International Journal of Basic & Clinical Pharmacology

Renal function and hydration strategies in high-dose methotrexate chemotherapy: a systematic review (2015-2025)

Fred Kinoti, Caroline Long — Wed, 22 Apr 2026 00:00:00 +0530

High-dose methotrexate (HDMTX) remains a cornerstone in the treatment of osteosarcoma, lymphoma, and acute lymphoblastic leukemia. Its therapeutic efficacy is tempered by nephrotoxicity risks, necessitating rigorous renal function screening, hydration protocols, and timely rescue strategies. This systematic review synthesized evidence published between 2015 and 2025 on renal thresholds, fluid management, and adjunctive interventions to optimize HDMTX safety and efficacy. Databases searched included PubMed, Embase, Cochrane Library, and Scopus. Inclusion criteria encompassed clinical trials, cohort studies, and guidelines addressing renal function, hydration, and rescue in HDMTX. Eleven eligible studies were reviewed. Findings highlight the importance of glomerular filtration rate (GFR) ≥ 60 ml/min/1.73m² as a prerequisite for HDMTX. Pre-infusion hydration (≥2.5 l/m²/day) and urinary alkalinization (pH > 7.0) are consistently recommended to prevent methotrexate crystallization. Leucovorin rescue timing and dosing are guided by serum MTX levels, while glucarpidase is reserved for delayed clearance or acute kidney injury (AKI). This review reinforces the need for standardized renal screening and hydration protocols, especially in older adults and those with borderline renal function. Early identification of delayed clearance and access to rescue agents are critical to reducing toxicity and improving outcomes.

A systematic review on dental perspectives on pycnodysostosis

Wed, 22 Apr 2026 00:00:00 +0530

Pycnodysostosis (PYND) is an inherited bone disorder known as autosomal recessive. Patients with this disorder can be distinguished by the presence of a height smaller than expected for adults as well as smaller limbs with other dental deformities. As this disorder is rarely diagnosed, this review aimed to highlight the various dental findings from case reports and determine the treatment for the same. To date, no definitive therapies have been developed for this disorder. New treatment modalities are needed for the disease, and proper written protocol guidelines must be adopted while treating patients from dental perspectives. Continuous medical education should be provided to undergraduate students so that they would become familiar with the disease. More large-scale clinical trials are needed to determine better outcomes in general.

Parkinson's disease and appendix: a hidden kinship

Hetvi H. Patel, Maitry H. Rathod, Bisojeet R. Khandai, Ami N. Vyas — Wed, 22 Apr 2026 00:00:00 +0530

Parkinson’s disease is now recognized as the second most prevalent neurodegenerative disorder after Alzheimer’s disease. More than 8.5 million people worldwide are estimated to have Parkinson’s, and its frequency is rising swiftly because of global population aging. The disease is primarily marked by abnormal protein clumps, called Lewy bodies, found in the brain. Numerous studies have connected Parkinson’s disease to the gut, suggesting that gastrointestinal issues like appendicitis could increase the likelihood of developing Parkinson’s later in life. A review of several studies on the link between Parkinson’s disease and gastrointestinal disorders shows that Parkinson’s often follows such disorders, though genetics, the environment, and an individual’s immune system also contribute. Some studies, however, report that early appendectomy may lower the risk of Parkinson’s or delay its onset in people with a family history of the disease. This review examines the evidence on the relationship between the appendix and Parkinson’s disease, presenting data on how the appendix may influence the development of PD. We conclude that while the appendix is not the only factor in Parkinson’s disease, it may play an important role in its development.

Occupational respiratory disorders: global exposure patterns, surveillance, preventive strategies, intervention, effectiveness and emerging innovations

Filander Karstan N., Julliyan Dilleban A., Naveena B., Abinaya S., Sheeba S. — Thu, 16 Apr 2026 00:00:00 +0530

Occupational respiratory disorders remain a significant global public health burden due to continuous exposure to airborne hazards across various industries. This narrative review synthesizes global exposure patterns, surveillance systems, preventive strategies, intervention effectiveness, and emerging innovations in occupational respiratory health. A comprehensive narrative review was conducted using peer-reviewed literature and reports from international organizations, including the World Health Organization (WHO), International Labour Organization (ILO), National Institute for Occupational Safety and Health (NIOSH), and European Agency for Safety and Health at Work (EU-OSHA). Mining, construction, agriculture, and manufacturing industries exhibit the highest exposure risks. Surveillance and preventive measures vary substantially across income regions, with high-income countries adopting advanced monitoring and engineering controls. Emerging technologies, such as wearable sensors and artificial intelligence, are increasingly integrated into occupational health systems. Occupational respiratory diseases are largely preventable through enhanced surveillance, exposure control strategies, worker education, and technological innovations. Strengthening global occupational health systems is essential to reducing the burden of respiratory morbidity and mortality.

