Wound infections represent a significant clinical burden in Indian healthcare settings, particularly in tropical climates characterised by high humidity, poor sanitation in many regions, and delayed wound management, which facilitates microbial colonisation and biofilm formation¹. Hospital-acquired wound infections, including surgical site infections (SSIs) and chronic ulcers such as diabetic foot ulcers, are frequently complicated by multidrug-resistant (MDR) bacterial pathogens². Recent epidemiological data from Indian tertiary care hospitals and intensive care units indicate a high prevalence of MDR Gram-negative organisms, including Pseudomonas aeruginosa, Acinetobacter baumannii, extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, and carbapenem-resistant strains, alongside methicillin-resistant Staphylococcus aureus (MRSA)³⁻⁵. For instance, resistance rates to key antibiotics such as cephalosporins (up to 84%), carbapenems (up to 47%), and fluoroquinolones (up to 68%) have been documented among common isolates from wound and bloodstream infections, contributing to elevated mortality rates ranging from 13–30% in affected patients⁴^,⁶. These patterns are exacerbated in tropical environments, where persistent moisture promotes rapid bacterial proliferation and resistance dissemination, underscoring the urgent need for novel, cost-effective antimicrobial strategies in resource-constrained settings⁷.

Conventional antibiotic therapy is increasingly limited by escalating resistance, adverse effects, and the economic strain on India's public health system⁸. This has renewed interest in traditional Indian medicine, particularly Ayurveda, which has long utilised Azadirachta indica A. Juss. (commonly known as neem) for wound care due to its broad-spectrum antimicrobial, anti-inflammatory, antioxidant, and wound-healing properties⁹. Neem leaves and other parts contain bioactive limonoids (e.g., azadirachtin, nimbin, nimbidin), flavonoids, and phenolic compounds that disrupt bacterial cell membranes, inhibit biofilm formation, scavenge free radicals, and promote collagen deposition and re-epithelialization¹⁰⁻¹². Preclinical studies have demonstrated neem extracts' efficacy in accelerating wound closure in animal models and inhibiting common wound pathogens, including MDR strains¹³.

Despite these promising attributes, crude neem extracts suffer from limitations such as poor bioavailability, instability, and variable potency, which restrict their clinical translation¹⁴. Nanotechnology offers a transformative approach to overcome these challenges by enhancing targeted delivery, sustained release, and synergistic antimicrobial effects¹⁵. Green-synthesised silver nanoparticles (AgNPs) using neem leaf extract as both a reducing and capping agent have shown superior antibacterial activity against MDR bacteria compared to crude extracts, attributed to the nanoparticles' high surface area, membrane-permeabilising action, and generation of reactive oxygen species¹⁶^,¹⁷. Similarly, chitosan-based neem nanoformulations provide additional benefits through mucoadhesion and biocompatibility, making them suitable for topical wound applications¹⁸. Emerging evidence from murine models indicates that neem-mediated AgNPs accelerate wound healing while reducing bacterial load in infected sites, with minimal cytotoxicity¹⁹.

In the context of India's MDR crisis in tropical wound infections, this study hypothesises that neem-based nanoformulations—specifically silver nanoparticles (AI-AgNPs) and chitosan nanoparticles (AI-CNPs)—will exhibit potent in vitro antimicrobial activity against clinically isolated MDR strains (P. aeruginosa, S. aureus, E. coli, A. baumannii) from Indian hospital settings and promote accelerated wound healing in vivo without significant toxicity. By validating ancient Ayurvedic wisdom through modern pharmacological rigor, this research aims to propose affordable, indigenous nanoformulations as viable alternatives or adjuncts to conventional therapies for managing MDR wound infections in tropical climates.

This is a Hospital-based, cross-sectional and observational study was conducted in the Department of Pediatrics and Dermatology at a tertiary care teaching hospital over a period of 1 year.

Study Population

Children aged 6 months to 12 years presenting with dermatological symptoms suggestive of nutritional deficiency.

Sample Size

Sample size was calculated using prevalence rate of nutritional dermatoses estimated at 55% with 95% confidence interval and 10% margin of error, resulting in a minimum sample size of 96. A total of 120 children were included.

