoeconomic analyses

Shreyas M. Sadalagi — 2025-12-23

Pharmacoeconomics is defined as the description and analysis of costs of drug therapy to health care systems and society. There are various methods used, such as cost-minimization (CMA), cost-effectiveness (CEA), cost-utility (CUA) and cost-benefit analyses (CBA). Others include willingness-to-pay (WTP) and incremental net benefit (INB) analysis. However, there is lack of knowledge in the proper application of these in a coordinated fashion. The aim is to create an algorithm for health-care professionals in deciding appropriate treatment in a pharmacoeconomic perspective when multiple treatment options are available, ensuring safe and effective health-care services within limited resources. For this we reviewed various literature on pharmacoeconomics and compiled various analytical methods being used, along with their pros and cons, including when they can be applied and not. We used all this information to prepare the algorithm which goes as follows. Step 1: for the given patient condition, find the minimum effectiveness of treatment required and list out the health interventions which can provide it along with their costs, benefits and utility. Step 2: conduct INB analysis using WTP method to rule out those which the patient cannot afford. Step 3: among others, conduct CUA followed by CBA, CEA and CMA in this order. Step 4: the treatment option which doesn’t get ruled out at the end of these steps should be considered. If sufficient data is available (which is an important limitation), this algorithm can serve as a powerful tool in optimizing health-care interventions, at least in selective health-care setups.

Emerging insights into the use of dexamethasone for high-altitude illness: bridging basic pharmacology and clinical practice

Snehashis Singha — 2025-12-23

Acute mountain sickness (AMS) and its severe forms high-altitude cerebral edema (HACE) and high-altitude pulmonary edema (HAPE) result from hypobaric hypoxia that triggers vascular leak, inflammation, and metabolic stress. Among preventive agents, acetazolamide remains conventional, but dexamethasone has emerged as the most potent pharmacologic safeguard due to its rapid and multi-level protective mechanisms. Acting through both genomic and non-genomic pathways, dexamethasone suppresses NF-κB and HIF-1α signalling, reinforces endothelial barrier integrity, reduces cytokine-driven edema, and enhances mitochondrial energy efficiency, collectively restoring vascular and metabolic stability under hypoxic stress. Evidence from randomized trials and meta-analyses demonstrates a 60-70% reduction in AMS incidence and accelerated recovery in HACE and HAPE with dexamethasone therapy. Multi-omics analyses further reveal that the drug reprograms over a thousand genes involved in immune, oxidative, and metabolic regulation, underscoring its system-wide impact. Recent advances including inhaled, transdermal, and depot formulations, as well as pharmacogenomic-guided dosing are transforming dexamethasone from a symptom-relief drug to a precision altitude pharmacology agent. Its unmatched combination of anti-inflammatory, anti-edematous, and metabolic-stabilizing actions firmly establishes dexamethasone as the most comprehensive and mechanistically validated therapy for both prevention and treatment of high-altitude illness.

From rodents to pigs: critical evaluation of animal models in cutaneous wound healing research studies

Navneet O. Soni — 2025-12-23

Animal models are vital to elucidate the mechanisms of skin wound repair and to evaluate new-fangled therapeutics in preclinical setting. However, the choice of model has a profound effect on translational relevance. This review synthesizes evidence from key methodological and comparative studies for a critical evaluation of strengths, limitations and appropriate use of commonly used animal models, in particular rodents, pigs and companion animals. We highlight the importance of matching the choice of models to specific research questions, wound pathophysiology and desired clinical outcomes.

Beyond folate antagonism: the unique pharmacological blueprint of methotrexate

Abhilash Menon — 2025-12-23

Methotrexate (MTX) possesses a uniquely complex pharmacological profile characterized by nonlinear pharmacokinetics, saturable absorption, transporter-dependent distribution, and intracellular polyglutamation, all of which contribute to substantial interindividual variability in therapeutic response and toxicity. This review summarizes current evidence on MTX absorption kinetics, dose-dependent oral bioavailability, and the role of renal and hepatic pathways in systemic clearance. Special emphasis is placed on the formation and accumulation of MTX polyglutamates (MTX-PGs), which act as long-acting intracellular metabolites that enhance therapeutic duration but may also increase the risk of adverse effects when present at higher concentrations. Genetic polymorphisms in key enzymes and transporters, including RFC1, FPGS, GGH, and members of the SLCO and ABC transporter families, significantly influence MTX disposition, efficacy, and toxicity, underscoring the expanding role of pharmacogenomics in individualized therapy. The review also highlights the relevance of routine laboratory monitoring, emerging biomarkers, and clinical dosing strategies, including split dosing and subcutaneous administration to optimize outcomes across oncology and autoimmune settings. By integrating current pharmacokinetic, pharmacodynamic, and pharmacogenomic insights, this work provides a comprehensive understanding of MTX’s therapeutic behaviour and supports the need for personalized approaches to maximize efficacy while minimizing adverse effects.

