International Journal of Basic & Clinical Pharmacology

Association of empagliflozin treatment with changes in the metabolic score for insulin resistance in Iraqi adults with type 2 diabetes: a 6-month prospective cohort study

Rawnaq Adil Aladhab — Wed, 05 Aug 2026 00:00:00 +0530

Background: The metabolic score for insulin resistance (METS-IR) is an insulin-free surrogate that combines fasting plasma glucose, triglycerides, body mass index, and high-density lipoprotein cholesterol. Evidence on its responsiveness to sodium-glucose cotransporter 2 (SGLT2) inhibition is limited.

Methods: In this 6-month prospective observational cohort study, 124 adults with type 2 diabetes were enrolled at Al-Yarmouk Teaching Hospital, Baghdad. Empagliflozin 10 mg/day was added to usual oral therapy in 62 patients according to routine prescribing and patient preference; 62 continued therapies without an SGLT2 inhibitor or glucagon-like peptide-1 receptor agonist. Complete-case analyses included 58 and 56 participants, respectively. The primary outcome was the between-group difference in change in METS-IR.

Results: At 6 months, mean METS-IR decreased from 48.6±6.2 to 42.8±5.8 in the empagliflozin group and from 49.1±6.5 to 48.5±6.4 in controls. The reported adjusted between-group difference was −5.42 points (95% CI −6.81 to −4.03; p<0.001). Empagliflozin exposure was also associated with larger reductions in HbA1c, body weight, body mass index, and triglycerides and a larger increase in HDL cholesterol. Within the empagliflozin group, change in METS-IR correlated with changes in HbA1c (r=0.48), triglycerides (r=0.41), and body mass index (r=0.35), but not fasting plasma glucose (r=0.18).

Conclusions: Empagliflozin initiation was associated with a clinically and statistically larger reduction in METS-IR over 6 months than continued non-SGLT2 therapy. Because METS-IR contains several treatment-responsive components and treatment allocation was nonrandom, the findings should be interpreted as evidence of metabolic improvement rather than direct proof of enhanced insulin sensitivity.

Prevalence of hypertension and its association with obesity and socio-demographic factors among adults attending a tertiary care hospital in Bangladesh: a cross-sectional study

Mon, 24 Aug 2026 00:00:00 +0530

Background: Hypertension is a major non-communicable disease and a leading risk factor for cardiovascular morbidity and mortality worldwide. Obesity is a well-established modifiable risk factor for hypertension, yet hospital-based evidence from Bangladesh remains limited. This study aimed to determine the prevalence of hypertension and its association with obesity and socio-demographic factors among adults attending a tertiary care hospital.

Methods: A facility-based cross-sectional study was conducted among 340 adults attending a tertiary care hospital in Bangladesh. Participants were selected using simple random sampling. Data were collected through a structured questionnaire, along with anthropometric measurements and blood pressure assessment. Data were analyzed using SPSS version 26. Chi-square test and multivariable logistic regression were performed and p < 0.05 was considered statistically significant.

Results: The prevalence of hypertension was 27.4%. A significant association was observed between BMI and hypertension (p=0.004). Participants aged >45 years had higher odds of hypertension (AOR=2.05, 95% CI: 1.20–3.50). Obesity was a strong independent predictor of hypertension (AOR=2.60, 95% CI: 1.50–4.50). Physical inactivity was also significantly associated with hypertension (AOR=1.60, 95% CI: 1.00–2.50). No significant association was found with gender, residence or religion.

Conclusions: Hypertension is highly prevalent among adults attending tertiary care hospitals in Bangladesh and is significantly associated with obesity, older age and physical inactivity. Early screening and lifestyle modification strategies are essential to reduce the burden of hypertension.

Comparative study of oral iron and intravenous iron sucrose in the management of iron deficiency anemia during pregnancy

Jyothi Dammur Basavaraj, Yeresime Surekha, Ajaykumar Rathod — Thu, 16 Jul 2026 00:00:00 +0530

Background: Iron deficiency anemia (IDA) is the most common nutritional disorder during pregnancy and has been identified as an indirect cause of 20-40% of maternal deaths. The objective of the study to compare the efficacy of oral iron (OI) and intravenous iron sucrose in the management of IDA in pregnant women between 24 and 36 weeks of gestation.

Methods: A prospective observational study was conducted at the Antenatal Clinic of Ballari Medical College and Research Centre, Ballari, between June 2024 and November 2024. Sixty pregnant women between 24 and 34 weeks of gestation, with hemoglobin (Hb) levels between 7 and 10 g/dL and peripheral smear findings suggestive of IDA, were enrolled and randomized into two groups of 30 each. Group A (OI): Received ferrous ascorbate tablets containing 100 mg of elemental iron, administered twice daily throughout pregnancy. Group B (Intravenous iron): Received iron sucrose complex containing 200 mg of elemental iron diluted in 100 ml of 0.9% normal saline, infused intravenously over 15-20 minutes on alternate days. OI was withheld during this period. Both groups were monitored clinically for adverse reactions. Laboratory investigations, including Hb percentage, complete blood count, peripheral smear, and urine analysis, were performed on day 1 and at designated follow-up visits. Data were tabulated and analysed using an unpaired t test. A p<0.05 was considered statistically significant.

Results: The increase in Hb and other hematological parameters from baseline was significantly greater in the intravenous iron group compared to the OI group at all time points.

Conclusions: Intravenous iron sucrose was found to be more effective and produced a faster correction of IDA in pregnancy compared to OI therapy.

Preclinical evaluation of methanolic extract of Malus domestica peel on epilepsy in Swiss Albino mice using maximal electroshock test

Chetana Omkar, Pratibha Omkar, Vinay Dandemmanvar — Mon, 27 Jul 2026 00:00:00 +0530

Background: Animal models for epilepsy have been used extensively to study the nature of seizures and epilepsy and to develop new therapies for epilepsy. In the present study, an effort has been made to evaluate the anticonvulsant activity of methanolic extract of Malus domestica peel (MEMDP) on epilepsy using maximal electroshock (MES) test in Swiss Albino mice.

Methods: The current study was prospective and single-center. Standard drugs: Phenytoin sodium 50 mg/kg orally (for MES test). Model used: MES. All drugs were administered orally to all 5 groups 45 minutes prior to experimentation with MES. Swiss Albino mice were weighed and marked, and then they were split into five groups of six at random (3 males and 3 females were included in each group).

Results: The MES test was performed on Swiss albino mice after grouping the animals. Six animals per group were used. Normal saline was used as a neutral control, and phenytoin sodium was used as positive controls. Doses of MEMDP used were 200 mg/kg, 400 mg/kg, and 800 mg/kg. MEMDP showed anticonvulsant activity with maximum activity at 400 mg/kg and 800 mg/kg body weight. The anticonvulsant activity of acute administration of 400 mg/kg and 800 mg/kg doses of MEMDP was comparable with phenytoin sodium at 50 mg/kg body weight (in the MES test).

Conclusions: The result of the present study indicates that MEMDP upon acute administration has significant anticonvulsant-like activity, which is comparable to phenytoin sodium.

Evaluation of drug utilization pattern of antiepileptic drugs and adherence to treatment in outdoor patients of neurology department at a tertiary care teaching hospital

Mon, 03 Aug 2026 00:00:00 +0530

Background: Epilepsy is a chronic condition characterized by recurrent seizures. Adherence to antiepileptic drugs (AEDs) is crucial for treatment success, reducing relapses and improving patient outcomes. Aim and objectives of this study were to evaluate the drug utilization pattern of AEDs, identifying the extent of polypharmacy and percentage of adherence to treatment in patients with epilepsy attending neurology OPD.

Methods: A cross-sectional observational study was conducted over 12 months at RNT Medical College, M.B. Hospital, Udaipur after IEC approval. Inclusion criteria include patients age≥18 years with confirmed diagnosis of epilepsy prescribed at least one AED. Exclusion criteria include patients with status epilepticus or admitted. Data collection included patient demographics, treatment details and adherence assessment through the Medication Adherence Rating Scale (MARS-10) questionnaire.

Results: We evaluated 144 epilepsy patients. Demography showed 59% (n=85) males and 41%(n=59) females; mean age of 32.88±13.30 years. Patients diagnosed with generalized seizure was 93.8% than focal seizure 6.3%. Mean age of onset of seizure was 24.13±13.58 years. Monotherapy was given in 49.3% (n=71) patients while 50.7% (n=73) treated with polytherapy. Most commonly prescribed AED was valproic acid (63.3%) followed by levetiracetam (37.5%) and clobazam (23.6%). Total 71.53% (n=103) patients were adherent to treatment.

Conclusions: Among 144 epilepsy patients, 93.8% had generalized seizures; Sodium valproate and Levetiracetam was most commonly used AEDs and total 71.53% patients was adhered to treatment.

