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Clinical pharmacology – the first 75 years and a view of the future

British Journal of Clinical Pharmacology2006-05-11作者：C. T. Dollery

When the Editor of the British Journal of Clinical Pharmacology commissioned this article he probably expected a scholarly step-by-step account of the development of our discipline. He also asked that the review should consider current difficulties and future prospects. A period of reflection and some background literature searches soon convinced this author that a comprehensive account would be so lengthy and take so long to research thoroughly that it was more likely to be complete for the 80th anniversary of the British Pharmacological Society (BPS) than the 75th. So this is a personal account by someone who has lived and worked through just under 50 years of the 75 years the Editor wanted to cover. To minimize personal bias I have sought advice from a substantial number of those who have been leaders in the development of the discipline. Their names are listed at the end of the article. I am profoundly grateful to all of them and if I have misrepresented their views here and there I hope that they will forgive me. For the many very active participants I have not mentioned I plead the exigencies of time and page space. The article contains no references because there would have been hundreds, but it does include many names, so those who want to know more can use Google and Medline. At the conclusion of the article I have tried to address some of the rather pessimistic views about the future of clinical pharmacology that are current in many academic circles. They are views that I understand but do not entirely share. From the standpoint of someone who now works in industry, the challenges and opportunities for clinical pharmacologists are greater than they have ever been, but a vibrant academic clinical pharmacology community is essential for the practice of clinical medicine and the training of physicians as well as an important source of ideas for industry. At the very end of this article I have put forward some possible solutions to the current problems. To overseas readers they may seem rather UK oriented, but I believe that similar concepts, adapted to local circumstances, could be applied more widely. Academic and health service clinical pharmacology is needed and not be to The of clinical pharmacology is very than the use of that a it to the of and who the in that now know as and know about who was and and difficulties they The period of is more for the in but it was a of and When the the at the was the to a and it was from that pharmacology who of pharmacology in of the of Pharmacology and an important of clinical at at the by the he a there to a clinical but it as a to clinical and and was soon a of in is about who the but it was probably a of Pharmacology at who the pharmacology of in the and important in was the of the of and very The Pharmacological of At this time the research was very The British the as a of all was to a I can just the in the clinical has also to be a of many at and and clinical and the all have their but this 75 years a the of the of through of the for in medicine from and some time research training in the at the of at he was of Pharmacology at the in he was of at the of in and it was from that that he applied the pharmacology of and the to At that time all pharmacologists training and it was to and as and have the years to that of of ideas and pharmacology and in a more For this article I to a and it is just 75 years I the of by the by and because of a and because they the from of the active in and They clinical it was not a they was a who just to in the of in to to the active to be in the from the of and in The was that in the they by the that no in their but this and they to and of and use them to the in their by to the of a from the from was by in The to and they but all they was a local The the was a who the of was very clinical a in as a of by the in of the a The to in of the and the lengthy now from to years from of an to is the was the source of a in for the in a was to the of and a at the in was convinced that the a was more important than the and the of They of and them a the end of the of the but at and a of and and the of and that of was They to that this as was an to the of the of He to there and to the of was of that he to in and all the he wanted was the the that to the was also and the worked at and to a of clinical and the a of the that was by the who there was who of pharmacology in at the in The was also for the of and their in to the Clinical in and was very in pharmacology and medicine at and in he of a of the training for a of clinical and of was to a clinical pharmacology research and training at in A of and of was the of and it was research in by that the of was The of was also a of the development of clinical pharmacology in there was no in the of a the so development was more from physicians a in some from He it for to the I to at the he that the he of important was to and this is have ever tried in the UK the of at and at in and some of the a I to and a training to to the of Pharmacology in I was at the the was more a to to the as research and take for the I was in the for a years a of as and that time from a a as as to that could I was to from at the as of pharmacology and to a to the of in the to a of very physicians to the and many from the UK and at of the to as a but there was from the number of and he a in the of at of in he was to for a that just at that he for he was a and so the clinical pharmacology in the a very active in many and clinical pharmacology a for of in important in a number of in the of the to clinical pharmacology was a by the The of clinical in the UK and from medicine and in from account for some of the in practice and that to this there has been the of by as the and in the and the of in the the was to the of in the the of the was as the in the of a as and from the in was not to this the the and of the of a is that in the of have in to as those by and The by in in to the in and the of the in and the UK of and UK the that have They very important for clinical but more about the of the The development of clinical pharmacology in the and in an of was a of and important a of the for more of in and opportunities as a When the of was in the of it was to a clinical was that the British to take the this period at the and in in and and in the and in in from research in the UK and the in the and some The and the development of clinical now in industry, a of in the that the of the discipline. as the British Journal of Clinical as clinical pharmacology of and as the and the physicians and the discipline. 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Sex and Gender Disparities in the COVID-19 Pandemic