A comprehensive review of biomarker-based therapies for hormone receptor-positive and HER2-low breast cancer: clinical pharmacists' implications

Wed, 22 Apr 2026 00:00:00 +0530

The purpose of this review is to outline the role of clinical pharmacist's in implementing precision oncology and to synthesize current evidence on biomarker-driven targeted therapies in metastatic breast cancer delivers significant regulatory approvals from 2024 to 2025. A thorough literature search was carried out using Scopus, PubMed and conference materials from the European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO). Breast neoplasms, molecular targeted therapy, PIK3CA, ESR1, Trop-2, and clinical pharmacy were among the most important search terms. Phase III randomized controlled trials and recent notifications derived from the U. S. Food and Drug Administration (FDA) were top prioritized during the selection process. From empirical hormonal blockade to a important molecular taxonomy, the therapy of hormone receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer has changed. Management of hormone receptor-positive, HER2-negative metastatic breast cancer shows differentiated from empirical hormonal blockade to a precise molecular taxonomy. In "HER2-low" illness, which is characterized as IHC 1+ or 2+ with ISH negative, trastuzumab and deruxtecan significantly improved results. Furthermore, the approval of inavolisib, datopotamab deruxtecan, and imlunestrant in 2024–2025 marks a regulatory turning point in HR-positive illness. The pharmacists must monitor these drugs closely as they have improved progression-free survival, but they also have some side effects, such as hyperglycemia, stomatitis, and ILD. Biomarker-driven therapy is the benchmark synonym for metastatic breast carcinoma with hormone receptor positivity and low HER2 expression. Biomarker-driven therapy is the current evidence-based practice standard for metastatic hormone receptor-positive and HER2-low breast cancer. Clinical pharmacists play a crucial role in the successful implementation of these complex regimens because they must manage diagnostic stewardship, treatment sequencing, and specific adverse effects to ensure complete patient safety.

Semaglutide salt versus base formulations: a regulatory and pharmacovigilance imperative

M. Salguna S. Vivek, Kantilal C. Chandaliya — Wed, 22 Apr 2026 00:00:00 +0530

Obesity is one of the most dreaded epidemics in the world, and it is a significant challenge to global public health that must be addressed aggressively through clinical and pharmacological interventions. The unprecedented rise in the global use of glucagon-like peptide-1 receptor agonists for the treatment of obesity and type 2 diabetes has created a critical regulatory and pharmacological challenge related to the proliferation of mass-marketed compounded alternatives.

A rare presentation of phenytoin toxicity triggered by isoniazid in reactivated pulmonary TB

Naseerah Maryam, Syeda Qadar Unnisa, Hadiya Aiman — Wed, 22 Apr 2026 00:00:00 +0530

Phenytoin is a commonly used antiepileptic drug with a narrow therapeutic index and is susceptible to clinically significant drug–drug interactions. It is primarily metabolized by hepatic cytochrome P450 enzymes, particularly CYP2C9. Isoniazid, a first-line anti-tubercular agent, is a known inhibitor of this enzyme and may precipitate phenytoin toxicity when co-administered. We report a case of phenytoin toxicity in a patient with reactivated pulmonary tuberculosis following the initiation of isoniazid therapy. The patient experienced neurological features including dizziness, generalized weakness, involuntary movements, and MRI brain revealed multifactorial encephalopathy suggestive of phenytoin toxicity, supported by laboratory findings (serum phenytoin levels-35.2 μg/mL) and clinical evaluation. Phenytoin was discontinued and replaced with levetiracetam, along with appropriate supportive management. The patient showed gradual clinical improvement after withdrawal of phenytoin, and antitubercular therapy was continued under close monitoring. This case highlights the importance of recognizing potential drug–drug interactions between phenytoin and isoniazid, early neuroimaging and therapeutic drug monitoring in tuberculosis patients receiving long -term antiepileptic therapy.

Hydroa vacciniforme mimicking eczema herpeticum: a rare case report

Balvinder Kaur Brar, Deepali Chauhan, Jenny Goyal — Wed, 22 Apr 2026 00:00:00 +0530

We report case of a 13-year-old male patient with characteristic clinical findings of a rare photodermatoses-hydroa vacciniforme supported by dermoscopy and laboratory investigations. Despite its characteristic presentation, it may mimic other photodermatoses and infectious conditions, making careful clinical assessment essential. Dermoscopy served as a valuable adjunct in reinforcing the diagnosis, especially when biopsy was not feasible. The patient demonstrated rapid improvement with systemic steroids, vitamin D supplementation, sunscreen and strict photoprotection, underscoring the importance of early recognition and appropriate management. Given its rarity, this case adds to the limited literature and emphasizes the critical role of clinical suspicion and dermoscopy in diagnosing hydroa vacciniforme.

Determinants and outcomes of hyperpolypharmacy among chronic kidney disease patients in a teaching hospital in Northern Ghana

Matthew Aidoo, Charles Ansah, Arnold Forkuo Donkor — Wed, 22 Apr 2026 00:00:00 +0530

Background: There is paucity of drug utilization studies among patients with chronic kidney disease (CKD) patients in Ghana. This study aimed to evaluate drug utilization pattern focusing on prevalence of hyperpolypharmacy and its determinants and outcomes among CKD patients in a teaching hospital in northern Ghana.

Methods: A retrospective cross-sectional was conducted among patients with CKD patients in the Tamale Teaching Hospital (TTH).

Results: Drugs acting on the cardiovascular system were the most commonly utilized (n=639/2081, 30.7%). Majority of the CKD patients 107/198 (54.0%) utilized prescriptions with ≥10 drugs concurrently (i.e. hyperpolypharmacy). Patients with 3-4 and ≥5 comorbidities were 5.3 times (AOR=5.3, 95% CI: 1.39-20.30, p=0.015) and about 8-folds (AOR=7.9, 95% CI: 2.04-30.31, p=0.003) more likely to have hyperpolypharmacy respectively. Exposure to hyperpolypharmacy was significantly associated with potential drug-drug interactions; contraindicated (OR=6.3, 95% CI: 2.51-15.92, p<0.001), serious-use alternative (OR=3.2, 95% CI: 1.71-5.73, p<0.001), and monitor closely (OR=3.1, 95% CI: 1.75-5.98, p<0.001), exposure to hyperpolypharmacy resulted in 4-folds higher likelihood to stay >7 days hospitalization (AOR=4.1, 95% CI: 2.26-7.51, p<0.001).

