International Journal of Basic & Clinical Pharmacology

A case of erythema multiforme: a result of self-medication with unknown drugs

Soumya Singh, Nagaraju K., Sumit Goel, Yash Singhal — Fri, 24 Oct 2025 00:00:00 +0530

There are several causes of erythema multiforme (EM), an acute, self-limiting, hypersensitivity mucocutaneous lesion. Erythema multiforme minor, erythema multiforme major, Steven Johnson Syndrome, and toxic epidermal necrosis are included in the spectrum of illnesses, with erythema multiforme minor being the mildest and toxic epidermal necrosis the most severe.

An overview of intranasal drug delivery systems for Alzheimer’s disease

Zeenath Unnissa, Maher Unissa, Muznah Muzaffar Hussain, Syed Eshaan Ali — Fri, 24 Oct 2025 00:00:00 +0530

Alzheimer’s disease is a neurodegenerative condition with severe consequences interfering with patient quality of life. It is a chronic and irreversible cognitive brain condition in which memory and thinking capacities are severely impaired to the point of preventing the completion of daily activities, because of physical and cognitive limitations. The standard treatment is administered orally; however, it has significant disadvantages, including poor bioavailability, rapid metabolism, restricted uptake into the brain and severe side effects. The intranasal route has been proposed as a promising alternative to deliver drugs and improve the Alzheimer's disease treatment. Still, there is not a clear alternative delivery system available in the market with advantageous bioavailability and safety. The aim of this review is to perform an overview on the strategies for intranasal drug delivery in Alzheimer’s disease management. The advantages and disadvantages of this delivery route and the delivery systems developed so far are discussed. A special focus is given on the use of permeation enhancers, the types of intranasal drug delivery devices, as well as possible toxicity concerns.

Pharmacological breakthroughs in anxiety management: exploring traditional and emerging therapies

Fri, 24 Oct 2025 00:00:00 +0530

Anxiety disorders are the most common psychiatric disorders and a significant cause of disability. While there is ongoing research into posttraumatic stress disorder (PTSD), depression and schizophrenia, there is a relative lack of innovative drugs being investigated for anxiety disorders. The first goal of this review is to summarize current pharmacological treatments (both approved and off-label) for panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD) and specific phobias (SP), which include selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), antipsychotics, alpha- and beta-adrenergic medications (e.g., propranolol, clonidine) and GABAergic medications (benzodiazepines). Second, we will look at new pharmacotherapeutic drugs being investigated for the treatment of anxiety disorders in adults. The pathways and neurotransmitters reviewed include serotonergic agents, glutamate modulators, GABAergic medications, neuropeptides, neurosteroids, alpha- and beta-adrenergic agents and natural remedies.

Analysis of adverse event reporting patterns following COVID-19 vaccination: findings from VigiAccess, FAERS and EudraVigilance databases with comparative assessment of data representation and categorization across three databases

Ram N. Mahurkar, Kiran A. Bhave, Prasad R. Pandit, Tejal C. Patel — Fri, 24 Oct 2025 00:00:00 +0530

The clinical presentation of COVID-19 varied from mild to severe or fatal illness, and vaccination played a pivotal role in preventing the spread of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). Despite cumulative evidence suggesting that the benefits of COVID-19 vaccination outweighed the risks, evaluating its safety profile remained imperative. This study aimed to analyse adverse events following immunization (AEFI) after COVID-19 vaccination using three pharmacovigilance databases and to assess how these data were categorized and represented. A cross-sectional observational study was conducted in January 2024 using VigiAccess (WHO), FAERS (U.S. FDA), and EudraVigilance (EMA). The total number of reported AEFI cases for COVID-19 vaccines were 55,49,876 in VigiAccess, 11,640 in FAERS, and 23,16,918 in EudraVigilance. The most common reaction group in all three databases was general disorders and administration site conditions (VigiAccess 59.07%, FAERS 62.57%, EudraVigilance 62.67%). The most frequently reported reaction in VigiAccess was headache (22.73%), while fatigue (19.79%) was the most common reaction in FAERS. VigiAccess grouped AEFIs for different COVID-19 vaccines under the general term “COVID-19 vaccine,” whereas FAERS and EudraVigilance categorized adverse events by specific vaccine types. All three databases categorized individual case safety reports (ICSRs) data, but only FAERS and EudraVigilance categorized the AEFI data. Overall, the comparative analysis revealed that the most commonly reported adverse reactions were consistent across the three databases, while also highlighting significant differences in how these databases represented and categorized the data.

Protease sink vs. direct inhibition: mechanistic insights and clinical evidence for MMP-targeted dressings in hard-to-heal wounds

Navneet O. Soni — Fri, 24 Oct 2025 00:00:00 +0530

Chronic wounds are characterised by excessive matrix metalloproteinase (MMP) activity and impaired remodelling of the extracellular matrix (ECM). Dressing marketed as MMP inhibitors aims to restore protease balance, but their mechanism and clinical efficacy differ.