Journal of Women s Health2020-04-01作者：Jewel Gausman, Ana Langer

Journal of Women's HealthVol. 29, No. 4 CommentaryFree AccessSex and Gender Disparities in the COVID-19 PandemicJewel Gausman and Ana LangerJewel GausmanWomen & Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Search for more papers by this author and Ana LangerAddress correspondence to: Ana Langer, MD, Women & Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB Building 6th Floor Office 643B, Boston, MA 02115 E-mail Address: [email protected]Women & Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Search for more papers by this authorPublished Online:17 Apr 2020https://doi.org/10.1089/jwh.2020.8472AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail In the case of the ongoing COVID-19 pandemic, sex-disaggregated data suggest that fewer women are dying from the disease than men.1 However, taking this observation at face value oversimplifies the biological, behavioral, and social and systemic factors that may cause differences to emerge with regard to how women and men experience both the disease and its consequences. As governments react with swift and severe measures in their ongoing fight to control the pandemic's spread, it is important to understand how these actions may disproportionately increase the risks for women both directly and indirectly with regard to sex and gender.Pregnant women are often among the most vulnerable groups during public health emergencies. In some cases, pregnant women face increased biological susceptibility to adverse health outcomes, as in the case of some respiratory infections. With other emergent coronaviruses, such as those responsible for severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS), pregnant women who became infected were found to be more likely than nonpregnant women to experience severe complications.2 It is still too early to tell whether this will be the case with COVID-19.In the ongoing pandemic, other factors may have a ripple effect that put women at increased risk even if the disease itself does not. As made clear during the 2014 Ebola outbreak, the consequences of large-scale infectious disease outbreaks on uninfected pregnant women can be dire. Routine prenatal care appointments, if not interrupted or discontinued, may put women at increased risk of exposure to the virus. Overwhelmed hospitals struggling to function with staff and supply shortages may not be able to provide the high quality of care that all pregnant women and their newborns deserve, let alone respond to emergency obstetric complications. Furthermore, there is also a risk that life-saving treatments or vaccines will be denied to pregnant women over concern for fetal safety or a lack of data.3,4The fear of infection, concern for the well-being of friends and loved ones, uncertainty, disruption, and social isolation that have become part and parcel of daily life for many around the world will undoubtedly have profound effects on mental health on the population at large, but being pregnant during a global pandemic is likely to be even more frightening for many women. Although containment strategies, such as those that require women to deliver without a companion present, including partners and doulas, that have already been put into place in some cities in the United States,5 or those that separate newborns from their mothers immediately after birth if the mother is infected with COVID-196 may be clinically important to reduce transmission, they may also have profound short- and long-term mental health implications for women. Among women who have young children, previous research in Ethiopia, India, and Vietnam found that women who experience family-related stressful life events, such as illness or death within the household and financial uncertainty, are more likely to experience episodes of severe mental distress.7 With the ongoing need to social distance, family and community networks may struggle and pregnant and postpartum women may feel even more vulnerable and isolated over a lack of social support.The adverse effects of the pandemic in relation to women's reproductive health are not limited to pregnancy or motherhood. As movement restrictions are put into place, supply chains are disrupted, and businesses are shuttered, some women may be at increased risk of unintended pregnancy should it become difficult to obtain their regular contraceptive method or emergency contraceptives, if needed. Furthermore, some states within the United States have begun to impose restrictions on certain medical procedures that they deem to be elective, including abortion, suggesting they must be delayed until after the pandemic is over.8 Spikes in domestic violence during times of crisis are another area of grave concern for women's health, and as governments continue to put into place more extreme measures to enforce social distancing, for some women, more time at home may mean more time spent with an abusive partner. Fewer social interactions may also mean less accountability for perpetrators and fewer opportunities for others to intervene.Gender-related factors may also increase the impact of the COVID-19 pandemic on women globally. Women constitute a disproportionately high percentage of caregivers in both the formal and informal sectors.9 A large proportion of frontline health care professionals (nurses, community health workers, health technicians, etc.) is women who face a higher risk of infection, morbidity, and death as a result of their profession.9 At the same time, women more frequently serve as the primary caregivers within a household, which may further increase their risk of exposure. In the United States, 65% of unpaid family caregivers are estimated to be women and 80% of them care for someone aged 50 years or older.10 Outside of their caregiving role, women are overrepresented in the informal employment sector. In low-and middle-income countries, two-thirds of women who work do so as part of the informal economy with limited access to health care for themselves and their families.9 Containment and mitigation policies that limit women's ability to perform their duties without offering effective alternatives, such as closing of daycare facilities for their children or not providing paid sick leave, may result in unnecessary exposure to disease and increased family vulnerability.It is urgent that we adopt a gender lens to study the pandemic and its effects, including the policies and actions that are put into place at the global, country, and local levels. This may be especially important in disadvantaged populations and resource-poor communities, where women are especially vulnerable. The public health community must ensure that existing health and social services meant to support women in the face of their unique needs do not disappear in lieu of the all-encompassing focus on stopping the pandemic. Furthermore, we argue that special attention needs to be paid to ensure that informal caregivers are supported, informed, and protected. To avoid making existing gender disparities larger as a result of the pandemic, a special body at the U.S. Centers of Disease Control and Prevention is urgently needed to track sex disaggregated data and analyze policies related to COVID-19 using a gender lens.Author Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.References1. Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respir Med 2020;pii: S2213-2600(20)30117-X. Medline, Google Scholar2. Favre G, Pomar L, Musso D, Baud D. 2019-nCoV epidemic: What about pregnancies? Lancet 2020;395:e40. Crossref, Medline, Google Scholar3. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: What obstetricians need to know. Am J Obstet Gynecol 2020;pii: S0002-9378(20)30197-6. Medline, Google Scholar4. Weigel G. Novel coronavirus "COVID-19": Special considerations for pregnant women. Available at: https://www.kff.org/womens-health-policy/issue-brief/novel-coronavirus-covid-19-special-considerations-for-pregnant-women/?utm_source=Global+Health+NOW+Main+List Accessed March 17, 2020. Google Scholar5. Caron C, Syckle KV. Laboring alone: Some hospitals bar partners because of virus fears. The New York Times. 2020. Google Scholar6. American College of Obstetricians and Gynecologists. Practice advisory: Novel coronavirus 2019 (COVID-19). Available at: https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019?IsMobileSet=false Accessed March 13, 2020. Google Scholar7. Gausman J, Austin SB, Subramanian S, Langer A. Adversity, social capital, and mental distress among mothers of small children: A cross-sectional study in three low and middle-income countries. PLoS One 2020;15:e0228435. Crossref, Medline, Google Scholar8. Tavernise S. Texas and Ohio include abortion as medical procedures that must be delayed. The New York Times. 2020. Google Scholar9. Langer A, Meleis A, Knaul FM, et al. Women and health: The key for sustainable development. Lancet 2015;386:1165–1210. Crossref, Medline, Google Scholar10. Feinberg L, Reinhard SC, Houser A, Choula R. Valuing the invaluable: 2011 update, the growing contributions and costs of family caregiving. Washington, DC: AARP Public Policy Institute, 2011:32. 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Obstetrics and Gynecology Public Health, Environmental and Occupational Health Clinical Psychology