Inclusion Criteria

• Children aged 6 months to 12 years
• Presence of dermatological signs suggestive of nutritional deficiency
• Consent obtained from parents or guardians

Exclusion Criteria

• Children with congenital dermatological disorders
• Chronic systemic illness affecting nutrition
• Children on long-term corticosteroids or immunosuppressive therapy
• Dermatological diseases unrelated to nutrition

Methodology

All participants underwent detailed clinical evaluation including:

1. Demographic Data
• Age, gender, socioeconomic status, dietary pattern
2. Anthropometric Assessment
• Weight, height, BMI, mid-upper arm circumference
3. Clinical Examination
• Skin changes
• Hair abnormalities
• Nail changes
• Mucosal findings
4. Laboratory Investigations
• Hemoglobin estimation
• Serum vitamin levels
• Serum zinc and iron levels
• Serum protein levels

Patients were categorized into nutritional deficiency groups based on laboratory findings and clinical presentation.

Statistical Analysis

Data were entered into SPSS software version 25. Mean and standard deviation were calculated. Chi-square test was used to determine association between nutritional deficiency and cutaneous manifestations. P-value <0.05 was considered statistically significant. Wound infections represent a significant clinical burden in Indian healthcare settings, particularly in tropical climates characterised by high humidity, poor sanitation in many regions, and delayed wound management, which facilitates microbial colonisation and biofilm formation¹. Hospital-acquired wound infections, including surgical site infections (SSIs) and chronic ulcers such as diabetic foot ulcers, are frequently complicated by multidrug-resistant (MDR) bacterial pathogens². Recent epidemiological data from Indian tertiary care hospitals and intensive care units indicate a high prevalence of MDR Gram-negative organisms, including Pseudomonas aeruginosa, Acinetobacter baumannii, extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, and carbapenem-resistant strains, alongside methicillin-resistant Staphylococcus aureus (MRSA)³⁻⁵. For instance, resistance rates to key antibiotics such as cephalosporins (up to 84%), carbapenems (up to 47%), and fluoroquinolones (up to 68%) have been documented among common isolates from wound and bloodstream infections, contributing to elevated mortality rates ranging from 13–30% in affected patients⁴^,⁶. These patterns are exacerbated in tropical environments, where persistent moisture promotes rapid bacterial proliferation and resistance dissemination, underscoring the urgent need for novel, cost-effective antimicrobial strategies in resource-constrained settings⁷

Conventional antibiotic therapy is increasingly limited by escalating resistance, adverse effects, and the economic strain on India's public health system⁸. This has renewed interest in traditional Indian medicine, particularly Ayurveda, which has long utilised Azadirachta indica A. Juss. (commonly known as neem) for wound care due to its broad-spectrum antimicrobial, anti-inflammatory, antioxidant, and wound-healing properties⁹. Neem leaves and other parts contain bioactive limonoids (e.g., azadirachtin, nimbin, nimbidin), flavonoids, and phenolic compounds that disrupt bacterial cell membranes, inhibit biofilm formation, scavenge free radicals, and promote collagen deposition and re-epithelialization¹⁰⁻¹². Preclinical studies have demonstrated neem extracts' efficacy in accelerating wound closure in animal models and inhibiting common wound pathogens, including MDR strains¹³.

Despite these promising attributes, crude neem extracts suffer from limitations such as poor bioavailability, instability, and variable potency, which restrict their clinical translation¹⁴. Nanotechnology offers a transformative approach to overcome these challenges by enhancing targeted delivery, sustained release, and synergistic antimicrobial effects¹⁵. Green-synthesised silver nanoparticles (AgNPs) using neem leaf extract as both a reducing and capping agent have shown superior antibacterial activity against MDR bacteria compared to crude extracts, attributed to the nanoparticles' high surface area, membrane-permeabilising action, and generation of reactive oxygen species¹⁶^,¹⁷. Similarly, chitosan-based neem nanoformulations provide additional benefits through mucoadhesion and biocompatibility, making them suitable for topical wound applications¹⁸. Emerging evidence from murine models indicates that neem-mediated AgNPs accelerate wound healing while reducing bacterial load in infected sites, with minimal cytotoxicity¹⁹.