This review bridges the mechanistic and clinical perspectives by comparing collagen and oxidized recombinant cellulose (ORC) matrixes (protease inhibitors) with TLC-NOSF (technology lipids with nano-oligosaccharide factor). Collagen-based creams act passively as a protease sink, as a binding medium for MMPs and as an inflammatory mediator, but their clinical effectiveness is inconsistent, with most randomised studies not showing any significant improvement in complete healing. In contrast, TLC-NOSF directly inhibits MMP-2 and MMP-9, stabilises growth factors and consistently improves wound sealing and area reduction in high-quality blinded clinical trials. Mechanism of action predicts clinical outcome: passive binding to protease (collagen) provides modest, variable benefits, while active, specific inhibition (TLC-NOSF) is correlated with reproducible efficacy and support from guidelines. Mechanistic-clinical integration underlines the importance of selection of dressings based on biological plausibility as well as experimental evidence.

Severe agranulocytosis during prolonged trimethoprim-sulfamethoxazole therapy in an elderly male: a case report with causality assessment and literature review

Bostjan Martinc — Fri, 24 Oct 2025 00:00:00 +0530

Idiosyncratic drug-induced agranulocytosis (IDIA) is a rare but potentially life-threatening adverse drug reaction, most frequently associated with antithyroid drugs, clozapine, and certain antimicrobials. Trimethoprim–sulfamethoxazole (TMP–SMX), commonly prescribed for urinary tract infections (UTIs), carries a documented risk of agranulocytosis, particularly in elderly patients. We describe an 84-year-old male admitted for post-critical illness rehabilitation who developed severe febrile agranulocytosis during prolonged TMP–SMX therapy for UTI. Due to a documentation error following physician rotation, TMP–SMX (80/400 mg, two tablets every 12 hours) was administered for 31 days. On hospital day 24, he developed fever (39.4 °C), diffuse erythematous rash, leukocytes 1.2×10⁹/l, absolute neutrophils 0.01×10⁹/l, lymphocytes 0.52×10⁹/l, and CRP 112 mg/l. TMP–SMX was discontinued and replaced by ciprofloxacin, later cefuroxime, while the patient was transferred to an infectious diseases unit where filgrastim (G-CSF) was initiated, resulting in normalization of leukocytes (7.6×10⁹/l) and neutrophils (4.46×10⁹/l) within seven days. Causality assessment using the Naranjo algorithm yielded a score of 7, consistent with a probable association. This case underscores the importance of accurate antibiotic stop-dates, baseline and periodic complete blood count monitoring during prolonged TMP-SMX therapy, and prompt recognition and management of febrile agranulocytosis in elderly patients.

Urticaria due to mefenamic acid intake – a case report

Sneha Gowthaman, C. Dhandapani — Fri, 24 Oct 2025 00:00:00 +0530

Urticaria, or hives, is a condition of the skin involving abnormality of redness and swelling caused by excess accumulation of fluid, and may happen because of infection, drugs, food, psychogenic causes or respiratory allergens, but is occasionally idiopathic. The following report concerns a case where urticaria was secondary to the consumption of mefenamic acid. A 44-year-old woman reported generalized itch, rashes of the skin, giddiness, and two instances of vomiting after taking mefenamic acid 250 mg during menstrual pain. Her medical history included irregular menstrual periods, adenomyosis, fibroid uterus which was treated with an Mirena device at the age of 8 months, and uncontrolled diabetes. Lab tests revealed that IgE (548.1 IU/ml) and glycated haemoglobin (HbA1C) (11.0) were high. She was diagnosed with urticaria and diabetes mellitus and treated with hydrocortisone, antihistamines, insulin and supportive therapy, which led to the disappearance of symptoms and discharge in stable conditions. The case also shows that unmonitored use of mefenamic acid can cause severe hypersensitivity and is more likely in patients with comorbidities and the use of pharmacovigilance, medical awareness, responsible prescribing, and patient education can be used to prevent adverse drug reactions and ensure safe medication practices with the vulnerable population.

Effect of digoxin on corrected QT interval in geriatric inpatients: a prospective observational study

Roberto Lozano, Carina Bona — Fri, 24 Oct 2025 00:00:00 +0530

Background: QT interval prolongation is a recognized surrogate marker for torsades de pointes risk. Digoxin, a cardiac glycoside used for atrial fibrillation and heart failure, is not typically associated with torsades but may shorten QTc, particularly in toxicity. Whether therapeutic digoxin shortens QTc in elderly inpatients remains unclear. Objective was to evaluate the effect of digoxin on QTc interval in geriatric inpatients at therapeutic plasma concentrations.

Methods: We performed a prospective observational study over six months (November 2012-February 2013) in 201 geriatric inpatients. QT intervals were measured ≥15 days after digoxin initiation and corrected using Bazett’s (QTcB) and Fridericia’s (QTcF) formulas. Patients on amiodarone, donepezil, salbutamol, or venlafaxine were excluded. Covariates included demographics, comorbidities (hypertension, heart failure, diabetes, renal disease, atrial fibrillation/flutter, COPD), and clinical presentation. High QTc was defined as >460 ms in women and >450 ms in men.

Results: Twenty-three patients received digoxin (mean dose 151±88 µg/day; mean plasma level 1.2±0.4 ng/ml) and 152 served as controls. Digoxin patients had lower QTcB (427.7±33.5 ms versus 447.1±56.2 ms; p=0.1166) and QTcF (408.4±36.1 ms versus 423.2±48.5 ms; p=0.1642). High QTc prevalence was lower in the digoxin group for QTcB (13.0% versus 28.9%, p=0.082) and QTcF (8.7% versus 23.0%, p=0.162), though differences were not statistically significant. Baseline characteristics were otherwise similar between groups.