Comparative evaluation of calcium hydroxide and amalgamated with NSAIDs as intracanal medicaments on preoperative and post operative pain in patients with symptomatic irreversible pulpitis: an in-vivo study

Tue, 04 Aug 2026 00:00:00 +0530

Background: Pain of endodontic origin has been a major concern to the patient and clinicians for many years. Calcium hydroxide is the least effective medication in reducing postoperative pain despite having good antibacterial properties. NSAIDs have shown anti-inflammatory and antibacterial activity when incorporated into calcium hydroxide by improving the properties of calcium hydroxide as intracanal medicaments. This study aims to compare and evaluate the preoperative and postoperative pain following use of NSAID’s with Calcium hydroxide Intracanal medicament.

Methods: Eighty participants were included in the study and preoperative pain scores were recorded using the Visual Analog Scale and were divided into four groups: group 1-calcium hydroxide, group 2-calcium hydroxide with paracetamol, group 3 - calcium hydroxide with ketorol, group 4-calcium hydroxide with ketorol sp. postoperative pain scores were recorded using the visual analog scale at 6,12,24,48 hours.

Results: Results revealed that calcium hydroxide with keterol group showed least pain and calcium hydroxide group has shown more pain.

Conclusions: This clinical study has provided evidence of anti-inflammatory efficacy of NSAIDs when used in addition with Calcium hydroxide as intracanal medicament.

Sexual function in patients with schizophrenia on anti-psychotics: a comparative study of hyperprolactinemia-inducing and hyperprolactinemia non-inducing antipsychotics

Mon, 24 Aug 2026 00:00:00 +0530

Background: Sexual dysfunction is a common but often under-recognized adverse effect in patients with schizophrenia receiving antipsychotic therapy. Hyperprolactinemia induced by certain antipsychotics has been implicated as a major contributing factor. This study aimed to compare sexual function among patients receiving hyperprolactinemia-inducing and hyperprolactinemia non-inducing antipsychotics and to assess whether sexual dysfunction is related to antipsychotic-induced hyperprolactinemia or the underlying illness itself.

Methods: A prospective observational study was conducted in the Department of Psychiatry at Sri Ramachandra Hospital, Chennai, from March to July 2025. Sixty patients diagnosed with schizophrenia according to ICD-10 criteria and receiving antipsychotic therapy were enrolled. Patients were categorized into two groups: hyperprolactinemia-inducing antipsychotics (olanzapine, haloperidol, risperidone) and hyperprolactinemia non-inducing antipsychotics (aripiprazole, cariprazine, lurasidone). Sexual function was assessed using the Arizona Sexual Experience Scale (ASEX), and serum prolactin levels were measured. Statistical analyses included independent t-tests and one-way ANOVA, with p<0.05 considered significant.

Results: Of the 60 participants, 32 (53.3%) were males and 28 (46.7%) were females. Patients receiving hyperprolactinemia-inducing antipsychotics demonstrated significantly higher ASEX scores compared with those receiving hyperprolactinemia non-inducing agents (21.53±2.97 vs 15.70±2.93; p=0.0005). Serum prolactin levels were also significantly elevated in the hyperprolactinemia-inducing group (137.5±51.60 ng/mL vs 33.2±17.14 ng/mL; p=0.0005). Within-group analysis revealed that haloperidol was associated with the highest ASEX scores and prolactin levels among prolactin-raising agents, while aripiprazole exhibited the lowest values among prolactin-sparing drugs.

Conclusions: Sexual dysfunction was significantly more prevalent among patients receiving hyperprolactinemia-inducing antipsychotics and was strongly associated with elevated serum prolactin levels. However, the presence of sexual dysfunction in some patients receiving prolactin-sparing agents suggests that factors related to schizophrenia itself may also contribute. Careful selection of antipsychotic therapy and routine monitoring of sexual function and prolactin levels may improve treatment adherence and quality of life in patients with schizophrenia.

A retrospective evaluation of anti-retroviral therapy regimen modifications due to adverse drug reactions in a tertiary care hospital

Deepika K. K., Syed Mohsin Ahmed, Basavanna P. L. — Mon, 24 Aug 2026 00:00:00 +0530

Background: Antiretroviral therapy (ART) has transformed HIV infection into a chronic manageable disease and substantially improved survival among people living with HIV. Despite these advances, adverse drug reactions (ADRs) remain a major cause of treatment modification, potentially affecting adherence, treatment continuity, and long-term outcomes. Real-world pharmacovigilance data describing ADR-driven ART regimen changes in Indian settings remain limited. Aim was to evaluate the frequency and pattern of ART regimen modifications attributable to ADRs reported to the adverse drug reaction monitoring centre (AMC) of a tertiary care teaching hospital.

Methods: A retrospective observational study was conducted using suspected ADR reporting forms received at the AMC, department of pharmacology, Mysore Medical College and Research Institute between January 2022 and December 2024. Data regarding patient demographics, ADR characteristics, suspected antiretroviral agents, and regimen modifications were extracted and analysed using descriptive statistics. The association between ADR type and regimen modification was assessed using the Chi-square test.

Results: A total of 93 ART-related ADR reports were analysed. Among them, 67 patients (72.0%) required modification of their ART regimen following an ADR. Renal ADRs were the most frequently reported reactions (67.7%), with tenofovir-based regimens accounting for the largest proportion of implicated drugs. Patients experiencing renal toxicity were significantly more likely to undergo regimen modification compared with those experiencing non-renal ADRs (χ²=24.45, p<0.001). Substitution from tenofovir-containing regimens to alternative regimens, particularly abacavir-based combinations, represented the most common modification pattern.

Conclusions: ADRs continue to be an important determinant of ART regimen modification in routine clinical practice. Renal toxicity, predominantly associated with tenofovir-containing regimens, emerged as the leading reason for treatment substitution. These findings highlight the importance of vigilant pharmacovigilance, timely recognition of drug-related toxicity, and routine renal function monitoring to support safer and more sustainable ART use.

Impact of ultra-processed food consumption on quality of life of menopausal women

Janshi Arora, Megha Sood, Nisar Ahmed — Mon, 24 Aug 2026 00:00:00 +0530

Background: Menopause is linked with many psychological, physical, and social changes that may profoundly impact the quality of life of women. The dietary patterns, especially the trend of rising consumption of ultra-processed foods, have been proposed to influence health outcomes, although their effect on menopausal quality of life remains underexplored.

Methods: The study was a cross-sectional, survey-based research among 56 women aged 40 years and above residing in Punjab, north India. The study was conducted at the Punjab Institute of Medical Sciences, over a period of 4 months (September 2025-December 2025). A food frequency questionnaire was used to measure the UPF intake based on the NOVA classification, and the menopausal quality of life (MENQOL) questionnaire to assess symptoms across vasomotor, psychosocial, physical, and sexual domains. Correlation analysis was done to find out the correlation between UPF consumption and MENQOL scores.

Results: The mean UPF score was 12.41, while the mean total MENQOL score was 57.77. There was a weak positive correlation between UPF consumption and total MENQOL score (r=0.17). The psychosocial domain showed the highest correlation (r=0.20), followed by the vasomotor domain (r=0.15) and the physical domain (r=0.14), with the sexual domain showing negligible correlation (r=0.03).

Conclusions: The study suggests a weak positive association between ultra-processed food and the quality of life among menopausal women. A relatively higher impact on the psychosocial well-being was associated with ultra-processed food consumption. Although the correlation is low, the findings suggest the possible role of dietary patterns in menopausal health and the need for further research in this field.

Are physiotherapy students meeting their professional demands? A cross-sectional correlational study

Priyanka C. Chovatiya, Nikita Rathod, Mamta Rani, Dhwanit Shah — Mon, 24 Aug 2026 00:00:00 +0530

Background: The physiotherapy profession demands strength, endurance, and flexibility, yet the preparedness of students is uncertain. This study assessed the relationship between self-perceived and measured fitness and described exercise behaviours and musculoskeletal complaints among physiotherapy students.

Methods: A cross-sectional correlational study of 127 students at the Government Physiotherapy College, Surat (October-November 2018). Self-perceived fitness was measured with a modified five-factor questionnaire (general fitness, endurance, muscular strength, flexibility, body composition). Objective fitness was assessed using the push-up and wall squat tests, toe touch and shoulder flexibility tests, and body mass index. Correlations were analyzed in SPSS 23.

Results: Body mass index correlated inversely with perceived body composition (r=-0.295, p<0.01). Flexibility tests correlated with perceived flexibility (toe touch r=0.449; shoulder flexibility r=0.218, p<0.05). No significant correlation existed between perceived muscular strength and push-up (r=0.016) or wall squat (r=0.145) performance. One third of students reported musculoskeletal pain, often in the neck, lower back, and shoulder while over half reported end-of-day fatigue. Most students rated their fitness as average. Among participants, 67.2% reported daily exercise, mainly walking, while only 32.7% engaged in organised sports; barriers were lack of time (33.6%) and low motivation (43.0%).

Conclusions: Students accurately judge body composition and flexibility but overestimate muscular strength. Given prevalent pain and limited strength-building activity, fitness and ergonomics training should be incorporated into undergraduate physiotherapy curricula.

Evaluation of anti-aging effects of swimming exercise on inflammatory parameters in D-galactose-treated Wistar albino male rats

Sriram B. S., Ravichandra V., Pooja K. M., Jayanthi M. K. — Mon, 24 Aug 2026 00:00:00 +0530

Background: The present study was undertaken to investigate the anti-ageing effect of swimming exercise on inflammatory parameters in D-galactose-induced Wistar albino male rats.