Optimized corticosteroid therapy for respiratory disorders and role of stewardship: a narrative review

Shaik Nusurath — 2025-12-23

Corticosteroids are considered the cornerstone in the treatment of respiratory diseases, especially asthma, chronic obstructive pulmonary disease (COPD) and other inflammatory airway diseases. Corticosteroids have established themselves as drugs of choice in modern respiratory practice due to their well-documented role in suppressing airway inflammation and improving pulmonary function. It’s obvious that inappropriate or prolong use of corticosteroids leads to significant adverse events, including osteoporosis, metabolic dysfunction, adrenal suppression, and infection risk. These challenges require an urgent need for optimized, evidence-based practices that balance efficacy with safety. Corticosteroid stewardship programs have emerged as a structured framework to tackle inappropriate prescribing, with the aim of fostering responsible, patient-centered use. The multidisciplinary collaboration, audit and feedback systems, digital prescribing dashboards, biomarker-guided strategies all make up part of the various elements included in the corticosteroid stewardship initiatives to ensure that such therapy is used in a rational and consistent manner. Advances in precision medicine have also extended to include the use of blood eosinophil counts and molecular biomarkers that clinicians can exploit to provide personalized corticosteroid therapy, thereby increasing therapeutic benefit while minimizing unnecessary exposure. The article provides a traditional review of the current evidence, emerging practice, and implementation models underlying the optimization of corticosteroid therapy in respiratory medicine. Also outlines how such stewardship programs can improve prescribing behaviors, mitigate adverse outcomes, and embed quality improvement processes across healthcare systems. Innovations in the integration of digital health, clinician education, and patient engagement in reshaping corticosteroid usage in both hospital and community settings are discussed.

Integrative hypoxia preconditioning: linking iron– hypoxia-inducible factor pathways and oxygen-based therapies from high-altitude physiology to clinical application: a comprehensive review

Snehashis Singha — 2025-12-23

Hypoxia, once seen solely as a threat, is now recognized as a potent driver of human adaptation. From Himalayan sojourners to critically ill patients, survival under low oxygen relies on a shared molecular axis the hypoxia-inducible factor (HIF)-iron-erythropoietin (EPO) network. Iron acts as the pivotal regulator, as prolyl hydroxylase enzymes that degrade HIF require ferrous iron, directly linking oxygen sensing to erythropoiesis. At high altitude, hepcidin suppression and erythroferrone induction mobilize iron stores for hemoglobin synthesis, while genetic variants such as EPAS1 and EGLN1 fine-tune erythropoietic response to prevent excessive polycythemia. Controlled hypoxia or hyperbaric oxygen preconditioning at sea level similarly activates HIF and Nrf2-mediated antioxidant defences, improving mitochondrial efficiency and tissue resilience. Clinically, HIF-prolyl hydroxylase inhibitors like roxadustat exploit this pathway to manage renal anemia. Emerging concepts in adaptive oxygen medicine including portable hyperbaric therapy and intermittent hypoxia training translate altitude physiology into therapeutic strategy. Thus, oxygen is redefined not only as a vital substrate but as a modifiable signal coordinating iron metabolism, redox balance, and cellular adaptation, a continuum linking acclimatization, preconditioning, and healing.

Global trends in using digital technology and smart inhalers in asthma management, problems, challenges and future directions

Vipula R. Bataduwaarachchi — 2025-12-23

Asthma management is increasingly patient-centred and tailored to individual needs. Medication non-adherence and a shortage of skilled personnel continue to pose challenges in asthma care. Digital health solutions and smart inhalers have shown promise in addressing these issues; however, they have not been assessed by meta-analysis. This systematic review and meta-analysis assess the effectiveness of using digital technology and smart inhalers in asthma care, exploring challenges and future directions in depth. We followed the preferred reporting items for systematic reviews and meta-analyses. The selected outcomes, compliance with asthma management and the level of asthma control were assessed separately. The results were displayed using a Forest plot and tables. Our data demonstrate significant effectiveness in achieving compliance and asthma control with digital health and smart inhaler interventions compared with controls. The pooled odds ratio for compliance was 2.64 (95% CI: 1.49-4.68); digital health and smart inhaler interventions have been shown to improve compliance significantly. However, its use is significantly limited, and differences are observed. Factors affecting these are further discussed with possible solutions. Based on the controlled trials, digital health and smart inhalers can revolutionize asthma care. To overcome current challenges, close collaboration between healthcare and technology teams is necessary, with implementation targeted to select groups and cost-effective. Although the initial investment is substantial, the long-term cost-effectiveness of digital applications in asthma care is likely to be favourable.

Adverse drug reaction to piperacillin-tazobactam mimicking Kounis syndrome in a pregnant lady diagnosed with pyelonephritis: a case report

Anurag Motwani — 2025-12-23

Piperacillin-tazobactam is commonly used to treat severe infections during pregnancy, but it can also lead to life-threatening hypersensitivity reactions like Kounis syndrome (KS). A 25-year-old primigravida (G1P0) at 20 weeks' gestation presented with intractable vomiting, fever, and abdominal pain. She was admitted to the ICU with a diagnosis of pyelonephritis with septic shock, evidenced by hypotension (70/40 mmHg), tachycardia (114 bpm), leukocytosis (20,300/mm³), and elevated C-reactive protein (338.9 mg/l). She was initiated on IV fluids, noradrenaline, and empirical antibiotics, including piperacillin-tazobactam. Shortly after the first dose of piperacillin-tazobactam, the patient developed an acute, severe reaction characterized by hypertension (180/100 mmHg), tachycardia (130 bpm), hypoxia (89% SpO₂), angioedema, wheezing, and chest pain with widespread ST-T abnormalities on ECG, suggesting a possible KS. The drug was immediately discontinued, and the patient was stabilized. A positive re-exposure on the following day with a single challenge dose confirmed the severe hypersensitivity and established causality. The drug was permanently withdrawn, and the patient was successfully managed with meropenem. This case suggests a life-threatening piperacillin–tazobactam hypersensitivity in pregnancy, with clinical features overlapping septic deterioration and possible KS.

