International Journal of Basic & Clinical Pharmacology

Artificial intelligence: transforming drug discovery

Shiva Mishra — Wed, 02 Sep 2026 00:00:00 +0530

Artificial intelligence (AI) has improved medication research and development by shortening schedules, decreasing costs, and raising success rates. AI uses machine learning (ML), deep learning (DL), and natural language processing (NLP) to analyse large datasets and quickly identify pharmacological targets, forecast chemical efficacy, and optimise medication designs. It speeds up lead development by predicting pharmacokinetics, toxicity, and probable side effects. It also improves clinical trial designs through better patient recruitment and data analysis. Recent advances in protein structure prediction and generative molecular design have further expanded the potential of AI in pharmaceutical research. However, challenges include data quality, algorithmic bias, lack of interpretability, validation, reproducibility, and regulatory concerns remain. Overall, AI represents a powerful complementary technology that may significantly accelerate the discovery and development of safer and more effective medicines. This article highlights the role of artificial intelligence in drug discovery, its applications, challenges and future perspectives.

Evolution of topical therapy: a comprehensive review of liposomal salicylic acid in dermatological management

Poulami Gupta Banerjee, Ranita Roy, Riya Halder — Mon, 26 Oct 2026 00:00:00 +0530

Liposomal salicylic acid represents a significant advancement in the formulation of topical dermatological therapies. Salicylic acid, an established beta-hydroxy acid, is highly effective for its keratolytic and comedolytic properties; however, its traditional formulations are often limited by poor aqueous solubility and the potential for significant cutaneous irritation. To address these challenges, liposomal delivery systems, such as Lipoedge^™ have been developed to encapsulate the active ingredient within phospholipid bilayers, facilitating a controlled and sustained release mechanism. This review examines the various preparation techniques, including thin-film hydration and reverse-phase evaporation, and analyses the physicochemical characterization essential for stable delivery, such as particle size and entrapment efficiency. Furthermore, the article explores the clinical efficacy of liposomal salicylic acid in managing acne vulgaris, post-inflammatory hyperpigmentation, and other hyperkeratotic conditions like psoriasis. By reinforcing the skin barrier and reducing trans-epidermal water loss, these next-generation formulations not only enhance therapeutic outcomes but also significantly improve safety profiles and patient compliance compared to conventional free-acid treatments.

Toxicity profile of Jatropha gossypiifolia Linn in zebra fish

Mon, 26 Oct 2026 00:00:00 +0530

A careful assessment of the safety profiles of medicinal plants is necessary due to their growing use, especially for species that have known hazardous and bioactive components. Because of its antibacterial, anti-inflammatory, and purgative qualities, Jatropha gossypifolia Linn. is frequently used in traditional medicine; however, its safe therapeutic application has been restricted due to toxicity concerns. With an emphasis on aquatic models and the growing significance of the zebrafish (Danio rerio), this work offers a comprehensive review and qualitative meta-analysis of the toxicity profile of Jatropha gossypifolia. Following PRISMA principles, a thorough literature search was carried out across many major databases, including PubMed, Scopus, Google Scholar, and ScienceDirect. Included were studies assessing aquatic toxicity, cytotoxicity, genotoxicity, and phytochemical toxicity. The results show that alkaloids, flavonoids, latex-derived chemicals, and diterpenoids like phorbol esters are the main causes of toxicity. Fish and invertebrate models used in experiments show dose-dependent toxicity, which manifests as aberrant behaviour, physiological stress, and mortality. A meta-analysis of LC50 values showed moderate toxicity levels that varied significantly based on the type of extract, the portion of the plant, and the length of exposure. In comparison to other plant components, methanolic root extracts and latex showed greater toxicity. Cytotoxic and genotoxic investigations further validated DNA damage, chromosomal abnormalities, and decreased cell viability. The necessity for consistent procedures was highlighted by the moderate variation found in forest plot analysis among studies. There is a significant research deficit in zebrafish-specific toxicity studies, despite a wealth of data from aquatic and mammalian models. Future studies should concentrate on developmental toxicity, molecular causes, and dose-response interactions given the sensitivity and translational significance of zebrafish. All things considered, this work highlights the significance of a thorough toxicological assessment of Jatropha gossypifolia and stresses the necessity of zebrafish-based research to guarantee safe pharmaceutical use.

Tebipenem pivoxil, the first oral carbapenem for complicated urinary tract infections: a review

Nivasini Natarajan Thangam, Kala Paneerselvam — Mon, 26 Oct 2026 00:00:00 +0530

Complicated urinary tract infections (cUTIs) are increasingly difficult to manage because emerging antimicrobial resistance limits conventional oral treatment options. Tebipenem pivoxil hydrobromide is an orally administered prodrug of tebipenem. It was recently approved by the US FDA in June 2026. It represents the first oral carbapenem available for adults with cUTI, including pyelonephritis, caused by specified susceptible organisms when limited or no alternative oral options exist. The pivotal PIVOT-PO trial demonstrated non-inferiority of oral tebipenem pivoxil 600 mg every 6 hours to intravenous imipenem-cilastatin for 7–10 days in hospitalised adults with cUTI or pyelonephritis, building on earlier non-inferiority evidence against intravenous ertapenem from the ADAPT-PO programme. After summarising the pharmacology, microbiology, pharmacokinetics, dosing, efficacy, safety and gut-microbiome data underlying the United States approval, this review offers a critical appraisal of where tebipenem pivoxil fits among the several new oral agents recently introduced for urinary tract infection, and considers its relevance to antimicrobial-resistance settings such as India, where carbapenem resistance among Enterobacterales is substantial and driven predominantly by metallo-β-lactamases against which no currently available carbapenem, including tebipenem, retains activity. The clinical value of tebipenem is therefore best understood not as a universal substitute for intravenous carbapenems or for narrower-spectrum oral agents, but as an option for carefully selected patients needing carbapenem-level activity and suitable for oral therapy, guided by local susceptibility data, renal dose adjustments, awareness of carnitine depletion and valproic acid interactions, and proper antimicrobial stewardship.

Beyond glycemic control: emerging therapeutic applications of GLP-1 receptor agonists: a comprehensive narrative review

Mon, 26 Oct 2026 00:00:00 +0530

The therapy of type 2 diabetes mellitus and obesity has been changed by glucagon-like peptide-1 receptor agonists (GLP-1 RAs). However, clinical evidences suggest their therapeutic potential extends far beyond glycaemic management with major function in cardiovascular, hepatic, renal and neurological illnesses To give a complete appraisal of the emerging non-glycaemic therapeutic potential of GLP-1 RAs through a survey of the available clinical evidence and to highlight future research options in this rapidly growing field. A thorough literature search was performed in the PubMed, Scopus and Google Scholar databases from inception to November 2025. The search criteria included GLP-1 receptor agonists, semaglutide, tirzepatide, and combinations with specified therapeutic areas. Clinical trials, systematic reviews and mechanistic research of landmark importance were prioritized GLP-1 RAs have shown important cardiovascular benefits, decreasing major adverse cardiovascular events (MACE) by 20%. Tirzepatide reduced heart failure hospitalization by 38% in patients with heart failure with intact ejection fraction. These medicines show potential for decreasing hepatic steatosis and fibrosis in metabolic dysfunction-associated steatotic liver disease . Observational studies demonstrate a 48% reduction in incidence of dementia and growing evidence suggests neuroprotective effects. Other therapeutic uses are for chronic renal disease, polycystic ovary syndrome, obstructive sleep apnoea and substance use disorders. GLP-1 RAs represent a paradigm change in pharmacology, evolving from glucose-lowering to multi-organ protecting treatments. The development of multiple and triple agonists and oral non-peptide formulations will certainly greatly enhance their clinical value.

GSK-3-mediated regulation of cellular functions and signaling pathways

Lingaraj Anawal, Sanjay Havaragi, Chandrasekhar V. M. — Mon, 26 Oct 2026 00:00:00 +0530

Glycogen synthase kinase-3 (GSK-3) is a highly conserved serine/threonine kinase that has emerged as a central regulator of diverse cellular signaling networks and physiological processes. Originally recognized for its role in glycogen metabolism, GSK-3 is now known to participate in the regulation of gene expression, metabolism, proliferation, differentiation, development, apoptosis, cellular adhesion, migration, and neuronal function. Its activity is controlled through multiple regulatory mechanisms, including inhibitory phosphorylation and modulation of protein complexes, enabling GSK-3 to respond dynamically to extracellular and intracellular signals. The two paralogues, GSK-3α and GSK-3β, share considerable structural similarity but may exhibit distinct and sometimes overlapping biological functions. Dysregulated GSK-3 signaling has been associated with neurological and neurodegenerative disorders, metabolic and inflammatory diseases, and cancer. Although pharmacological inhibition of GSK-3 has therefore attracted considerable therapeutic interest, clinical translation remains challenging because of limited isoform selectivity, context-dependent biological effects, and the complex physiological functions of this kinase. Recent findings further demonstrate that GSK-3 can regulate central cellular processes through distinct isoform-dependent mechanisms, emphasizing the importance of understanding its spatial, temporal, and substrate-specific regulation. A comprehensive characterization of GSK-3α and GSK-3β may consequently facilitate the development of more selective and clinically effective therapeutic strategies.