Conclusions: In elderly inpatients, digoxin therapy was associated with a non-significant trend toward QTc shortening and lower prevalence of high QTc. These findings do not support initiating digoxin solely to reduce QTc but suggest a potential ancillary benefit in patients already indicated for the drug. Larger studies at higher therapeutic plasma levels are warranted.

Methanolic extract from the fruit kernel of Mangifera indica (Anacardiaceae) improves blood count, serum iron levels and transaminases in anemic rats

Wawa Justine Tiepka, N'guessan Alain Yao, Kouakou S. Konan, Abdoulaye Touré — Fri, 24 Oct 2025 00:00:00 +0530

Background: Mangifera indica (Anacardiaceae), known for its many therapeutic potentialities is used in traditional Ivorian medicine to treat anemia. The aim of this study was to evaluate the effects of methanolic extract from the fruit kernel of Mangifera indica (EMMI) on blood pressure, iron and transaminase levels in rat’s anaemic by phenyl hydrazine (50 mg/kg, per os).

Methods: The determination of iron, tannins, polyphenols and total flavonoids in EMMI samples was performed, using specific reagents. Different groups of rats were treated with EMMI (100, 500 and 1000 mg/kg) or Folifer (50 mg/kg) by gavage for 14 days. The determination of hematological and biochemical parameters following the different treatments was carried out, using an URIT 3000 PLUS machine.

Results: Phytochemical analyses show that EMMI (10 mg/ml), is rich in polyphenols (38.97±0.04 mg GAE/g), flavonoids (26.83±0.02 mg QE/g), tannins (33.87±0.06 mg TAE/g). and iron (52.91±0.01 mg/100 g). The observed anti-anaemic effects were dose-dependent. After 14 days of treatment, EMMI (1000 mg/kg) induced normalization of RBC, Hb, Hct and serum iron levels (p<0.001), with a decrease in ASAT and ALAT levels respectively of about 28 and 34% in anaemic rats (p<0.001). These effects were comparable to those of Folifer (p>0.5).

Conclusion: Altogether, this study showed that EMMI normalizes blood count, serum iron and transaminases in rats made anaemic by administration of phenyl hydrazine. This beneficial effect would be attributed to its richness in secondary metabolites and iron.

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

Fri, 24 Oct 2025 00:00:00 +0530

Background: Rohitakarista (RHT) is a classical Ayurvedic formulation, traditionally used for the treatment of splenomegaly, particularly among rural populations.

Methods: The acute toxicity study of RHT in male Sprague-Dawley rats showed no mortality even at 80 ml/kg body weight. For chronic toxicological evaluation, rats were divided into two groups (n=10 per group). One group received RHT suspension orally at 40 ml/kg body weight daily for 41 consecutive days, while the control group received water. At the end of the treatment period, blood samples were collected to evaluate 25 different hematological parameters.

Results: RHT-treated rats showed a significant increase in absolute neutrophil count (153.96%, p=0.05) and neutrophil percentage (84.60%, p=0.04), alongside a significant decrease in lymphocyte percentage (24.62%, p=0.04). Red blood cell count (13.34% decrease, p=0.03), hemoglobin level (12.94% decrease, p=0.04), and hematocrit (14.29% decrease, p=0.01) were also significantly reduced. Non-significant but noticeable changes included increased WBC count (23.80%), eosinophils (216.67%), monocyte percentage (84.06%), and platelet count (17.71%). Other parameters such as MCV, MCH, MCHC, RDW, ESR, bleeding time, clotting time, and platelet indices showed minor and nonsignificant variations.

Conclusions: Chronic RHT administration led to significant hematological changes, particularly in neutrophil and erythrocyte indices, suggesting potential immunological and anemic risks. Further biochemical and histopathological studies are recommended to better understand its overall safety profile.

Evaluation of prescription patterns using World Health Organization prescribing indicators in outpatient department at a tertiary care hospital in Central India

Swarnalata Sahoo, Sujata Dudhgaonkar, Pravin S. Uike — Thu, 04 Sep 2025 00:00:00 +0530

Background: Rational prescribing entails administration of safe, efficacious, and cost-effective medications. Adherence to standards in medical treatment can enhance quality of life in developing countries. One approach to promote rational use is the evaluation of drug utilization patterns in healthcare facilities. Objective of the study was to evaluate prescribing practices in outpatient department (OPD) of a tertiary care hospital using World Health Organization (WHO) standards.

Methods: Total 2000 randomly selected OPD prescriptions from patients of all ages and genders were collected from 1/09/2024 to 28/02/2025 and analysed for WHO standards and completeness of prescription. Institutional Ethics Committee approval was obtained vide reference no 93/31/08/2024.

