Abstract Background: Conventional prescriptions aim to ensure safe, effective and economical pharmacotherapy. However, irrational practices, such as misuse of antibiotics, irrational fixed-dose combinations (FDCs) and preference for branded drugs, persist, leading to adverse outcomes and higher healthcare costs. Capturing huge data manually is difficult; therefore, induction of digital tools in prescription analysis through digital platform is important to evaluate the prescribing trends in a tertiary care hospital, assessing various prescribing indicators and use of FDCs and medicines from the National List of Essential Medicines (NLEM), 2022. Methodology: A prospective observational study was conducted from June 2023 to January 2024. Prescriptions from various outpatient departments were analysed using the VaidyaRx digital prescription analytics platform. Prescribing indicators, use of NLEM medicines and FDCs were evaluated, with descriptive statistics applied for analysis. Results: In the study, 2270 prescriptions comprising 5552 drugs were analysed. The average number of drugs per prescription was 2.5. Generic prescribing accounted for 36.6%, while 39.7% of drugs were from the NLEM 2022. Antibiotics were prescribed in 14.5% of encounters, and injections were used in only 2.2%. FDCs constituted 22.1% of prescriptions, with pantoprazole + domperidone and amoxicillin + clavulanate being the most common. Conclusion: The study highlights the use of digital analytical platforms to identify and understand prescribing trends. Strengthening antibiotic stewardship, promoting generic prescribing and ensuring rational use of FDCs are vital for optimising pharmacotherapy and aligning with guidelines. Integrating platforms like VaidyaRx offers a promising technology-driven approach to monitor and improve prescription practices.

In Alzheimer's-like dementia, neurodegeneration and synaptic dysfunction are known to be the critical players in explaining cognitive impairment. Adult neurogenesis, normally a chronic and quiet process, is explained to have potential in the field of Alzheimer's therapy. Previous research on noninvasive brain stimulation showed that by controlling the pattern of stimulation externally, we can regulate/entrain neuronal activity, possibly altering the structural changes at the circuit level. However, literature investigating whether noninvasive brain stimulation could hold any potential to initiate the process of adult neurogenesis is scarce. In the present study, with the use of behavioural, microscopic and biochemical tools, we found that extremely low-frequency magnetic field at an intensity of 17.96 μT with a sinusoidal wave of 50 Hz for 2 h daily for a period of 2 weeks in a streptozotocin-induced animal model of sporadic Alzheimer's disease can cause improvement in spatial and reference memory, influencing their swimming strategy in the water maze. This is caused by stimulation in immature neural pluripotent stem cells, with additional redox balance and mitigation of glial aggravation in brain areas like the olfactory bulb, prefrontal cortex and hippocampus. These changes were accompanied by neuroprotection, as observed in the granular layer of dentate gyrus. Taken together, the present study explains a plausible mechanism of action on the protection of neurodegeneration in Alzheimer's disease through noninvasive brain stimulation.

In Alzheimer’s like dementia, neurodegeneration and synaptic dysfunction is known to the critical player in explaining the cognitive impairment. Adult neurogenesis, normally a chronic and quite process is explained to have potential in the field of Alzheimer’s therapy. Previous research on the non-invasive brain stimulation showed that controlling pattern of stimulation externally we can regulate/ entrain neuronal activity, possibly altering the structural changes in the circuit level. However, literature investigating if non-invasive brain stimulation could hold any potential to initiate process of adult neurogenesis are scarce. In the present study, with the use of behavioural, microscopic and biochemical tools we found that extremely low frequency magnetic field at an intensity of 17.96µT with sinusoidal wave of 50Hz for 2hr daily for a period of two week in streptozotocin induced animal model of sporadic Alzheimer’s disease can cause improvement in spatial and reference memory, influencing their swimming strategy in water maze. Which is caused by stimulation in immature neural pluripotent stem cells, with additional redox balance and mitigation of glial aggravation in brain areas like olfactory bulb, prefrontal cortex and hippocampus. These changes were accompanied by neuroprotection as observed in the granular layer of dentate gyrus. Taken together, present study explains plausible mechanism of action on protection of neurodegeneration in Alzheimer’s disease through non-invasive brain stimulation. ![Figure][1] Graphical illustration representing external magnetic field causing cognitive improvement eliciting adult neurogenesis in animal model of Alzheimer’s disease ### Competing Interest Statement The authors have declared no competing interest. Indian Council of Medical Research, https://ror.org/0492wrx28, (IR-594/2019/RS), STS 2019-04291 Department of Biotechnology, https://ror.org/03tjsyq23 [1]: pending:yes