Conclusions: The presence of three or more comorbidities was an independent determinant of hyperpolypharmacy. which was associated with adverse outcomes; increased severity of potential drug-drug interactions and longer hospitalization. Hence, clinicians of TTH need to implement measures to prevent hyperpolypharmacy among CKD patients to help mitigate its associated burden.

Dengue and severe dengue fever: comparison of clinical characteristics, haematological and biochemical parameters in a tertiary care hospital

Wed, 22 Apr 2026 00:00:00 +0530

Background: Dengue is a mosquito-borne viral disease worldwide. The number of new cases and death in Bangladesh increased in current years. The aim of the study was to detect the difference between demo-graphic data, warning signs, comorbidity, treatment pattern, and laboratory investigations in two different types of dengue fever during the pick season.

Methods: This retrospective observational study was done in Holy Family Red Crescent Medical College from May to October 2021 from records of hospital on a total of 113 dengue NS1, IgG and IgM positive patients. The classical dengue fever (CDF) group consists of 76 and dengue hemorrhagic fever (DHF) group consists of 37 patients. Socio-demographic data, co-morbidity (DM, HTN, Bronchial Asthma, COVID-19), ‘warning sign’ (abdominal tenderness, mucosal bleeding, lethargy, restlessness, persistent vomiting, clinical fluid accumulation, liver enlargement >2cm, increase HCT, decrease Platelet), treatment pattern, and laboratory findings were assembled, analyzed and compared between two groups.

Results: Out of 113 patients, the majority were male. The mean age of patients was (26.0±15.8 and 27.7±17.2) in CDF and DHF. The mean duration of hospital stay was slightly longer in DHF (6.78±2.1 days) compared to CDF patients (6.13±1.45 days). The co-morbidities were similar between groups. Among warning signs, only mucosal bleeding was significantly more in DHF (37.8%) than in CDF patients (7.9%) (p <0.001). Similarly, decreased HCT and clinical fluid accumulation were significantly higher in the DHF group (p <0.001 and p=0.024).

Conclusions: The frequency of CDF was higher than DHF, but the ‘warning sign’ and significant thrombocytopenia and leucopenia in DHF reflect the progression to dengue shock syndrome.

A prospective analysis on drug usage and assessment of health-related quality of life in a medical intensive care unit at a tertiary care teaching hospital

Divya S. Bhat, Sathisha Aithal, Vimarsha U. K. — Tue, 10 Mar 2026 00:00:00 +0530

Background: Drug use research is vital for evaluating prescribing trends and its impact on healthcare. Despite guidelines, intensive care unit (ICU) prescriptions often vary due to patient and prescriber related factors. Analyzing these patterns helps optimize therapy and identify drug related issues. The world health organization (WHO) ATC system enables standardized comparisons but may not reflect actual doses. The EQ-5D-5L questionnaire assesses health related quality of life (HRQoL) and treatment outcomes. This study evaluates of prescription pattern in medical ICU (MICU) and estimates HRQoL index.

Methods: A prospective cross-sectional study was conducted in MICU of KVGMCH, Sullia (March to August 2025) after ethical approval (KVGMCIEC202502). Eligible patients were included, excluding those with incomplete data or discharged against medical advice. Data on demographics, diagnosis, ICU stay, drug therapy, treatment outcome, ADRs, HRQoL was collected and descriptively analyzed using excel.

Results: Study included 102 patients with 68.62% male and 31.38% of females. Adults (18-64 years) accounted for 64.7%, while elderly (>65 years) were 35.3%. Average drug count was 8.88 per patient, mainly administered intravenously (50.8%) followed by oral (34.9%). ICU stay ranged from 2-8 days on an average and a total of 906 drug were prescribed. Gastrointestinal, respiratory conditions being most common cause of admissions. ceftriaxone-sulbactam was most prescribed drug. Recovery rate was 92.2% and EQ-5D-5L scores improved from -0.923 to 0.897.

Conclusions: Analysis of case records revealed that prescribed drugs were despite high antibiotic usage, with improved EQ-5D-5L scores. Polypharmacy was unavoidable in ICU. However, single centre, small sample size, short duration, descriptive design limits its generalizability.

Effect of carbetocin versus oxytocin in postpartum hemorrhage in vaginal delivery

Wed, 22 Apr 2026 00:00:00 +0530

Background: Postpartum hemorrhage (PPH) is excessive bleeding after childbirth, defined as more than 500 ml after a vaginal birth. It can occur within 24 hours (primary PPH) or up to 12 weeks after delivery (secondary PPH). This study aims to observe the effect of carbetocin versus oxytocin in PPH in vaginal delivery.

Methods: A prospective cohort study was conducted for a period of six months April 2024 to October 2024 for a study population postpartum hemorrhage in vaginal delivery.

Results: A comparative analysis was conducted between the carbetocin and oxytocin groups in terms of age and body mass index (BMI). Both groups consisted of 50 participants each, representing 100% of their respective groups. When examining the history of chronic diseases, such as hypertension and diabetes, 20% of participants in the carbetocin group had a history of hypertension, compared to 16% in the oxytocin group. Similarly, 10% of participants in the carbetocin group had a history of diabetes, while 14% in the oxytocin group reported the same condition. Both comparisons showed no statistically significant differences, with p values of 0.524 and 0.631, respectively.