Methods: Wistar albino rats were divided into four groups, namely, normal control, D-galactose-treated group (positive control), normal control with swimming exercise, and D-galactose-treated rats with swimming exercise. The experiment was conducted for 42 days. D-galactose was administered as a compound to induce ageing-like changes, and swimming exercise was used as a non-pharmacological treatment. Plasma was separated from blood samples on the 43^rd day for estimation of inflammatory markers, interleukin-6 (IL-6) and c-reactive protein (CRP) taken from the tail vein.

Results: The plasma levels of IL-6 and CRP were significantly higher in the D-galactose-treated rats than in the normal control rats, suggesting an enhanced inflammatory response. The swimming exercise significantly reduced IL-6 and CRP levels in D-galactose-treated rats compared with the positive control group.

Conclusions: Swimming exercise was found to have a significant anti-inflammatory and anti-aging effect on Wistar albino male rats treated with D-galactose, as the plasma levels of IL-6 and CRP were reduced. Therefore, swimming exercise could be regarded as a useful non-pharmacological method to prevent inflammatory changes associated with aging.

Evaluation of antidiarrheal, antiulcer, anti-collagenase and cholesterol lowering activity of Heyndrickxia coagulans MTCC 25308 (Bacospore®)

Mon, 24 Aug 2026 00:00:00 +0530

Background: Probiotics are increasingly recognized for their role in promoting gastrointestinal health and metabolic regulation. The present study investigated the multifunctional biological activities of Heyndrickxia coagulans (formerly Bacillus coagulans) MTCC 25308 (Bacospore^®), focusing on its antiulcer, antidiarrheal, cholesterol-lowering, and anti-collagenase properties.

Methods: Antiulcer activity was evaluated in rats using an ethanol-induced gastric ulcer model. Bacospore^® was administered orally at doses of 100 and 200 mg/kg body weight, and its effects were compared with ranitidine (20 mg/kg body weight). Antidiarrheal activity was assessed in a castor oil-induced diarrhea model using the same doses and compared with loperamide. Anti-collagenase activity was determined in vitro using enzyme inhibition assays, while cholesterol-lowering potential was assessed through bile salt hydrolase (BSH)-mediated cholesterol reduction assays.

Results: Bacospore^® exhibited significant gastroprotective activity against ethanol-induced gastric ulcers, with the highest ulcer inhibition observed at 200 mg/kg body weight, surpassing the protective effect of ranitidine. In the castor oil-induced diarrhea model, Bacospore^® demonstrated notable antidiarrheal activity comparable to the standard treatment. In vitro studies showed strong collagenase inhibition, reaching 85% at 200 µg/ml, indicating potential extracellular matrix-protective effects. Additionally, Bacospore^® achieved 97.72% cholesterol reduction at 1000 µg/ml through BSH-mediated bile salt deconjugation, suggesting substantial hypocholesterolemic potential.

Conclusions: Heyndrickxia coagulans MTCC 25308 (Bacospore^®) demonstrated significant antiulcer, antidiarrheal, anti-collagenase, and cholesterol-lowering activities. These findings suggest that Bacospore^® exerts pleiotropic health benefits through modulation of gastrointestinal function, enzymatic activity, and lipid metabolism, supporting its potential as a multifunctional next-generation probiotic for managing gastrointestinal disorders and metabolic dysregulation.

Assessment of triggering tools and risk factors of adverse drug reactions at a tertiary care hospital

Druthi M. S., Balakeshwa Ramaiah — Mon, 24 Aug 2026 00:00:00 +0530

Background: Adverse drug reactions are a significant cause of morbidity, mortality, and healthcare burden, making their identification, reporting, and prevention critical. This study aimed to assess the incidence, risk factors, causality, severity, and preventability of adverse drug reactions in a tertiary care hospital using standardized pharmacovigilance tools.

Methods: A prospective observational study was conducted among inpatients across multiple departments. Data were analyzed using the World Health Organization-Uppsala Monitoring Centre causality scale, Hartwig’s severity scale, and the Thornton and Schumock preventability scale. Clinical grading was performed using the common terminology criteria for adverse events version 5.0 to determine associations between risk factors and adverse outcomes.

Results: A total of 258 adverse drug reactions were identified from 313 suspected drugs. Adults comprised 57.7% of cases and elderly patients 37.2%, with females accounting for 51.9%. Antibiotics were the leading cause at 25.5%. Analysis showed that 88.3% of reactions were serious, with 62.01% requiring hospitalization or extended stay. Clinical recovery was observed in 86% of patients. Causality assessment classified 77.5% of reactions as probable. Approximately 55.03% of events were probably and definitely preventable, primarily linked to errors in dosing or administration. Polypharmacy and multiple comorbidities were identified as the primary risk factors for serious outcomes.

Conclusions: Adverse drug reactions are frequent among adults and the elderly, with antimicrobials most commonly implicated. The high proportion of serious events emphasizes the need for rational prescribing, continuous monitoring, and active pharmacovigilance to enhance patient safety.

Exploring adult vaccination awareness and practice: a cross-sectional study of knowledge, attitudes and immunization practices among postgraduates and interns at a tertiary care hospital

Nagaraju Vangapalli, Syed Mohsin Ahmed — Mon, 24 Aug 2026 00:00:00 +0530

Background: Adult vaccination is an important part of disease prevention, but it is often not given enough attention, especially in developing countries like India. Many effective vaccines are available for adults, such as those for influenza, hepatitis B, and HPV, yet awareness and use of these vaccines remain low. Healthcare professionals, including interns and postgraduate students, have a key role in promoting vaccination among the public. Studying their knowledge, attitude, and practice (KAP) toward adult vaccination helps to find existing gaps and improve future vaccination programs.

Methods: Predesigned and validated questionnaires were given to post graduates and Interns of the hospital. The KAP questionnaire which include 22 questions, out of these 8 questions are regarding knowledge, 7 for attitude, 5 for practice and 2 questions regarding barriers/facilitators to vaccination. The questionnaire was distributed to the participants electronically via google forms with digital informed consent, and their responses were collected and analyzed, results were expressed in frequencies and percentages.

Results: Among 106 participants, 56 (52.8%) were females and 50 (47.2%) were males. All were postgraduate trainees and interns. About 71.7% knew that a separate adult vaccination schedule exists. Most participants agreed that adult vaccination is important, and many (66.7%) strongly agreed. Most (94.3%) had received at least one adult vaccine such as COVID-19 or Hepatitis B, and 76.5% had recommended vaccines to patients. However, some barriers like lack of awareness, time limits, and unclear institutional guidelines were noted.

Conclusions: Overall, the study found good knowledge and a positive attitude toward adult vaccination among postgraduates and interns. Yet, some gaps remain in practical implementation and patient guidance. More structured training sessions, awareness programs, and clear hospital policies can help improve adult vaccination practices among healthcare workers.

Potential effect of ethanolic extract of Abutilon indicum (L.) against acetic acid induced ulcerative colitis in albino rats

Mon, 24 Aug 2026 00:00:00 +0530

Background: Ulcerative colitis (UC) is a chronic, relapsing inflammatory disorder of the colon characterized by mucosal inflammation, ulceration, and disruption of intestinal homeostasis Abutilon indicum (L.), a traditionally used medicinal plant in Ayurvedic and folk medicine, has been reported to possess various pharmacological activities including anti-inflammatory, antioxidant, analgesic, and wound healing effects. However, its potential role in the management of ulcerative colitis remains inadequately explored and requires scientific validation.

Methods: Animals were treated for 11 days in different groups. Group I received normal saline, Group II received distilled water, Group III received sulfasalazine, and Groups IV & V received Abutilon indicum extract at two doses. On day 8, ulcerative colitis was induced in Groups II-V using 4% acetic acid administered rectally. On day 11, animals were anesthetized, blood samples were collected, and colon tissues were preserved for analysis (cytokine study and histopathology).

Results: The study showed that ethanolic extract of Abutilon indicum leaves has significant anti-ulcerative colitis activity against acetic acid-induced colitis. Both doses (250 mg/kg and 500 mg/kg) were effective, but 500 mg/kg showed better results. This effect was confirmed by reduced inflammatory markers (TNF-a, IL-6), decreased colon weight-length ratio, and improved histopathological findings.

Conclusions: The findings suggest that the plant possesses promising anti-colitic potential and may serve as a natural therapeutic candidate for the management of ulcerative colitis. Further studies are warranted to isolate the active constituents, elucidate the underlying molecular mechanisms, and establish its clinical efficacy and safety.

A prospective study to assess the pharmacotherapeutic management of chronic diabetic foot ulcers in a tertiary care hospital

Jyothi Dammur Basavaraj, Ajaykumar Rathod — Mon, 03 Aug 2026 00:00:00 +0530

Background: Chronic diabetic foot ulcers (DFUs) are a major cause of morbidity, prolonged hospitalization, and non-traumatic lower-limb amputations in patients with diabetes mellitus. Effective management requires rational pharmacotherapy, appropriate antimicrobial use, and objective wound assessment. This study evaluated pharmacotherapeutic management, drug utilization using World Health Organization (WHO) prescribing indicators, microbiological profile, and clinical outcomes in patients with chronic DFUs admitted to a tertiary care teaching hospital.