Essential drug availability and affordability in Gunungsitoli

Ervin Rosanti Anastasia Laowo, Khairunnisa Khairunnisa, Wiryanto Wiryanto — Sat, 19 Sep 2026 00:00:00 +0530

Background: A key element of universal health care is equitable access to Essential medicines (EMs). Disparities in medicine availability, cost, and affordability, however, continue to be a global problem, especially in decentralized health systems like Indonesia. A standardized World Health Organization/health action international (WHO/HAI)-based evaluation of these indicators has never been carried out in Gunungsitoli City.

Methods: The study employed a descriptive sequential mixed-method approach. Using WHO/HAI sample guidelines, quantitative secondary data on the accessibility, cost, and affordability of 50 basic medications were retrieved retroactively from 2023 records from eight Puskesmas and two hospitals. To contextualize procurement difficulties, in-depth interviews with pharmaceutical staff were used to gather primary qualitative data. Descriptive analysis and benchmarking against WHO/HAI indicators were performed on the data.

Results: The majority of necessary medications in Puskesmas showed 100% availability. While program medications (Albendazole, DHP, and anti TB drugs) were unavailable at hospitals because of procurement laws connected to BPJS and centralized supply at the City Pharmacy Installation, stock-outs for ranitidine and retinol injections were noted at Puskesmas. At Puskesmas, all medications were reasonably priced, costing less than a day's minimum salary (Rp 93,633). According to a median price ratio (MPR) research, Puskesmas prices fell within the affordable range.

Conclusions: At the primary care level, access of EMs in Gunungsitoli is usually sufficient; nevertheless, stock-outs of certain injectables and program medications suggest systemic procurement limitations. Price fluctuations at the hospital level point to the necessity of better forecasting, more robust regulatory alignment, and more efficient procurement procedures to guarantee fair and long-term access to necessary medications.

Phenotypic adaptation of clinical Pseudomonas aeruginosa to increasing ceftazidime exposure

Maxmillando Rymbai, Vedant V. Borah — Sat, 05 Sep 2026 00:00:00 +0530

Background: Pseudomonas aeruginosa readily adapts to antibiotic stress, but the effect of increasing ceftazidime exposure on colony morphology across specimen sources is poorly defined. This study determined whether ceftazidime alters growth and colony morphology in a concentration-dependent manner and whether the response varies by specimen source.

Methods: Forty-eight non-duplicate clinical P. aeruginosa isolates from pus, wound swabs, urine, and tracheal aspirates were characterised for ceftazidime susceptibility, extended-spectrum β-lactamase (ESBL) and metallo-β-lactamase (MBL) production, and biofilm formation. Colony morphology was assessed after 24 hours on M9 agar with Congo red and Coomassie brilliant blue (RB medium), alone and with ceftazidime at one-half, one, and two times the isolate-specific minimum inhibitory concentration (MIC).

Results: Ceftazidime resistance was 70.8%, ESBL production 47.9%, MBL production 33.3%, and strong biofilm formation 45.8%. Growth fell from 97.9% on RB medium to 45.8% at twice the MIC (p<0.001). Mean colony diameter decreased from 19.59 to 5.00 mm among growing isolates, and from 19.18 to 2.29 mm when non-viable colonies were scored as 0 mm (p<0.001). Colony diameter differed by specimen source under every condition (p<0.05); tracheal aspirate isolates retained the largest median diameter at and above the MIC. Morphology was characterised by small, round, flat, dry, red colonies.

Conclusions: Ceftazidime produced dose-dependent reductions in bacterial growth and colony morphological variety, indicating phenotypic adaptation not detected by routine susceptibility testing. The response differed by specimen source, with respiratory isolates retaining the greatest growth capacity under drug pressure.

Experimental evaluation of the safety and hepato-protective activity of Raktaphaladi Vati against ethanol induced hepatotoxicity in Wistar rats: an in vivo study

Shubham Ramnarayan Dhoot, N. S. Gangasagre — Mon, 19 Oct 2026 00:00:00 +0530

Background: Ethanol-induced hepatotoxicity is characterized by oxidative stress, inflammation, hepatocellular injury, and impairment of hepatic function. Raktaphaladi Vati is a classical Ayurvedic formulation traditionally indicated in disorders associated with Yakrit Dushti. However, its hepatoprotective potential against ethanol-induced hepatic injury has not been adequately evaluated experimentally. Objectives were to evaluate the safety and hepatoprotective activity of Raktaphaladi Vati against ethanol-induced hepatotoxicity in Wistar albino rats and to compare its efficacy with the standard hepatoprotective drug, Silymarin.

Methods: An experimental study was conducted on healthy Wistar albino rats weighing 150-250 g. Acute oral toxicity was evaluated according to OECD guideline 423 at doses of 300 and 2000 mg/kg body weight. Thirty rats were randomly allocated into five groups (n=6): normal control, ethanol-induced disease control, standard control receiving Silymarin (25 mg/kg), curative Raktaphaladi Vati (87.3 mg/kg), and preventive Raktaphaladi Vati (87.3 mg/kg). Hepatotoxicity was induced by ethanol administration for 28 days. Serum SGOT, SGPT, ALP, bilirubin, total protein and albumin, along with organ weights and hepatic histopathology, were evaluated. Data were analyzed using one-way ANOVA followed by Bonferroni post-hoc test.

Results: Raktaphaladi Vati was safe up to 2000 mg/kg, with no mortality or observable signs of toxicity. Ethanol administration resulted in marked elevation of SGOT, SGPT and ALP, increased liver weight, and histopathological evidence of hepatocellular degeneration and inflammatory infiltration. Raktaphaladi Vati treatment attenuated these alterations, improved hepatic biochemical parameters, normalized liver weight, and preserved hepatic architecture. The preventive regimen demonstrated comparatively greater protection than the curative regimen and showed effects approaching those of Silymarin.

Conclusions: Raktaphaladi Vati demonstrated a favorable safety profile and significant hepatoprotective activity against ethanol-induced hepatic injury in Wistar albino rats. Its protective effect may be associated with antioxidant, anti-inflammatory, detoxifying and Rasayana properties. The greater efficacy of preventive administration suggests its potential role in preventing ethanol-induced hepatocellular injury.

Gevalin™ Aegle marmelos fruit extract improves gastrointestinal symptoms, quality of life and inflammatory markers in symptomatic adults: a randomized, double-blind and placebo-controlled trial

Thu, 08 Oct 2026 00:00:00 +0530

Background: This is randomised, double-blind, placebo-controlled trial evaluated the efficacy and tolerability of Gevalin^™, a standardised Aegle marmelos (bael) fruit extract, in adults with chronic upper gastrointestinal symptoms such as postprandial fullness, early satiation, bloating, acidity, and epigastric discomfort etc.

Methods: Eighty-four adults meeting Rome IV criteria were randomised 1:1 to Gevalin™ 250 mg (n=42) or placebo (n=42) once daily for 56 days. The primary endpoint was change in GIS Rating Scale (GSRS) total score from baseline to Day 56. Secondary outcomes were gastrointestinal symptom and Functional Dyspepsia Related Quality of Life (FDQoL) total scores; inflammatory and oxidative stress biomarkers were exploratory. Analysis was per protocol (n=40 vs. 38).

Results: Gevalin™ significantly reduced GSRS total score versus placebo (change -3.87±4.03 vs. -0.55±1.19; difference -3.32, 95% CI -4.66 to -1.98; p<0.0001), a 20.2% vs. 2.7% reduction. Gastrointestinal symptom total score improved significantly (-7.30±5.25 vs. +0.29±2.73; p<0.0001), as did all four FDQoL domains (p≤0.0083). Exploratory analyses showed greater reductions in erythrocyte sedimentation rate (p<0.0001), C-reactive protein (p=0.0119), and 8-hydroxy-2′-deoxyguanosine (p=0.0076), and improved sleep quality (p<0.0001). No serious or treatment-related adverse events (AEs) were reported.

Conclusions: Gevalin™ significantly improved GISs, quality of life, sleep quality, and selected exploratory biomarkers over 56 days, with favorable short-term tolerability, and warrants confirmation in multicentre trials with long-term follow-up.

Impact of clinical pharmacist mediated patient education on HbA1c and insulin adherence among diabetic population

Mon, 26 Oct 2026 00:00:00 +0530

Background: To evaluate the association of structured clinical pharmacist-mediated patient education with glycemic control, medication adherence, and diabetes self-management among insulin-treated adults with diabetes mellitus.

Methods: A single-arm prospective cohort study was conducted from July 2024 to March 2025 among 70 adults with type 1 or type 2 diabetes mellitus receiving insulin therapy for at least three months at the Department of Diabetology, NRI Academy of Sciences General and Super Specialty Hospital, Chinakani, Andhra Pradesh, India. Participants received structured pharmacist-mediated education on diabetes self-management, insulin administration and storage, medication adherence, lifestyle modification, and self-monitoring of blood glucose, supported by a Patient Information Leaflet. HbA1c, fasting blood glucose (FBS), postprandial blood glucose (PPBS), MMAS-8, and DMSES were assessed at baseline and after three months. Continuous variables were summarized as mean ± SD and compared using paired Student’s t-tests; p<0.05 was considered statistically significant.