BACKGROUND:There is a need to examine the impact of increasingly prevalent antibiotic shortages on patient outcomes and on the emergence and spread of antimicrobial resistance. OBJECTIVES:To: (1) assess patterns and causes of shortages; (2) investigate the effect of shortages on health systems and patient outcomes; and (3) identify strategies for forecasting and managing shortages. DATA SOURCES:PubMed/MEDLINE, EMBASE, Scopus, and Web of Science. STUDY ELIGIBILITY CRITERIA:Studies published in English from January 2000 to July 2023. Participants health care, policy, and strategic teams managing and responding to shortages. Patient populations (adults and children) affected by shortages. PARTICIPANTS:Healthcare workers responding to and populations affected by antibiotic shortages. INTERVENTIONS:Strategies, policies, and mitigation options for managing and responding to antibiotic drug shortages. ASSESSMENT OF RISK OF BIAS:The methodological quality of included studies was reviewed using the most appropriate tool from Joanna Briggs institute critical appraisal tool for each study design. METHODS OF DATA SYNTHESIS:Data synthesis was qualitative and quantitative using descriptive statistics. RESULTS:The final analysis included 74 studies (61/74, 82.4% high-income countries). Shortages were most reported for piperacillin-tazobactam (21/74, 28.4%), with most of the reported antibiotics being in the WHO Watch category (27/54, 51%). Frequent cause of shortages was disruption in manufacturing, such as supply of active pharmaceutical ingredients and raw materials. Clinical implications of shortages included increased length of hospital stay, treatment failure after using inferior alternative agents, and a negative impact on antimicrobial stewardship programmes (AMS). Robust economic impact analysis of shortages is unavailable. Successfully reported mitigation strategies were driven by AMS and infectious diseases teams in hospitals. CONCLUSIONS:Antibiotic shortages are directly or indirectly driven by economic viability and reliance on single source ingredients. The limited data on clinical outcomes indicates a mixed effect, with some infections becoming more difficult to treat, though there is no robust data on the impact of shortages on antimicrobial resistance. The mitigation strategies to manage shortages rely heavily on AMS teams.

Background: Bortezomib, a commonly used anti-myeloma drug, is metabolized by liver microsomal enzymes which may be polymorphic and responsible for lack of response in 30% patients. Hence, the association of CYP2C19 polymorphism with treatment response was explored in this study. Methods: Treatment naive multiple myeloma (MM) patients, eligible for bortezomib based induction treatment, were recruited as per the inclusion - exclusion criteria. The genotyping of CYP2C19 was done using polymerase chain reaction-restriction fragment length polymorphism for *2, *3 and *17 allele. The incidence and severity of peripheral neuropathy was noted at follow-up visits and graded as per CTCAE criteria ver 5.0. Results: Total 220 patients were recruited from August 2016 till May 2021 with a mean age of 55.6 (9.5) years and 65.9% males. Bortezomib+cyclophosphamide+dexamethasone (41.8%) and bortezomib+lenalidomide+dexamethasone (38.2%) were the most prescribed regimens. The CYP2C19 was polymorphic in 38.6%, 2.3% and 23.7% patients for *2, *3 and *17 allele respectively. There were 195 treatment responders and 25 non-responders, and CYP2C19*2 allele was different between responders and non-responders (p=0.02). All extensive metabolisers (n=54) were noted to be treatment responders. Peripheral neuropathy was reported by 23.2% patients. The frequency of peripheral neuropathy was somewhat lower in patients having either *2/*2 or *3/*3 allele pattern for CYP2C19 (p=0.44). Conclusions: Polymorphism in CYP2C19 enzyme is likely to have an impact on bortezomib treatment response and peripheral neuropathy. The study suggests the role of pharmacogenetics in personalised treatment of MM.

Antibiotics have substantially improved life expectancy in past decades through direct control or prevention of infections. However, emerging antibiotic resistance and lack of access to effective antibiotics have significantly increased the death toll from infectious diseases, making it one of the biggest threats to global health. Addressing the antibiotic crisis to meet future needs require considerable investment in both research and development along with ensuring a viable marketplace to encourage innovation. Fortunately, there has been some improvement in the number of antibiotics approved or in different phases of development through collective global efforts. However, the universal access to these essential novel and generic antibiotics, especially in low- and middle-income countries (LMICs), is challenged by poor economic incentives, regulatory hurdles and poor health infrastructure. Recently, the agenda of securing and expanding access has gained global attention. Several mechanisms are now being proposed and implemented to improve access to essential antibiotics. This review provides an insight into the major barriers to antibiotic access as well as the models proposed and implemented to mitigate accessibility issues. These models include but are not limited to market entry rewards, subscription models and transferable exclusivity vouchers. Further, global access programmes including, Global Antibiotic Research and Development Partnership, Antimicrobial Resistance Action Fund and SECURE Platform are discussed. We also propose the way forward for improving access in LMICs with suggested measures to improve access to generic and novel antibiotics.