Prescribing pattern of drugs in chronic kidney disease patients undergoing maintenance hemodialysis in a tertiary care hospital, Assam

Mery Khangia — 2025-11-05

Background: Chronic kidney disease (CKD) is a progressive disorder associated with significant morbidity and mortality. Patients undergoing maintenance hemodialysis require multiple medications for comorbid conditions, prevention of complications, and improvement of quality of life. Assessing prescribing patterns helps in evaluating rationality of drug use and identifying areas for optimization. Purpose of the study was to evaluate the prescribing pattern of drugs in CKD patients undergoing maintenance hemodialysis in a tertiary care hospital in Assam.

Methods: The study was a cross-sectional observational study carried out in the department of pharmacology and medicine. The prescriptions of CKD patients under maintenance haemodialysis were gathered and examined in terms of demographic profile, comorbidities, classes of drugs prescribed, and mean number of drugs per prescription. Data were analysed and prescribing indicators were assessed according to WHO core indicators.

Results: The 120 prescriptions were examined. The average age of the patients was 55.6, and the majority of them were men. The most common comorbidities were hypertension and diabetes mellitus. Polypharmacy was observed with an average of 10.5 drugs per prescription. The most frequently prescribed classes of drugs were antihypertensives (calcium channel blockers, betablockers, diuretics), phosphate binders, erythropoiesis-stimulating agents, diuretics, and nutritional supplements. The rate of generic prescribing was 78.16 and rate of essential drug list adherence was 76.26.

Conclusions: Polypharmacy is common among CKD patients on maintenance hemodialysis. Rational drug use and adherence to WHO and evidence-based guidelines is essential to improve disease outcomes and reduce treatment burden.

Adverse drug reaction reporting in a tertiary care teaching hospital of Eastern Odisha: a five-year retrospective study

Paramita Parida — 2025-12-04

Background: Adverse drug reactions (ADRs) related morbidity and mortality is a concern as it reduces quality of life, prolongs hospital stay and inflicts significant burden on the healthcare resources. This study was under taken to evaluate the patterns of spontaneously reported ADRs, at an ADR monitoring centre (AMC) in a tertiary care teaching hospital in Eastern India.

Methods: The present study was carried out for a period of five years from January 2020 to December 2024. Data were analysed for their demographic patterns, associated medications and reactions, system organ class affected, seriousness, outcomes and causality using the WHO causality scale. Mean, standard deviation, Chi-square ‘p’ and binomial ‘p’ were analysed.

Results: Total ADRs reported was 500. Highest ADRs was in the group of 30-60 years (48.6%), females reporting was 52.4%. Maximum cases reported in 2024 (42%). Department of psychiatry reported maximum ADRs (17.8%). 51.8% cases reported possible causality. Rash was the most common ADR in 25.6% and ceftriaxone sulbactam combination caused 16% ADRs. The most affected system organ class was skin and subcutaneous tissue disorder (61%).

Conclusions: The study depicted the pattern of reactions to various medications and helpful in augmenting the awareness of spontaneous reporting of ADRs amongst healthcare professionals, thereby enhancing patient safety and improving the quality of life.

Educational outcome of inquiry-based teaching learning method versus traditional learning among second phase medical students in pharmacology

Urmi Choudhury — 2025-12-10

Background: Pharmacology is a core discipline in medical education, bridging basic and clinical sciences. Traditional lecture-based teaching promotes factual recall but may not sufficiently develop analytical and problem-solving skills. Inquiry-based teaching-learning (IBTL) emphasizes critical thinking, active participation, and self-directed learning.

Methods: A prospective, cross-sectional educational intervention was conducted among 92 phase-II MBBS students of Nagaon Medical College, Assam. Students were divided into group A (IBTL) and group B, traditional teaching method (TTM). Identical topics were taught in both groups. Assessment included pre- and post-tests, student feedback, and faculty perception. Data were analyzed using paired and unpaired t tests (SPSS v21).

Results: IBTL produced significant improvement in post-test scores (p<0.001) and led to higher student engagement and satisfaction. Faculty feedback reflected 100% agreement that IBTL enhanced conceptual understanding and critical thinking. Although traditional teaching yielded higher factual recall for the topic “vitamins” (p=0.004), IBTL supported better long-term retention, motivation, and deeper understanding.

Conclusions: IBTL is more effective than traditional methods in promoting active learning, conceptual clarity, and critical thinking. A blended model combining both approaches is recommended for optimal pharmacology education.

Influence of educational status on compliance and psychological outcomes of injectable contraceptive use among postpartum mothers

Rajasee Adhikary — 2025-12-23

Background: Injectable depot Medroxyprogesterone acetate (DMPA) is a progestogen-only contraceptive widely used in the postpartum period. Despite its efficacy, there is limited regional data on compliance patterns and psychological impacts associated with its use among postpartum women in Eastern India. The objectives were to assess the clinical and biochemical adverse drug reactions of DMPA, analyze compliance levels in relation to educational status and evaluate psychological outcomes using the CES-D depression scale in postpartum mothers.