Results: Mean HbA1c decreased from 8.754±1.915% to 8.085±1.481% (reduction 0.669%; p=0.00013). FBS decreased by 18.274 mg/dL (p=0.0078), and PPBS decreased by 25.257 mg/dL (p=0.00187). MMAS-8 increased from 3.957±1.215 to 5.585±1.210 (p=0.00000127), while DMSES increased from 4.216±1.137 to 5.983±1.408 (p=0.00000189).

Conclusions: Pharmacist-mediated education was associated with improved glycemic parameters, medication adherence, and diabetes self-management self-efficacy. Due to the absence of a control group, findings represent pre-post associations rather than definitive causal effects.

Comparative analysis of edaravone add-on versus riluzole alone in amyotrophic lateral sclerosis

Suhasini Dehury, Chetna Kaushik, Ashok Kumar Mallik, Vedvyas Mishra — Mon, 26 Oct 2026 00:00:00 +0530

Background: Amylotropic Lateral Sclerosis (ALS) is a neurodegenerative progressive disorder affecting the motor neurons with a prevalence of 5 per 100000 population in India. Riluzole, a presynaptic glutamate receptor blocker, was the only treatment available for last 20 yrs. Recently Edaravone, a free radical scavenger, was approved in 2017 by FDA for its neuroprotective behaviour in ALS and is being used as an add-on drug. This study was undertaken to analyse the add-on beneficial effects of Edaravone with Riluzole in ALS patients and compare it with patients on Riluzole alone.

Methods: A prospective, analytical, hospital-based study of 2 years in duration was conducted in the Department of Pharmacology and Neurology, S.C.B. MCH, Cuttack. All adult patients diagnosed with ALS (based on neurogenic pattern with spontaneous activity in EMG) were included in the study. One study group received Riluzole orally alone while the other group received Edaravone IV infusion along with Riluzole. Efficacy was assessed using ALSFRS-R score, evaluated at baseline and at the end of each month till 6 months. Causality assessment was done by using the WHO-UMC Causality assessment scale and severity assessment was done using Modified Hartwig and Seigel severity scale. Cost effective analysis was done by calculating ICER (Increamental cost effective ratio).

Results: Each group had 70 study subjects with similar baseline characters. There was no significant difference observed studying the baseline characteristics. The ALSFRS-R scores were assessed for 6 months which showed deterioration. Mean ALSFRS-R score significantly decreased by – 5.12 and – 8.87 in Gr A and B respectively at the end of 6 months. A total of 80 ADRs were recorded in the study subjects which were of mild severity.

Conclusions: Edaravone add-on significantly improved functions in ALS patients in comparison to Riluzole alone therefore, it may be prescribed to ALS patients to reduce the disease progression.

Clinical profile, serological patterns and treatment outcomes of dengue fever: a prospective cohort study at a tertiary care university hospital

Rishabh Gupta, Aina Bansal, Harsh Dhundhla, Aviral Verma, Mahesh Kumar Posa — Mon, 26 Oct 2026 00:00:00 +0530

Background: Dengue fever, a globally significant mosquito borne viral infection, exhibits a wide spectrum of clinical manifestations, yet gender specific variations in its presentation and outcomes remain underexplored. We conducted a prospective observational study at Jaipur National University Institute for Medical Sciences and Research Centre, enrolling 50 confirmed dengue patients to evaluate demographic, clinical, and serological differences between genders.

Methods: The cohort comprised 62% females and 38% males, with fever (90%), generalized weakness (54%), and myalgia (44%) as the most common symptoms. Hematological involvement was predominant (92%), followed by hepatic (54%) and respiratory (28%) systems. Serological analysis revealed IgM as the most detected marker (50%), while thrombocytopenia (92%) and hepatomegaly (34%) were frequent comorbidities.

Results: Notably, gender-based differences emerged, with females exhibiting significantly higher IgG seropositivity (p=0.026) and lower hemoglobin levels (p=0.011) compared to males. Treatment regimens were largely supportive, including pantoprazole (98%), paracetamol (84%), and ondansetron (66%). Our findings highlight the critical role of early hematological and serological monitoring in identifying severe cases, while underscoring the need for gender specific considerations in dengue management.

Conclusions: The study provides novel insights into the interplay between gender and disease manifestations, offering actionable evidence to refine clinical protocols and public health strategies in endemic regions. These results emphasize the importance of tailored interventions to mitigate complications and improve patient outcomes.

Drug utilisation pattern among neonates admitted to a tertiary care neonatal intensive care unit: a prospective observational study

Yash Patel, Vimesh R. Mistry, Neeta Kanani, Kuntal Jain, Keval Patel — Mon, 26 Oct 2026 00:00:00 +0530

Background: Neonates in NICUs frequently require numerous medications because of severe illnesses and immature physiology. Drug utilization studies help identify prescribing trends and potential areas for enhancing rational pharmacotherapy. This research assessed drug utilization patterns among neonates in a tertiary care NICU, utilising World Health Organization (WHO) prescribing indicators.

Methods: A prospective study over eight months (May–December 2025) was conducted in a NICU at a tertiary hospital in Gujarat, India. Neonates receiving at least one therapeutic medication and meeting eligibility criteria were enrolled. Demographic, clinical data, prescribed medications, therapeutic classes, and antibiotic use were recorded. Prescribing practices were assessed using WHO indicators, and drugs classified via the WHO ATC system.

Results: A total of 302 neonates received 1581 prescribed medications, with an average of 5.23±2.93 drugs per encounter. Generic drugs made up 67.17%, and 79.32% of the medications were from the National List of Essential Medicines 2022. Antibiotics were prescribed in 85.10% of cases, and injections in all cases. Antibiotics represented the largest therapeutic category at 49.40%. The most frequently prescribed drugs were calcium gluconate (81.13%), piperacillin–tazobactam (73.51%), and gentamicin (66.89%). No significant differences were found between preterm and full-term neonates regarding the average number of medications, antibiotic use, or length of hospital stay.

Conclusions: The prescribing pattern reflected the clinical complexity of neonates requiring intensive care, with substantial use of antibiotics and supportive medications. Regular drug utilisation monitoring and antimicrobial stewardship may help promote rational and safe pharmacotherapy in NICUs.

Cost variation analysis of agents used to treat hyper pigmentation available in the Indian market

Neel S. Pandit, Kiran Bhave, Prasad Pandit, Radhika Mittal — Mon, 26 Oct 2026 00:00:00 +0530

Background: Hyperpigmentation is a condition in which patches of skin become darker in colour; usually treated by various topical, oral and injectable agents. Very few studies have been done to analyse their cost variation, despite a number of agents in various dosage forms being freely available in India. Thus, this study was designed to their compare cost ratio and percentage cost variation.

Methods: The maximum and minimum price of each brand of the agents used to treat hyperpigmentation, in INR per unit, was noted by using ‘CIMS’ 2023-24 issue, Indian Drug Review Triple I Compendium Issue 6 (2024)) and NPPA’s ‘Pharma Sahi Daam’ website. The cost ratio and percentage cost variation for individual drug brands was calculated and compared.

Results: A total of 520 brands (207 single and 313 combination-agent) were analysed, comprising a total of 109 formulations. Across all dosage forms, the percentage cost variation and cost ratio were maximum for injection glutathione 500mg and minimum for tranexamic acid 3% gel. For topical single-agent formulations, the highest cost ratio of 8.54 and variation of 753.93% were observed for hydroquinone 2% cream (7 brands). Among combination agents with known concentrations, hydroquinone + mometasone + tretinoin 2/0.1/0.025% cream (48 brands), showed the highest cost ratio and variation of 14.06 and 1305.52% respectively.

Conclusions: Out of total 109 formulations, 48 had cost variation of more than 100%. The prescribing physicians should be aware of this disparity in cost of the agents to reduce the economic burden of treatment.

Vasoactive-inotropic score as a predictor of mortality in neonatal shock: a prospective validation study in a sepsis dominant resource-limited setting

Sreya Mazumder, Suparna Chatterjee, Anindya Kumar Saha, Bijan Saha — Mon, 26 Oct 2026 00:00:00 +0530

Background: Shock is an important clinical entity in critically ill neonates. Vasopressors and inotropes are mainstay of therapy. There is paucity of good quality evidence regarding the outcome of vasopressors/inotropes in neonatal shock management from Indian setting. The objective was to evaluate the maximum vasoactive-inotropic score (VIS_max) an independent predictor of mortality and identify a high-risk threshold in a sepsis-dominant neonatal cohort.

Methods: This prospective study enrolled 107 neonates requiring vasoactive support in a tertiary level neonatal intensive care unit. VIS_max was calculated during the first 72 hours. Predictive accuracy was assessed via ROC analysis and multivariate logistic regression adjusting for birth weight and sepsis.