Purpose: Kappa opioid receptor (KOR) agonists have anticonvulsant effect but their antiepileptogenic effect is unknown. U50488, a selective KOR agonist is used to determine its effect on status epilepticus (SE), spontaneous convulsive seizures (SS) and cognitive impairment in rat lithium-pilocarpine SE model. Effect of an antiepileptic drug levetiracetam is also studied.Method: Male Wistar rats with SE were divided into three groups namely, LiP, LiP + U50488 (10 mg/kg, i.p.) and LiP + levetiracetam (400 mg/kg, i.p.) group. SE was terminated after 90 min of its onset with diazepam (15 mg/kg, i.p.) and phenobarbitone (25 mg/kg, i.p.). Drug treatment was started after 15 min of onset of SE and repeated once after 4 h. Rats were video monitored 12 h daily (9 AM to 9 PM) to determine severity of SE using modified Racine scale and onset and frequency of SS from day 0 to day 21. Morris water maze (MWM) test was done at baseline i.e. day -1 (before lithium administration) and day 22, to assess cognitive impairment.Results: As compared to LiP, U50488 decreased the severity of SE (1.98 +/- 0.13 vs 2.95 +/- 0.12; p-value < 0.0001) but not levetiracetam (2.62 +/- 0.09; p-value = 0.3112). Survival increased with both U50488 (90%, n = 10) and levetiracetam (81.8%, n = 11) as compared to NS (56.2%, n = 16). No effect on onset and frequency of SS was found in U50488/levetiracetam group. U50488 improved seizures-induced cognitive impairment. Levetiracetam group showed thigmotactic (wall hugging) behaviour in MWM in 8 out of 9 rats.Conclusion: Acute treatment with U50488, a kappa opioid receptor agonist has a beneficial effect on SE, SE-related mortality and memory impairment. The dual protective effect of U50488 on seizures and related cognitive impairment is advantageous over currently used antiseizure drugs which are known to cause cognitive impairment.

Modulating the brain renin-angiotensin system presents an innovative pathway for exploring newer treatment approaches in epilepsy. The current study aimed to evaluate the influence of losartan (LOS) and enalapril (ENP), which are angiotensin receptor blocker and angiotensin-converting enzyme inhibitor, respectively, on the incidence, initiation, and duration of status epilepticus (SE), spontaneous convulsive seizures (SCS), survival, and cardiac alterations in rats subjected to lithium-pilocarpine (LiP)-induced SE. Lithium (127 mg/kg, i.p.) pretreated male Wistar rats were administered pilocarpine (30 mg/kg, i.p.) after 24 h to induce SE, which was terminated after 90 min of onset. Daily 10-h video monitoring was carried out for examining onset, frequency, duration of SCS, and mortality till 18 days. The administration of LOS (10 mg/kg, i.p.), ENP (20 mg/kg, i.p.) and atenolol (AT; 50 mg/kg, p.o.) was started before lithium in pre-SE protocol and for post-SE protocol these drugs were administered 1 h after terminating SE and continued for 7 days’ post-SE. Cardiac pathology, echocardiography, heart weight/body weight ratio, and histopathology were evaluated. None of the drugs used (LOS/ENP/AT) offered protection against SE. Administration before SE decreased and post-SE administration increased the latency of SCS, and the overall duration of seizures remained short in both cases as compared to untreated rats. The heart weight/body weight ratio decreased in rats that did not survive. No echocardiographic changes were observed in any of the groups. Untreated SE rats showed myocyte ischemic changes, which were not present in any treated rats. In conclusion, LOS may reduce cardiac complications in SE rats. Hence, further evaluation of LOS as an add-on in epilepsy treatment should be performed.