Methods: This cross-sectional observational study included 107 postpartum women attending the Antara Clinic under the Department of Community Medicine, Medical College, Kolkata. Inclusion criteria were women aged 18–45 years who received at least one DMPA injection within the past year. Compliance was determined through DMPA card review. Depression was evaluated using the CES-D scale and lipid profiles were analyzed.

Results: The mean age of participants was 27.14±4.28 years. Of the total, 50% had received their first injection, 36% the second, and 15% three or more. ADRs were reported in 91% of participants, predominantly menstrual abnormalities (64%), weight gain (40%), and headache (10%). Amenorrhea was more common among ≥3 injection recipients (43%). Compliance was observed in 56% of participants and was significantly associated with educational status; 83% of those with secondary or higher education showed good compliance (p<0.001; OR=18.5). Discontinuation was most commonly due to irregular spotting (30%). Depression scores (CES-D≥16) were significantly higher in those receiving ≥3 injections (81%) (p=0.001; OR=7.616).

Conclusion: The study highlights a significant association between educational status and compliance with DMPA use. Pre-treatment counselling, especially for women with lower educational levels, is crucial to improving adherence and managing adverse outcomes.

Bridging knowledge and practice gaps in pharmacovigilance: a study among medical interns in Uttar Pradesh

Aanchal Dwivedi — 2025-12-23

Background: Adverse drug reactions (ADRs) are a major public health concern globally, contributing to significant morbidity and mortality. Despite the presence of pharmacovigilance systems, underreporting is common within medical colleges and antimicrobial stewardship programs, particularly in India. Medical interns are pivotal in ADR reporting, but gaps persist between their knowledge and practical application. By integrating pharmacovigilance into medical curricula, healthcare professionals can be better equipped to identify and report ADRs, ultimately enhancing patient outcomes. This study aims to evaluate the knowledge, attitudes, and practices (KAP) of ADR reporting among medical interns at Sarojini Naidu Medical College, Agra, and identify barriers to reporting.

Methods: A cross-sectional study was conducted among 125 medical interns using a pre-tested, structured questionnaire to assess their KAP regarding ADR reporting. Data were analyzed using descriptive statistics in Microsoft Excel.

Results: While 95% of interns were aware of ADRs and 70% understood the need to report them, only 25% had reported an ADR. Barriers included time constraints, lack of training, and legal concerns.

Conclusion: The study highlights high awareness but low reporting rates among medical interns, emphasizing the need for targeted educational interventions and streamlined reporting systems to improve pharmacovigilance practices.

Unraveling Iris ensata Thunb: a pharmacognostical, physicochemical and HPLC-assisted phytochemical investigation

Sania Khan — 2025-12-23

Background: Iris ensata Thunb, commonly known as the Japanese iris, is a species of flowering plant in the Iris family (Iridaceae). Native to Japan, China, Korea, and Russia, it thrives in wetland environments and is often found near ponds and streams.

Methods: To standardize the test drug, various analytical techniques were employed, including organoleptic evaluation, extractive value determination, ash content analysis, phytochemical screening, elemental analysis, fluorescence study, and HPLC profiling.

Results: The findings revealed that the total ash content was 6.98%, while the water-soluble and alcohol-soluble extractive values were 13.3% and 9.81%, respectively. The loss on drying was recorded at 4.21%, foreign matter was 0.66% and the bulk density was found to be 0.63%. The HPLC analysis displayed 18 peaks, with peak 02 and peak 03 being the most significant, showing area concentrations and retention times of 54.676% at 2.828 minutes and 43.822% at 3.051 minutes, respectively.

Conclusions: This study provided essential reference data for ensuring the quality, purity, and identification of future batches of I. ensata Thunb contributing to its standardization in medicinal applications.

In vitro evaluation of antifungal property of ethanolic extract of Syzygium aqueum fruit in leucorrhoea using zone of inhibition

Deepika Lakshmi P. — 2025-12-23

Background: Leucorrhoea, characterized by abnormal vaginal discharge, is commonly associated with Candida albicans infection. Conventional antifungal agents face resistance, creating the need for plant-based alternatives. Syzygium aqueum (water apple) is known to possess antimicrobial activity.

Methods: Ethanolic extract of Syzygium aqueum fruit was prepared by cold maceration. Antifungal activity was evaluated against Candida albicans using agar well diffusion on potato dextrose agar medium. Extract concentrations (10, 5, 2.5, 1.25 mg/ml) were tested. DMSO served as negative control, and ketoconazole (50 mg/ml) as positive control. Zones of inhibition were measured after incubation at 37°C for 24 hours.

Results: Extract exhibited concentration-dependent antifungal activity with maximum inhibition zone of 20 mm at 10 mg/ml, while ketoconazole showed 31 mm inhibition.

Conclusions: Syzygium aqueum demonstrated moderate antifungal efficacy against Candida albicans, supporting its potential as a natural antifungal option in leucorrhoea management.

A prospective observational study to monitor the prescription pattern of anti-hypertensive drugs in a tertiary care hospital in Kashmir, India

Shazia Jamsheed — 2025-12-23

Background: Hypertension remains a formidable public health challenge in India, with a staggering prevalence of 29.8% in the adult population. The situation in Kashmir is particularly concerning, with hypertension prevalence reported to be as high as 45.2% in some studies.

Methods: This comprehensive study meticulously analyzed the prescription patterns of antihypertensive drugs in the general medicine outpatient department of a tertiary care hospital in Kashmir, India. A rigorous prospective observational study was conducted over six months, involving 150 hypertensive patients.