Better Health Systems for India's Poor

Health, nutrition, and population series2002-05-01作者：David H. Peters, Abdo S. Yazbeck, Rashmi Sharma

No AccessHealth, Nutrition, and Population1 Feb 2013Better Health Systems for India's PoorFindings, Analysis, and OptionsAuthors/Editors: David H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam WagstaffDavid H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam Wagstaffhttps://doi.org/10.1596/0-8213-5029-3SectionsAboutPDF (1.3 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This report focuses on four areas of the health system in which reforms, and innovations would make the most difference to the future of the Indian health system: oversight, public health service delivery, ambulatory curative care, and inpatient care (together with health insurance). Part 1 of the report contains four chapters that discuss current conditions, and policy options. Part 2 presents the theory, and evidence to support the policy choices. The general reader may be most interested in the overview chapter, and in the highlights found at the beginning of each of the chapters in part 2. These highlights outline the empirical findings, and the main policy challenges discussed in the chapter. The report does not set out to prescribe detailed answers for India ' s future health system. It does however, have a goal: to support informed debate, and consensus building, and to help shape a health system that continually strives to be more effective, equitable, efficient, and accountable to the Indian people, and particularly to the poor. 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Public Health Approach of Ayurveda and Yoga for COVID-19 Prophylaxis

The Journal of Alternative and Complementary Medicine2020-04-20作者：Girish Tillu, Sarika Chaturvedi, Arvind Chopra

The Journal of Alternative and Complementary MedicineVol. 26, No. 5 CommentariesPublic Health Approach of Ayurveda and Yoga for COVID-19 ProphylaxisGirish Tillu, Sarika Chaturvedi, Arvind Chopra, and Bhushan PatwardhanGirish TilluAYUSH Center of Excellence, Center for Complementary and Integrative Health, Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India.Search for more papers by this author, Sarika ChaturvediDr. D.Y. Patil Vidyapeeth (DPU), Pune, India.Search for more papers by this author, Arvind ChopraCenter for Rheumatic Diseases, Pune, India.Search for more papers by this author, and Bhushan PatwardhanAddress correspondence to: Bhushan Patwardhan, AYUSH Center of Excellence, Center for Complementary and Integrative Health, Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India E-mail Address: [email protected]AYUSH Center of Excellence, Center for Complementary and Integrative Health, Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India.Search for more papers by this authorPublished Online:11 May 2020https://doi.org/10.1089/acm.2020.0129AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byDNA metabarcoding uncovers fungal communities in Zingiberis RhizomaChinese Herbal Medicines, Vol. 6"We are adapting to it because it is within us": The co‐becoming of COVID‐19 in Malawi20 December 2023 | World Medical & Health Policy, Vol. 5COVID-19 Cases and Comorbidities: Complementary and Alternative Medicinal Systems (CAM) for Integrated Management of the PandemicJournal of Herbal Medicine, Vol. 42Traditional Formulations for Managing COVID-19: A Systematic Review Rudra B. 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Complementary and alternative medicine Complementary and alternative medicine Complementary and alternative medicine

A Study on Prevalence of Malarial Retinopathy among Malaria Cases and to Determine Its Presence as a Marker of Severe Malaria: Observations from Eastern India.