Conclusions: This study found no statistically significant differences in maternal and obstetric characteristics, pregnancy complications, or labor and delivery outcomes between women treated with carbetocin and those treated with oxytocin.

An experimental study on the influence of metformin on monosodium glutamate‑treated depressed Wistar albino male rats

Sriram B. S., Pooja K. M., Venkatesh K. M., Priyanka P. C. — Wed, 22 Apr 2026 00:00:00 +0530

Background: The current experiment aimed to determine the antidepressant-like properties of metformin in a monosodium glutamate- induced depression model in Wistar albino male rats.

Methods: The subjects were subjected to depression induced using oral intake of 500 mg/kg of MSG over a period of 21 days. The experimental period was between day 9 and day 21, during which metformin and an antidepressant drug, the standard dose of imipramine, were administered. The sacrifice of animals was conducted on day 23, and biochemical analyses were performed on the supernatants of hippocampal and amygdaloid tissues. Statistical analysis was done with a significance of p<0.05.

Results: MSG exposure led to a high level of interleukin-6 (IL-6) and a low level of brain-derived neurotrophic factor (BDNF). Metformin and imipramine treatment led to a significant decrease in IL-6 levels and a significant increase in BDNF concentrations compared with the MSG-treated group (p<0.001). The results of metformin were similar to the impact of a standard drug, imipramine.

Conclusions: The observed study results indicate that metformin has antidepressant-like properties in MSG-induced depressed rats, which could be due to the inhibition of neuroinflammation and the promotion of neurotrophic support.

Evaluation of the knowledge, attitude and practice of cosmetovigilance among medical and paramedical students in a tertiary care hospital

Preethi S., Kalaiselvi B., Arvind N. — Wed, 22 Apr 2026 00:00:00 +0530

Background: Cosmetovigilance is an emerging system aimed at monitoring and preventing adverse cosmetic reactions (ACRs). Despite extensive cosmetic usage, reporting of ACRs remains inadequate, particularly in developing countries. Healthcare students, as future professionals, play a crucial role in recognizing and reporting these reactions; however, their knowledge and practice regarding cosmetovigilance are not well established. Objectives were to assess the knowledge, attitude and practice (KAP) of cosmetovigilance among medical and paramedical students in a tertiary care hospital and to evaluate their willingness to report ACRs.

Methods: A descriptive cross-sectional study was conducted from August 2025 to September 2025 among approximately 200 medical and paramedical students of ACS Medical College and Hospital, a tertiary care teaching hospital in Tamil Nadu. Participants were selected using simple random sampling. Data were collected using a validated structured questionnaire assessing KAP related to cosmetovigilance. The data were analyzed using SPSS version 25.0, and results were expressed as frequencies and percentages.

Results: The study revealed inadequate knowledge and poor practice of cosmetovigilance among the participants, with paramedical students showing lower levels compared to medical students. Awareness regarding the concept of cosmetovigilance and reporting mechanisms was limited. However, a positive attitude towards cosmetovigilance was observed, as most participants agreed that reporting ACRs is necessary and expressed willingness to report such reactions in the future.

Conclusions: Although the attitude towards cosmetovigilance was favorable, significant gaps in knowledge and practice were identified among medical and paramedical students. Incorporation of cosmetovigilance training into healthcare curricula and regular educational programs is essential to promote adverse cosmetic reaction reporting and improve patient safety.

Cost minimization analysis of antihypertensive drugs available in the pharmacy of tertiary care hospital

Wed, 22 Apr 2026 00:00:00 +0530

Background: Hypertension is a major preventable cause of cardiovascular morbidity and mortality and poses a significant public health burden in India. Its rising prevalence is linked to urbanization, lifestyle changes, and an aging population. As lifelong treatment is required, medication adherence is crucial, but high out-of-pocket costs can affect it. Despite similar therapeutic effects, antihypertensive drugs show significant inter-brand price variation, highlighting the need for cost-minimization to support rational prescribing.

Methods: A three-month cross-sectional cost-minimization study was conducted in a tertiary care hospital pharmacy to assess inter-brand price variation among oral, single-molecule antihypertensive drugs. Data from pharmacy stock records were analysed using cost difference, cost ratio, and percentage cost variation. Only drugs with multiple brands of the same strength were included.

Results: Enalapril and ramipril showed minimal inter-brand price variation (≤10%), indicating stable pricing. Among ARBs, telmisartan had low variability (≤16%) and remained close to NLEM prices, while losartan showed moderate variation (~56%). Atenolol also maintained stable NLEM-compliant pricing. Verapamil and diltiazem showed minimal variation, whereas amlodipine 5 mg had higher variability (~97%). Among diuretics, frusemide (~84%) and spironolactone (~68%) showed notable variation. Clonidine showed minimal variation at 100 µg but moderate variability at 150 µg (~23%).

Conclusions: This cost-minimization analysis shows significant inter-brand price variation among antihypertensive drugs despite therapeutic equivalence. Greater prescriber awareness, stricter price regulation, and cost-effective prescribing are needed to reduce patient burden and improve adherence.

Efficacy and safety of combined lactoferrin and luliconazole therapy compared with luliconazole alone in fungal skin infections: a prospective, randomized and active-controlled study

Wed, 22 Apr 2026 00:00:00 +0530

Background: Fungal skin infections are a prevalent global health concern, affecting millions and often impairing quality of life. Standard antifungal therapies, including azoles, are increasingly limited by rising resistance and biofilm-mediated tolerance. Lactoferrin, an iron-chelating glycoprotein with antimicrobial and antifungal synergy, may enhance therapeutic outcomes. Sequential application of lactoferrin with luliconazole, a potent topical azole, offers a potential strategy to improve biofilm inhibition and accelerate clinical and mycological cure.