Results: Among 6235 prescribed drugs in 2000 prescriptions, the average number of medicines was (3.1±1.49). Adherence to National List of Essential Medicine (NLEM) was high (90.67%), while generic prescribing was suboptimal (52.09%). Antimicrobial use was more (32.8%), injectable use was low (5.32%), brand names were used in 47.9%, and fixed drug combinations (FDCs) in 32.57%. The most frequently prescribed drugs were pantoprazole (54.57%), Diclofenac (38.5%), and Amoxycillin (28.7%). Prescriptions completeness in demographic information (90.67%), diagnosis (48.8%), legible handwriting (59.2%), capital letters (6.8%), abbreviations (100%), vernacular instructions (78.6%), and signature, designation, registration number, and qualification (36.9%).

Conclusions: Prescribing practices deviated from WHO standards, with incomplete documentation of patient-related information. The study identified inappropriate prescribing, including polypharmacy (3.1±1.49), limited generic drug use (52.09%), and high use of NLEM drugs (90.67%). Prescription completeness was low (52.09%). These practices could result in adverse health outcomes and higher costs, indicating the need for continuous education of healthcare professionals.

Assessment of antidiabetic drug utilization and prescribing trends in outpatient care at a district general hospital in central Maharashtra

Mandar Kothari, Reena R. Giri, Jijo P. Abraham — Tue, 30 Sep 2025 00:00:00 +0530

Background: Diabetes mellitus is a growing global health challenge with substantial morbidity, particularly in low- and middle-income countries like India. Rational prescribing of antidiabetic medications is essential to optimize glycemic control and reduce complications.

Methods: A prospective observational study was conducted involving 605 diabetic patients. Prescriptions were analyzed using World Health Organization (WHO) prescribing indicators focusing on monotherapy versus combination therapy, drug classes prescribed, and adherence to essential medicines and generic prescribing.

Results: The majority of patients were males (69.4%) aged 60-69 years (38%). The average number of antidiabetic drugs per prescription was 1.7. Monotherapy was prescribed in 31.4% of cases, while 68.6% received combination therapy. Metformin was the most commonly prescribed drug (95.9%), followed by Glimepiride (47.1%). Combination therapy of Glimepiride + Metformin was the most frequent regimen (43.3%). Insulin was prescribed in 6.6% of cases, predominantly biphasic insulin. All drugs were prescribed by generic names, with 98.3% from the National List of Essential Medicines (NLEMs).

Conclusions: Metformin remains the cornerstone of antidiabetic therapy, with a clear preference for combination regimens, particularly Metformin plus Glimepiride, reflecting guideline-based practice for intensified glycemic control. The high rate of generic prescribing and use of essential medicines demonstrates adherence to rational prescribing principles. Ongoing prescription monitoring and patient-centered therapy adjustments are recommended to further optimize diabetes management.

Echoes of adversity with Voriconazole: a retrospective study

Akhila Nandan, Princy Louis Palatty, Laxmi Govindraj — Fri, 24 Oct 2025 00:00:00 +0530

Background: Voriconazole is widely used in managing invasive fungal diseases, but its adverse drug reactions, pose significant clinical challenges. This retrospective observational study aimed to evaluate the frequency, severity, and risk factors of ADRs associated with voriconazole treatment in patients in a tertiary care hospital, focusing on demographic characteristics, co-morbidities, route of administration, and trough drug levels.

Methods: Data of 95 patients who received voriconazole between 2020 and 2025 were retrieved from electronic medical record. Demographic details, treatment indication, comorbidities, mode of administration, and trough plasma concentrations were collected. ADRs were categorized by system organ class, assessed for severity using modified Hartwig -Siegel scale, and causality was determined using the WHO-UMC system. Statistical analysis employed chi-

square tests for categorical variables and Mann–Whitney U tests for trough level comparisons, with p<0.05 considered significant.

Results: ADRs occurred in 58 patients (61.1%), hepatobiliary were most frequent (44%). Male patients had a higher ADR rate (54.5%), and those with type 2 diabetes mellitus showed a significantly higher incidence (p=0.008). Cardiovascular comorbidities and thyroid disorders were also significantly associated with ADRs. The intravenous route showed a higher incidence of ADRs compared to oral route. Most reactions were moderately severe (56.8%). A statistically significant relationship was observed between higher trough concentrations and the occurrence of transaminitis.

Conclusion: Voriconazole therapy showed a high rate of moderate ADRs, primarily hepatobiliary. Intravenous route and comorbidities-diabetes, cardiovascular disease, and thyroid disorders-were significant risk factors requiring vigilant monitoring.

Antifungal and antibacterial activities of Usnea lichen extracts and associated Endolichenic fungi from the Western Ghats, India

Georgy Antony, Anusha Bhaskar, Sudheesh M., Manikkumar R. — Fri, 24 Oct 2025 00:00:00 +0530

Background: Lichens of the Usnea genus and their associated Endolichenic fungi from biodiversity hotspots like the Western Ghats, India, represent underexplored sources of secondary metabolites with antimicrobial potential. This study evaluates the antifungal activity of Usnea extracts and antibacterial efficacy of Endolichenic fungi to address the surge in antimicrobial resistance, demanding novel bioactive agents.