Results: The study revealed that angiotensin receptor blockers (ARBs), particularly telmisartan and losartan, were the most frequently prescribed class of antihypertensive drugs (40.7%), followed closely by calcium channel blockers (CCBs) such as amlodipine and cilnidipine (28.7%). ACE Inhibitors like ramipril and enalapril (14.7%), beta blockers including metoprolol and atenolol (10.0%), and diuretics such as hydrochlorothiazide and chlorthalidone (6.0%) were also prescribed. Monotherapy was the preferred approach in 65.3% of cases, while 34.7% received combination therapy. The study found significant associations between comorbidities and specific drug choices, with ARBs being more commonly prescribed in diabetic patients (p=0.003) and CCBs alone and with combination of ACE inhibitors and ARB’s in patients with coronary artery disease (p=0.041).

Conclusions: This research provided invaluable insights into current prescribing trends and adherence to hypertension treatment guidelines in the region, offering a foundation for future healthcare policy and practice improvements. The findings underscore the need for personalized treatment approaches and continuous medical education to ensure optimal hypertension management in this high-prevalence region.

Cost-variation analysis between different brands of cardiovascular drugs available in the Indian market

P. Pavan Kumar Reddy — 2025-12-23

Background: Cardiovascular diseases (CVDs) emerging as a leading cause of mortality in India, access to affordable medications is crucial for managing these conditions. Our study examined the significant cost variations among different brands of cardiovascular drugs available in the Indian market. The study was conducted to find out the cost variation in the cardiovascular drugs available in India and to evaluate the difference in cost of various brands of the same by calculating percentage of variation in cost.

Methods: The analytical study was carried out by taking the cost of a particular drug in the same dosage forms and strength being manufactured by different companies was obtained from July-October 2024 edition of the current index of medical specialities (CIMS) and July-October 2024 edition of monthly index of medical specialties (MIMS) and percentage cost variation was calculated.

Results: Our analysis revealed a wide price variation among various drug brands of cardiovascular drugs. Furosemide 40 mg tablet has shown the highest price variation (1572.86%), while least price variation is seen in hydrochlorothiazide 25 mg tablet (3.98%).

Conclusions: Prices of various drugs used in the treatment of cardiovascular drugs show a wide variation in the Indian market. Medication adherence, community health, and the financial burden of healthcare costs on the country would all be improved by lowering price variation and making drugs more affordable. The findings highlight the urgency of implementing measures to reduce price variations and improve affordability, thereby enhancing healthcare access and mitigating the financial burden on individuals and society. However, it’s important to note the study’s limitations, including the selection of only a subset of drug brands available in CIMS and MIMS for analysis.

Evaluation of effectiveness of practical assessment by objective structured practical examination and its comparison with traditional pharmacology practical examination among II MBBS students: a cross-sectional study

Sujata Dudhgaonkar — 2025-12-23

Background: The undergraduate medical curriculum in India has adopted a competency-based medical education (CBME) model emphasizing cognitive, affective, and psychomotor domains to produce competent Indian medical graduates. Traditional pharmacology practical assessments, based on written exercises and viva voce, often lack objectivity and clinical relevance. The objective structured practical examination (OSPE) offers a structured, reliable, and competency-based alternative aligning with CBME principles.

Methods: This prospective cross-sectional educational study was conducted from March - July 2025 among 150 II MBBS students at Government Medical College in India. Students were randomly divided into two groups (n=75 each) and assessed through OSPE and traditional practical examination (TPE), respectively. OSPE included 11 structured stations evaluating cognitive, psychomotor, and affective domains using validated checklists, while TPE followed conventional methods. Quantitative data were analyzed using the unpaired Student’s t-test, and student perceptions were collected through a structured feedback questionnaire.

Results: Students assessed by OSPE scored significantly higher (mean±SD = 40.45±4.74) than those assessed through TPE (36.80±5.63; p<0.001). Over 90% of students found OSPE well-structured, fair, and relevant; 67.1% perceived it as less stressful, though 21.1% reported anxiety and 32.9% desired more faculty support. Reliability of feedback tools was high (Cronbach’s α=0.96 and 0.80).

Conclusions: OSPE is a valid, objective, and student-preferred assessment tool that enhances the evaluation of pharmacological competencies. Its wider implementation, supported by faculty training and student orientation, can significantly strengthen CBME-based pharmacology education.

In vitro assessment of ceftazidime-avibactam combined with aztreonam for mitigating antimicrobial resistance in clinical isolates of multidrug-resistant Gram-negative bacilli

Adheena Joemon — 2025-12-23

Background: Antimicrobial resistance (AMR) represents a major global public health threat, with increasing MDR infections caused by Gram-negative such as Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter spp. The limited antibiotic pipeline and ineffective treatments have necessitated the development of novel drug combinations. Among these, the combination of ceftazidime-avibactam with aztreonam has shown promise, particularly against serine-β-lactamase and metallo-β-lactamase producing strains that are resistant to conventional therapeutics.

Methods: Identification of isolates was done by routine biochemical testing; AST was determined by Kirby-Bauer disc diffusion, interpreted by CLSI guidelines. MDR, XDR, PDR were characterized. ESBL producers and carbapenem resistant strains were detected phenotypically using CLSI guidelines. In vitro synergy of ceftazidime-avibactam plus aztreonam was assessed by broth disc elution, following CLSI recommendations.