Methods: This prospective, randomized, open-label, single-center clinical trial included 60 adults with KOH-confirmed cutaneous candidiasis or dermatophytosis. Participants were randomized 1:1 to receive either sequential lactoferrin with luliconazole (Group A) or luliconazole alone (Group B) for 14 days. Outcomes included biofilm inhibition, mycological and clinical cure, and lesion size reduction. Assessments were performed at baseline, Day 7, and Day 14. Safety was evaluated through adverse event monitoring.

Results: Sixty patients were randomized and analyzed. Baseline demographic characteristics were comparable between groups. Biofilm inhibition was significantly greater in Group A at Day 7 (45.45% vs 19.64%) and Day 14 (90.90% vs 58.92%; p<0.001). Mycological cure reached 96.66% in both groups by Day 14, while clinical cure was higher in Group A (80% vs 40%; p<0.05). Lesion size reduction was greater in Group A (80.56% vs 65.44%; p=0.004). Adverse events were mild and fewer in Group A.

Conclusions: These findings indicate that lactoferrin, when used alongside standard antifungal treatment, showed beneficial effect on biofilm inhibition, supporting its use as a promising adjunctive therapy in superficial fungal infections.

ABC–VED matrix analysis of drug inventory management in a tertiary care teaching hospital: a retrospective observational study

Kanika Jain, Namrata Makkar — Wed, 22 Apr 2026 00:00:00 +0530

Background: Drug inventory management is essential for ensuring uninterrupted availability of medicines while maintaining financial sustainability in tertiary care hospitals. ABC analysis categorizes drugs based on expenditure, whereas VED analysis classifies them based on clinical criticality. The combined ABC–VED matrix provides a comprehensive approach for prioritizing managerial control. The present study aimed to analyse drug inventory using ABC, VED, and ABC–VED matrix methods in a tertiary care teaching hospital.

Methods: A retrospective observational study was conducted using pharmacy procurement records over a one-year period at tertiary care teaching hopsital, New Delhi. Data on annual drug expenditure (ADE) for 4,581 drug items were analysed. ABC analysis categorized drugs according to expenditure, VED analysis classified drugs based on clinical importance, and an ABC–VED matrix was constructed for prioritization. Data were analysed using descriptive statistics.

Results: Of 4,581 drug items, 1,003 (22%) were classified under Category A accounting for 70% of ADE; 1,245 (27%) under Category B accounting for 20%; and 2,333 (51%) under Category C accounting for 10%. VED analysis showed 1,423 (31.06%). Vital items accounting for 30.44% of ADE; 2,758 (60.20%). Essential items accounting for 57.12%; and 400 (8.53%) Desirable items accounting for 12.44% of ADE. The ABC–VED matrix identified 1,967 (42.93%) items under Category I consuming 78.91% of ADE.

Conclusions: ABC-ED matrix analysis is an effective tool for rational drug inventory control in tertiary care hospitals. Focused monitoring of Category I drugs can improve financial efficiency while ensuring uninterrupted patient care.

Assessment of knowledge, attitude and practice of pharmacoeconomics among healthcare professionals in a tertiary care teaching hospital

Ritu R. Kerketta, Kamarapu Sravan, Chetna A. Shamkuwar — Wed, 22 Apr 2026 00:00:00 +0530

Background: Escalating healthcare costs in developing countries necessitates rational resource allocation pharmacoeconomic evaluations analyse costs and outcomes of drug therapy and related services to support evidence-based formulary, pricing, and policy decisions. Limited Indian data exist on healthcare professionals’ understanding and practical use of pharmacoeconomics. This study therefore aimed to assess the knowledge, attitude, and practices regarding pharmacoeconomics among healthcare professionals in a tertiary care teaching hospital.

Methods: A cross-sectional, questionnaire-based study was conducted in a tertiary care teaching hospital after ethics committee approval. A pre-validated online questionnaire assessed knowledge of pharmacoeconomic concepts, attitudes toward cost considerations, and practices in clinical decision-making. Data were analysed using descriptive statistics.

Results: A total of 206 participants were included in the study. Overall, 74.8% correctly defined Pharmacoeconomics, 64.1% had encountered the term in practice, and 48.5% correctly identified monetary units as outcome measures in cost-benefit analysis. The majority considered cost as an important factor in patient care (87.4%), supported inclusion of pharmacoeconomics in the curriculum (91.3%), and agreed that pharmacoeconomic studies influence prescribing (79.6%). In practice, 61.7% regularly discussed costs with patients, 64.1% frequently considered costs in clinical decisions, and 76.2% had changed prescriptions due to cost. Limited knowledge and training emerged as prominent barriers (19.9%).

Conclusions: Healthcare professionals exhibited good theoretical knowledge and positive attitudes toward pharmacoeconomics, but gaps persist in practical application. Integrating pharmacoeconomic principles into medical curricula and implementing structured training programs are essential to bridge this knowledge–practice gap.

Preclinical haematological profile studies of an ayurvedic medicine ajowan after chronic administration to male Sprague-Dawley rats

Wed, 22 Apr 2026 00:00:00 +0530

Background: Ayurvedic medicines are widely utilized for their therapeutic potential, yet many remain insufficiently evaluated for safety. Ajowan (Trachyspermum ammi Linn.), a traditional remedy for gastrointestinal disturbances, is commonly used in South Asia. However, data on its haematological safety following prolonged use are scarce. This study aimed to assess the haematological effects of chronic ajowan administration in male Sprague-Dawley rats.