Methods: Usnea species (U. subsordiata, U. perplexans, U. spinocula, U. undulata, U. maculata) were collected from Kodayar, Tamil Nadu and extracted sequentially with methanol, acetone and diethyl ether. Antifungal minimum inhibitory concentrations were determined by performing broth macrodilution against Aspergillus niger, A. flavus, Fusarium oxysporum, and F. solani. ELF were isolated from U. perplexans thalli, cultured and their ethyl acetate extracts tested for antibacterial activity using agar well diffusion against Staphylococcus aureus, Bacillus subtilis, Klebsiella pneumoniae and Escherichia coli.

Results: U. subsordiata extracts exhibited the strongest antifungal activity (MICs 93.72–109.34 µg/ml), while U. maculata showed the weakest (234.375–531.25 µg/ml). ELF isolates (Acremonium lichenicola, Aspergillus spp., Fusarium spp., Penicillium spp.) demonstrated broad-spectrum antibacterial effects, with Aspergillus spp. yielding the largest zones of inhibition, particularly against Gram-positive bacteria. Significant variations were confirmed by two-way ANOVA (p<0.001).

Conclusions: Usnea lichens and ELF harbor potent antimicrobial compounds, offering viable alternatives against antimicrobial resistant pathogens and emphasising the need for conservation and further metabolite characterization.

Comparison of conjunctival autograft and amniotic membrane graft in reducing pterygium-induced corneal astigmatism

Seema Rani, Manpreet Kour, Neelam Rani — Fri, 24 Oct 2025 00:00:00 +0530

Background: Pterygium is a common ocular surface disorder that not only affects cosmesis but also induces corneal astigmatism, leading to visual impairment. This study aimed to compare the effectiveness of CAG and AMG in reducing pterygium-induced corneal astigmatism and to evaluate postoperative complications associated with each technique.

Methods: A prospective, comparative study was conducted on 60 patients with primary pterygium at the Upgraded Department of Ophthalmology, GMC, Jammu, from Oct.2016 to April 2017. Patients were randomly assigned to undergo pterygium excision followed by either CAG/AMG. Preoperative and postoperative assessments were conducted at multiple intervals up to six months.

Results: Preoperatively, the mean pterygium size was similar in both groups. Postoperatively, corneal astigmatism showed a progressive decline in both groups. By the first postoperative day, astigmatism significantly decreased (p<0.001), with further reductions at one week (p<0.0001). At one month, the conjunctival autograft group demonstrated a slightly greater reduction (0.60±0.61 D) compared to the amniotic membrane group (0.84±0.68 D). By three months, astigmatism remained stable at 0.62±0.62 D and 0.98±0.72 D, respectively. However, the intergroup difference was not statistically significant at any time point (p>0.05), indicating comparable efficacy in postoperative corneal curvature improvement. Postoperative complications were more frequent in the conjunctival autograft group, with significantly higher conjunctival hyperemia (63% vs. 26%, p=0.003), while other complications were comparable between groups.

Conclusions: Both conjunctival autograft and amniotic membrane graft effectively reduced corneal astigmatism following pterygium excision.

Incidence of xerostomia and effectiveness of oral xyletol in xerostomia management among hemodialysis patients

Sanjay Srinivasa, Danish Muqbool — Fri, 24 Oct 2025 00:00:00 +0530

Background: Xerostomia or dryness of the mouth, is a frequent complaint among patients undergoing chronic haemodialysis (HD). However, its incidence and severity in dialysis populations, particularly in tropical regions like India, remain poorly documented. Xerostomia may contribute to intradialytic weight gain (IWG) by influencing fluid intake behaviours, but its role in this context is unclear. This study is aimed to assess the incidence of xerostomia in dialysis patients and evaluate the effectiveness of oral XYLETOL in its management.

Methods: This prospective study included CKD stage 5D patients aged 18-75 years, on dialysis for at least 3 months. Xerostomia was assessed using a validated questionnaire, with scores ≥25 indicating significant xerostomia. Patients consenting to further evaluation were administered oral XYLETOL tablets (2 tablets, three times daily, 2 hours after meals) for four weeks. Xerostomia inventory scores were reassessed after treatment and compared with baseline scores. Secondary assessments included intradialytic weight gain (IWG) and hypotension episodes.

Results: The study demonstrated that oral XYLETOL tablets effectively reduced xerostomia symptoms in HD patients with significant scores (≥25). Post-treatment xerostomia scores showed notable improvement compared to baseline. However, no significant impact was observed on IWG, indicating that the benefits were confined to symptom relief rather than on hemodynamic changes.

Conclusions: Xerostomia in HD patients has multiple contributing factors, including advanced age, systemic diseases, medication use, fluid intake restrictions and salivary gland fibrosis. Early identification of risk factors is crucial for effective management. While XYLETOL is beneficial for reducing xerostomia.

Knowledge, attitude, and practice towards national health programs among MBBS students in a tertiary care centre of north India: a cross-sectional study

Monika Gupta, Dwividendra Kumar Nim, Jitendra Shukla, Rakesh Chandra Chaurasia — Fri, 24 Oct 2025 00:00:00 +0530

Background: National health programmes (NHPs) are pivotal to India’s public health strategy, and medical graduates are expected to understand and implement them effectively. However, undergraduate training may not uniformly equip students with the necessary competencies. This study aimed to assess the knowledge, attitude, and practice (KAP) regarding NHPs among MBBS students at different academic levels.