PubMed2026-03-01作者：Chatterjee R, Bhadra TR, Chatterjee N

Malarial retinopathy refers to a constellation of changes seen in severe or complicated malaria cases. These include: retinal whitening, vessel changes-whitening, tramlining, retinal hemorrhages, and papilledema. There are very few Indian studies on this entity. Since retina can be easily visualized by direct ophthalmoscopy, this study was done to determine prevalence of malarial retinopathy among malaria cases and to determine relationship between malarial retinopathy and severity of the disease. The study was done at Indoor and Outdoor Departments of Tropical Medicine, School of Tropical Medicine (STM), Kolkata, with the support of the Department of Ophthalmology, Regional Institute of Ophthalmology (RIO), Medical College, Kolkata. Adult malaria cases, both complicated/severe and uncomplicated, were included. Patients unable or unwilling to cooperate with eye examination, contraindications to tropicamide eye drops (angle closure glaucoma or known allergy to product), severe corneal scarring or cataracts hindering view by ophthalmoscopy, diabetes mellitus, hypertension, intracranial space occupying lesions, epilepsy, alcohol use, chronic renal failure, age > 60 years and any other known ocular/systemic disease that can cause retinopathy changes were excluded. Severe malaria was diagnosed as per the WHO criteria. Cases with acute febrile illness of other causes were taken in control arm, and normal population subjects were taken as controls. All patients were assessed clinically, followed by appropriate laboratory investigations and then direct ophthalmoscopic examination was done. Ocular findings were be collaborated with severity of illness. A total of 71 malaria cases were included in our study. Among them, 12 cases were of severe malaria, and rest of the cases were uncomplicated. Of the 12 severe malaria cases, 8 were Plasmodium vivax, 3 were Plasmodium falciparum, and 1 was mixed. Uncomplicated malaria cases were mostly P. vivax (35 out of 59). Features suggestive of malarial retinopathy were noted in 9 out of 12 cases of severe malaria (75%) and 2 out of 59 cases of uncomplicated malaria (3.4%). We noted two cases of retinal changes-one case of retinal whitening in falciparum malaria and one case of vivax malaria with retinal hemorrhage in the uncomplicated group. Both of the cases subsequently needed admission for recurrent vomiting, reduced urine output, and severe weakness 40 dengue cases were included in control arm of AFI cases-20 DHF cases and 20 cases of DF with warning signs. Among them, retinal hemorrhage was noted in one case of DHF (2.5%). Out of 40 sepsis cases, retinal hemorrhage was seen in one case (2.5%). No retinal changes were noted among 40 other AFI cases which included scrub typhus, enteric fever, chikungunya, and acute viral hepatitis. Also, no abnormality was detected on ophthalmoscopy in 40 healthy individuals. The presence of retinopathy was suggestive of severe malaria (p < 0.05). We found the sensitivity and specificity of malarial retinopathy as a marker of severe malaria to be 75% and 96.6% with a positive predictive value of 81.8%. Malarial retinopathy may serve as an important clinical biomarker for predicting severe malaria. All clinicians should be appropriately trained in performing direct ophthalmoscopy to detect the retinopathy changes.

The Journal of the Association of Physicians of India

Reporting statistics in clinical trials published in Indian journals: a survey.

PubMed2010-06-01作者：Goyal Jaykaran, N. D. Kantharia, Y Preeti

OBJECTIVES: Clinical trials are having very important place in the hierarchy of evidence based medicine. It has been observed that current methods of use and reporting of statistics of clinical trials are responsible for errors in the interpretation of results. So we decided to evaluate clinical trials published in three Indian journals of 2007 and 2008 to analyse statistical issues which may affect the interpretation of results. SETTINGS AND DESIGN: Retrospective observational study MATERIALS AND METHODS: We analyzed all the clinical trials (46) published in Indian pediatrics, Indian journal of pharmacology, journal of postgraduate medicine and of 2007-2008. RESULTS: We found that median number of end points reported in clinical trials was 4 and median number of end points which were used for testing of significance was also 4. (21) 45% of trials reported repeated measurement. 18 (39%) trials had three or more than three treatment groups. median number of test of significance was 15. post hoc subgroup analysis was done in 19% (9) of trials. P value was the sole criteria for interpretation of results in most of the trials, confidence interval was calculated in 11 (23%) trials. Baseline comparison between the study groups was done in 41 (89%) trials. in all cases comparison was done by statistical tests. Exact sample size was calculated in 18 (39%) trials. CONCLUSION: There are great chances of having error during the interpretation of results of these trials was because of multiple treatment groups, repeated measurements of endpoints, multiple tests of significance, over reliability on P value and less use of confidence interval. Statistical methods available for reducing chances of errors should be used and result should be interpreted accordingly.

Statistics, Probability and Uncertainty Statistics and Probability Molecular Biology

Impact factor and other indices to assess science, scientists and scientific journals.

PubMed2011-03-30作者：K Satyanarayana

This paper traces the evolution of measures and parameters for the evaluation of science and scientific journals from the first attempts during the early part of the last century to the development of the most popular, current and widely used metrics viz., citations, impact factor (IF) etc. The identification of measures of evaluation in science and scientific reporting paralled the post-war increase in funding in the United States of America. Biomedical and medical sciences continue to garner a major share, estimated to be almost two-thirds of total research and development funding of over US$ 350 billion. There has been a concomitant growth in the publications in learned journals. About 1.4 million papers are published every year in an estimated 20,000 journals. In India there are an estimated 100 journals in medical sciences. With a steady increase of about 10% every year, the competition for grants, awards, rewards etc., is fierce. This unrelenting increase in number of scientists and the resultant competition, the limitation of peer review was felt. A search was on for new quantifiable measures for informed decision making for funding, awards, rewards, etc. Now virtually all major decisions all over the world are based on some data linked to publications and/or citations. The concept of citations as tool for 'evaluating' science was first proposed by Eugene Garfield in 1955. The availability of Science Citation Index (SCI), Journal Citation Reports (JCR), Web of Science etc. and the relative ease with which they could be used (and abused) has spawned an entirely new area bibliometrics/scientometrics. As only a limited number of journals could be included in the Thomson Reuters (TR) databases (currently numbering about 10500), analyses based on such a limited dataset (also selected in a non-transparent way by the TR) has been widely and severely criticized by both the developed and developing countries. Yet, studies have shown that citation-based data and indicators (warts and all) could still be put to productive use for purposes of evaluation (as scientists just love numbers). There were simultaneous efforts to find alternative indicators using the TR databases, and through other innovative methods. Some of these include Google Scholar, PageRank, H-index, Y-factor, Faculty of 1000, Eigen Factor etc. The advantages and limitations of these indices are discussed. There is a need for a more critical look at these parameters from the Indian perspective to compute/ device/adapt these measures to suit our needs. There are 205 journals under the category Physiology and 201 in the Pharmacology category listed in the JCR. There are four major Indian journals under the category of Physiology and Pharmacology and none of them are listed in the TR databases reflecting the limitation of these databases. Eventually, and in the long run, the quality of our journals needs to be improved as the current era of globalization and web-access provides both a challenge and an oppportunity for the science and scientific journals published from India to get increased global visibility.