Methods: A 12-month prospective observational study was conducted in collaboration with the Departments of Pharmacology and General Surgery. Forty-two patients aged ≥30 years with chronic DFUs were enrolled after Institutional Ethics Committee approval and informed consent. Drug utilization was assessed using WHO/INRUD prescribing indicators. Wound healing was evaluated using the leg ulcer measurement tool (LUMT) at baseline, 1 week, and 4 weeks. Wound swabs were subjected to microbiological analysis, and data were analyzed using descriptive statistics.

Results: Most patients were males aged 41–60 years. Wound cultures were positive in 57.1% of cases, with Escherichia coli and Staphylococcus aureus being the predominant isolates. Polypharmacy was common (mean 6.8 drugs/prescription), although most medications were prescribed from the Essential Medicines List. β-lactams and nitroimidazoles were the most frequently prescribed antimicrobials. Mean LUMT scores decreased significantly over four weeks, indicating improved wound healing, and clinical cure was achieved in 78.6% of patients.

Conclusion: Rational pharmacotherapy guided by WHO prescribing indicators, culture-directed antimicrobial therapy, and standardized wound assessment using LUMT were associated with significant clinical improvement in patients with chronic diabetic foot ulcers.

Alfuzosin versus tamsulosin for symptomatic benign prostatic hyperplasia: a prospective comparative study

Noor Husain, Prabhat Kumar Agrawal, Ahsan Ahmad, Raj Narayan Seth — Mon, 24 Aug 2026 00:00:00 +0530

Background: Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in aging men. Alpha-1 adrenergic receptor antagonists are recommended as first-line pharmacological therapy. This study compared the efficacy and safety of alfuzosin and tamsulosin in men with symptomatic BPH.

Methods: In this prospective, open-label, comparative study, 60 men with symptomatic BPH were allocated to receive either alfuzosin 10 mg once daily (n=30) or tamsulosin 0.4 mg once daily (n=30) for 12 weeks. International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual urine volume (PVRU) were assessed at baseline, 4 weeks, and 12 weeks. Adverse events were recorded throughout the study.

Results: Baseline characteristics were comparable between groups. Both treatments produced significant improvement in IPSS, Qmax, and PVRU from baseline to 12 weeks (all p<0.001). At 12 weeks, mean IPSS was lower in the alfuzosin group than in the tamsulosin group (6.30±2.02 vs. 7.37±2.17; p=0.050). Mean Qmax increased from 6.03±1.81 to 23.33±3.79 ml/s with alfuzosin and from 6.30±1.73 to 21.60±4.10 ml/s with tamsulosin (p=0.090). Mean PVRU decreased from 85.30±28.51 to 11.40±6.08 ml and from 73.90±45.51 to 14.83±11.93 ml, respectively (p=0.160). Both medications were well tolerated, and no serious adverse events occurred.

Conclusions: Both alfuzosin and tamsulosin significantly improved LUTS, urinary flow rate, and bladder emptying in men with symptomatic BPH. Their efficacy and safety profiles were broadly comparable.

Effect of chemotherapy on cognition and depression among solid tumor cancer patients in a tertiary care hospital

Mon, 24 Aug 2026 00:00:00 +0530

Background: Chemotherapy is a key treatment modality for solid tumors but is often associated with cognitive impairment, depression, and reduced quality of life. Early identification of these complications is important for improving patient outcomes and treatment adherence.

Methods: A prospective cohort study was conducted over six months in the Department of Medical Oncology, Sri Ramachandra Hospital, Chennai. Adult patients (18-65 years) with solid tumors receiving platinum-based agents, taxanes, or antitumor antibiotics were enrolled. A total of 267 patients completed the study. Cognitive function, depression, quality of life, and medication adherence were assessed at baseline and follow-up using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), Brief Edinburgh Depression Scale (BEDS), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Medication Adherence Rating Scale (MARS), respectively.

Results: Among the 267 participants, females constituted the majority. Significant deterioration in cognitive function and increased depression scores were observed during chemotherapy, particularly among patients receiving platinum-based regimens. Depression scores showed significant worsening at weeks 8 and 12 in the platinum-based group (p<0.05). Quality of life declined significantly, with reductions in physical, emotional, role, and cognitive functioning. Overall health status deteriorated in 75.6% of patients. Medication adherence remained satisfactory throughout the study. Adverse drug reactions were reported more frequently in patients receiving platinum-based chemotherapy.

Conclusions: Platinum-based chemotherapy is associated with increased cognitive impairment, depression, and reduced quality of life in patients with solid tumors. Routine screening for cognitive dysfunction and depression should be incorporated into oncology care to enable timely interventions and improve patient-centered outcomes.

A prospective, randomized, open label, comparative study of efficacy and tolerability of oral itraconazole versus combination therapy with oral itraconazole and oral terbinafine in treatment of dermatophytosis

Srinjoy Bhattacharya, Kumaraswamy Girish, Nandini Albur Shankaraiah — Mon, 24 Aug 2026 00:00:00 +0530

Background: Superficial dermatophytosis, caused by fungi like Trichophyton and Microsporum, affects skin, hair and nails, presenting as round, red, scaly patches with itching. Generally, topical antifungals are common preferred treatment, while extensive infections and immunocompromised patients often require systemic oral treatments due to frequent relapses and resistance to topical terbinafine. This study compares itraconazole monotherapy with combination therapy of itraconazole and terbinafine to optimize treatment.

Methods: The study was conducted at Kempe Gowda Institute of Medical Sciences Hospital & Research Centre, Bengaluru, the study included 152 clinical and 10% KOH smear confirmed superficial dermatophytosis patients. Participants were randomly assigned to Group A (77 received oral itraconazole 100 mg twice daily for 3 weeks) and Group B (75 received oral itraconazole 100 mg twice daily plus oral terbinafine 250 mg once daily for 3 weeks). Participants were followed -ups at 3, 6 and 9 weeks for symptoms, KOH smear test results, clinical response and rescue medication use.

Results: Group B had a higher proportion of complete recoveries without relapse (p value 0.00775). No significant differences were found between the groups in terms of symptom severity, KOH test results, clinical response or rescue medication use, indicating comparable effectiveness.

Conclusions: Combination therapy with itraconazole and terbinafine was more effective than itraconazole alone in achieving relapse-free recovery in dermatophytosis patients. Both regimens were well-tolerated, suggesting combination therapy as a potentially better approach for fungal infections. This study supports combination therapy as a cost-effective treatment for tinea infections.

Assessing the effect of layering gingival shade composite resin thickness on the flexural strength of denture base polymer resin material processed by CAD/CAM and injection moulded technique

Mon, 24 Aug 2026 00:00:00 +0530

Background: Acrylic resin denture base as materials for dentures, do not mimic the gingival esthetics. Gingival composite resin used for fabrication of denture; it enhances the denture esthetics but affects the material's flexural strength. The study aimed to investigate the flexural strength of denture base polymer resin material CAD/CAM milling and injection molding, as well as the impact of gingival shade composite resin thickness.

Methods: Two types of denture acrylic resins were used as base materials: CAD/CAM pre-polymerized PMMA resin and injection molded acrylic resin. Specimens of both groups, each size 32×10×3 mm, were fabricated. The denture base material was layered with a Gingiva-shade composite resin in thicknesses of 1.0 mm and 1.5 mm, creating subgroups for each material type (n=10). After conditioning of samples, a UTM was used to conduct a 3-point bending test measured the flexural strength and results were analyzed statistically

Results: The compression strengths of the injection-molded acrylic resin samples varied between 125.4±3.115 MPa and 114.3±5.074 MPa, whereas the compression strengths of the CAD-CAM prepolymerized acrylic resin varied between 129.4±3.84 MPa and 119.4±8.16 MPa. All test groups maintained flexural strength values above the ISO 20795-1 minimum requirement of 65 MPa, clinical acceptability for denture fabrication.

Conclusions: CAD/CAM PMMA denture bases exhibited superior flexural compared to injection-molded, both pre and post aging and in different thickness of GSCR layering.

Acute oral toxicity study of ethanolic extract of Hygrophila auriculata and Hygrophila polysperma leaves using Wistar Albino rats

F. Nishvanth, D. Nagavalli, B. Prem Kumar — Mon, 24 Aug 2026 00:00:00 +0530

Background: To find out toxicity and fix the safe dose of ethanolic extract of Hygrophila auriculata and Hygrophila polysperma leaves using female Wistar Albino rats.

Methods: Acute oral toxicity was assessed in wistar albino rat following organisation for economic co-operation and development guideline 423. The ethanolic extracts were administered orally at doses of 300 mg/kg and 2000 mg/kg body weight and animals were observed for 14 days for mortality, behavioural changes, body weight variation and gross pathological alterations.

Results: No mortality or significant signs of toxicity were observed in any treatment group. Body weight, food intake and organ morphology remained normal throughout the study period. The extracts were well tolerated at the tested doses.