Results: Sepsis was the primary aetiology in 70.6% of non-survivors. Non-survivors required significantly higher support (median VIS_max 20 versus 10; p=0.002). A VIS_max≥20 yielded a PPV of 84.8% and specificity of 78.1% (AUC=0.690). Multivariate analysis identified Sepsis (aOR=3.965) and VIS_max (aOR=1.080) as independent predictors of death (p<0.01).

Conclusions: VIS_max≥20 is a critical bedside "red flag" for septic neonates, marking an 85% case fatality rate and providing a robust framework for prognostic counselling.

Perceptions and implementation gaps of elective modules under the CBME curriculum: a cross-sectional study among faculty and students

Nandini T., Farah Naaz Fathima, Sushma P. — Mon, 26 Oct 2026 00:00:00 +0530

Background: Electives are student-centered learning components within the competency-based medical education (CBME) curriculum, designed to enhance clinical competence, professional development and self-directed learning. Although well-established globally, electives are relatively new in the Indian medical education context. This study aimed to assess faculty and student knowledge, perceptions and experiences regarding elective rotations to identify implementation gaps and optimize their integration with evolving educational needs.

Methods: A cross-sectional observational study was conducted at a tertiary care teaching hospital in Tumkur, Karnataka, involving 165 Phase III Part II MBBS students and 60 faculty members. After Institutional Ethics Committee approval, data were collected using a pre-validated online questionnaire. Responses were analyzed using Microsoft Excel and JASP software.

Results: Faculty awareness of electives was high, with 100% awareness among preclinical/para-clinical faculty and 93.3% among clinical faculty. However, discrepancies were observed regarding scheduling, duration and compulsory block requirements. Student engagement was high, with 99.4% maintaining ≥75% attendance, 97.6% receiving preceptor guidance and 98.8% understanding learning objectives. Post-elective Likert scores exceeded 4.2 across all assessed domains including active participation (4.47), professional development (4.40), supervision (4.39) and perceived program benefit (4.40).

Conclusions: Electives were positively perceived by faculty and students and demonstrated potential to enhance professional development, clinical preparedness, active participation and reflective learning. Improved communication, structured faculty orientation, adequate resources and periodic program review in accordance with evolving NMC guidelines may facilitate uniform and effective integration of electives within the CBME framework.

A prospective, parallel group, interventional and open label study to evaluate the effect of probiotics on glycemic control in pre-diabetic patients

Anjalika Brar, Ajay Chhabra, Navyug Raj Singh — Mon, 26 Oct 2026 00:00:00 +0530

Background: Prediabetes represents an intermediate metabolic state characterized by impaired glucose tolerance and a high risk of progression to diabetes. With rising global burden of diabetes, early interventions are essential. Emerging evidence suggests that gut microbiota plays a significant role in metabolism and probiotics may offer a novel and safe therapeutic approach.

Methods: This prospective, parallel-group, interventional and open-label study was conducted on 70 prediabetic patients. Participants were divided into two groups: Group A received a probiotic capsule containing Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum and Saccharomyces boulardii (2.5 billion CFU) once daily along with diet control as per American Diabetes Association recommendations, while Group B was advised only diet control for 90 days. Fasting Plasma Glucose (FPG), 2-Hour Plasma Glucose (2HPG) and HbA1c were assessed as primary objectives along with Total cholesterol, LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), Serum Triglycerides, Body weight and BMI as secondary objectives. Safety was evaluated through monitoring of adverse events.

Results: Probiotic supplementation along with diet control resulted in statistically significant reduction in mean FPG (p=0.018) within group A. There was a statistically non-significant difference in change in FPG (p=0.28), 2HPG (p=0.48) and HbA1c (p=0.17) between group A and B. Statistically significant difference was seen in reduction in mean Total cholesterol (p=0.01), LDL-C (p=0.009), body weight (p=0.03) and BMI (p=0.03), increase in mean HDL - C (p=0.006) and a statistically non-significant difference in change in mean Triglyceride (p=0.17) levels between group A and B. The intervention was well tolerated, with minimal and non-serious adverse events reported.

Conclusions: Probiotic supplementation did not provide a significant additional benefit over diet control in improving glycemic parameters in prediabetic patients. However, it resulted in significant improvement in lipid profile, body weight and BMI. Both interventions were well tolerated with comparable safety profiles.

A randomised, prospective, parallel and open label study to compare efficacy and safety of single dose versus double dose intra-articular platelet rich plasma in patients of osteoarthritis knee

Samridhy Goklaney, Iqbal Singh Ghai, Gurpreet Kaur Randhawa, Kanwaljit Kaur — Mon, 26 Oct 2026 00:00:00 +0530

Background: Knee osteoarthritis (OA) is a leading cause of chronic pain, disability and impaired quality of life worldwide, with a rapidly increasing burden in the aging population. Conventional therapies primarily provide symptomatic relief and fail to alter disease progression. Platelet-rich plasma (PRP), an autologous biologic has emerged as a promising regenerative therapy. However, the optimal dosing strategy particularly the comparative efficacy of single versus multiple injections remains uncertain.

Methods: This randomized, prospective, parallel, open-label study evaluated 70 patients with Kellgren–Lawrence grade I–III knee OA at a tertiary care center in North India. Participants were randomized into two groups: Group A received a single intra-articular PRP injection (10 ml) while Group B received two PRP injections (10 ml each) administered three weeks apart. Patients were followed up at 21, 60 and 90 days. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Safety was monitored through adverse event reporting.

Results: Both groups demonstrated statistically significant improvements in VAS and WOMAC scores over the 90-day follow-up period (p<0.001). Double-dose PRP group showed greater reductions in VAS scores and superior improvement in WOMAC parameters compared to the single-dose group (p<0.001). PRP therapy was well tolerated with only minor and self-limiting adverse events.

Conclusion: Intra-articular PRP is a safe and effective treatment modality for knee OA. A double-dose regimen offers superior outcomes compared to a single-dose approach. These findings highlight the importance of dosing strategy in optimizing PRP therapy and support the use of repeated injections for improved patient outcomes.

Intravenous dexmedetomidine versus magnesium sulphate for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation in adults undergoing cardiac valve replacement surgery at a tertiary care hospital in Udaipur, Rajasthan

Mon, 26 Oct 2026 00:00:00 +0530

Background: Laryngoscopy and endotracheal intubation induce sympathetic activation (increased heart rate, blood pressure), which may be hazardous in patients undergoing cardiac valve replacement. This study aimed to compare intravenous dexmedetomidine (1 mcg/kg) and magnesium sulphate (20 mg/kg) in attenuating the hemodynamic response to laryngoscopy and intubation during elective cardiac valve replacement surgery.

Methods: This prospective, randomized, double-blind, parallel-group trial enrolled 66 adult patients (ASA II–III, aged 18–70 years) undergoing elective cardiac valve replacement surgery under general anaesthesia at a tertiary care centre. Patients were allocated to Group D (dexmedetomidine 1 mcg/kg, n =33) or Group M (magnesium sulphate 20 mg/kg, n =33), each infused over 10 minutes in 100 ml normal saline commencing 20 minutes before anticipated intubation. Haemodynamic parameters (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP]) were recorded at baseline, after drug infusion, after induction, and at 1, 3, 5, 8, 10, and 15 minutes following intubation.

Results: Following drug infusion, dexmedetomidine reduced HR (84.3 ± 4.5 to 78.2 ± 4.3 bpm), whereas magnesium sulphate was associated with a paradoxical mild increase (85.8 ± 5.3 to 87.4 ± 5.1bpm; p < 0.001 intergroup). At one-minute post-intubation, HR (99.4 ± 4.6 vs 104.5 ± 5.3 bpm), SBP (125.0 ± 5.7 vs 135.5 ± 6.2 mmHg), DBP (81.3 ± 3.9 vs 89.9 ± 4.0 mmHg), and MAP (95.9 ± 4.2 vs 105.1 ± 4.8 mmHg) were all significantly lower in Group D (p < 0.001 for all). These differences were sustained through 15 minutes.

Conclusions: Intravenous dexmedetomidine (1 mcg/kg) provides significantly superior attenuation of the haemodynamic response than magnesium sulphate 20 mg/kg in adults undergoing cardiac valve replacement surgery.

Pharmacovigilance in clinical practice: a retrospective observational study of spontaneously reported adverse drug reactions among patients at a tertiary care hospital

Giriraju Eswar Meher, Rashmi B. Kharde, Palak Agrawal, Rahul Kunkulol — Mon, 26 Oct 2026 00:00:00 +0530

Background: Adverse drug reactions continue to cause problems in day-to-day practice. They increase hospital stay, add to treatment cost, and sometimes can lead to significant morbidity. Pharmacovigilance helps in detecting, assessing, and preventing these reactions. In India, spontaneous reporting through VigiFlow under the Pharmacovigilance Programme of India (PvPI) is the main source of real-world safety data. We analysed all complete ADR reports received at our centre during the year 2023.

Methods: A total of 436 complete spontaneous ADR reports containing 907 reactions were reviewed. Reactions were coded using MedDRA system organ classes. Suspected drugs were coded using the WHO Drug Dictionary, and causality was assessed by the WHO-UMC scale. Only frequencies and percentages were calculated.