Statistics, Probability and Uncertainty Information Systems and Management Public Health, Environmental and Occupational Health

Pharmacovigilance of paracetamol-induced Stevens-Johnson Syndrome and toxic epidermal necrolysis in the Indian population.

PubMed2026-05-01作者：Ray RS, Yadav A, Bhushan S

Despite decades of proven safety of paracetamol, serious and rare reactions such as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) often occur in the Indian population. The current study aimed to understand the safety profile of this relatively safer drug, paracetamol, with respect to rare and serious adverse events, SJS/TEN, based on data collected from the Indian population through the Pharmacovigilance Programme of India. The collected, collated and analyzed all Individual Case Safety Reports with the use of paracetamol from the Indian population for the period January 1, 2010, to December 31, 2021, were reported to VigiBase and analyzed using the WHO database, VigiLyze. Analysis of the reported data showed that 313 SJS/TEN adverse events were associated with the use of paracetamol. Disproportionality analysis of paracetamol-induced SJS/TEN reactions in the Indian population using the Proportional Reporting Ratio (PRR), reporting odds ratio, and the information component indicated higher risk of paracetamol in the Indian population. The findings provide crucial insights into the extent of rare and infrequent SJS/TEN associated with the use of paracetamol in the Indian population. Owing to the seriousness of reaction and the widespread use of paracetamol for fever-like illness, the prescribing physicians, pharmacists, and other healthcare professionals should closely monitor patients administered paracetamol for this potential rare reaction, SJS/TEN.

Indian journal of pharmacology

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Effects of Traditional Chinese Medicine on Restoroing the immune balance of mild-to-moderate Patients with new coronavirus.

PubMed2026-03-01作者：Chen S, Li H, Jiang Z

Coronavirus disease 2019 (COVID-19) which brings the epidemic situation to the public has spread rapidly and produce multiple variations. At present, Western medicine still lacks the specific medicine or vaccines for coronavirus. However, amount of evidence shows that traditional Chinese medicine (TCM) has advantages in releasing the symptoms of mild-to-moderate COVID patients. Those treatments are not only improving the course of the primary disease but also curb progress to severe pneumonia or acute respiratory distress syndrome. Therefore, taking TCM intervention or combined treatments appropriately to prevent worsening illness is of vital significance. This study mainly focuses on the data analysis on the effects of TCM in restoring the immune balance of COVID patients. By collecting clinical data from mild to moderate patients, we expected to figure out if TCM only plays the role of curbing inflammation or having a two-way influence in balancing the immune microenvironment. Seven digital databases including PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database (VIP), Wanfang Database, and China Biology Medicine were searched from December 2019 to August 2022 nothingness of language restrictions. The studies retrieved from the database were selected and the data extracted to assess the methodological quality of the included randomized controlled trials (RCTs). Statistical analysis was completed. Pulmonary computed tomography, clinical cure rate, rate of conversion to severe cases, length of hospital stay, and scores of TCM syndrome were defined as the primary outcomes, the secondary outcomes were white blood cell count, lymphocyte (LYM) count, and C-reactive protein (CRP). This study was registered with PROSPERO (CRD42022341482). Nine eligible RCTs including 1159 participants were included in this meta-analysis. Compared with Western medicine treatment alone, our meta-analyses found that traditional Chinese combined Western medicine treatment has a higher clinical cure rate, better absorption of lung inflammation, and significantly shorter hospital stay. In terms of inflammatory factors, TCM can significantly reduce the CRP content compared with Western medicine methods, but the leukocyte and LYM content was not significantly different between the two treatments. In some research, TCM even has a trend accelerating the inflammation process on some specific stages of the disease. Chinese herbal medicine combined with conventional therapy is significantly effective and invulnerable in the treatment of mild-to-moderate COVID-19. In terms of control inflammation, TCM does not only block the disease onset by simply inhibiting inflammation but balancing the human environment through bidirectional regulation of inflammatory cells. However, considering of the lack of research into how TCM could activate the natural immune response, the discussion of the mechanism cannot be stretched, more high-quality RCTs are still needed in the future.

Indian journal of pharmacology

Molecular and Pharmacogenetic Marker Evaluation in Relation to the Toxicity and Clinical Response of Acute Lymphoblastic Leukemia Treatment in Indian Children (MPGx-INDALL): Protocol for a Prospective Observational Cohort Study.