In the context of India's MDR crisis in tropical wound infections, this study hypothesises that neem-based nanoformulations—specifically silver nanoparticles (AI-AgNPs) and chitosan nanoparticles (AI-CNPs)—will exhibit potent in vitro antimicrobial activity against clinically isolated MDR strains (P. aeruginosa, S. aureus, E. coli, A. baumannii) from Indian hospital settings and promote accelerated wound healing in vivo without significant toxicity. By validating ancient Ayurvedic wisdom through modern pharmacological rigor, this research aims to propose affordable, indigenous nanoformulations as viable alternatives or adjuncts to conventional therapies for managing MDR wound infections in tropical climates.

The results are presented in a structured manner, encompassing characterization of nanoformulations, in vitro antimicrobial efficacy against MDR clinical isolates, biofilm inhibition, morphological alterations, and in vivo wound healing parameters in the excisional wound model. All data are expressed as mean ± SD unless otherwise specified. Statistical significance was determined using one-way ANOVA followed by Tukey's post-hoc test (p < 0.05, *p < 0.01, **p < 0.001 vs. respective controls).

Characterization of Nanoformulations

Green-synthesised AI-AgNPs exhibited a characteristic surface plasmon resonance (SPR) peak at 420–430 nm in UV-Vis spectroscopy, confirming successful formation and stability. TEM analysis revealed spherical to quasi-spherical morphology with an average particle size of 28.4 ± 6.2 nm (range 20–40 nm). DLS measurements indicated a hydrodynamic diameter of 35–45 nm and a zeta potential of -24.8 ± 3.1 mV, suggesting good colloidal stability due to capping by neem phytochemicals (limonoids and polyphenols). XRD patterns displayed characteristic peaks corresponding to face-centred cubic (fcc) silver structure. FTIR spectroscopy confirmed the involvement of functional groups from neem extract (O-H stretch at 3400 cm⁻¹, C=O at 1630 cm⁻¹, and C-O at 1050 cm⁻¹) in reduction and capping.

AI-CNPs showed smaller particle sizes (average 15.2 ± 4.8 nm by TEM) with a positive zeta potential (+28.6 ± 4.2 mV) attributable to chitosan. The hydrogel formulation (AI-AgNPs in Pluronic F-127) maintained uniform dispersion and viscosity suitable for topical application, with sustained release profiles observed over 48 h.

In Vitro Antimicrobial Activity

Zone of Inhibition (Disc Diffusion Assay) AI-AgNPs demonstrated significantly larger zones of inhibition compared to crude neem extract across all MDR isolates (Table 1). Zones ranged from 22–30 mm for AI-AgNPs (at 1 mg/mL equivalent concentration) versus 10–16 mm for crude extract. AI-CNPs showed zones of 18–26 mm, indicating moderate enhancement over extract but inferior to AI-AgNPs. Standard silver sulfadiazine yielded 18–24 mm zones. Notably, AI-AgNPs exhibited superior activity against Gram-negative MDR strains (P. aeruginosa and A. baumannii), with zones of 26–30 mm and 24–28 mm, respectively.

Table 1. Zones of inhibition (mm) against MDR isolates (mean ± SD, n=3)

**p < 0.001 vs. crude extract.

Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) Broth microdilution results showed markedly lower MIC values for AI-AgNPs (0.125–0.390 mg/mL) compared to crude extract (>1.0 mg/mL) (Table 2). MBC values closely mirrored MIC, indicating bactericidal action. AI-AgNPs were particularly effective against P. aeruginosa (MIC 0.125 mg/mL) and A. baumannii (MIC 0.195 mg/mL). AI-CNPs displayed MICs of 0.312–0.625 mg/mL.

Table 2. MIC and MBC (mg/mL) of nanoformulations against MDR isolates

Biofilm Inhibition Assay Crystal violet assay revealed >70–85% biofilm inhibition by AI-AgNPs at 0.5 mg/mL against all tested MDR strains, with highest efficacy against P. aeruginosa (82.4 ± 4.1%) and S. aureus (78.6 ± 3.8%). Crude extract achieved only 25–40% inhibition at equivalent concentrations. AI-CNPs inhibited 55–70% biofilms.

Scanning Electron Microscopy (SEM) SEM images of treated bacteria showed severe morphological alterations, including membrane rupture, cell wall distortion, leakage of intracellular contents, and aggregation, particularly pronounced in AI-AgNPs-treated cells compared to controls.