Conclusions: The ethanolic leaf extracts of H. auriculata and H. polysperma were found to be safe up to 2000 mg/kg, indicating low acute toxicity and supporting their further pharmacological evaluation.

Drug utilization pattern of cardiovascular medications and assessment of WHO-INRUD prescribing indicators among geriatric patients in a tertiary care hospital: a cross-sectional study

Janvi A. Gandani, Snigdha Misra, Amrit Kejriwal — Mon, 24 Aug 2026 00:00:00 +0530

Background: Cardiovascular disorders are a major cause of morbidity and mortality among older patients. Drug utilization studies are useful in assessment of prescribing behaviour and rational use of drugs. To study the drug utilization pattern of cardiovascular drugs and to evaluate the prescribing practices by WHO-INRUD prescribing indicators in geriatric patients of cardiovascular illnesses admitted in tertiary care hospital.

Methods: A hospital based observational cross-sectional study was carried out in Medicine wards and Intensive Care Unit of MGM Hospital, Navi Mumbai from April 2024 to March 2026. A total of 250 patients ≥65 years with cardiovascular illnesses were involved. The data were acquired from patient files, medication administration records and laboratory reports. The descriptive statistics were used to analyse drug consumption patterns and WHO-INRUD prescribing indicators.

Results: Of 250 patients, 62.4% were males and 37.6% females. The mean age was 70.88±4.00 years. The most prevalent cardiovascular disease was hypertension (87.6%), followed by ischemic heart disease (27.2%) and heart failure (11.2%). The most common pharmacological class used was calcium channel blockers (24.8%), followed by antiplatelet medicines (24.1%). 30.02% medications were prescribed generically and 51.69% drugs were prescribed from national list of essential medicines. Antibiotic and injectable prescriptions were written for 20.03% and 29.17% of encounters, respectively.

Conclusions: Hypertension was the most frequent cardiovascular illness among geriatric people. Moderate generic prescribing and compliance with NLEM suggest the necessity of regular prescription audits for promoting rational drug use.

Evaluation of rational use of drugs used in hypertension in a tertiary care hospital: a cross-sectional observational study

Suneel I. Majagi, Devasena Manohar, Jagadeesh Gaddeppanavar — Mon, 24 Aug 2026 00:00:00 +0530

Background: Hypertension is a major public health problem due to increased morbidity, mortality and cost to the public. Various group of antihypertensive drugs are used in the management of hypertension. Criteria like medications appropriate to the clinical needs, required individual doses, adequate period and lowest cost are considered during rational use of medicines. Irrational prescribing can cause increased morbidity, mortality, adverse drug reactions (ADRs), and economic burden. World Health Organization (WHO) stress the need to promote rational use of drugs. Hence the present study has been planned to evaluate rational use of antihypertensive drugs according to the WHO guidelines.

Methods: Present study design is a cross-sectional observational study. Data regarding antihypertensive drugs was collected as per WHO guidelines viz., details of prescriptions, patient counselling and drugs. Details of co-morbid illnesses, ADRs, precautions and contraindications were also noted. Standard statistical tests were used to analyse the data and the study was approved by the institutional ethics committee.

Results: Various criteria required for rational use of medicines in regard to prescription, patient counsel and drugs were followed in all (100%) the patients. Diuretics caused ADRs in a greater number of patients. More patients suffered from ADRs affecting central nervous system followed by gastro intestinal tract, and cardio vascular system. No precautions and contraindications were found for any of the prescribed drug.

Conclusions: WHO-rational use criteria and joint national committee (JNC) 8 guidelines were adhered. Medical council registration number and stamp have to be mentioned in the prescription. Prescriptions of generic name drugs must be promoted.

Psychological distress and quality of life in patients with chronic obstructive pulmonary disease: a cross-sectional study

Mon, 24 Aug 2026 00:00:00 +0530

Background: COPD has been associated with decreased QOL as well as various psychological disorders like anxiety, depression and stress. The study conducted was to measure psychological distress among COPD patients and the relation of it with QOL.

Methods: A cross-sectional study done on 74 COPD patients who had their consultation in a tertiary care hospital at Jaipur, Rajasthan, India. The QOL among COPD patients was evaluated applying CAT. Depression, anxiety and stress levels were assessed using the DASS-21 questionnaire. The relationship between QOL and psychological distress parameters was assessed using Spearman’s correlation test, Kruskal–Wallis test and multiple linear regression analysis.

Results: The mean CAT score was 29.19±9.53 which implied poor QOL among COPD patients. Moderate depression was found in 40.5% of COPD patients while extremely severe anxiety was found in 77% of the patients. Poor QOL showed significant correlation with depression (ρ=0.394, p<0.001), anxiety (ρ=0.548, p<0.001) and stress (ρ=0.443, p <0.001). Increased disease duration was strongly correlated with elevated psychological distress scores. In multiple regression analysis, anxiety was found to be the only independent predictor of poor QOL (B=0.618, p<0.001).

Conclusions: There is significant impairment in the QOL as well as a heavy psychological burden in terms of anxiety among COPD patients. Psychometric evaluation should be included as a key aspect of COPD management.

Effect of polypharmacy on healthcare costs in hospitalized patients diagnosed with hypertension and diabetes mellitus in a tertiary care teaching hospital

Ravindra B. Nagarajappa, Ankitha Mahesha, Balaji S. Manjunath — Mon, 24 Aug 2026 00:00:00 +0530

Background: Hospitalised patients with diabetes mellitus and hypertension, particularly older adults, often have multiple comorbidities requiring polypharmacy. While the clinical consequences of polypharmacy are well documented, its economic impact, including healthcare expenditure, financial burden, and cost-related medication nonadherence, remains underexplored in resource-limited settings. Objectives of the study were to evaluate the association of polypharmacy and comorbidities with healthcare costs, financial burden, and cost-related medication non-adherence among hospitalised patients with diabetes mellitus and hypertension.

Methods: A cross-sectional study was conducted among 180 hospitalised patients with diabetes mellitus and hypertension, with or without comorbidities, at a tertiary care teaching hospital. Data were collected using a validated proforma through patient interviews and medical records. Polypharmacy was defined as the use of ≥6 medications. Healthcare costs were categorized into direct medical, direct non-medical and indirect costs. Financial burden was estimated by comparing healthcare expenditure to income and cost-related medication nonadherence was assessed using a structured questionnaire. Statistical significance was set at p<0.05.

Results: Polypharmacy was observed in 94.4% of patients. Those with polypharmacy incurred significantly higher direct medical (INR 8,380.24 versus INR 4,705; p<0.001), direct non-medical (INR 4,388.22 versus INR 1,174; p<0.001), and indirect costs (INR 2,638.82 versus INR 1,200; p=0.038). Patients with comorbidities had higher direct medical and non-medical costs, greater financial burden (70.29% versus 52.5%), and higher cost-related medication nonadherence (65.34% versus 32.5%).

Conclusions: Polypharmacy and comorbidities substantially increase healthcare costs, financial burden, and cost-related medication nonadherence among hospitalised patients with diabetes and hypertension. Strategies to optimize medication use and improve financial support are essential to reduce these burdens.

A cross-sectional study on hospital-based evaluation of adverse drug reactions and drug-related issues in hypertensive patients

Mon, 24 Aug 2026 00:00:00 +0530

Background: The primary goal of the study was to evaluate adverse drug reactions and drug-related problems in patients with hypertension at the tertiary care hospital in Lucknow. The secondary goal was to assess the treatment patterns and outcomes for these patients at the same hospital.

Methods: This was a prospective, observational study. A total of 100 patients who met the inclusion and exclusion criteria were recruited from the outpatient and inpatient departments of the general medicine division at the Integral Institute of Medical Science and Research Hospital. Patients’ data were evaluated to identify Drug-Related Problems using a systematic, evidence-based approach.

Results: Data from 100 patients were collected in this study. The main identified drug-related problems affecting blood pressure control included failure to receive medications, drug-drug interactions and untreated indications. A total of 3 adverse drug reactions (ADRs) were observed among the 100 cases. Hyperkalemia was observed in 02 patients (28.6%), pedal edema in 02 patients (28.6%) and dry cough in 03 patients (42.9%).

Conclusions: Patients taking anti-hypertensive medications frequently encounter adverse drug reactions. Our study recommends regular ADR monitoring in hospital settings to encourage rational medication prescribing.

Impact of the revised CLSI M100 (36th edition, 2026) minimum inhibitory concentration breakpoints on antimicrobial susceptibility interpretation and multidrug-resistance classification of clinical Pseudomonas aeruginosa isolates: a retrospective study

Maxmillando Rymbai, Vedant Vikrom Borah — Mon, 24 Aug 2026 00:00:00 +0530

Background: Susceptibility interpretation depends on the breakpoint applied to the measured minimum inhibitory concentration (MIC). The CLSI M100 36th edition (2026) introduced revised criteria for Pseudomonas aeruginosa, including lower fluoroquinolone breakpoints, removal of the gentamicin breakpoint, restriction of amikacin reporting to urinary isolates and removal of the colistin-susceptible category. Authors assessed how reinterpreting archived MICs altered susceptibility categorisation and multidrug-resistant (MDR)/extensively drug-resistant (XDR) classification.