PubMed2026-03-17作者：Sharma S, Ganguly S, Murugadoss K

Understanding interindividual variability in treatment response and toxicity is essential for optimizing outcomes in pediatric acute lymphoblastic leukemia (ALL). Molecular and pharmacogenetic markers hold promise in predicting treatment efficacy and adverse effects, particularly in genetically diverse populations. This protocol outlines the methodology for a prospective, nonrandomized observational cohort designed to evaluate molecular and pharmacogenetic factors associated with treatment response and toxicity in Indian children diagnosed with ALL. The primary objective is to identify genetic markers associated with treatment-related toxicity and therapeutic response. Secondary objectives include evaluating associations between the occurrence of early toxicities and quality of life during active ALL treatment, specific pharmacogenetic variants, and survival outcomes along with generating data to support the future implementation of personalized treatment strategies in Indian children with ALL. In this prospective, observational cohort, 556 children (≤18 years of age) with newly diagnosed ALL treated under the Indian Childhood Collaborative Leukemia-Acute Lymphoblastic Leukemia 2014 (ICiCLe-ALL-14) protocol at two Indian centers will be enrolled, aiming for a minimum of 500 evaluable children. Eligible participants will be enrolled prior to the initiation of chemotherapy and followed longitudinally throughout treatment. Clinical and laboratory data (demographics, nutritional assessment, quality of life, comorbidities, treatment regimen, toxicity graded by Common Terminology Criteria for Adverse Events v5.0, remission status, and survival) will be collected at predefined intervals up to day 100 of the maintenance phase. Germline and somatic DNA will be sampled at diagnosis and remission. The first phase will use whole-exome sequencing to discover candidate variants by implementing a candidate gene prioritization strategy. The second phase will genotype the top candidates in the full cohort using array technology. Associations with early treatment-related toxicities, steroid response, and survival will be tested by multivariable regression and Cox models. A machine learning approach with pharmacogenetic predictors as classifiers will be implemented further with cross-validation and sensitivity analyses. Ethical committees approved the protocol version 1.0 in 2020: IEC-1167/06.11.2020 (All India Institute of Medical Sciences, New Delhi), JIP/IEC/2020/201 (Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry), and AO_2021-00048 (UNIGE, Geneva). Funding was received from Swiss National Science Foundation, Switzerland; Department of Biotechnology, India; and CANSEARCH Foundation, Switzerland. Recruitment began in December 2022 and is likely to conclude by 2027. A comprehensive analysis of the complete study cohort is anticipated to be completed by 2027. The MPGx-INDALL (Molecular and Pharmacogenetic Marker Evaluation in Relation to the Toxicity and Clinical Response of Acute Lymphoblastic Leukemia Treatment in Indian Children) study will generate actionable insights for individualized ALL therapy in India via systematically evaluating germline and somatic markers in a large ethnically distinct cohort.

JMIR research protocols

Emerging patterns, impact, and collaborative networks of global scientific output on carrageenan and digestive problems: A bibliometric analysis.

PubMed2026-05-01作者：Espinoza-Carhuancho F, Cabanillas-Lazo M, Quispe-Tasayco L

The study aimed to analyze the current trends and spatiotemporal dynamics of research on carrageenan and digestive problems through a bibliometric study from 2019 to 2024. The literature published on carrageenan and digestive issues from the period of January 2019 until July 2024 was examined using an observational and descriptive approach. The use of a quantitative approach was made in relation to authorship distribution and collaboration, country collaboration, and the evolution of themes. A search of the Scopus database was conducted with different keywords of "Carrageenan" and "Digestive problems." Analysis and visualization of the data were done with the use of SciVal and RStudio software. Between 2019 and 2024, a significant increase in publication activity occurred, with associated variations in publication types and pronounced growth in international collaboration. In regard to scientific production, there was an average year-on-year increase of 18.98%, with an average age of the papers of 3.2 years and an average of 15.72 citations per article. A total of 889 authors produced the articles, with an average of 6.71 co-authors per paper and 21.33% international collaborations. Notable institutions producing articles include the Ocean University of China, which produced seven articles, and Jimei University, which produced five articles. The scientific production was highest in China (40), followed by Brazil and Japan, and while most authors contributed a single article, there was a lack of equal scientific productivity accumulated in the articles. The results highlight both the importance and the need to investigate carrageenan and its impact on digestive issues that might yield exciting avenues of research. The number of publications being produced regarding this foundational aspect of research continues to be relevant. The examination of literature also illustrated the key role of international collaborations and changing research agendas in dealing with the challenges related to digestive problems.

Indian journal of pharmacology

Global, regional, and national burden of breast cancer among females, 1990-2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023.

PubMed2026-03-01作者：GBD 2023 Breast Cancer Collaborators

Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.

The Lancet. Oncology

Effects of insecticides and awareness on the dynamics of a delayed malaria model: A real-data calibration.

PubMed2026-05-21作者：Khatun MS, Paul P, Ghosh D

We introduce a time-delayed human-malaria interaction model to examine the dynamics of malaria transmission and to evaluate the impact of awareness-based interventions. In this study, we incorporate two time delays: one representing the incubation period of malaria during transmission and the other accounting for the time required to organize and implement awareness programs. The delayed and non-delayed models are calibrated using observed malaria case data from India, the Democratic Republic of the Congo, and Uganda, and their predictive performance is assessed using relevant evaluation metrics to determine their accuracy and reliability. In the non-delayed model, variance-based MeFAST and correlation-based LHS-PRCC global sensitivity analyses are conducted to determine the key parameters that significantly influence the model dynamics. Based on the convergence test and statistical analyses, the two methods yield nearly the same number of significant parameters for the infected compartments. The existence of periodic oscillations emerging with a stable limit cycle is established by analyzing a supercritical Hopf bifurcation associated with the decay rate of awareness. Subsequently, in the delayed system, the direction and stability of the delay-induced Hopf bifurcation have been demonstrated using the normal form and the center manifold theorem, revealing the supercritical Hopf bifurcation and highlighting the challenges in controlling disease spread. Compared to a single delay, the presence of multiple delays destabilizes the system earlier and lowers the delay threshold for periodic behavior. Chaotic dynamics has been observed due to the high value of time delay in reported cases of infectives which reflects the importance of low delay value in awareness to control the spread of the disease. Despite chaotic behavior, the high availability of treatment and the extensive use of insecticides have been found to effectively control the dynamics.The delayed optimal control results indicate that the combination of insecticide measures and treatment is the most effective in controlling infections.