Results: Most reports came from adults (282, 64.7%) and elderly patients (123, 28.2%). Females accounted for 295 reports (67.7%). Paclitaxel was the most commonly suspected drug (66 reports), followed by cisplatin (30) and carboplatin (28). The intravenous route was responsible for 292 reports (67%). Gastrointestinal disorders formed the largest group (362 reactions, 39.9%), followed by nervous system (161, 17.8%) and skin disorders (152, 16.8%). The majority of the reactions were non-serious (95.6%) and had recovered (95.4%).

Conclusions: Adult female patients and anticancer drugs dominated the reports. Gastrointestinal, neurological and skin reactions were most frequent. Although most reactions were non-serious and recovered, the serious cases still highlight the need for continuous monitoring.

Assessment of renoprotective effect of Hygrophila auriculata (K. Schum) Heine against mercury-induced nephrotoxicity defects

M. P. Sridhar, Ramesh Venkatachalam, Arun Kumar Parthasarathy, K. Punnagai — Mon, 26 Oct 2026 00:00:00 +0530

Background: The therapeutic potential of Hygrophila auriculata (K. Schum) Heine (Syn. Astercantha longifolia) against mercury-induced nephrotoxicity in rats was investigated, specifically assessing its capacity to restore altered mercury-sensitive indices in urine and isolated renal brush-border membrane preparations.

Methods: Toxicity was induced in male Wistar albino rats by administering mercuric chloride (HgCl2) at 1 mg/kg body weight intraperitoneally three times a week for two weeks. Following mercury induction, rats were treated with an ethanolic extract of the whole plant of Hygrophila auriculata at 100 mg/kg body weight orally for 10 days to evaluate its protective/reparative effects on kidney weight changes, urinary constituents (urea, uric acid, creatinine, and protein), urinary enzyme activities (alkaline phosphatase, acid phosphatase, lactate dehydrogenase, N-acetyl-β-D-glucosaminidase, γ-glutamyl transferase, and β-D-glucuronidase), and isolated brush-border membrane enzymes.

Results: Mercuric chloride administration caused significant alterations in kidney weights, elevated levels of urinary constituents, and increased activities of urinary enzymes due to cellular damage. Conversely, mercury administration resulted in a decline in the activities of isolated brush-border enzymes. Post-treatment with the ethanolic extract of Hygrophila auriculata significantly ameliorated these toxic effects and successfully improved the altered parameters toward normal levels.

Conclusion: The post-treatment administration of Hygrophila auriculata demonstrates significant efficacy in protecting and maintaining renal integrity and functional parameters against mercury-induced nephrotoxicity in rats.

Temporal trends in mortality from diverticular disease of the intestine with septicemia stratified by demographics: a retrospective study

Vishakha, Supreeth Ramu Sunku, Swathi Dasineni — Mon, 26 Oct 2026 00:00:00 +0530

Background: Diverticular disease of the intestine is a major cause of mortality, and its association with septicemia remains underexplored. Understanding this relationship is essential to identify high-risk population and develop targeted public health interventions. The aim of the study is to analyze mortality trends and demographic disparities in diverticular disease of intestine with septicemia as a contributing cause using the CDC multiple causes of Death (MCD) database from 1999-2020.

Methods: A retrospective observational study was conducted using CDC MCD database to assess mortality trends in individuals aged 25 years and older in the United States From 1999-2000. The study included deaths where diverticular disease of intestine (ICD - 10: K57) was listed as the underlying cause and septicemia (ICD-10:A44) as a contributing cause. Data were analyzed by age, gender, race, geographic region, and place of death. Age- related mortality rates (AAMR) and annual percentage change (APC) were calculated.

Results: A total of 67310 Deaths were recorded. The AAMR for diverticular disease of intestine showed increase over time (APC). The highest mortality was observed in females, whites and temporal trends showed increase with disparities noted across demographic and geographic factors.

Conclusions: This study highlights significant mortality trends increasing in diverticular disease of intestine with septicemia, with disparities by gender, age and location. Findings underscore the need for targeted prevention strategies and improved healthcare success.

Pharmacoeconomic analysis of price disparities among anti-alzheimer drug brands in the Indian market

Pankaj U. Mahadkar, Pratik S. Rane, Samruddhi S. Vichare — Mon, 26 Oct 2026 00:00:00 +0530

Background: Alzheimer’s disease (AD) is a leading cause of dementia, with a rapidly increasing burden in India. Although pharmacotherapy can halt disease development, treatment is mostly out-of-pocket, making drug affordability a key concern. Wide pricing disparities between branded generics may further impede access and adherence. The study objective of this study was to evaluate inter-brand cost variation among anti-Alzheimer drugs available in the Indian pharmaceutical market.

Methods: A cross-sectional pharmacoeconomic analysis was conducted by using the data obtained from the Current Index of Medical Specialties (CIMS) and MIMS website. Commonly prescribed drugs such as donepezil, rivastigmine, memantine, and their combinations were analyzed. Cost ratio and percentage of cost variation were calculated for each formulation.

Results: Prices varied significantly across all medicines. Rivastigmine displayed the most fluctuation, especially in 1.5 mg capsules (1634.13%; price ratio 17.34). Memantine 10 mg pills varied by 364.72%, whilst donepezil exhibited a lower but still considerable variance, with a maximum of 120.44%. Fixed-dose combinations showed moderate variability, with the largest being donepezil 5 mg plus memantine 5 mg (117.44%). Substantial discrepancies between the top and lowest expensive brands emphasize the possibility of cost savings.

Conclusion: Significant inter-brand price disparities exist among anti-Alzheimer medications in India, with rivastigmine showing the highest variability, followed by memantine and donepezil. Promoting cost-conscious prescribing and the use of lower-priced, bioequivalent alternatives could reduce economic burden and improve treatment continuity in patients with AD.

Efficacy and safety of Koff-N-Cold tablets in patients with allergic rhinitis or seasonal cough and cold: a prospective, randomized, open label, two-arm clinical trial

Tahira H. S., Gangothri S. Kumar, Ashok Godavarthi, Suda Amarnath Reddy — Mon, 26 Oct 2026 00:00:00 +0530

Background: Koff-N-Cold is a proprietary polyherbal formulation developed to target both allergic and anti-inflammatory conditions. The objective of this study is to evaluate the efficacy and safety of Koff-N-Cold tablets compared with standard antihistamine therapy in adults with allergic rhinitis or seasonal cough and cold.

Methods: This study is a prospective, randomized, open-label, two-arm clinical trial. Sixty adult subjects (18-65 years) with allergic rhinitis or seasonal cough and cold were randomized in a 1:1 ratio to receive standard therapy [combination of levocetirizine (5 mg) and phenylephrine (5 mg)] for 5 days and Koff-N-Cold tablets for up to 10 days. Efficacy was assessed using symptom severity questionnaires and allergen-specific and anti-inflammatory biomarkers such as serum immunoglobulin E (IgE) and C-reactive protein (CRP) at baseline and Day 10. Safety was evaluated through adverse event monitoring, vital signs, and hematological parameters.

Results: Both treatment groups showed significant improvement in symptom scores from baseline to Day 10. The Koff-N-Cold group showed marked reduction in total symptom scores, serum IgE, and CRP levels by Day 10, therefore achieving improvements greater than the standard levocetirizine and phenylephrine. No adverse events or clinically significant laboratory abnormalities were reported in either group.

Conclusions: Koff-N-Cold tablets were safe and effective in reducing symptoms and inflammatory markers associated with allergic rhinitis and seasonal cough and cold. The findings support Koff-N-Cold as a well-tolerated, evidence-based herbal alternative to conventional antihistamine therapy.

Trial registration: Trial registration number: CTRI/2025/07/092048

PCSK9 rs11591147 polymorphism and response to atorvastatin in patients with type 2 diabetes mellitus and/or hypertension

Smita Tripathi, Ghan Shyam Pangtey, Animesh Ray, Subhradip Karmakar — Mon, 26 Oct 2026 00:00:00 +0530

Background: The loss-of-function (LOF) variant rs11591147 of PCSK9 reduces PCSK9 activity and is expected to lower low-density lipoprotein cholesterol (LDL-C) and improve the response to statins, meaning a greater LDL-C reduction. However, studies are few and inconsistent. This study explored the association of the LOF variant with baseline lipid levels and the response to atorvastatin in statin-naïve patients.

Methods: Eligible patients with type 2 diabetes mellitus and/or hypertension from two tertiary care hospitals in Delhi (n=260) received atorvastatin for 10–12 weeks. The PCSK9 rs11591147 polymorphism was studied by PCR-restriction fragment length polymorphism (PCR-RFLP) and the lipid profile, including LDL-C, was measured before and after treatment.

Results: The frequency of the LOF T allele was 16.5%, with genotype frequencies of GG 66.9%, GT 33.1% and TT 0%. Baseline LDL-C was similar in both groups (GG 136.04±43.89 vs. GT 134.79±41.38 mg/dl; p=0.813), as was the percentage fall in LDL-C after atorvastatin (GG 28.7% vs. GT 26.9%; p=0.386). Genotype distribution deviated from Hardy–Weinberg equilibrium (p=0.001).