Methods: Archived VITEK-2 MIC results for 200 non-duplicate clinical P. aeruginosa isolates (December 2020–January 2025) were interpreted twice using the laboratory’s previously reported interpretations and the 2026 CLSI criteria. Categorical agreement, susceptibility percentages (Wilson 95% CIs) and MDR/XDR proportions (Magiorakos framework) were compared and paired changes were tested using the exact McNemar test.

Results: Of the 1,871 drug–isolate results interpretable under both schemes, 285 (15.2%) changed categories. According to the 2026 criteria, susceptibility ranged from 35.8% (levofloxacin) to 54.1% (piperacillin/tazobactam). Reinterpretation resulted in increased susceptibility for several β-lactams and ciprofloxacin, mainly through resistant-to-susceptible reassignment (McNemar p≤0.015). Colistin lost its susceptible category, leaving 91.9% intermediate and 8.1% resistant strains, without any MIC changes. Overall, 38.5% of the isolates were non-MDR, 10.0% were MDR and 51.5% were XDR strains.

Conclusions: Under CLSI M100 36th edition, reinterpretation reclassified roughly one in seven results, with a net susceptibility gain for several β-lactams and ciprofloxacin and removal of the colistin susceptible category, while most isolates remained XDR. Laboratories should revalidate these breakpoints and account for colistin and aminoglycoside reporting changes in the antibiograms.

Multimodal mechanistic pathways in Alzheimer’s disease: toward an integrated model of pathogenesis

Cavan D. Souza, Shiva Murthy Nanjundappa, Nirupama Murali — Mon, 24 Aug 2026 00:00:00 +0530

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder marked by β-amyloid plaques, tau tangles, synaptic dysfunction, and large-scale network failure. While the amyloid cascade hypothesis has dominated, emerging evidence suggests distinct yet interacting amyloid and tau trajectories influenced by genetic, vascular, metabolic, and inflammatory factors. Understanding this multimodal convergence is key to redefining AD pathogenesis. Following PRISMA 2020 guidelines, mechanistic studies published from January 2016 to August 2025 were reviewed from pubmed and the cochrane library. Eligible studies provided original data on molecular, cellular, or systems-level mechanisms of AD. Findings were synthesized across seven domains: amyloid, tau, neuroinflammation, synaptic dysfunction, mitochondrial stress, metabolic dysregulation, and genetics. Across 22 studies, evidence supports a shift from a linear amyloid model to a multidimensional framework. Amyloid and tau initiate independently but later interact to accelerate degeneration. APOE ε4 carriers show amyloid-driven disease, while non-carriers exhibit tau-dominant progression, with females showing higher vulnerability. fMRI and DTI reveal early Default Mode Network and white matter disruption. Biomarkers (Aβ42, tau, NfL, neurogranin, SNAP25) detect early changes, while mitochondrial and glial dysfunction and vascular-metabolic stress further modulate progression. AD emerges from converging genetic, molecular, and network-level abnormalities. A multimodal approach integrating imaging, fluid biomarkers, and genetics offers promise for early detection, risk stratification, and personalized multi-target therapies.

Iron deficiency anemia as a multisystem disorder: linking molecular dysregulation to clinical outcomes

Sanjeyan N., Nirmala K., Indhumathi M. — Mon, 24 Aug 2026 00:00:00 +0530

Iron deficiency anemia (IDA) is the most prevalent nutritional deficiency worldwide and remains a major public health challenge affecting children, women of reproductive age, pregnant women, and individuals with chronic diseases. Although traditionally regarded as a hematological disorder characterized by impaired hemoglobin synthesis and reduced oxygen-carrying capacity, increasing evidence indicates that iron deficiency produces multisystem dysfunction through disturbances in cellular metabolism, mitochondrial function, neurotransmitter synthesis, immune regulation, and iron homeostasis. This review summarizes the epidemiology, etiology, molecular pathophysiology, clinical manifestations, diagnostic evaluation, treatment strategies, and complications of IDA. Central to its pathogenesis is dysregulation of the hepcidin–ferroportin axis, leading to impaired iron absorption, defective erythropoiesis, and altered tissue iron utilization. Beyond anemia, iron deficiency contributes to cognitive impairment, reduced physical performance, cardiovascular stress, immune dysfunction, adverse pregnancy outcomes, and diminished quality of life. Early diagnosis using appropriate hematological and biochemical markers, together with timely identification of the underlying cause and individualized iron replacement therapy, is essential to prevent irreversible complications. A comprehensive understanding of the molecular mechanisms linking iron deficiency to systemic clinical manifestations may facilitate earlier diagnosis, optimize therapeutic strategies, and improve long-term patient outcomes.

Role of molecular diagnostics in early detection of neonatal sepsis: a narrative review

Mon, 24 Aug 2026 00:00:00 +0530

Neonatal sepsis is a major cause of illness and death in infants across the globe, particularly in low and middle-income countries. The diagnosis of infections is important in order to provide early treatment to the patient, which may result in improved outcomes. Automated blood culture with antimicrobial susceptibility testing (AST) is considered to be the gold standard, but it has limited clinical utility due to the time required to obtain results, the sensitivity of the method in case of low bacterial loads, and previous antibiotic therapy. The review aims to critically compare the utility of molecular techniques with culture-based techniques in terms of their performance characteristics, like the time required to detect the causative agent, and their clinical utility. The existing literature is in support of the use of molecular techniques in terms of their rapidity and high specificity. Nevertheless, despite their utility, they are not suitable to be used individually, first because they cannot detect phenotypic susceptibility, and second, they may detect non-viable organisms. Therefore, it is important to have a combined approach in order to have a synergistic effect, which may result in improved therapy, enhanced antimicrobial therapy, and improved neonatal health.

A complete narrative review on polypharmacy: role of clinical pharmacist in managing interventions in polypharmacy and improving patient outcomes

Mon, 24 Aug 2026 00:00:00 +0530

Polypharmacy, commonly defined as the concurrent use of multiple medications, has emerged as a significant global health concern, especially among elderly patients with multimorbidity. It is associated with an increased risk of adverse drug reactions, drug–drug interactions, prolonged hospital stays, and poor medication adherence, ultimately leading to unfavorable clinical outcomes. This review critically evaluates existing literature on polypharmacy, focusing on its etiology, associated risks, and clinical consequences. It examines patient-, physician-, and healthcare system-related factors contributing to inappropriate prescribing. Additionally, the role of clinical pharmacists and the application of assessment tools such as Beers criteria, STOPP/START criteria, and the medication appropriateness index are analyzed. The findings highlight that inappropriate polypharmacy is driven by multiple factors, including fragmented healthcare delivery, lack of medication review, and limited awareness among healthcare providers. Clinical pharmacists play a pivotal role in mitigating these risks by identifying potentially inappropriate medications, conducting medication reviews, and implementing deprescribing strategies. The use of standardized tools and multidisciplinary collaboration has been shown to improve medication appropriateness and patient safety. Polypharmacy remains a complex challenge requiring a coordinated and systematic approach. Integration of clinical pharmacy services into routine healthcare practice significantly enhances medication safety and clinical outcomes. Clinical pharmacists are essential in promoting rational pharmacotherapy and reducing medication-related harm through targeted interventions and patient-centred care.

Triple-negative breast cancer: unmet needs and emerging targeted and immunotherapeutic approaches

Mon, 24 Aug 2026 00:00:00 +0530

Triple-negative breast cancer (TNBC) is a tough type of breast cancer. It does not have estrogen, progesterone, or HER2 receptors. This makes it hard to treat because common hormone and HER2 therapies do not work, often leading to poor results. To look at new treatments for TNBC, focusing on new molecular targets, antibody-drug conjugates (ADCs), immunotherapy, resistance issues, and future personalized medicine. A detailed review was done, combining information from molecular biology, clinical trials, immuno-oncology, and new technologies like artificial intelligence and liquid biopsy to assess progress in TNBC treatment. TNBC is very diverse at the molecular level, involving pathways like PI3K/AKT, TP53 mutations, and DNA repair problems. New treatments include ADCs like sacituzumab govitecan targeting TROP-2, and immune checkpoint inhibitors targeting PD-1/PD-L1 pathways, which have helped some patients live longer. Combining ADCs and immunotherapy shows better results by causing cancer cells to die in a way that triggers the immune system. However, resistance to treatment is still a big problem due to tumor diversity, loss of antigens, poor drug delivery, and resistance to the drug's effects. Advances in liquid biopsy, ctDNA monitoring, and AI-driven models are helping create real-time, personalized treatment plans. TNBC treatment is moving from standard chemotherapy to more precise approaches using targeted therapies, immunotherapy, and flexible treatment plans. Despite progress, overcoming resistance and improving long-term survival need more research into biomarkers, combination therapies, and personalized medicine.