Methods: Eighteen healthy male Sprague-Dawley rats were randomized into three groups: control (n=8), low-dose ajowan (JAN) (50 mg/kg; n=5), and high-dose ajowan (JAN) (400 mg/kg; n=5). The extract was administered orally for 28 days. On day 29, blood samples were collected and haematological parameters- including red and white blood cell indices, platelet counts, and erythrocyte sedimentation rate (ESR), were analysed using a CELL-DYN 3700 haematology analyser.

Results: Chronic ajowan administration produced dose-related, though mostly statistically insignificant, changes in red cell indices, with slight increases in RBC, haemoglobin, and haematocrit values. White blood cell counts increased by 21.1% (low dose) and 32.8% (high dose; p=0.039), suggesting mild immunostimulation. Differential counts revealed decline in eosinophil and neutrophil, while lymphocytes and monocytes rose slightly. Platelet counts fell modestly (−2.5% at low-dose and −10.2% at high-dose), but platelet indices and ESR largely remained within normal ranges. No marked hemotoxic effects were observed.

Conclusions: Chronic ajowan administration did not induce significant haematological toxicity in male rats, though elevated WBC counts and mild platelet reductions warrant further study.

Assessment of drug prescribing pattern and quality indicators among chronic kidney disease patients in a tertiary hospital in Northern Ghana

Matthew Aidoo, Charles Ansah, Arnold Forkuo Donkor — Wed, 22 Apr 2026 00:00:00 +0530

Background: Drug utilization research in chronic kidney disease (CKD) patients is essential for identifying prescribing pattern, and evaluating prescribing quality against standard prescribing indicators and clinical guidelines. Evidence from Ghana on this research topic is limited. This study aimed to assess drug prescribing pattern and quality prescribing indicators among CKD patients in a tertiary hospital in Northern Ghana.

Methods: Retrospective cross-sectional study was conducted among CKD patients in the Tamale Teaching Hospital.

Results: Cardiovascular drugs were the commonly utilized across all CKD stages (n=790,31.7%). Potential appropriate prescribing of antihypertensive agents (93.5%), and renin-angiotensin system (RAS) inhibitors alone (66.1%) were higher compared to combined RAS inhibitor with diuretic (55.4%), phosphate binders (50.0%) and statins (35.6%). Patients with advance CKD stages received fewer RAS inhibitors but more statins compared to stag-3 CKD patients. There was optimal compliance with avoidance of inappropriate prescription including dual RAS inhibitors, erythropoietin stimulating agent (ESA) and digoxin. For contraindicated prescribing, metformin (57.9%) was higher than nonsteroidal anti-inflammatory drugs (NSAIDs) (1.2%) and the combination of NSAIDs + RAS inhibitor + diuretic (1.1%).

Conclusions: This study is the first the assessment of prescribing quality indicators among CKD patients in Ghana. It provides findings for clinical practice improvement and establishes baseline evidence for future research. Priority areas for improvement include prescribing RAS inhibitors alone or combined with diuretic, phosphate binders and statins when indicated. However, there is urgent need for intervention to reduce contraindicated prescribing of metformin in the setting.

Plasma phenytoin concentration in epileptic patients with adequate seizure control in a North-Eastern tertiary care hospital in India

Wed, 22 Apr 2026 00:00:00 +0530

Background: In this study, estimation of plasma phenytoin level was done on epileptic patients with adequate seizure control. Since, no such study reporting on phenytoin estimation on seizure-free period in the north-eastern part of India was undertaken; hence rationale of adequate seizure control with phenytoin is yet to be ascertained. This retrospective study is being done to obtain a satisfactory clinical outcome with minimal adverse effects in our setting regarding the target plasma level of phenytoin.

Methods: The patients from the Neurology Department were enrolled for this study. Blood samples were taken and the plasma extracted was used for the phenytoin estimation using HPLC.

Results: Results showed that the majority of the study population exhibited total plasma phenytoin levels within the recommended therapeutic range (10-20 μg/ml).

Conclusions: The study findings showed that patients with adequate seizure control exhibited plasma phenytoin concentration within the recommended therapeutic level, which is the safe level of the drug in blood. However, some variations in the plasma phenytoin level are suggestive of the inter-individual differences in pharmacokinetics after phenytoin therapy. Hence, monitoring of phenytoin treatment is necessary to ensure dosage delivery is at therapeutic levels and to avoid any untoward toxicity.

The impact of pre reading material before didactic lectures on the learning outcomes of second year medical students in Pharmacology

Raja Priya, Niranjana Jeba Jeeviha, Samuel Santhosh, Margaret Shanthi — Wed, 22 Apr 2026 00:00:00 +0530

Background: Although didactic lectures remain the primary mode of teaching in pharmacology, they often encourage passive learning. Providing pre-reading materials before lectures may enhance understanding and facilitate clinical application. This study aimed to evaluate the academic performance of second-year medical students using pre-reading materials and to compare two modes of pre-reading in pharmacology teaching.

Methods: A cross-sectional study was conducted among 99 MBBS students, who were provided with pre-reading material for four out of six lectures on the Central Nervous System. The materials were in the form of videos for two lectures and brief notes for two others, provided one week before the lecture. Student performance was assessed through MCQ tests conducted. Feedback obtained. Comparison was made between the performance of students with and without pre-reading material by using paired T-test.