The growing need for effective antibiotics is attributed to the intrinsic ability of bacteria to develop survival mechanisms. The speed at which pathogens develop resistance is at par or even faster than the discovery of newer agents. Due to the enormous cost of developing an antibiotic and poor return on investment, big pharmaceutical companies are stepping out of the antibiotic research field, and the world is now heading towards the silent pandemic of antibiotic resistance. Lack of investment in research has further led to the anemic antibiotic pipeline. To overcome these challenges, various organizations have come forward with push funding to financially assist antibiotic developers. Although push funding has somewhat reinvigorated the dwindled field of antibiotic development by bearing the financial risks of failure, the landscape is still large and staggered. Most of the funding is funneled towards the early stages; however, to carry the promising compounds forward, equal or more funding is required formid- and late-stage research. To some extent, the complexity associated with accessing the funding mechanisms has led to their underutilization. In the present review, we discuss several major push funding mechanisms, issues in their effective utilization, recent strategies adopted, and a way forward to streamline funding in antibiotic research.

Introduction: Morphine is widely used in patients and has been reported to alter seizure threshold, but its role in the development of epilepsy is unknown. In this study, role of morphine administration in the development of epilepsy using the status epilepticus (SE) model was determined in rats.Methods: Rats experiencing SE with lithium-pilocarpine (LiP) were randomized into four groups- saline, morphine low dose (5 mg/kg, s.c.), morphine high dose (5-20 mg/kg, s.c.), and naloxone (1 mg/kg, s.c.). Treatments were started 90 min after termination of SE and repeated twice daily for next three days. Rats were video monitored daily for 21 days to determine onset and frequency of spontaneous convulsive sei-zures (SS).Results: Morphine in low doses increased frequency of SS (1.51 +/- 0.15 vs LiP 0.60 +/- 0.12 seizures/rat/day, p-value = 0.0026) and seizures occurred during handling (SDH) (0.08 +/- 0.02 vs LiP control 0.01 +/- 0.01) (p -value = 0.0018). In high doses, no significant change in SS and SDH was found as compared to LiP. No effect of morphine on the onset of SS and percentage of rats experienced SS was found. No effect of nalox-one per se was found on SS. Conclusion: Morphine administration after SE does not affect epileptogenesis as no change in the onset of SS and percentage of rats experiencing SS was found. However, it might alter the susceptibility and fre-quency of SS. As no other study is available with a similar finding, it needs further evaluation.(c) 2022 Elsevier Inc. All rights reserved.

Abstract Background Polypharmacy is principal cause of potentially inappropriate medications (PIMs) in elderly patients, which include over prescribing, under prescribing, and misprescribing. Methods Elderly subjects (≥60 years), of either sex, receiving two or more medications for one or more chronic ailments, attending Geriatrics Outpatient Department (OPD), at All India Institute of Medical Sciences (AIIMS) New Delhi, were included. Their prescriptions were assessed for PIMs by using Beers criteria 2015 and were further followed up at least once in 6 months for adverse events, telephonically. The results were analyzed by using suitable regression models and correlation analysis. Results Three hundred eighty patients average age of 65.4 ± 4.7 years were enrolled. Eighty‐eight percent of the people were having greater than or equal to two ailments. Each patient was prescribed 6.7 ± 2.1 medications with 65% of prescriptions having one or more PIMs. Out of the total prescribed drugs, 15% were satisfying Beers criteria for PIMs. There were 63 adverse drug reactions (ADRs) reported. A statistically significant correlation was observed among comorbidities, number of prescribed medications, PIMs, and ADRs. Quality of life (QOL) of the elderly patients was negatively corelated with polypharmacy and female sex. Conclusion A risk‐benefit analysis of prescribed medications is part and parcel of prescribing, especially in elderly patients. In order to decrease further risks associated with inappropriate prescribing, there is need for indigenous guidelines and intensive training.

Insulin-resistant brain state is proposed to be the early sign of Alzheimer's disease (AD), which can be studied in the intracerebroventricular streptozotocin (ICV-STZ) rodent model. ICV-STZ is reported to induce sporadic AD with the majority of the disease hallmarks as phenotype. On the other hand, available experimental evidence has used varying doses of STZ (< 1 to 3 mg/kg) and studied its effect for different study durations, ranging from 14 to 270 days. Though these studies suggest 3 mg/kg of ICV-STZ to be the optimum dose for progressive pathogenesis, the reason for such is elusive. Here, we sought to investigate the mechanism of action of 3 mg/kg ICV-STZ on cognitive and non-cognitive aspects at a follow-up interval of 2 weeks for 2 months. On the 60th day, we examined the layer thickness, cell density, ventricular volume, spine density, protein expression related to brain metabolism, and mitochondrial function by histological examination. The findings suggest a progressive loss of a spatial, episodic, and avoidance memory with an increase in anxiety in a span of 2 months. Furthermore, hippocampal neurodegeneration, ventricular enlargement, diffused amyloid plaque deposition, loss of spine in the dentate gyrus, and imbalance in energy homeostasis were found on the 60th day post-injection. Interestingly, AD rats showed a uniform fraction of time spent in four quadrants of the water maze with a change in strategy when they were exposed to height. Our findings reveal that ICV-STZ injection at a dose of 3 mg/kg can cause cognitive and neuropsychiatric abnormalities due to structural loss both at the neuronal as well as the synaptic level, which is tightly associated with the change in neuronal metabolism.