Therapeutic benefits of melatonin beyond sleep regulation: a comprehensive review

Mon, 24 Aug 2026 00:00:00 +0530

Melatonin is an endogenous indoleamine primarily synthesized by the pineal gland and is best known for its role in regulating the sleep–wake cycle and circadian rhythm. However, accumulating evidence suggests that melatonin exerts a wide range of biological actions beyond sleep regulation. It displays antioxidant, anti-inflammatory, and immunomodulatory properties, and has been investigated for potential benefits in neurological, cardiovascular, metabolic, respiratory, gastrointestinal, hepatic, renal, reproductive, oncological, and aging-related disorders. In addition, melatonin may influence gene regulation, mitochondrial function, appetite control, energy homeostasis, and thermoregulation, highlighting its pleiotropic therapeutic profile. Preclinical and clinical studies have also explored novel formulations, including sustained-release systems and nanotechnology-based delivery approaches, to improve its bioavailability and therapeutic utility. Although melatonin is generally considered safe and well tolerated, clinical evidence remains heterogeneous, and variations in dose, formulation, and treatment duration continue to limit standardization. Therefore, larger randomized controlled trials are needed to clarify its efficacy, optimize dosing strategies, and define its long-term safety across different disease settings. Overall, melatonin represents a promising multifaceted therapeutic agent with expanding clinical relevance beyond its traditional use in sleep medicine.

CRISPR gene therapy: a review

Sanjeyan N., Gobika G., Harshini Reethu S., Renuka A. — Mon, 24 Aug 2026 00:00:00 +0530

The adaptive immune system of prokaryotes is the source of CRISPR-Cas9, a ground-breaking genome editing technique that uses RNA-guided nucleases to precisely alter DNA sequences. An summary of CRISPR/Cas9's discovery, structural elements, mode of action, therapeutic uses, and present limitations is given in this article. The Cas9 nuclease and guide RNA work together to identify particular DNA targets and cause double-strand breaks in the system. Cellular processes like homology-directed repair or non-homologous end joining fix these defects, allowing for gene disruption or correction. Numerous genetic abnormalities, such as hemoglobinopathies including sickle cell disease and β-thalassemia, hereditary retinal diseases, muscular dystrophies, liver metabolic disorders, congenital lung diseases, and genetic deafness, have showed great potential for treatment with CRISPR/Cas9. Clinical applicability is limited by issues such off-target effects, PAM sequence restrictions, DNA damage-induced toxicity, and immunological responses to Cas proteins, despite its wide therapeutic potential. These obstacles are being addressed by improvements in delivery methods and high-fidelity Cas9 variations. All things considered, CRISPR/Cas9 is a revolutionary development in molecular medicine and gene therapy, providing strong prospects for accurate genome engineering and upcoming clinical uses in personalized medicine.

Enhancement or endangerment: a narrative review of pharmacological agents used in the fitness industry

Yogesh Shergin Balakrishnan — Mon, 24 Aug 2026 00:00:00 +0530

The global fitness industry has witnessed a significant rise in the use of pharmacological agents for enhancement of muscle mass, athletic performance, fat reduction, and physical appearance. Even though regular exercise and balanced nutrition remain the cornerstone of fitness, increasing societal pressure for rapid aesthetic transformation has contributed to the misuse of performance-enhancing drugs (PEDs). This narrative review aims to provide a comprehensive overview of the major pharmacological agents currently used in the fitness industry, including anabolic-androgenic steroids (AAS), selective androgen receptor modulators (SARMs), growth hormone and peptide analogues, stimulants, fat burners, insulin, thyroid hormones, diuretics, and post-cycle therapy drugs. A literature search was conducted using PubMed, Scopus, and Google Scholar databases using relevant keywords related to performance enhancement and fitness pharmacology. Recent evidence from clinical studies, systematic reviews, and regulatory reports were included. Advantages such as increased lean muscle mass, enhanced recovery, improved endurance, and accelerated fat loss were offered by these agents. However, their misuse is associated with serious cardiovascular, endocrine, hepatic, renal, neuropsychiatric, and metabolic complications. The emergence of social media promotion and unregulated online markets has further increased accessibility and misuse, especially among young adults. World anti-doping agency (WADA) and the United States Food and Drug Administration (FDA) continue to issue warnings regarding the safety concerns associated with these substances. This review highlights the pharmacology, benefits, adverse effects, ethical concerns, and public health implications of pharmacological agents used in the fitness industry, emphasizing the urgent need for awareness, regulation, and evidence-based education.

Low carbohydrate high fat diet: history and its impact on health

Lakshmi Deepika Patchva, Sankar Kurli — Mon, 24 Aug 2026 00:00:00 +0530

The low carbohydrate high fat (LCHF) diet is a way of eating that restricts the amount of carbohydrates and increases the amount of healthy fats that you eat to optimize your health and nutrition. Consuming fats has very little direct effect on blood glucose levels and, as a result, does not lead to an increase in insulin levels. The principle of the LCHF diet is to replace carbohydrate intake with fat, thus reducing insulin levels and increase the body’s ability to utilize its own fat stores for energy.

Current insights suggest gabapentin-induced neurodegeneration

Mon, 24 Aug 2026 00:00:00 +0530

Antiepileptic drugs (AEDs) are commonly prescribed to treat epilepsy and other neurodegenerative disorders (NDs). Gabapentin (GBP) is a newer, off-label antiepileptic/anticonvulsant for NDs that remains underexplored. Recent evidence indicates that prolonged, frequent, and high-dose use of GBP may be associated with an increased risk of various types of dementia and cognitive impairment. GBP has become 1 of the top 20 most prescribed drugs for NDs. GBP modulates voltage-gated calcium channels by binding to the alpha2delta subunit. One possible mechanism is oxidative stress, which can damage neuronal structures, impair synaptic function, and cause mitochondrial dysfunction, all of which are strongly implicated in the pathogenesis of several NDs and contribute to cognitive decline. Another factor is excitotoxicity, where abnormal glutamatergic activity causes excessive calcium influx and neuronal injury, thereby exacerbating mood problems and memory deficits. Long-term use of GBP interferes with SIRT1 (neuroprotective), CaMKII (calcium regulator), and tau phosphorylation regulation, damaging downstream signalling, disrupting central pain pathways in the spinal cord and brain (central sensitisation), damaging neuronal survival pathways, and promoting neurodegeneration. This literature review aims to synthesise current insights on GBP neurotoxic effects, including changes at the gene and protein levels, neuronal structure, function, and network connectivity, as well as strategies for managing GBP-associated NDs. Further research is needed to clarify the exact mechanisms and to develop protective strategies to reduce neurodegenerative risks, optimise seizure control, and evaluate the risks of GBP in clinical settings.

The emerging role of glucagon-like peptide-1 receptor agonists in male infertility: mechanisms, experimental evidence, and future clinical perspectives

Shubham Biswas, Fatima Rani, Kaustubh Bhardwaj, Chhandak Bera, Sneha Yadav — Mon, 24 Aug 2026 00:00:00 +0530

Obesity and metabolic dysfunction are major modifiable risk factors for male infertility, affecting reproductive function via insulin resistance, oxidative stress, chronic inflammation, hypothalamic-pituitary-gonadal axis dysregulation and impaired steroidogenesis. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are commonly used to treat obesity and type 2 diabetes mellitus and have emerged as potential modulators of male reproductive health, due to their metabolic effects and potential direct effects on reproductive tissues. This narrative review aimed to assess the current evidence regarding the potential role of GLP-1RAs in obesity-related male infertility, including underlying mechanisms, experimental findings, clinical evidence, and future therapeutic implications. A narrative literature search was conducted in PubMed, Scopus, Google Scholar, and Web of Science for relevant publications from 2018 to 2025, including original research, clinical trials, observational studies, experimental studies, systematic reviews, and relevant guidelines on GLP-1RAs, male reproductive physiology, semen parameters, reproductive hormones, and obesity-associated infertility. Evidence suggests that GLP-1RAs may influence male reproductive function via both indirect and direct effects on reproductive tissues. Experimental studies have shown expression of the GLP-1 receptor in reproductive cells including Leydig cells, Sertoli cells and spermatozoa, suggesting potential roles in steroidogenesis, cellular metabolism, mitochondrial function and spermatogenesis. In addition, the relative contribution of direct pharmacological effects compared to metabolic improvement by weight loss remains unclear. Overall, GLP-1RAs appear to be a promising therapeutic approach for treating obesity-related male reproductive dysfunction by acting on both metabolic health and possibly restoring reproductive function. However, there is not enough evidence at present to justify the recommendation of GLP-1RAs as established fertility-enhancing agents. To determine their role in the evidence-based management of male infertility, large, adequately powered randomised controlled trials evaluating semen quality, sperm DNA integrity, reproductive hormone profiles, pregnancy, and long-term safety are required.