Conclusions: In this North Indian cohort, the LOF T allele was not associated with baseline LDL-C or with the response to atorvastatin. Larger studies, including TT homozygotes, are needed to confirm these findings.

General anaesthesia with propofol versus etomidate and cognitive dysfunction in the immediate postoperative period: a randomized double-blind study

Malvika Patil, Naresh Tirpude — Mon, 26 Oct 2026 00:00:00 +0530

Background: Propofol and etomidate are commonly used intravenous induction agents for general anaesthesia (GA), but comparative data on postoperative cognitive dysfunction (POCD) alongside haemodynamic and adverse-effect profiles are limited. This study compared propofol and etomidate with respect to POCD, haemodynamic stability, and adverse effects.

Methods: In this prospective, randomized, double-blind, parallel-group trial, 80 ASA I-II patients aged 18-40 years undergoing short elective surgery (dilation and curettage, or fracture reduction/fixation) under GA were randomized 1:1 to propofol 1 mg/kg (Group P, n=40) or etomidate 0.3 mg/kg (Group E, n=40) for induction. Cognitive function was assessed preoperatively and at 30, 60 and 120 minutes postoperatively using the Tirpude GMC-OMC score. Vitals were recorded intraoperatively (0-20 min) and postoperatively (0-60 min), and adverse effects were noted. Data were analysed using SPSS, with between-group differences and 95% confidence intervals reported; P<0.05 was considered significant.

Results: All 80 randomized patients were analysed. Baseline characteristics were comparable between groups. Tirpude GMC-OMC scores did not differ significantly between groups at any time point (p>0.05). Intraoperative vitals were significantly more stable in Group E than Group P at most time points (p<0.05). Hypotension was significantly more frequent in Group P (p=0.01); nausea and vomiting were more frequent, though not significantly, in Group E.

Conclusions: Propofol and etomidate produced comparable, clinically insignificant postoperative cognitive change in young, healthy patients undergoing short elective surgery. Etomidate offered superior intraoperative haemodynamic stability and less hypotension, while propofol was associated with less postoperative nausea and vomiting.

A descriptive study on drug prescription pattern among preoperative and postoperative inpatients in Department of General Surgery at SMS hospital, Jaipur

Mon, 26 Oct 2026 00:00:00 +0530

Background: Perioperative pharmacotherapy plays an important role in preventing complications, relieving pain, controlling infection, and supporting recovery after surgery. Evaluation of prescribing patterns using World Health Organization (WHO) core prescribing indicators can identify areas for improving rational and cost-effective medicine use. Aim was to evaluate the drug prescription pattern among preoperative and postoperative inpatients in the Department of General Surgery at SMS Hospital, Jaipur.

Methods: A hospital-based observational study was conducted among 322 adult surgical inpatients at SMS Hospital, Jaipur, over one year from September 2024 to August 2025. Prescription data were assessed during the preoperative period and on the second postoperative day. Drug utilization was evaluated using WHO core prescribing indicators and the National List of Essential Medicines (NLEM) 2022. Data were entered into Microsoft excel and summarized using means, standard deviations, frequencies, percentages, tables, and graphs; a p<0.05 was considered statistically significant where applicable.

Results: Among 322 patients, the mean number of drugs per encounter increased from 6.33±1.17 preoperatively to 7.61±1.47 postoperatively. The proportion of drugs prescribed by generic name decreased from 77.84-68.80%. Proportion of encounters with antimicrobials increased from 98.45% to 100%, while injections were prescribed in 100% of encounters during both periods. Prescribing from NLEM 2022 98.82% preoperatively and 93.84% postoperatively.

Conclusions: Drug utilization increased after surgery, with frequent use of analgesics, antimicrobials, gastrointestinal protective agents, and intravenous fluids. Prescribing from the NLEM 2022 remained high; however, the lower proportion of generic prescribing postoperatively and extensive antimicrobial and injection use indicate areas where prescribing practices and antimicrobial stewardship could be further strengthened.

Assessment and evaluation of rational use of antibiotics in pediatric population at a tertiary care hospital

Kasa Kavya Dharani, Banjara Raju Prabhudev, Balakeshwa Ramaiah — Mon, 26 Oct 2026 00:00:00 +0530

Background: Rational antibiotic use in paediatric patients is essential to optimize treatment outcomes and minimize adverse effects. Inappropriate prescribing may result in treatment failure, toxicity, and antimicrobial resistance.

The objectives are to assess antibiotic prescribing patterns, evaluate appropriateness, describe culture and susceptibility findings, and assess antibiotic optimization among paediatric inpatients in a tertiary care hospital.

Methods: A prospective observational study was conducted among 250 paediatric inpatients aged below 18 years who received at least one systemic antibiotic for suspected or confirmed infection. Data were collected from case notes, medication charts, and laboratory reports. Appropriateness was assessed according to the hospital antibiotic policy, and culture and susceptibility results were reviewed.

Results: Toddlers (39.2%) and children (36.4%) constituted the largest age groups, while males accounted for 53.6% of participants. Respiratory tract infections were the predominant indication (44.7%). Among 414 antibiotics prescribed, ceftriaxone (28.5%), azithromycin (18.8%), and amoxicillin-clavulanate (17.1%) were most frequently used. Intravenous administration accounted for 71.49% of prescriptions. Overall, 98% of prescriptions were appropriate, 0.8% inappropriate, and 1.2% not assessable. Watch antibiotics constituted 64% of use. Four mild, probable adverse drug reactions were reported. Escherichia coli was the most frequently isolated organism, with 91.3% susceptibility to imipenem.

Conclusions: Antibiotic prescribing was generally appropriate; however, the high use of Watch antibiotics emphasizes regular prescription review, culture-guided therapy, adherence to hospital guidelines, and continued antimicrobial stewardship.

Assessment of neuropharmacological effects of ethanolic leaf extract of Pergularia daemia in migraine induced rat

R. Abinaya, V. Charumathi, B. Kalaivani, S. Lokeshwari, A. Sandhiya — Mon, 26 Oct 2026 00:00:00 +0530

Background: Migraine is a common neurological disorder. Pergularia daemia has reported anti-inflammatory and analgesic properties. We evaluated the neuropharmacological effects of its ethanolic leaf extract (EEPD) in nitroglycerin (NTG)-induced migraine in rats.

Methods: Leaves were extracted with ethanol (Soxhlet), screened phytochemically and analysed by GC-MS. Thirty male Wistar rats formed five groups: normal control; disease control (NTG 10 mg/kg I.P., days 1, 4, 7, 10, 13); sumatriptan 1 mg/kg I.P.; and EEPD 200 or 400 mg/kg P.O. for 14 days plus NTG. Migraine-like behaviour was scored (maximum 16), brain nitrite was estimated with Griess reagent, and hippocampal histology was examined. Scores were analysed by ANOVA with Dunnett's test.

Results: Yield was 28.78% w/w. Alkaloids, flavonoids, phenolics, tannins, steroids, carbohydrates and anthraquinone glycosides were detected; GC-MS tentatively identified 15 compounds, chiefly 3-O-acetyl-6-methoxy-cycloartenol (38.3% of area). The behavioural score was 9.40±0.24 in disease control versus 2.40±0.24 in normal control (p<0.0001), and 3.60±0.40 with sumatriptan, 2.80±0.49 and 2.60±0.24 with EEPD 200 and 400 mg/kg (all p<0.0001 versus disease control). Brain nitrite fell by 61% (sumatriptan), 26% and 29% (EEPD 200 and 400 mg/kg), although most values exceeded the calibration range and are qualitative. Disease-control hippocampus showed neuronal loss and degeneration; treated groups appeared normal.

Conclusions: EEPD attenuated NTG-induced behavioural changes, brain nitrite elevation and hippocampal alterations in rats, supporting further mechanistic evaluation as an anti-migraine candidate.

Bioavailable curcumin (CurcuBoost®) as an adjunct therapy for liver dysfunction: a randomized controlled study

Deepti Gupta, Devesh Kumar — Mon, 26 Oct 2026 00:00:00 +0530

Background: Chronic liver dysfunction is associated with persistent liver enzyme elevations, hepatocellular injury and impaired quality of life. Curcumin has demonstrated hepatoprotective properties. This study aimed to evaluate the efficacy, safety and tolerability of CurcuBoost®, a bioavailable curcumin formulation, as an adjunct to standard of care (SOC) in adults with deranged liver function.

Methods: In this randomized, open-label, parallel-group trial, 50 adults with biochemical evidence of liver dysfunction were randomized (1:1) to CurcuBoost® (500 mg orally) plus SOC or SOC alone for 12 weeks. The primary endpoint was change in serum liver enzymes from baseline to Week 12. Secondary endpoints included changes in liver disease quality of life (LDQOL) scores and safety outcomes. Analyses used a modified intention-to-treat approach with ANCOVA.