Results: Teaching with pre-reading material (Mean± SD: 10.06±3.18) significantly improved the performance of the students in the test as compared to the test in which no pre-reading material was given (4.56±2.49) which was statistically significant(p<0.001). Pre reading material with video as resource (11.18±3.73) compared with notes (8.95±4.01) was also statistically significant(p<0.001). 90% of students felt that teaching with pre-reading material improves their understanding of the subject and can be implemented in routine curriculum in future.

Conclusions: Providing pre reading material can be effectively integrated into the undergraduate curriculum to make pharmacology more engaging and applicable in the clinical setting.

Isolation and characterization of flavonoid fractions from orange peel with antioxidant properties

Saikat Santra, Pinki Biswas, Soumyadeb Dutta, Deepannita R. Mukherjee — Wed, 22 Apr 2026 00:00:00 +0530

Background: Citrus sinensis peel is an abundant agro-industrial byproduct rich in flavonoids and a potentially underexploited source of natural antioxidants. This study aimed to extract, characterize, and evaluate the antioxidant potential of flavonoid fractions from orange peel for food and pharmaceutical applications.

Methods: Dried Citrus sinensis peel underwent hydroalcoholic extraction (ethanol: water, 1:1 v/v) for 72 hours by column chromatography purification. Characterization utilized HPLC, UV-Vis, and FTIR spectroscopy. Antioxidant activity was quantified via DPPH radical scavenging and FRAP assays.

Results: HPLC identified hesperidin as the predominant flavonoid (52.4 mg/g extract), followed by naringin (18.9 mg/g), rutin (13.7 mg/g), and quercetin (8.5 mg/g). Total flavonoid content was 4.29 mg quercetin equivalents/g extract. The extract demonstrated concentration-dependent DPPH scavenging (32.4–88.6% at 0.5–2.5 mg/ml; IC₅₀=1.21 mg/ml) and strong ferric reducing capacity (1655±18 µmol Fe(II)/g). FTIR confirmed characteristic flavonoid functional groups.

Conclusions: Citrus sinensis peel extract exhibits significant antioxidant activity, validating its potential as a sustainable natural antioxidant source for food preservation and pharmaceutical formulations.

Knowledge, attitude and practice of self-medication with antibiotics among first-year and third-year medical students: a questionnaire-based study

Wed, 22 Apr 2026 00:00:00 +0530

Background: Self-medication (SM) involves using medicines without consulting a doctor, which can lead to wrong diagnosis, harmful interactions and delays in proper treatment. The market value of self-medication was estimated to be USD 87.5 billion in 2022 and is projected to reach USD 200.5 billion by 2032. Antibiotic resistance has emerged as a critical global concern in today’s world. One of the causes of antibiotic resistance is self-medication. This study assesses knowledge, attitude, and practice of antibiotic self-medication among first and third-year medical students.

Methods: This study was a cross-sectional, survey-based study conducted to assess the knowledge, attitude and practice of self-medication with antibiotics among first-year and third-year medical students at a tertiary care teaching hospital in India. The data for this study were collected through a self-designed, semi-structured, pre-validated questionnaire circulated through Google Forms to medical students.

Results: A majority of students from both academic years demonstrated awareness that antibiotics are organism-specific. However, the understanding of the ineffectiveness of antibiotics against viral infections was higher among third-year students than among first-year students. Students in both first-year and third-year groups identified textbooks as the primary source of information about antibiotics.

Conclusions: This study highlights a significant gap between the knowledge and practical application of antibiotic use among first-year and third-year medical students. To address this, targeted educational interventions are essential, including formal training, workshops and the establishment of specific courses on antibiotic use.

Vitamin D3 in severe chronic obstructive pulmonary disease: from profound deficiency to functional recovery

Parth Patel, Prathana Patel, Krutik Nayak — Wed, 22 Apr 2026 00:00:00 +0530

Background: Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation and systemic inflammation. Vitamin D deficiency is prevalent among COPD patients and correlates with disease severity. This study evaluated the association between serum vitamin D3 levels and COPD severity, and the therapeutic effect of vitamin D3 supplementation.

Methods: A prospective interventional, single-blinded study enrolled 147 COPD patients. Baseline spirometry (FEV1), COPD assessment test (CAT), modified Medical Research Council (mMRC) scores, and serum vitamin D3 levels were recorded. Patients with severe and very severe COPD (GOLD stages 3 and 4, n=58) were randomized into group A (vitamin D3 supplementation) and group B (placebo). Follow-up spirometry and clinical scoring were performed at six months.

Results: Mean serum vitamin D3 levels decreased significantly as GOLD classification increased, from 44.77 ng/ml in GOLD 1 to 18.00 ng/ml in GOLD 4 (p<0.001). A strong negative correlation existed between CAT scores and vitamin D levels (r=-0.822, p<0.0001). Post-intervention, group A showed a highly significant improvement in mean FEV1 from 34.5% to 60.2% (p=0.001). Furthermore, vitamin D3 supplementation significantly improved mMRC and CAT scores.

Conclusions: Vitamin D deficiency is profoundly prevalent in advanced COPD. Targeted supplementation in deficient, severe COPD patients significantly improves FEV1, alleviates dyspnea, and reduces overall symptom burden, shifting patients to a moderate disease classification.