Enlicitide (Lipfendra): the first oral PCSK9 inhibitor - from macrocyclic peptide innovation to clinical translation

Mon, 24 Aug 2026 00:00:00 +0530

A substantial proportion of patients with hypercholesterolaemia, particularly those with atherosclerotic cardiovascular disease (ASCVD) or heterozygous familial hypercholesterolaemia (HeFH), do not achieve recommended LDL-cholesterol (LDL-C) targets despite statins, ezetimibe, and injectable PCSK9 inhibitors. The parenteral route of the latter remains a well-recognised barrier to their wider use. Objective of the study was to review the discovery, pharmacology, clinical evidence, and therapeutic positioning of enlicitide (Lipfendra), the first oral PCSK9 inhibitor, approved by the US FDA in July 2026. A structured narrative review of PubMed/MEDLINE, ClinicalTrials.gov, FDA regulatory documents, and the primary CORALreef trial publications, with priority given to original clinical and discovery-chemistry sources over secondary reviews. Enlicitide is an orally bioavailable macrocyclic peptide that binds circulating PCSK9 and preserves hepatic LDL-receptor recycling. Across the CORALreef phase 3 programme, it produced placebo-adjusted LDL-C reductions of approximately 56–60%, with concordant reductions in apolipoprotein B, non-HDL-cholesterol, and lipoprotein(a). Its short-term safety profile was comparable to placebo. Its approval further demonstrates, for the first time, that a large extracellular protein-protein interaction, previously considered accessible only to injectable biologics, can be disrupted through an orally administered peptide. Enlicitide brings potent PCSK9 inhibition within an oral formulation for the first time. Whether this translates into reduced cardiovascular events, how it performs over long-term use, and how accessible it will prove outside the United States - including in India, where familial hypercholesterolaemia remains substantially underdiagnosed - are questions that current evidence cannot yet answer.

Perioperative usage of eculizumab for prevention of recurrent thrombotic microangiopathy and graft dysfunction in a live related renal transplant recipient with atypical hemolytic uremic syndrome

Mon, 24 Aug 2026 00:00:00 +0530

This case report describes about the graft protective role of perioperative eculizumab in a kidney transplant recipient with long standing atypical hemolytic uremic syndrome (aHUS), on 19 years of dialysis. A 30 years old male patient with history of systemic hypertension, chronic kidney disease, End stage renal disease, aHUS and Thrombotic micro‑ angiopathy on maintenance hemodialysis since 19 years was admitted for live related renal transplant. Eculizumab was administered perioperatively for prevention of complement mediated thrombotic microangiopathy (TMA) recurrence and graft loss. Following the surgery, the patient’s kidney function improved gradually, and his serum creatinine levels remained stable. There was no evidence of recurrent TMA. The patient was discharged with preserved graft function and advised regular follow up for monitoring of renal function and complement activity.

Effect of integrated yoga and naturopathy intervention on psychological states and quality of life in a patient with irritable bowel syndrome: a single case report

Mon, 24 Aug 2026 00:00:00 +0530

Irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction characterized by abdominal pain, altered bowel habits, and significant psychological distress, which adversely affect quality of life. The present case report describes the effect of an integrated Yoga and Naturopathy (Y and N) intervention on psychological well-being and quality of life in a patient with IBS associated with autoimmune comorbidities. A 57-year-old male with a 25-year history of IBS and a 40-year history of vitiligo presented with epigastric pain, altered bowel habits, anxiety, depression, and reduced quality of life. He had a strong family history suggestive of autoimmune predisposition and was receiving pharmacological treatment for multiple conditions. The patient underwent a 10-day residential Y and N program comprising yoga practices, pranayama, deep relaxation techniques, hydrotherapy, mud therapy, acupuncture, massage therapy, reflexology, cleansing procedures, and a plant-based naturopathic diet. Psychological well-being and quality of life were assessed using the generalized anxiety disorder-7 (GAD-7), patient health questionnaire-9 (PHQ-9), and IBS quality of life (IBS-QOL) scales before and after the intervention. Following the intervention, anxiety scores decreased from 18 to 10, depression scores reduced from 14 to 4, and IBS-QOL scores improved from 57.3 to 69.9. The patient also demonstrated reductions in body weight and body mass index and reported discontinuing long-term symptomatic medications, with a subjective improvement in overall well-being. This case suggests that integrated Y and N interventions may improve psychological health and quality of life in patients with IBS and associated autoimmune conditions. Further large-scale studies are warranted to validate these findings.

Preoperative wound bed preparation with Ayurvedic management followed by split-thickness skin grafting in a post-debridement wound of the right lower leg: a case report

Mon, 24 Aug 2026 00:00:00 +0530

Large post-debridement wounds are often associated with infection, tissue loss, oedema, unhealthy granulation and delayed recovery, making their management challenging. Adequate preparation of the wound surface before grafting is important for successful healing. This case report describes the management of a post debridement wound of the right lower leg using Ayurvedic wound care measures followed by split-thickness skin grafting (STSG) with vacuum-assisted closure (VAC). A 62-year-old female presented with wounds over the posteromedial region of the right leg and ankle joint after trauma complicated by cellulitis and surgical debridement. Examination revealed slough, foul odour, irregular margins, exposed tendons and muscles, swelling and pain. Preoperative treatment included Panchavalkala Kashaya Dhavana and internal Ayurvedic medications aimed at wound cleansing and promotion of healthy granulation tissue. After improvement in the wound condition, STSG was performed and VAC therapy was applied with continuous negative pressure. Gradual reduction in pain, discharge, oedema, and unhealthy tissue was observed. Healthy granulation developed before grafting, and satisfactory graft uptake was noted during follow-up, with complete healing achieved subsequently. This case indicates that wound bed preparation with Ayurvedic management along with surgical intervention may contribute positively in healing.

Melasma-like facial hyperpigmentation associated with long-term dasatinib therapy in Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia: a rare cutaneous adverse event

Kavya Ronanki, Reshma Benson, Arjun Kacchwaha, Uttam Kumar Nath — Mon, 24 Aug 2026 00:00:00 +0530

Tyrosine kinase inhibitors (TKIs) have significantly improved survival in Philadelphia chromosome-positive leukemias, including chronic myeloid leukemia (CML) and Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL). Dasatinib, a second-generation TKI, is frequently used in Ph+ ALL due to its potent BCR-ABL inhibition and ability to cross the blood-brain barrier. While common adverse effects of dasatinib include cytopenias and fluid retention, cutaneous side effects are rare, particularly pigmentary changes, and among these, melasma-like hyperpigmentation has seldom been reported. We report the case of a 29-year-old woman diagnosed with high-risk Ph+ B-cell ALL with baseline CNS-III involvement, who was treated with the augmented BFM 2009 protocol along with dasatinib (100 mg once daily). After achieving complete molecular remission and transitioning to maintenance therapy, the patient developed progressive, asymptomatic, brown-gray hyperpigmented macules and patches over the malar areas, forehead, nasal bridge, and upper lip consistent with a centrofacial melasma-like pattern. No history of sun exposure, hormonal therapy, cosmetic products, or systemic illness was identified. A dermatologic evaluation attributed the lesions to dasatinib-induced hyperpigmentation, and the patient was treated with topical fluticasone and 2% hydroquinone, along with strict photoprotection. Cutaneous pigmentary changes induced by TKIs are typically hypopigmentary and most commonly associated with imatinib, whereas hyperpigmentation, especially with melasma-like features, remains a rare adverse effect of dasatinib; the pathogenesis is believed to involve inhibition of the c-KIT/stem cell factor signaling pathway, which is vital for melanocyte function. In this patient, the delayed onset of pigmentation nearly four years after dasatinib initiation highlights the unpredictable nature of TKI-induced skin changes, and given the importance of dasatinib in disease control, continuation of therapy with symptomatic dermatologic management was deemed appropriate. This case underscores the importance of recognizing rare dermatologic adverse effects of TKIs, such as melasma-like hyperpigmentation associated with dasatinib; early identification and management are essential to prevent cosmetic distress and ensure treatment adherence, and further research is needed to elucidate the mechanisms underlying such pigmentary changes and to guide optimal management strategies.

Underrecognized phototoxicity from prolonged doxycycline therapy: a case highlighting early nail involvement

Kashish Jindal, Prakash Tendulkar, Ravi Kant, Akhilesh Kumar, Dheeraj Dheeraj — Mon, 24 Aug 2026 00:00:00 +0530

A 27-year-old man developed photo-onycholysis and a facial phototoxic rash after taking doxycycline, cefuroxime and aceclofenac for about 40 days following incision and drainage of a wrist abscess. He had no other illness. The wound healed well and his laboratory results were unremarkable, but several fingernails turned reddish-brown and became so tender that light pressure was painful, and both cheeks developed erythematous maculopapular lesions. The toenails were normal. There was no separation of the nail plate, no pitting and no subungual debris, so the usual morphological clues to photo-onycholysis were absent. Other causes were excluded clinically, and of the three drugs he had taken only doxycycline is an established cause of this reaction. Causality assessment using the Naranjo scale gave a score of 5, indicating a probable adverse drug reaction. All three drugs were stopped and the patient was counselled about ultraviolet A protection and nail care; the rash and the nail changes settled over eight weeks without progressing to detachment. Two aspects of the case deserve emphasis. The nail changes were inflammatory and painful but pre-lytic, a stage at which the diagnosis is easily missed, and the reaction occurred during a north Indian winter rather than in summer or in a returning traveller, which is the setting of most published reports. The case is also a reminder that a short course would have sufficed after drainage of an uncomplicated abscess, and that the reaction would not have occurred had the prescription been stopped on time.