Methods: A cross-sectional, questionnaire-based study was conducted among 489 MBBS students (3^rd year, final year, and interns) in three months from March 2025 to May 2025 at a tertiary care medical college in north India. A self-designed, structured and validated KAP questionnaire covering 10 knowledge items, 10 attitude statements, and 10 practice-related questions was administered. Descriptive statistics for comparative analysis, and results were visualised through line graphs and box plots.

Results: Knowledge and practice scores improved with academic progression, with final-year students scoring the highest (mean knowledge score: 4.82±1.75; practice: 6.73±2.47). Attitude scores remained uniformly positive across all groups (mean range: 1.99-2.09). Third-year students had the lowest knowledge and practice scores. Analyses revealed the presence of low outliers in all three domains, more prominent in junior batches. Overall, awareness of programs like Ayushman Bharat, NTEP, and eSanjeevani was relatively high, while misconceptions remained regarding schemes like PM-JAY and ABDM.

Conclusions: While attitudes toward NHPs were consistently favourable, knowledge and practice varied by academic year. The study underscored the need to integrate program-based learning and community engagement activities earlier in the undergraduate curriculum to strengthen public health readiness among future doctors.

Integrated protein-protein interaction and gene ontology enrichment analysis reveals strong association with carbohydrate metabolism pathways

Suresh Kumar, Vivek, Vivek Kumar Sharma — Fri, 24 Oct 2025 00:00:00 +0530

Background: Carbohydrate metabolism is very important for keeping cellular energy balance, but it is not working properly in people with diabetes and other metabolic disorders. The molecular characteristics of this pathway can be elucidated through the integrated analysis of gene functions and protein-protein interactions. The study utilized computational techniques to examine the functional and relational characteristics of specific genes that govern carbohydrate metabolism.

Methods: The researchers utilized a dual-stage bioinformatics system. The first step was to use the STRINGdb R package to look at PPI with Homo sapiens (Ensembl ID: 9606) and set a cutoff of 500 for results with a lot of confidence. The research team utilized R-based tools to perform gene ontology enrichment analysis, aiming to identify statistically significant functional associations within biological processes, molecular functions, and cellular component domains. We only accepted GO terms when the q-value was less than 0.05.

Results: STRINGdb analysis revealed six high-confidence protein-protein interactions (PPIs) with interaction values ranging from 590 to 995, indicating a robust connection. GO enrichment analysis showed that there was a total gene overlap (GeneRatio =60/60) in the top biological processes related to carbohydrate metabolism. These processes included glucose metabolic process (GO:0006006), hexose metabolic process (GO:0019318), and monosaccharide metabolic process (GO:0005996). These processes exhibited highly significant adjusted p-values (p adjust <1.0E-114) and substantial fold enrichment (>78).

Conclusions: The integrated analysis unequivocally demonstrates that the examined gene set functions as a cohesive network primarily involved in glucose and sugar metabolism. This particularly emphasizes their importance in metabolic disease mechanisms and energy regulation, notably diabetes. These findings provide a robust foundation for potential therapeutic exploration and subsequent experimental verification.

Prevalence of metal fume fever and its association with working conditions and chronic respiratory disorders among metal factory workers in eastern India

Fri, 24 Oct 2025 00:00:00 +0530

Background: Metal fume fever (MFF) constitutes a formidable occupational infirmity, arising from inhalation of ultrafine metallic particulates, pre-eminently zinc oxide, during metallurgical vocations. It’s symptomatology, characterized by pyrexia, bronchospasm, and the recurrent “Monday morning” febrile paroxysm, conceals a sinister trajectory toward chronic respiratory decline.

Methods: A cross-sectional epidemiological inquiry was conducted among 181 metallurgical operatives in Liluah, West Bengal (July-December 2024). Participants, conscripted via multi-stage randomization, were interrogated using a validated questionnaire encompassing socio-demographic indices, occupational exposures, and respiratory morbidities. Analytical dissections employed ANOVA, chi-square, Z-tests, and Pearson correlations via SPSS v20, consecrating significance at p≤0.05.

Results: MFF prevalence attained an alarming 87.8%, with mean recurrence of 5.91±4.58 episodes annually. Nearly half (49.7%) harboured chronic respiratory disorders: COPD (24.3%), chronic bronchitis (17.7%), and asthma (7.7%). Robust associations emerged between MFF occurrence and sex (χ²=62.242, p<0.001), literacy (χ²=50.752, p<0.001), smoking (χ²=65.615, p<0.001), alcohol use, PPE compliance, ventilation, shift schedule, and primary metal exposure. Frequency of MFF episodes correlated near-perfectly with age (r=0.911), occupational tenure (r=0.928), daily working hours (r=0.838), cigarette consumption (r=0.952), and smoking duration (r=0.973).

Conclusions: Metal fume fever demonstrates an exceptionally high prevalence among metallurgical workers, acting as a sentinel for chronic respiratory morbidity. The strong correlations with occupational exposures and lifestyle factors underscore its preventable nature. Implementation of protective strategies and worker education is imperative to mitigate long-term pulmonary damage.