Journal of theoretical biology

A prospective observational study on the off-label use of medications in the psychiatry outpatient department of a tertiary care hospital.

PubMed2026-03-01作者：Gadaria S, More SA, Pal VS

Off-label prescribing - using medications outside their approved indications, doses, or populations - is common in psychiatry, with Indian studies estimating a prevalence of 30%-40%. Despite this, data on prescribing patterns and associated factors remain limited. This study aimed to assess the prevalence, pattern, and demographic factors associated with off-label prescribing in a psychiatric outpatient setting. The specific objectives included identifying common psychiatric conditions linked to off-label use and its correlation with patient age. A prospective, cross-sectional, and observational study was conducted over 3 months in the psychiatry outpatient department of a tertiary care hospital after ethics approval. Data on demographics, clinical history, and prescriptions were collected using a predesigned pro forma. Off-label status was determined using the National Formulary of India (NFI, 6th edition, 2021) and Central Drugs Standard Control Organization records. The Chi-square test was used for statistical analysis. Among 500 patients (mean age 40.74 ± 15.49 years), 1197 drugs were prescribed, of which 417 (34.83%) were off-label. Clonazepam (40.28%) and lorazepam (15.35%) were the most frequently used off-label drugs, followed by risperidone and propranolol (4.32%). Depressive disorder was the most common condition linked to off-label use. Off-label prescribing was highest (49.6%) in the 21-40 years' age group. Inappropriate indications were the most frequent reason for off-label use. Off-label prescribing is prevalent in psychiatric practice, with benzodiazepines and antipsychotics commonly involved. These findings highlight the need for improved awareness and regulation.

Indian journal of pharmacology

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Hexarelin promotes the survival of retinal ganglion cells after optic nerve transection.

PubMed2026-03-01作者：Chow KBS

Hexarelin is a growth hormone secretagogue receptor type 1a agonist with a potent anti-apoptotic effect. We studied the neuroprotective effect of hexarelin on the survival of retinal ganglion cells (RGCs) in the retina following optic nerve transection (ONT). Golden hamsters of 8-9 weeks old were used. For 7 days following ONT with one dose of drug, hamsters were injected with single dose of saline, 25 μg/kg, 50 μg/kg, and 100 μg/kg hexarelin daily for 5 days. For 7 days after ONT with two doses of drugs, saline, 100 μg/kg and 150 μg/kg hexarelin were injected twice daily for 5 days. Survival of RGCs was quantified by immunostaining with Tuj1 antibody in retina whole mount. Single daily doses of 25 μg/kg, 50 μg/kg, and 100 μg/kg hexarelin dose dependently and significantly increased the survival of RGC. The survival rates of RGC in saline, 25 μg/kg, 50 μg/kg, and 100 μg/kg hexarelin-treated hamsters were 51.2%, 62.4%, 68.5%, and 74.6%, respectively, in 7 days ONT. Two daily doses of saline, 100 μg/kg and 150 μg/kg hexarelin promoted survivals to 72.9%, 91.4%, and 109.2%, respectively, in 7 days ONT. Single daily doses of hexarelin dose dependently increased the survival of RGC. Two daily doses of hexarelin increased RGC survival further and 150 μg/kg hexarelin twice daily is optimal for the survival of RGC.

Indian journal of pharmacology

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Reporting and critical appraisal of evidence-based research: Making the journal club most effective.

PubMed2026-03-01作者：Das RR, Bang A

Evidence-based research (EBR) has become a cornerstone in the scientific, medical, and social sciences disciplines, informing decision-making processes and advancing knowledge across various fields. Evidence-based practice emphasizes integration of EBR, clinical expertise, and patient preferences to guide clinical practice. However, the mere existence of research evidence is not enough; it is essential to critically appraise the evidence to ensure its reliability, validity, and relevance to the context in which it is applied. Critical appraisal involves systematically evaluating the design, methodology, results, and conclusions of a research study to assess its quality and applicability. This article will provide an in-depth insight about reporting and critical appraisal of EBR, examining the principles of critical appraisal, available tools for reporting and appraising a research paper, challenges faced in critical appraisal, and how to make the most of the journal club.

Indian journal of pharmacology

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Hepatic adverse effects of valproic acid: Management strategies.

PubMed2026-05-01作者：Bouaziz I, Atheymen R, Sahnoun R

Valproic acid (VPA) is a widely prescribed first-generation antiepileptic drug. It can induce different liver adverse effects (AEs) which range from mild to severe. A retrospective study was conducted by collecting 9-year reports (from January 2015 to June 2023) of VPA-associated hepatic AEs. It was collected in the Regional Center of Pharmacovigilance of Sfax (Tunisia). Causality was evaluated with the French Bégaud et al. imputability method. Plasma VPA concentrations were measured using an automated enzyme immunoassay (INDIKO). We collected the eight cases of hepatic cytolysis with varying severity: Six had mild elevations of liver enzymes, one presented with moderately severe cytolysis and one case was fatal. There management strategies were guided by both transaminase levels and VPA concentrations. For those with alanine aminotransferase levels ≥5 times the upper limit of normal (ULN), we conducted the drug discontinuation. However, for patients with lower levels of transaminases, plasma VPA level measurement was recommended. The concentrations were within or near the ULN. Management consisted of either withdrawal or dose reduction, depending on associated clinical symptoms. Additional investigations to rule out nondrug-related causes performed in five cases were negatives. Most patients recovered favorable outcome after discontinuation or VPA dose reduction. Management of VPA-induced hepatic cytolysis requires integrating the severity of liver enzyme elevations, plasma drug level measurements, and the results of etiological investigation to guide the clinical decisions.