Results: All 50 participants completed the study. Compared with SOC alone (n=25), CurcuBoost® plus SOC (n=25) produced greater reductions in alanine aminotransferase (−109.72 vs −93.39 IU/l; p=0.0012), aspartate aminotransferase (−107.07 vs −86.81 IU/l; p=0.0001), alkaline phosphatase (−354.42 vs −311.75 IU/l; p<0.0001) and gamma-glutamyl transferase (−44.46 vs −38.78 IU/l; p=0.0364) at Week 12. Total bilirubin also decreased significantly more with CurcuBoost® (p=0.0008), while renal function remained stable. LDQOL scores improved in both groups, with greater improvement in the CurcuBoost® plus SOC group (p<0.0001). No serious adverse events were reported.

Conclusions: Adjunctive treatment with CurcuBoost® significantly improved liver enzyme profiles and liver-related quality of life compared with standard of care alone, with an excellent safety profile.

Evaluation of systemic immune-inflammation index in young patients with coronary artery disease: association with glycaemic status

Rishitha Bygari, Shibi Mary Thomas, Balakeshwa Ramaiah — Mon, 26 Oct 2026 00:00:00 +0530

Background: Coronary artery disease (CAD) in young adults is an important health concern, particularly in India. The Systemic Immune-Inflammation Index (SII) is a composite inflammatory marker derived from platelet, neutrophil and lymphocyte counts. However, limited information is available regarding its relationship with glycaemic status in young patients with CAD. To assess the association of Systemic Immune-Inflammation Index (SII) with glycaemic status and evaluate cardiovascular risk factors, comorbidities, clinical, laboratory, biochemical and angiographic characteristics in young patients with coronary artery disease.

Methods: A prospective observational study was conducted among 80 patients aged 18–45 years with CAD admitted to the Coronary Care Unit of Bangalore Baptist Hospital, Bangalore, during 2025. Demographic, clinical, laboratory, echocardiographic and angiographic data were collected. SII was calculated as platelet count × neutrophil count / lymphocyte count. Patients were grouped according to SII level and glycaemic status and the groups were compared using appropriate statistical tests.

Results: The mean age was 38.6±3.6 years, with males accounting for 87.5% of participants. Smoking (53.8%), diabetes (43.8%) and hypertension (36.3%) were the most common cardiovascular risk factors. The mean SII was 1049±881. Significant differences between the SII and glycaemic groups were observed for age (p=0.039), dyslipidaemia (p=0.006), HbA1c (p<0.00001), platelet count (p=0.0003), neutrophil count (p<0.00001) and lymphocyte count (p<0.00001). Angiographic disease extent did not differ significantly between the groups (p=0.379).

Conclusions: SII showed significant differences according to glycaemic status, particularly in relation to HbA1c and its cellular components. SII may provide additional information regarding systemic inflammation in young patients with CAD.

Pattern of adverse drug reactions reported through VigiFlow at a tertiary care teaching hospital in North India: a retrospective analysis

Veena Verma, Anugya Kushwaha, Preeta Kaur Chugh, Himanshu Singh Saini — Mon, 26 Oct 2026 00:00:00 +0530

Background: To analyse adverse drug reactions (ADRs) reported to the VMMC & Safdarjung Hospital, New Delhi, entered into VigiFlow analysing causality, severity, preventability and outcome.

Methods: Individual case safety reports (ICSRs) entered into VigiFlow from March 2021 to March 2026 were retrospectively reviewed. Reports lacking a documented suspect drug and reaction term were excluded as incomplete. Complete reports were analysed for demographics, system organ class (SOC), suspect drug classes, causality (WHO-UMC and Naranjo scales), severity (Modified Hartwig and Siegel scale), preventability (Schumock and Thornton criteria) and outcome.

Results: Of 974 ICSRs, 925 (95.0%) were evaluable. Mean age was 38.9±17.6 years; 54.2% were male. Gastrointestinal (27.4%), skin/subcutaneous (25.1%) and general/administration-site disorders (20.1%) were most affected. Antimicrobials (24.0%), antineoplastics (13.1%) and cardiovascular drugs (11.4%) were leading suspect classes. WHO-UMC causality was probable/likely (73.4%) or possible (25.7%), with similar Naranjo findings. Reactions were mostly mild (63.4%) or moderate (29.8%); 6.8% were severe and 8 (0.9%) fatal, six linked to antineoplastic chemotherapy. Preventability was noted in 88.6%; recovery was documented in 44.6%.

Conclusions: Antimicrobials, antineoplastics and cardiovascular drugs predominated among ADRs, most being probable, mild-to-moderate and preventable. Strengthening dose monitoring, allergy screening, drug-interaction checks and ICSR completeness may reduce ADR burden, especially in oncology and radiocontrast use.

Knowledge, attitude and practise of self-medication among MBBS and nursing undergraduate students: a comparative cross-sectional study

Sukhmeen Kaur Johar, Shruti Chandra, Deepali Jaybhaye, Sehej Kaur Johar — Mon, 26 Oct 2026 00:00:00 +0530

Background: Self-medication is a common practise among health care students. But comparative studies evaluating knowledge, attitude and practises (KAP) between different academic streams are limited. Hence, the presence study aimed to compare the prevalence and existing self-medication behaviour between medical and nursing students.

Methods: A 3- month comparative cross-sectional study was conducted across 213 students (107 MBBS and 105 Nursing). Self-administered digital questionnaire was utilized to collect data regarding socio- demographic details and KAP domains. SPSS version 26 was utilized to analyse data, employing Chi Square and Student T test, with p<0.05 considered significant.

Results: The overall prevalence of SM was found to be 81.60%, with no significant difference between the two academic streams (MBBS 82.24% vs Nursing 80.95%; p=0.81). MBBS students demonstrated significantly higher knowledge (81.31% vs 55.24%; p<0.001) and positive attitude (85.05% vs 69.52%; p=0.011) as compared to nursing students. However, the adequate practises were low across both the groups (MBBS: 19.63% Nursing: 14.29%; p=0.394), highlighting a notable knowledge- practise gap. Although headache was the most common indication reported in both the streams, MBBS students significantly self-medicated for fever and respiratory problems using their academic knowledge and evidence-based databases. On the contrary, nursing students self-medicated majorly for gastro-intestinal problems driven by financial constraints, easy availability of medicines without prescription and consultation with pharmacists or old prescriptions. Digital platforms were extensively used by both the groups. Unsafe practises such as prescription sharing, ignoring package instructions, failure to check expiry dates and premature cessation of treatment were more prevalent among nursing students.

Conclusions: Self-medication practices were prevalent in both the academic streams. This warrants need of incorporating educational programs related to safe self-medication practices, rational pharmacotherapy, pharmacovigilance and anti-microbial stewardship in undergraduate curricula of healthcare students.

A comparative evaluation of antimicrobial efficacy of extracts of Rosa Indica, Jasminum grandiflorum L and Hibiscus rosa-sinensis L against Streptococcus Mutans, Lactobacillus acidophilus and Staphylococcus aureus: an in vitro study

Lilly B. K., Prashant G. M., Alwin Antony, Mohammed Subhan I., Mahalakshmi A. C. — Mon, 26 Oct 2026 00:00:00 +0530

Background: Early humans were driven to explore their immediate natural surroundings for remedies to relieve pain and discomfort by using many plants and animal products. Despite advances in medicine, plants play a vital role in contributing to health care. However, scientific knowledge of the antimicrobial properties of plant species may contribute to the development of drugs against microorganisms of medical interest, particularly in dentistry. Aim was to evaluate the antimicrobial efficacy of Jasmine, Hibiscus and Rose leaf extracts on oral microorganisms versus the gold standard, Chlorhexidine.

Methods: Ethanol extracts prepared from Jasmine, Hibiscus, and Rose leaves were screened for antimicrobial activity against S. mutans, L. acidophilus, and S. aureus using the agar well diffusion method. The minimum inhibitory concentration (MIC) was determined for the test organisms. Statistical analysis was performed with one-way analysis of variance (ANOVA) followed by post hoc and Kruskal-Wallis tests.

Results: At low concentration, 0.2% chlorhexidine (5 μg/ml) showed the maximum zone of inhibition, followed by Rose, Jasmine, and Hibiscus leaves. Rose leaves (10 μg/ml, 25 μg/ml, 50 μg/ml, 75 μg/ml) showed the maximum zone of inhibition, followed by 0.2% chlorhexidine, hibiscus, and jasmine leaves against S. aureus. Extracts were found to have statistically significant (p≤0.05) antimicrobial activity against S. mutans and S. aureus with MIC values of 0.2 μg/ml and 3.125 μg/ml respectively. Whereas no significant value was seen against L. acidophilus. A proportional increase in their antimicrobial activity (zone of inhibition) was observed.

Conclusions: Chlorhexidine continues to remain as the gold standard; however, a highly significant difference was noted between the groups. Thus, confirming the presence of active constituents in medicinal plants.

An audit of outpatient prescriptions in a tertiary care center of eastern Uttar Pradesh: a cross-sectional study

Mon, 26 Oct 2026 00:00:00 +0530

Background: Prescription audits are essential for evaluating prescription writing practices, ensuring rational drug use, minimizing errors, and improving patient safety. This study assesses the quality of prescriptions in the outpatient departments (OPDs) of a tertiary care center in Eastern Uttar Pradesh based on WHO guidelines and NABH recommendations.