In the face of growing resistance against existing antibiotics and a dried-up pipeline of newer agents, the world is heading toward a silent pandemic. Globally, an estimated 4.95 million deaths occurred in 2019 due to drug-resistant infections including 1.27 million deaths attributable directly to bacterial antimicrobial resistance (AMR).[1] As per projected estimates, by 2050, AMR would cause approximately 10 million deaths worldwide and 2 million deaths in India.[1] [2] Recently (2019), in World Health Organization's (WHO) list of 10 threats to global health, AMR stands on fifth place.[3] In the preantibiotic era, infectious diseases were the primary cause of mortality worldwide. Today, if AMR left unchecked, treatable infections will lead to huge increases in fatality from bacterial infections worldwide. The resistance to first line of empirical therapy (β-lactam antibiotics and fluroquinolones) against six priority pathogens (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas. aeruginosa) accounted for more than 70% deaths globally.[1] This continued escalation puts at risk the very practice of modern medicine, unless drastic measures are taken today to counter this threat.

Intracerebroventricular streptozotocin (ICV-STZ) injection at 3mg/kg of b/w is reported to induce sporadic Alzheimer disease (sAD) like pathology, where it causes an insulin resistance brain state. Synaptic dysfunction along with glial aggravation poses major risk factor for sAD. Brain stimulation evinced to be promising in AD patients, however, mechanism of the same in the form of magnetic field (MF) stimulation are elusive. Total 55 rats were recruited and randomly divided into five groups: Control, Sham, AD, Sham+MF, AD+MF. Animals were provided with ad libitum food and water, experiments were performed under permission from IAEC (file no. 937/IAEC/2016). Rats were exposed to 17.96µT for 2hr/day for 30 days and at end elevated plus maze task was performed. Next, transmission electron microscopy(TEM), Golgi-Cox staining was done on hippocampal sample. In addition, GPx activity and serotonin was measured in hippocampal homogenate. Reduction in ratio of time spent in close versus open arm in AD group as compared to Sham (p<0.001), Sham+MF (p<0.01) and AD+MF (p = 0.008). In continuation, head dipping duration was also reduced significantly in AD group as compared to control (p = 0.008), Sham+MF (p = 0.03) and AD+MF (p = 0.001). We found a loss of spine density in apical dendrite of with invasion of ramified microglia in neurovascular-unit in dCA1 layer of AD group versus control (p<0.0001) and AD+MF(p = 0.004). TEM examination of hippocampal samples, we found invasion of ramified microglia in NVU as well as loss of synaptic density. Furthermore, GPx activity was found to be decreased in AD group (p<0.05) versus other counterparts on 30 th day post-injection of STZ. Similarly, serotonin was depleted in AD group as compared to other groups (p<0.05). In addition, results showed a strong correlation between head dipping duration and serotonin level in AD group on 30 th day post-injection of STZ (r = 0.7;p = 0.02). Hence, this work reveals that MF stimulation to have anxiolytic effect through replenishing the synaptic dysfunction and serotonin loss in dorsal CA1 pyramidal cells of hippocampus in ICV-STZ model of sAD.