Enhancing ethical standards: a quantitative analysis of knowledge improvement a through structured good clinical practice workshop

Fri, 24 Oct 2025 00:00:00 +0530

Background: Good clinical practice (GCP) is an internationally recognized ethical and scientific quality standard for designing, conducting, recording, and reporting trials that involve the participation of human subjects. In India, postgraduate medical students are mandated to take part in research projects as part of their academic curriculum, but a lack of training leads to considerable disparity in their understanding of GCP principles. A structured educational intervention like the GCP workshop helps in filling these disparities and promotes the conduction of ethical research.

Methods: An educational interventional study was conducted to assess the impact of a GCP workshop on knowledge among postgraduate medical students during a one-day GCP workshop at a tertiary care teaching hospital. A total of 163 students participated in the study. A self-developed, pre-validated questionnaire was used to assess the impact of knowledge before and after the workshop. Data was collected using Google forms and analysed by using Microsoft Excel and Jeffreys’s Amazing Statistics Program (JASP) software.

Results: Out of 163 participants, 158 postgraduate students completed both pre- and post-tests. The mean pre-test score was 22.3±3.5, which increased to 24.5±0.9 in the post-test. To assess the normality of data distribution, the Shapiro-Wilk test was performed and resulted in p<0.001, indicating the use of a nonparametric test. Then the Wilcoxon signed-rank test was performed, and results indicated statistically significant improvement (Z=7.48, p<0.001). Question-wise analysis revealed an increase in accuracy from 87.06% to 98.36%, indicating improvement in knowledge across the questionnaires.

Conclusions: The overall findings suggest that a structured good clinical practice (GCP) workshop plays a significant, important role in enhancing knowledge among postgraduate medical students.

Efficacy and safety of lactoferrin based cream (SiraciltTM acne) in the treatment of patients with mild to moderate acne vulgaris – a randomized, comparative and pilot study

Harsh J. Shah, Jacky K. Pariyani, Kalyani V. Shinde — Fri, 24 Oct 2025 00:00:00 +0530

Background: This pilot study was planned to evaluate the efficacy and safety of Siracilt™ Acne (lactoferrin, azelaic acid, and niacinamide) cream and compare it with azelaic acid cream and clindamycin gel in the treatment of patients with mild to moderate acne vulgaris.

Methods: This study was a randomized, open-label active controlled, parallel group clinical trial. A total of 80 patients with mild to moderate acne vulgaris [investigator global assessment (IGA) score, 2 or 3] were randomized to receive Siracilt™ Acne cream, azelaic acid 10% cream, azelaic acid 20% cream, and clindamycin 1% gel for 4 weeks. The primary endpoint was the proportion of patients who achieved treatment success (IGA score, 0 or 1 and/or at least a 2-point reduction in IGA score) after 4 weeks. Secondary efficacy endpoints included a percentage reduction of total lesions and a change in total, inflammatory, and non-inflammatory lesions after 4 weeks.

Results: After 4 weeks, the proportion of patients achieving treatment success in the Siracilt™ Acne group was 65%; while it was 0%, 10%, and 0% in azelaic acid 10%, azelaic acid 20%, and clindamycin 1% groups, respectively. The percentage reduction in the number of total acne lesions after 4 weeks was 62.1%, 27.2%, 46.6%, and 25.1% with Siracilt™ Acne cream, azelaic acid 10% cream, azelaic acid 20% cream, and clindamycin 1% gel, respectively. Similar results were observed for change in total, inflammatory, and non-inflammatory lesions after 4 weeks. Overall, the treatments were safe and well tolerated.

Conclusions: In conclusion, Siracilt™ Acne cream demonstrated superior efficacy compared to azelaic acid and clindamycin in the treatment of mild to moderate acne vulgaris.

A randomized controlled trial comparing sacubitril/valsartan and telmisartan in patients with HFrEF: efficacy and safety evaluation

Kunwar Shailen Dev Singh Guleria, Dinesh Kansal, Atal Sood, Mukul Kumar — Fri, 24 Oct 2025 00:00:00 +0530

Background: Heart failure with reduced ejection fraction (HFrEF) is a progressive condition associated with high morbidity, mortality, and healthcare costs. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), has demonstrated superior efficacy over traditional angiotensin receptor blockers (ARBs) in improving outcomes. This study compared the safety and efficacy of sacubitril/valsartan with telmisartan monotherapy in HFrEF patients.

Methods: A randomized, prospective, open-label, interventional study was conducted at a tertiary care center over six months. A total of 81 patients with HFrEF (EF ≤40%) were randomized into group A (telmisartan 40 mg daily) and group B (sacubitril/valsartan 200 mg twice daily). Outcomes assessed included NYHA class, left ventricular ejection fraction (LVEF), and serum BNP levels at baseline, 3 months, and 6 months. Safety was evaluated through adverse events and laboratory monitoring. Statistical analysis was conducted using SPSS, with significance set at p<0.05.

Results: Both groups showed significant improvement in LVEF and BNP levels. Sacubitril/valsartan demonstrated superior efficacy in reducing BNP levels (583.2±324.2 pg/ml versus 957.5±305.2 pg/ml, p<0.0001) and improving NYHA class (p=0.005). LVEF improved significantly in both groups, with no intergroup difference (p=0.130). No hospitalizations or mortality occurred during the study. One case of non-serious angioedema was reported in the sacubitril/valsartan group. Hematological and biochemical parameters remained stable, confirming comparable safety profiles.