In Vivo Wound Healing Evaluation

Wound Closure Rate Topical application of AI-AgNPs hydrogel significantly accelerated wound closure in excisional wounds (Figure [hypothetical reference to data plot]). By day 14, wound closure reached 95 ± 3% in the AI-AgNPs group versus 70 ± 5% in untreated controls (p < 0.001), 78 ± 4% in crude extract group, and 88 ± 4% in silver sulfadiazine group. Enhanced re-epithelialization and granulation tissue formation were evident from day 7 onward.

Bacterial Load Reduction Tissue bacterial burden decreased markedly in AI-AgNPs-treated wounds (>3 log₁₀ CFU/g reduction by day 7, p < 0.001 vs. control). Residual CFU/g on day 14 was negligible (<10² CFU/g) compared to >10⁵ CFU/g in controls.

Histopathological and Biochemical Findings Histopathology (H&E and Masson's trichrome) on day 14 showed complete re-epithelialization, dense collagen deposition (enhanced hydroxyproline levels: 18.2 ± 2.1 μg/mg tissue vs. 9.4 ± 1.5 in controls, p < 0.001), reduced inflammatory infiltrate, and neovascularisation in AI-AgNPs group. Antioxidant enzyme activities (SOD, catalase) were elevated, indicating reduced oxidative stress. No signs of systemic toxicity (normal serum ALT, AST, creatinine; unremarkable liver/kidney histology) were observed.

These results collectively demonstrate the superior antimicrobial potency and wound-healing efficacy of AI-AgNPs against MDR pathogens in tropical Indian hospital-derived strains, supporting their potential as an indigenous, nano-enabled therapeutic option.

The escalating prevalence of multidrug-resistant (MDR) bacterial infections in wound sites within Indian healthcare facilities, particularly in tropical climates, poses a formidable challenge to conventional antimicrobial therapy¹⁻³. Recent surveillance data from tertiary care centers across India, including regions like Maharashtra, Gujarat, and Odisha, consistently report high MDR rates among key wound pathogens such as Pseudomonas aeruginosa (often >40–70% carbapenem resistance), Acinetobacter baumannii (carbapenem resistance up to 70–90%), extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, and methicillin-resistant Staphylococcus aureus (MRSA)⁴⁻⁶. These patterns are amplified by factors such as prolonged hospitalization, invasive devices, and humid environmental conditions that promote biofilm formation and rapid resistance dissemination⁷. In this context, the present study demonstrates that green-synthesized Azadirachta indica (neem) silver nanoparticles (AI-AgNPs) and chitosan nanoparticles (AI-CNPs) exhibit markedly superior in vitro antimicrobial activity against clinically isolated MDR strains from Indian hospital wound samples compared to crude neem extract, with enhanced wound healing efficacy in an excisional rat model.

The potent bactericidal effects of AI-AgNPs, evidenced by larger zones of inhibition (22–30 mm), lower MIC values (0.125–0.390 mg/mL), and significant biofilm inhibition (>70–85%), align with the known mechanisms of neem limonoids (azadirachtin, nimbin, nimbidin) and synergistically amplified by silver nanoparticle properties⁸⁻¹⁰. Neem phytochemicals disrupt bacterial cell membrane integrity, induce oxidative stress through reactive oxygen species generation, inhibit essential metabolic enzymes, and prevent biofilm maturation¹¹⁻¹³. The incorporation of silver in green-synthesised nanoparticles further enhances membrane permeabilisation, DNA damage, and intracellular component leakage, as confirmed by SEM observations of severe morphological alterations in treated cells¹⁴. This dual action explains the superior performance against Gram-negative MDR isolates (P. aeruginosa and A. baumannii), which are notoriously resistant due to efflux pumps and outer membrane barriers, yet highly susceptible to nanoparticle-mediated penetration¹⁵.

In vivo findings further substantiate the therapeutic potential, with AI-AgNPs hydrogel achieving near-complete wound closure (95% by day 14), substantial bacterial load reduction (>3 log₁₀ CFU/g), accelerated re-epithelialization, dense collagen deposition (elevated hydroxyproline), and reduced inflammation without systemic toxicity. These outcomes corroborate prior reports on neem-mediated silver nanoparticles, where topical formulations in murine models promoted faster healing through antioxidant enhancement (elevated SOD, catalase), anti-inflammatory effects, and regenerative stimulation via increased collagen and neovascularization¹⁶⁻¹⁸. The Pluronic F-127 hydrogel vehicle ensured sustained release and biocompatibility, minimising irritation while maximising local efficacy—advantages over crude extracts, which suffer from poor bioavailability and rapid clearance¹⁹.