Results: Of 183 isolates of gram-negative bacilli, Escherichia coli (n=67), Klebsiella pneumoniae (n=72), Pseudomonas aeruginosa (n=29) and Acinetobacter spp. (n=15) in which MDR 68.65% was reported in Escherichia coli and 66.66% of XDR was reported in Klebsiella pneumoniae. ESBL was detected in 68 of 80 Enterobacterales, while 90 of 150 tested GNB were carbapenem resistant; Klebsiella pneumoniae contributed highest numbers. The combination of ceftazidime-avibactam with aztreonam yielded synergistic activity in 83.4% of all GNB isolates. Within carbapenem-resistant Enterobacterales, susceptibility to the combination was 97.2%, contrasting with only 15.7% susceptibility among carbapenem-resistant non-fermenters. Resistance to the combination was especially high among XDR and PDR Acinetobacter spp. and Pseudomonas aeruginosa.

Conclusions: The combination of ceftazidime-avibactam with aztreonam demonstrates strong in vitro synergy and enhanced susceptibility against MDR and carbapenemase-producing Enterobacterales especially Klebsiella pneumoniae suggesting clinical promise where conventional drugs fail. However, limited efficacy was observed against non-fermenter groups, underscoring the need for continuing resistance surveillance and further therapeutic innovation in multidrug-resistant non-fermenters.

A study on prescribing pattern of medications for chronic disorders in community setting

Jennifer James — 2025-12-23

Background: Non-communicable diseases (NCDs) or chronic disorders are preventable and costly conditions which are a leading cause of mortality worldwide. Monitoring and evaluating prescribing patterns provide crucial insights into current medication trends, usage, and emerging practices, informing necessary modifications.

Methods: This was a prospective cross-sectional observational study conducted over six months in community pharmacies in Mysuru. Patients diagnosed with chronic disorders who visited community pharmacies and who met the study criteria were enrolled. Data was collected from prescriptions, patient/caretaker interviews, medical records, and medication strips. Disorders were classified using ICD-10, and drugs were classified based on ATC classification to assess prescribing patterns.

Results: A total of 511 patients were enrolled, with a mean age of 56.4 years and a male predominance. Diseases of the circulatory system were the most common, followed by endocrine, nutritional, and metabolic diseases. Cardiovascular system drugs were most frequently prescribed, followed by those for the alimentary tract and metabolism. The most common comorbidity was T2DM with HTN.

Conclusions: Prescribing patterns for chronic diseases vary across regions in south India. In chronic disorders, where patients are on lifelong medication, patient adherence, counselling on potential side effects and correct medication usage are essential. This study highlighted the need for continuous monitoring of prescribing practices to ensure optimal patient outcomes and rational drug use in community settings.

A study on assessment of inappropriate prescribing of proton pump inhibitors at a teaching hospital

Neelkantreddy Patil — 2025-12-23

Background: Proton pump inhibitors (PPI’s) are amongst the most extensively utilized therapies for conditions characterized by excessive gastric-acid production, making them highly susceptible to inappropriate long-term use predisposing individuals to a higher risk of side effects. This study seeks to evaluate the prevalence and patterns of inappropriate PPI prescribing in both in-patients and out-patients, with a focus on adherence to clinical guidelines regarding indications, dosage, frequency, and duration of therapy by using National Institute for Health and Care Excellence (NICE) guidelines.

Methods: Appropriateness of PPI prescriptions was prospectively assessed in 120 in-patients during their hospitalization and at discharge, and 50 out-patients with regard to the indication, dosage, frequency and duration of therapy for their compliance with NICE guidelines. The required data for the study was noted in a suitably designed data collection form.

Results: Among 120 in-patients, 56 (46.67%) were males and 64 (53.33%) were females. Pantoprazole 40 mg was the commonly prescribed PPI, accounting 115 (95.83%) IV and 5 (4.17%) oral prescriptions among In-patients whereas 94 (93.07%) prescriptions account for pantoprazole 40 mg and 7 (6.93%) with rabeprazole 20 mg during discharge, all through an oral route. On assessing the appropriateness of prescription, it was revealed that 80 (66.67%) were appropriate, while 40 (33.33%) were inappropriate in IPD. In 35 inappropriate indications, 14 (40%) are due to prophylaxis in low-risk patients with concomitant use of NSAIDs and 1 (2.86%) with corticosteroids. Twenty (57.15%) prescriptions had no indications. Four (10%) prescriptions had inappropriate frequency and 1 (2.50%) had inappropriate duration. Among the out-patients, 32 (64%) were males and 18 (36%) females. Pantoprazole 40 mg was prescribed in 5 (10%) through an IV route and 32 (64%) were oral prescriptions whereas 13 (26%) were given rabeprazole 20 mg orally. Inappropriateness was seen in 14 (77.78%) due to prophylaxis in low-risk patients co-prescribed with NSAIDs and 4 (22.22%) prescriptions had no clear indications. Three (14.29%) accounted for inappropriate frequency.

Conclusions: The study concludes that, the rate of inappropriate prescribing of PPIs is relatively low in both in-patients during hospitalization, at discharge, and in outpatients. Pharmacists can work closely with prescribers to ensure the proper indication, dose, frequency and duration of therapy.