Methods: A cross-sectional observational study was conducted between August and October 2024 across 10 clinical OPDs, analyzing 1000 prescriptions (100 per department). Prescriptions were evaluated for legibility, completeness, patient follow-up and referral documentation. Data collection was performed using a WHO-based checklist and analyzed using descriptive statistics.

Results: While 100% of prescriptions included patient identifiers, only 18% were legibly written, and 30% had proper prescriber identification. Generic prescribing was low (21%), with a majority of prescriptions using brand names. Allergy status was documented in only 10% of prescriptions, raising patient safety concerns. Follow-up instructions were missing in 41% of prescriptions, and medications were not numbered in any prescription, potentially increasing the risk of errors. Senior residents showed better compliance in prescriber identification, but consultants provided more definitive diagnoses and follow-up instructions.

Conclusions: While basic documentation standards were maintained, deficiencies in legibility, prescriber identification, generic prescribing, allergy documentation, and medication numbering highlight areas for improvement. Strengthening prescriber training, enforcing structured prescription templates, conducting regular audits, and implementing digital prescribing systems can significantly improve prescription quality and patient safety.

Assessment of knowledge and awareness of antibiotic use and antimicrobial resistance among the general population: a cross-sectional study in Pathanamthitta district, Kerala

Vani Devi S — Mon, 26 Oct 2026 00:00:00 +0530

Background: Antimicrobial resistance (AMR) is a mounting global health threat predominantly driven by inappropriate antibiotic use. Purpose of the study was to determine the existing knowledge and awareness of the individuals about antibiotic usage and AMR and how an educational intervention is effective in increasing the level of knowledge.

Methods: This cross-sectional study was conducted among 500 adults aged between 18 and 60 in Pathanamthitta district, Kerala. A structured questionnaire adapted from WHO guidelines was used to assess knowledge. Baseline knowledge was evaluated, followed by an educational intervention and immediate post-intervention reassessment.

Results: Initial results revealed moderate understanding: 45.80% correctly identified antibiotics as effective only against bacterial infections, 92.20% recognized the necessity of prescriptions, and 36.40% correctly defined AMR. Post-intervention, knowledge significantly improved across all parameters, with 100% recognizing appropriate antibiotic use and 97.40% understanding AMR. Awareness of causes and consequences of AMR, antibiotic side effects, and transmission routes also showed marked enhancement.

Conclusions: The study revealed considerable knowledge gaps among the study population of adults regarding use of antibiotics and AMR. Educational interventions specifically directed at individuals are very effective in improving knowledge and awareness, thus supporting antibiotic stewardship efforts to combat AMR.

Domperidone-induced galactorrhea and abnormal uterine bleeding: a case report with review of clinical implications

Damian Maruba, Cesilia Charles — Mon, 26 Oct 2026 00:00:00 +0530

Domperidone is a peripheral dopamine (D2) receptor antagonist that is widely prescribed for gastrointestinal symptoms and is often used as an over-the-counter drug. It can cause galactorrhoea through drug-induced hyperprolactinemia, an adverse effect that remains underrecognized in clinical practice. A 36-year-old multiparous woman was prescribed domperidone 10 mg twice daily for four weeks, together with pantoprazole, for gastro-oesophageal reflux disease. While responding well to treatment, she developed bilateral galactorrhoea on day 7 and abnormal uterine bleeding on day 21 of therapy. Serum prolactin was elevated (86.37 ng/ml), with reduced follicle-stimulating hormone (1.56 mIU/l), and pregnancy, thyroid dysfunction, and structural pelvic pathology were excluded. Domperidone-induced hyperprolactinaemia was diagnosed, and the drug was discontinued. Galactorrhoea resolved after 14 days and abnormal uterine bleeding after 23 days, with normalization of prolactin and follicle-stimulating hormone on repeat testing. Domperidone-induced hyperprolactinaemia should be considered in women presenting with galactorrhoea and menstrual disturbance, particularly abnormal uterine bleeding, which has not been well documented as a concurrent manifestation. Prompt recognition and drug discontinuation led to complete clinical and biochemical resolution, underscoring the need for thorough medication history-taking and patient counselling when prescribing domperidone.

Chemotherapy induced toxic erythema mimicking toxic epidermal necrolysis: a case report

Neerja Puri, Harmandeep Kaur Aulakh, Sumir Kumar — Mon, 26 Oct 2026 00:00:00 +0530

Toxic erythema of chemotherapy (TEC) refers to a variety of skin eruptions secondary to the use of antineoplastic drugs. We report a case of 49-year-old female, diagnosed case of right- side Ca breast, on chemotherapy for 3 months after MRM, who presented with gradually progressive skin rash on bilateral dorsa of hands, forearms, neck folds, bilateral axilla, groins, perianal area and buttocks with pain and burning sensation on lesions. Sloughed skin, denudation, and ruptured bullae generate a broad range of differential diagnoses, including toxic epidermal necrolysis (TEN), PNP and acute GVHD. Topical corticosteroids applied two to three times daily for several weeks can be beneficial in treating affected areas in TEC along with dose reduction of offending agent, extending the interval between treatment cycles, or discontinuing the offending chemotherapeutic agent.

Disseminated tuberculosis with central nervous system involvement in a patient with chronic myeloid leukaemia receiving dasatinib: cytochrome P450 3A4-mediated drug interaction and multifactorial cytopenia

Mon, 26 Oct 2026 00:00:00 +0530

Concurrent chronic myeloid leukaemia (CML) and tuberculosis presents substantial management challenges when tyrosine kinase inhibitor therapy must be combined with rifampicin-based anti-tubercular treatment. Rifampicin, a potent inducer of cytochrome P450 3A4 (CYP3A4) and P-glycoprotein, reduces the maximum plasma concentration (C_max) and area under the concentration-time curve (AUC) of dasatinib by 81% and 82%, respectively, potentially compromising molecular disease control. We report a 27-year-old man with BCR::ABL1-positive CML in chronic phase, previously in complete cytogenetic and major molecular response on dasatinib 100 mg daily, who presented with generalised tonic-clonic seizures. Magnetic resonance imaging of the brain showed multiple ring-enhancing lesions with leptomeningeal enhancement and vasculitic infarcts. A clinical diagnosis of disseminated tuberculosis with central nervous system involvement was made and treated empirically; the documented findings met, at most, the “possible” category of the Marais consensus case definition for tuberculous meningitis. Rifampicin-containing anti-tubercular therapy was started and dasatinib was escalated to 140 mg daily. Approximately three and a half months later he was readmitted with severe thrombocytopenia (nadir 10.0×10³/µl), a rising leukocyte count (53.3×10³/µl) and life-threatening hypercalcaemia (corrected serum calcium 17.0 mg/dl). Dasatinib was withheld and intensive supportive care was given, after which he was discharged for outpatient follow-up; outcome data beyond discharge were not available. This case illustrates the pharmacokinetic conflict between dasatinib and rifampicin and its clinical consequences when dose escalation within the approved range proves insufficient. Rifabutin substitution, rifampicin-free anti-tubercular regimens, asciminib and therapeutic drug monitoring (TDM) of dasatinib are discussed as management strategies, although none has been validated in this clinical scenario.

An uncommon triad of toxicity: sinus bradycardia, cytopenia and gastrointestinal symptoms induced by thalidomide

Harshitha Sannidhanam, G. Anantha Lakshmi, Badugula Chethana Reddy — Mon, 26 Oct 2026 00:00:00 +0530

Thalidomide, an immunomodulatory and antiangiogenic agent, is widely used in oncology but rarely causes cardiac conduction abnormalities such as sinus bradycardia. Chemotherapy with temozolomide may also result in cytopenia. Early recognition of these adverse effects is critical for patient safety. We report a 50-year-old female with malignant melanoma undergoing chemotherapy with thalidomide (400 mg/day) and temozolomide (150 mg/day) who presented with persistent nausea, recurrent vomiting, generalized weakness, and bradycardia. On admission, vital signs revealed sinus bradycardia (heart rate 40 beats/min) with prolonged QTc, and laboratory findings demonstrated mild anemia, leukopenia, neutropenia, thrombocytopenia, hyponatremia, and borderline hyperkalemia. Imaging and echocardiography were largely unremarkable except for mild tricuspid regurgitation and pulmonary hypertension. A diagnosis of thalidomide-induced bradycardia with chemotherapy-associated cytopenia was established. Thalidomide was discontinued, and the patient received supportive care including intravenous fluids, electrolyte correction, antiemetics, corticosteroids, thyroid hormone replacement, and cardiac monitoring. Atropine was administered for bradycardia as needed. Over 48 hours, the patient’s symptoms and laboratory abnormalities improved, with stabilization of heart rate and resolution of vomiting. This case highlights a rare but significant manifestation of thalidomide-induced sinus bradycardia with cytopenia and gastrointestinal symptoms in a patient receiving chemotherapy for malignant melanoma. Early recognition, prompt drug withdrawal, and comprehensive supportive care were crucial for recovery. Clinicians should remain vigilant for uncommon cardiac and hematologic adverse effects of thalidomide and coordinate multidisciplinary management to optimize patient outcomes.