Indian journal of pharmacology

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Out-of-pocket expenditure incurred by patients suffering from tuberculosis treated under national TB elimination program: A mixed method study from Papum-pare district of Arunachal Pradesh, India.

PubMed2026-01-01作者：Boro P, Paul S, Paul D

Out-of-Pocket Expenditure (OOPE) refers to the direct payments made by individuals for healthcare services and non-medical expenses, excluding health taxes or insurance premiums. Although the National Tuberculosis Elimination Program (NTEP) provides free laboratory services and medications, tuberculosis continues to impose a financial burden on underprivileged populations. This is due to increased healthcare costs, loss of daily wages, and dependency on others. Therefore, this study was conducted with the objectives to determine OOPE for smear-positive tuberculosis patients who are currently under treatment or diagnosed and enrolled within last 1 year under NTEP. 2. To assess the coverage and completeness of Direct Benefit Transfer (DBT). A mixed method study using a tool-based questionnaire was conducted amongst the patients registered under NTEP in Papum-pare district during a period of June 2022 till May 2023. Total of 320 patients were eligible for the study and were interviewed. The data was collected from the patient card and by using a Questionnaire from the WHO's "The Tool to estimate patients' costs". Mean and median costs were used for comparison. The overall estimated mean total costs expended from the onset of symptoms and till treatment completion were Rs.41481.04 under NTEP. Among direct medical costs, investigation fee (Rs.14, 415.16) and direct non-medical costs, hospitalisation cost (Rs. 47,614.49) were maximum.29.95 % patients stopped working less than 1 month and had average per capita income Rs.6701.25. 28.44 % patients borrowed money to cover expenses and 0.31 % sold their land. 55.78 % patients enrolled under Nikshay Scheme received DBT. Compliance to treatment was good and an overall cost incurred by TB patients was low. However, still there is a huge burden of expenses among lower economic section due to scarcity of medicine in DOTS centres and delayed transfer of DBT. The role of NIKSHAY SCHEME in such settings requires further study.

The Indian journal of tuberculosis

Target product profile to guide development of next generation diagnostic test for Salmonella enterica: Responding to the crisis of drug resistant typhoid.

PubMed2026-04-01作者：Singh H, Sharma M, Sikri K

A rapid point-of-care diagnostic test is essential for detecting and differentiating Salmonella enterica serovars Typhi and Paratyphi while also assessing antimicrobial susceptibility to support evidence-based treatment in low-resource settings. This manuscript outlines the key features of an ideal Target Product Profile (TPP) for a typhoid diagnostic that integrates antimicrobial susceptibility testing , addressing the needs of patients in resource-limited low- and middle-income countries (LMICs). The TPP has been developed through a two-round Delphi survey, incorporating feedback from key stakeholders. Antibody detection tests currently available and used in endemic LMICs, suffer from challenges due to pre-existing titres from past infections or vaccinations. Next generation of antibody detection diagnostics tests can achieve enhanced accuracy by amending the threshold values and/or combining with other biomarkers. Molecular techniques such as CRISPR-based detection, droplet digital PCR, recombinase polymerase amplification, helicase-dependent amplification and loop-mediated isothermal amplification have the potential to revolutionise detection of typhoid by improving precision and speed of diagnosis. These nucleic acid-based methods offer high sensitivity and specificity while overcoming the limitations of antigen and antibody based tests, which are prone to false positives and cross-reactivity. To enable effective antimicrobial resistance detection, the test should incorporate key antibiotic resistance markers as these are crucial for tracking emerging multidrug-resistant Salmonella enterica strains and guiding appropriate treatment. Integrating molecular antimicrobial resistance detection with pathogen identification, can prove to be transformative for clinical management of typhoid in low resource settings and have direct impact on rising drug resistant typhoid rates.

Journal of infection and public health

Advancing Prostate Cancer Diagnostics: The Potential of Paper-Based Biosensors for Point-of-Care Testing.

PubMed2026-03-15作者：Lim WY, Chin WJ, Packirisamy G

Prostate cancer remains one of the most frequently diagnosed malignancies among men and continues to be a major cause of cancer-related deaths worldwide. Early and accurate detection is crucial for improving patient survival and enabling timely and appropriate treatment. Although the prostate-specific antigen (PSA) test is widely used for screening, its limited specificity-particularly within the diagnostic "gray zone"-often results in unnecessary biopsies, overdiagnosis, and missed detection of early-stage disease. Consequently, growing attention has turned to novel biomarkers with greater sensitivity and specificity that can complement or even replace PSA in clinical settings. Recent advances in biosensor technology have facilitated the development of rapid, cost-effective, and portable diagnostic tools. Among them, paper-based biosensors have emerged as a promising platform due to their low fabrication cost, simplicity, biodegradability, and compatibility with point-of-care (POC) testing. These devices enable highly sensitive and quantitative detection, where performance largely depends on the selection and engineering of sensing materials. The integration of nanomaterials and surface modification strategies has further enhanced target recognition, signal transduction efficiency, and sensor stability. This review provides an overview of recent progress in biosensor platforms for prostate cancer detection. It emphasizes the potential of advanced materials to improve analytical performance, highlights promising biomarkers beyond PSA, and discusses the major challenges impeding clinical translation. Addressing these barriers will be crucial for enabling paper-based biosensors to transition from research prototypes to reliable, field-ready tools for early prostate cancer diagnosis and monitoring.

Clinica chimica acta; international journal of clinical chemistry