Evaluating blood pressure variability in hypertensive patients with comorbidities: a prospective observational study using 24-hour ambulatory blood pressure monitoring

Manjree Dube — 2025-12-23

Background: Blood pressure variability (BPV) is an independent predictor of cardiovascular risk, particularly in patients with hypertension and diabetes. This study aimed to evaluate BPV in hypertensive patients with comorbidities using ambulatory blood pressure monitoring (ABPM) and assess the influence of gender and antihypertensive therapy.

Methods: This prospective observational study included 58 patients (aged 26–85 years) undergoing 24-hour ABPM in Mumbai, India. BPV was assessed using the standard deviation of 24-hour systolic blood pressure (SD 24-h SBP). Patients were categorized based on hypertension and diabetes status, gender, and antihypertensive therapy (monotherapy, dual, or triple therapy). Statistical comparisons were made using t-tests and chi-square tests, with significance set at p<0.05.

Results: Patients with diabetes exhibited significantly higher BPV than those without diabetes (p<0.05). Gender differences were observed, with females showing greater BPV than males. Among hypertensive patients, those on triple therapy had higher BPV than those on dual therapy, indicating greater difficulty in achieving BP control. Despite antihypertensive and adjunct therapies, BPV remained elevated in some patients, particularly those with diabetes and those requiring multiple antihypertensive agents.

Conclusions: BPV is significantly elevated in patients with diabetes and those on intensive antihypertensive regimens, highlighting the challenges in BP management. The observed gender differences suggest potential influences of hormonal and vascular factors. These findings underscore the need for personalized treatment strategies to improve BP control and reduce cardiovascular risk in high-risk populations.

Exploring the efficacy of herbal toothpaste formulated with karanj, miswak and banana peel

Chhayya Nagwani — 2025-12-23

Background: Oral health is essential for maintaining overall well-being, as poor oral hygiene has been associated with various systemic diseases. Common issues such as halitosis, dental caries, and gum inflammation adversely affect quality of life. Conventional toothpastes often contain synthetic ingredients that may cause side effects, creating a growing need for natural alternatives. This study aimed to develop an herbal toothpaste using karanj (Millettia pinnata), miswak (Salvadora persica), and banana peel (Musa spp.), known for their antibacterial, anti-inflammatory, and antimicrobial properties.

Methods: Active compounds were extracted from the botanicals using standard solvent extraction techniques. The extracts were characterized for their phytochemical constituents and incorporated into a toothpaste base optimized for pH, stability, texture, and consistency. The antimicrobial activity of the formulation was tested against common oral pathogens, Staphylococcus aureus and Escherichia coli. Additionally, a sensory evaluation was conducted to assess taste and foaming ability.

Results: Phytochemical screening confirmed the presence of alkaloids, flavonoids, saponins, and phenolic compounds responsible for antimicrobial action. The herbal toothpaste exhibited significant antibacterial activity, showing inhibition zones comparable to some commercial formulations. Sensory evaluation results indicated favorable responses in terms of taste, texture, and overall satisfaction. The formulation remained stable in consistency and pH during the testing period.

Conclusions: The herbal toothpaste formulated demonstrated strong antimicrobial efficacy. This study supports the potential of plant-based ingredients as safe, cost-effective, and eco-friendly alternatives to synthetic oral care products, promoting sustainable and holistic oral hygiene.

Investigation of the hepatoprotective potential of the hydroalcoholic leaves extract of Ricinus communis on isoniazid induced and thioacetamide induced hepatotoxicity in Wistar rats

Tina Saldanha — 2025-12-23

Background: The liver is highly susceptible to drug- and chemical-induced injury. Isoniazid and thioacetamide are known hepatotoxins that cause oxidative damage. R. communis leaves possess bioactive compounds with reported antioxidant and hepatoprotective potential. This study evaluated the hydroalcoholic leaf extract of R. communis against isoniazid and thioacetamide induced hepatotoxicity in Wistar rats.

Methods: Wistar rats were divided into five groups in each model. Each group consisted of five animals. Hepatotoxicity was induced using isoniazid (250 mg/kg, p.o., 14 days) and in another model using thioacetamide (400 mg/kg, i.p., 3 days). Test groups received R. communis extract at 250 and 500 mg/kg, with Liv.52 (400 mg/kg) as standard. Serum hepatic markers, body weight, liver-to-body weight ratio, and liver histology were assessed. Antioxidant activity was determined by ferric reducing antioxidant power assay. Data were analyzed using one-way ANOVA followed by Tukey’s test.

Results: In the isoniazid model, RIC 250 mg/kg and 500 mg/kg significantly reduced ALT levels (p<0.05), however at 500 mg/kg, the extract increased AST and ALP levels. The liver-to-body weight ratio decreased significantly in treatment groups. Histology revealed minimal hepatic changes compared to moderate-to-severe injury in controls. In the thioacetamide model, R. communis produced mild biochemical improvement but caused mortalities in both dose groups. FRAP assay confirmed antioxidant potential (EC₅₀=12.39 µg/ml).

Conclusions: R. communis extract demonstrated significant hepatoprotective and antioxidant activity, particularly at 250 mg/kg. However, the inconsistent effects at a higher dose and observed mortalities in the TAA model necessitate further investigation into its safety and therapeutic window.

Adverse drug reactions: a prospective observational study at a tertiary care hospital

Rithunandana Sreeja — 2025-12-23

Background: Reporting and assessing adverse drug reactions is essential for regulators to monitor, research and maintain patient safety. The main purpose of this study was to report, assess the adverse drug reactions and its incidence at a tertiary care hospital.