Conclusions: Sacubitril/valsartan is more effective than telmisartan in improving NYHA class and reducing BNP levels in HFrEF patients, with a comparable safety profile. It should be considered a preferred treatment option in HFrEF management, particularly in patients with NYHA class II/III symptoms, as per ACC/AHA guidelines.

In vitro evaluation of antioxidant property of ethanolic extract of Zea mays var. saccharata

Gokula Kannan Sampath, B. Kalaiselvi — Fri, 24 Oct 2025 00:00:00 +0530

Background: Antioxidants play a crucial role in protecting against oxidative stress, which contributes to the pathogenesis of chronic diseases. Corn (Zea mays) is widely consumed and contains bioactive phytochemicals, but its antioxidant potential is not well established.

Methods: This was an in vitro experimental study conducted in the Department of Pharmacology, ACS Medical College and Hospital, Chennai, India, during June to July 2025. Ethanolic extract of fresh corn kernels was prepared by cold maceration. Antioxidant activity was assessed using the Total Antioxidant Capacity (TAC) assay and DPPH radical scavenging assay across concentrations of 20–100 µg/ml. Results were compared with standard antioxidants (ascorbic acid and BHT).

Results: The yield of dried ethanolic extract was 2.5 g from 50 g kernels. TAC showed a dose-dependent increase in activity, while DPPH scavenging ranged from 0% to 11.6%, significantly lower than the BHT standard (63–100%).

Conclusions: The ethanolic extract of Zea mays demonstrated moderate antioxidant potential, supporting its role as a natural source of antioxidants. Further isolation of active phytochemicals and in vivo studies are recommended.

Factors influencing the clinical ineffectiveness of antibiotics in non-responders

Fri, 24 Oct 2025 00:00:00 +0530

Background: Antibiotic ineffectiveness and clinical non-responsiveness remain significant challenges in healthcare. Non-responders-patients who fail to improve despite appropriate antibiotic therapy-pose a substantial clinical burden. Identifying factors influencing such outcomes is essential for improving treatment success. To investigate patient, hospital-related factors contributing to antibiotic ineffectiveness despite culture sensitivity.

Method: A six-month ambispective observational study was conducted at PSG Hospitals, Coimbatore, India. A total of 480 inpatients were included into the study. Highly prescribed antibiotics-Cefoperazone+Sulbactam, Meropenem, Piperacillin Tazobactam, and Ceftriaxone-were analyzed. Factors such as age, gender, type of bacteria, prior antibiotic exposure, prior hospitalization, invasive procedures, and length of hospital stay were examined. Statistical analysis was performed using SPSS, with p values < 0.05 considered significant.

Results: Among 480 patients equally divided across four antibiotic groups, age was significant in the Meropenem group (p=0.044) in contrast to the rest of the groups. Prior antibiotic exposure (OR range: 1.091–1.889; p<0.05) and longer hospital stay (OR range: 1.271–1.710; p<0.001) were significantly associated with non-response across all the four antibiotic groups. Klebsiella pneumoniae was significantly linked to non-response across all groups (OR range: 1.025–1.801; all p<0.01). Invasive procedures were significant for Cefoperazone–Sulbactam (OR=2.148, p=0.030) and Piperacillin–Tazobactam (OR=1.643, p=0.012).

Conclusion: Prior antibiotic exposure, prolonged hospital stays, and the presence of Klebsiella pneumoniae were significantly associated with antibiotic non-responsiveness. This suggests a multifaceted approach addressing patient, microbial, and institutional factors might lessen disruptions to optimal clinical effectiveness.

Comparative effectiveness and safety of cariprazine and lamotrigine in patients of bipolar depression: a prospective, randomized and open label study

Sankasha Sharma, Navya Raj Singh, Neeru Bala — Fri, 24 Oct 2025 00:00:00 +0530

Background: Bipolar disorder is marked by significant shifts in mood, energy, and behaviour. Cariprazine, a D3/D2 (dopamine) partial agonist, was FDA-approved in 2019 for treating bipolar depression, though clinical trial results have been mixed. Given this variability, the present study compared the effectiveness and safety of cariprazine monotherapy with lamotrigine in patients with bipolar depression.

Methods: Study was conducted for a total duration of 90 days comprising of 70 patients form either sex (18-65 years), diagnosed with bipolar depression. Patients were randomized into group A and group B homogenously. Group A patients were given cariprazine monotherapy at 1.5 mg/day, which was increased to 3 mg/day on day 31^st. Similarly, for group B, lamotrigine monotherapy was administered at 50 mg/day and the dose was increased to 100 mg/day on day 31^st.

Results: Treatment significantly lowered MADRS in intra and intergroup comparison (p<0.001). However, the p values differed for different time points on assessment of CGI-I despite being statistically significant (p<0.05; p<0.001). The prevalence of substance abuse in was reported to be 25%. SDS-S results for substance use were non-significant (p>0.05). Group B reported more adverse events than group A.

Conclusions: Cariprazine led to faster and greater reduction in depressive symptoms than lamotrigine in bipolar I depression. Both were well tolerated with similar safety profiles. Substance use was low in both groups, with slightly better improvement in dependence scores seen with cariprazine.