GRP78 overexpression in myeloma cells has been associated with bortezomib resistance in multiple myeloma (MM). However, serum GRP78 as a maker of bortezomib-based treatment response remains unexplored. The objective of the study was to evaluate serum GRP78 levels in MM patients who underwent a bortezomib-based induction regimen. This cross-sectional study included adult MM patients (n=30) who completed at least four cycles of bortezomib-based induction therapy. Healthy volunteers (n=30) and newly diagnosed MM patients (n=19) were also recruited to identify the disease-associated change in GRP78 levels. Serum GRP78 was estimated by ELISA. Surface and intracellular expression of GRP78 in bone marrow plasma cells was evaluated in ten MM patients by flow cytometry. Among 30 MM patients [median (range): 52 (38-68) years; 20 males] who completed at least four cycles of bortezomib-based induction therapy, 20 were responders and 10 were non-responders. Serum GRP78 levels were not significantly different between responders [median (IQR): 5.2 (3.1, 8.0) μg/ml] and non-responders [median (IQR): 4.3 (0.1, 7.1) μg/ml] (p=0.4). Although non-significant (p=0.3), median serum GRP78 was higher in newly diagnosed patients when compared to healthy volunteers. Bone marrow plasma cells ranged from 0.2 to 57.8% in the analyzed samples. Intracellular GRP78 expression in bone marrow plasma cells was higher (1.6 to 5 times) when compared to surface expression. To conclude, serum GRP78 levels vary widely in different MM patient groups but did not correlate with response to a bortezomib-based induction regimen.

Traditional drug development is a tedious process with involvement of enormous cost and a high attrition rate. Outsourcing drug development services to contract research organizations (CROs) has become an important strategy for cost and risk reduction, capacity building, and data generation. The therapeutic and operational expertise of these CROs has allowed pharmaceutical industry to reduce in-house infrastructure as well as research capacity. Working with specialized CROs has not only increased the rate of success but also the speed of drug discovery process. Small firms with promising molecules but limited resources and large firms interested in diversifying their dimensions are utilizing the services of efficient CROs. Globally, approximately one-third of the drug development processes are now being outsourced and the data generated by the independent third party are well appreciated during regulatory submissions. In this article, we discuss the international and national trends, outsourcing services and models, key considerations while selecting CRO, and benefits and challenges of outsourcing. Further, we discuss how the technical expertise of competent CROs was utilized when traditional ways of conducting clinical trials were disrupted by the COVID-19 pandemic. Taken together, the increasing health-care demands, COVID-19 pandemic or any other such upcoming health crisis, and recent advances in advanced technologies (machine learning and artificial intelligence, etc.) are likely to fuel global CRO market in the coming years.

Background: The benign enlargement of the prostate gland is known as benign prostatic hyperplasia (BPH). It refers to stromal and glandular epithelial hyperplasia that develops in the region of the prostate that surrounds the urethra known as the periurethral transition zone. Aims and Objectives: The aim of the study was to perform a survey of urologists over the management of BPH in India. Materials and Methods: A survey questionnaire was e-mailed to a random sample of 57 urologists of India through surveymonkey.com. The enrolled questionnaires were statistically analyzed. Of the 57 questionnaires sent, nine were returned, and 48 of those were included in the final analysis (response rate of 84.21%). Results: Majority of urologists’ opinion is that USG-KUB with uroflowmetry is the most reliable investigation for diagnosis of BPH. Tamsulosin (tamsulosin 0.4 mg) was the most preferred α-1 selective blocker drug in BPH patients across all the age groups, whereas silodosin was the most preferred α-1 selective blocker drug in cardiac patients having BPH. The preferred 5-alpha reductase inhibiting drug and dose was recorded as dutasteride 0.5 mg/day. Solifenacin is the preferred anti-cholinergic drug for urinary urgency and incontinence. The IPSS score of the patient improved usually within 1–6 weeks of treatment with alpha blockers/5-alpha reductase inhibitor. As per Indian urologists, the drug therapy with alpha blockers gave the fastest symptomatic improvement in BPH patients. Conclusion: In our conclusion, there is no uniformity in the treatment of acute urinary retention; however, the overall care must be individualized for the patient. Lack of understanding of the population’s history of BPH hinders advancement in appropriate care.

Background: Active Pharmaceutical Ingredient (API) manufacturing is an important segment of the Indian pharma industry. India ranks third in terms of volume of medicines produced, and is a major global supplier of generic medicines. However, India depends heavily on the import of several raw materials used to produce some of these medicines. Main Body: This paper highlights how the situation emerged, as well as the various steps taken by the government to reduce import dependency and promote domestic manufacturing of APIs. Through various consultations with government officials, policy analysts and academicians, and interactions with key industry experts, the paper also highlights the public health perspectives of such dependence, especially regarding the secure access to essential medicines. India needs a conducive ecosystem to capitalize on the full potential of its API manufacturing capabilities, which may require some short-term and some mid/long-term interventions. Conclusions: It concludes by providing certain short-, medium- and long-term recommendations in the policy, fiscal and technology domains, to promote API independence. It also summarizes the various steps taken by the government in moving towards domestic manufacturing of APIs.