Methods: This was a prospective observational study conducted in a tertiary care hospital in Bengaluru. A total of 184 suspected adverse drug reactions were recognized and documented during the study period of six months. After data collection, each suspected adverse drug reactions were assessed.

Results: The suspected adverse drug reactions were reported and evaluated from 178 patients. Among them, 60.11% were adults and 35.39% were elderly patients. The majority of patients were females (55.98%) followed by males (44.02%). A higher number of adverse drug reactions was reported from the general medicine department (48.37%). The majority of the route of administration of suspected drugs was through the oral route (54.31%). Most of the Adverse drug reactions outcome were recovered/resolved (57.60%). The severity of the majority of ADRs was moderate (77.17%). According to causality assessment, most of the ADRs were probable (75%) and were classified as type A (54.34%) reactions. The incidence rate of ADRs during the study period was 0.93%.

Conclusions: The study results indicate a significant decrease in the occurrence of adverse drug reactions compared to previous year. This reduction highlights the need for enhanced monitoring, improved drug safety measures and more effective ADR reporting. This investigation draws attention to ADR reporting practices and highlights the need for a more organized approach to ADR detection and management in hospitals.

Prescription pattern of antibiotics in hospital discharge summaries of a tertiary care hospital in India: a cross-sectional study

Tabinda Nazir — 2025-12-23

Background: Particularly in poor and developing nations, antibiotics have a remarkable role in extending life. Inappropriate antibiotic prescribing methods are implicated by a number of factors, including a lack of communication between the doctor, pharmacist, and patients, peer pressure and patient demands, diagnostic uncertainty, and inadequate expertise among clinicians. Aim of this study was to observe pattern of antibiotic prescribing in discharge summaries of admitted patients.

Methods: A cross sectional IPD based study was carried out in a tertiary care hospital of north India for a period of 3 months.500 discharges were collected and data regarding antibiotic prescribing was analysed in the form of Name, and route of the antibiotic prescribed, usage of multiple antibiotics, usage of prophylactic antibiotic, prescribing of antibiotics according to access watch and reserve. The recorded data was then compiled in spreadsheet (Microsoft Excel) and then exported to data editor of SPSS Version 29.0 and R software.

Results: Total 500 discharge summaries were analysed. A total of 468 (93.6%) antibiotics were prescribed. Females were prescribed a high number of antibiotics compared with males. Antibiotics were prescribed most commonly to patients of >60 years of age. Out of 468 antibiotics (101) antibiotics were from ACCESS group 314 from WATCH group and 53 from RESERVE. Percentage of drugs prescribed by generic name was 1.6%.58.4% of prescriptions had a single antibiotic, and 16.6% of the population have received multiple antibiotics.

Conclusions: Out of 500 prescriptions analysed 468 prescriptions had antibiotics prescribed which constituted a percentage of about 93.6% exceeding the WHO limit of 30% suggestive of irrational antibiotic prescribing. WATCH group of antibiotics constituted the highest number according to AWaRe which is a concern since these antibiotics have higher resistance potential and includes highest priority agents among antibiotics. Awareness among the physicians must be boosted up in this regard. Strict implementation of the use of standard treatment guidelines and Adherence to AWaRe prevents inappropriate prescribing. To combat antibiotic resistance such studies should be continued and proper auditing after every 3 months should be implemented.

Assessment of knowledge, attitude and practices of pharmacovigilance among health care professionals at a tertiary care teaching hospital in Central India

Ashvika Acharya — 2025-12-23

Background: Adverse drug reactions (ADRs) are a significant cause of morbidity and mortality worldwide and remain substantially underreported. Pharmacovigilance and spontaneous ADR reporting by health care professionals (HCPs) are critical to identify and mitigate drug-related harm. Our study assessed knowledge, attitude and practice (KAP) regarding pharmacovigilance and explored factors underlying ADR underreporting among HCPs at a tertiary teaching hospital in central India.

Methods: A cross-sectional questionnaire-based survey was administered via Google forms to 160 consenting HCPs (48 doctors, 112 nurses) at a tertiary care teaching hospital. The instrument contained 15 KAP items (5 knowledge-yes/no; 5 attitude-5-point Likert; 5 practice-yes/no) plus a multiple-option item on causes of underreporting. Pretesting, expert validation and Cronbach’s α (0.773) were done. Descriptive statistics were computed.

Results: All doctors (100%) correctly identified ADRs and life-threatening potential; 93.8% recognized that rare ADRs are primarily identified in post-marketing (phase IV) surveillance. Nurses demonstrated high recognition of ADR concept (88.4%) but lower awareness on some specifics (e.g., 67.9% aware that rare ADRs appear in phase IV). Practice differed markedly: while 91.7% of doctors reported routinely encountering ADRs and 89.6% acknowledged ADR documentation, only 16.7% of doctors reported using the covigilance programme of India (PvPI) mobile app; nurses reported substantially lower active reporting behaviours (practice item responses range 6.3-48.2%). Major reasons for underreporting cited were lack of knowledge (doctors 85.4%, nurses 75.0%), difficulty in causality decision (doctors 56.3%, nurses 48.2%), and limited access to reporting forms (doctors 47.9%, nurses 36.6%).

Conclusions: HCPs exhibited satisfactory knowledge and positive attitudes but suboptimal reporting practices, especially among nurses. Interventions such as targeted training, simplified reporting pathways, and institutional pharmacovigilance centres are recommended to improve ADR reporting rates.