Nebulized lignocaine versus saline in non-sedated flexible bronchoscopy: a double-blind randomized controlled trial

Anjali Minhas, Atal Sood, Devendra S. Dadhwal, Sushma Sawaraj — Wed, 22 Apr 2026 00:00:00 +0530

Background: Flexible bronchoscopy performed without sedation can cause patient discomfort, coughing, and anxiety, potentially affecting procedural quality. Nebulized lignocaine has been proposed as an adjunct to standard topical anesthesia to improve tolerance, but evidence remains inconsistent.

Methods: In this double-blind, randomized, placebo-controlled trial, 150 adult patients undergoing diagnostic non-sedated flexible bronchoscopy were randomized to receive pre-procedure nebulization with 4 ml 2% lignocaine (n=73) or 4 ml 0.9% saline (n=77), in addition to standard topical anesthesia. Primary outcomes included operator- and patient-rated cough scores assessed by visual analogue scale (VAS). Secondary outcomes included cumulative lignocaine dose, procedural characteristics, complications, and willingness to undergo repeat bronchoscopy. Statistical significance was set at p<0.05.

Results: Operator- and patient-rated cough scores were comparable between groups (3.04±0.79 versus 3.12±0.84, p=0.53; 2.91±0.76 versus 2.98±0.81, p=0.57). Cumulative lignocaine dose was significantly higher in the lignocaine group but did not exceed upper safety limit. (12.2±1.4 ml versus 12.7±1.2 ml, p<0.020). So pre procedural nebulized lignocaine does not produce additional benefit and may be safely omitted during routine flexible bronchoscopy. Procedural timings, complications, and willingness to repeat bronchoscopy did not differ significantly. No adverse events or signs of lignocaine toxicity were observed in either group.

Conclusions: Pre-procedural nebulized lignocaine did not improve cough suppression, procedural comfort, or willingness for repeat bronchoscopy as compared to normal saline. Although it reduced total lignocaine exposure, routine use as an adjunct to standard topical anesthesia provides limited additional benefit and may be safely omitted, particularly in resource-limited settings.

Adverse drug reaction reporting practices and reasons for underreporting among healthcare professionals in a tertiary care hospital: a questionnaire-based study

Anurag Motwani, Kiran Bhave, Prasad R. Pandit, Tejal Patel — Wed, 22 Apr 2026 00:00:00 +0530

Background: Adverse drug reactions (ADRs) are a major global public health issue. When severe it can lead to morbidity, mortality, hospital admissions, increased risk of readmission, longer hospital stays, and other negative outcomes. Unfortunately, underreporting is a major limitation of spontaneous notification systems, with only 6-10% of all ADRs reported, weakening pharmacovigilance and jeopardizes patient safety. This study was done to evaluate ADR-reporting practices and reasons for underreporting among healthcare professionals at a tertiary-care hospital.

Methods: A cross-sectional, questionnaire-based study was conducted using an online self-administered form circulated to all doctors and nurses at the study site. Data from 111 respondents were analysed. The questionnaire covered knowledge, attitudes and practices related to ADR reporting and perceived barriers to its reporting.

Results: Of 400 healthcare practitioners (HCPs) only 111 responded (27.75%). Among the 111 respondents; 77% knew the meaning of pharmacovigilance, 82% of respondents felt qualified to report ADRs, only 64.9% were aware of what to report, and even fewer (53.2%) knew how to report an ADR. Only 30 (27.0%) reported ever submitting an ADR report, while 81 (73.0%) had never reported. Among these non-reporters, the commonest barriers were lack of knowledge about the reporting procedure, uncertainty regarding causality, time constraints, and the perception that observed events were already known or not sufficiently serious to warrant reporting. Awareness of the institutional reporting mechanism and of national pharmacovigilance pathways was low.

Conclusions: Although awareness of pharmacovigilance was high, actual ADR reporting was low, hindered by unfamiliarity with processes, time constraints, and poor access to ADR reporting forms. Practical steps like hands-on training, simplified reporting, institutional support, and regular feedback are needed to convert positive attitudes into sustained reporting. Multicentre and longitudinal studies should evaluate these interventions.

Prescription pattern of antihypertensive drugs in a tertiary care hospital: a cross-sectional study

Wed, 22 Apr 2026 00:00:00 +0530

Background: Hypertension is a significant public health issue requiring long-term pharmacological management. This study aimed to analyse the prescription pattern of antihypertensive drugs and evaluate adherence to WHO prescribing indicators in a tertiary care hospital.

Methods: A cross-sectional study was conducted among 178 hypertensive patients attending the Medicine Out-Patient Department of VMMC and Safdarjung Hospital, Delhi. The sociodemographic details were recorded, and prescriptions were analysed using WHO Core Drug Prescribing Indicators.

Results: The majority of the study population (67%) was aged above 50 years, with females (63.48%) outnumbering males (36.52%). The most commonly diagnosed hypertension grade was pre-hypertension (43.25%), followed by stage 1 (38.20%) and stage 2 (16.30%). Monotherapy was observed in 38.76% of prescriptions, while dual therapy (46.06%) was the most frequently prescribed combination. Amlodipine (5mg,10mg) was the most commonly used monotherapy (20.22%), whereas Amlodipine + Telmisartan (17.41%) was the most prescribed dual therapy. WHO prescribing indicators revealed an average of 4.76 drugs per prescription, with 73.58% of drugs prescribed by generic name and 71.34% from the WHO Essential Drug List.

Conclusions: The study highlights a preference for combination therapy in hypertension management, with adherence to WHO prescribing guidelines showing room for improvement. Emphasis should be placed on rational prescribing, especially with generic drugs, to optimize treatment outcomes.