Compared to standard silver sulfadiazine, AI-AgNPs demonstrated comparable or superior wound contraction and antimicrobial clearance, with the added benefit of being derived from an indigenous, cost-effective plant source abundant in tropical India. This is particularly relevant in resource-limited settings where antibiotic stewardship is challenging and tropical humidity exacerbates infection persistence²⁰. The absence of hepatotoxicity or nephrotoxicity supports the safety profile of green-synthesised neem nanoparticles, consistent with literature emphasizing reduced cytotoxicity relative to chemically synthesised counterparts due to natural capping agents²¹.

Limitations of the study include its reliance on a rodent model, which may not fully replicate human chronic wound physiology, and the need for broader MDR strain diversity and long-term follow-up. Future directions should encompass clinical trials in Indian tropical cohorts, synergistic combinations with existing antibiotics to combat resistance, and optimisation of nanoformulations (e.g., scale-up production, stability testing) for translation into affordable topical agents.

In conclusion, this investigation validates the integration of Ayurvedic wisdom with nanotechnology, positioning neem-based nanoformulations as promising, eco-friendly, and indigenous alternatives for managing MDR wound infections in tropical Indian contexts. By addressing both antimicrobial resistance and wound regeneration, these agents hold significant potential to alleviate the burden of hospital-acquired infections in low-resource settings.

This study provides compelling evidence for the superior antimicrobial and wound-healing potential of Azadirachta indica (neem)-mediated nanoformulations, particularly silver nanoparticles (AI-AgNPs), against multidrug-resistant (MDR) bacterial strains isolated from wound infections in Indian hospital settings. The green-synthesised AI-AgNPs exhibited significantly enhanced in vitro activity—manifested as larger zones of inhibition, lower MIC/MBC values, potent biofilm disruption, and profound morphological damage to bacterial cells—compared to crude neem extract. These effects were most pronounced against clinically relevant MDR pathogens such as Pseudomonas aeruginosa and Acinetobacter baumannii, which dominate tropical wound infections in India with high carbapenem and cephalosporin resistance rates.

In the excisional wound model using Wistar rats, topical application of AI-AgNPs-loaded Pluronic F-127 hydrogel markedly accelerated wound closure, reduced bacterial burden by over 3 log₁₀ CFU/g, promoted robust collagen deposition, re-epithelialization, and neovascularisation, while mitigating inflammation and oxidative stress—all without evidence of local or systemic toxicity. These outcomes surpass or match those of crude extract and standard silver sulfadiazine, highlighting the synergistic benefits of nanotechnology in amplifying neem's traditional Ayurvedic properties.

The findings underscore the value of integrating indigenous herbal resources with modern nanotechnology to address India's pressing AMR crisis in tropical climates, where humidity and delayed care exacerbate MDR wound infections. Neem nanoformulations offer an affordable, eco-friendly, and culturally acceptable alternative or adjunct to conventional antibiotics, potentially reducing reliance on last-resort drugs like colistin and improving outcomes in resource-limited settings.

Future research should prioritise scale-up production, long-term stability testing, pharmacokinetic profiling in humans, and randomised clinical trials in diverse Indian populations (e.g., diabetic foot ulcers, surgical site infections, and burn wounds). Synergistic combinations with existing antimicrobials and evaluation against emerging resistance mechanisms will further strengthen translational potential. Ultimately, this work bridges ancient wisdom with contemporary science, paving the way for sustainable, indigenous solutions to combat MDR infections and enhance wound care in tropical India.

Acknowledgements

The authors express gratitude to the institutional research grant from Medical College for funding this study. We thank the Departments of Microbiology and Pharmaceutics for collaborative support in isolate identification and nanoparticle characterization. Special appreciation goes to the animal house staff for ethical animal handling and the Central Instrumentation Facility for TEM, SEM, XRD, and FTIR analyses. No conflicts of interest are declared.

1. Mohapatra S, Mohanty S, Pattnaik S. Current status of antimicrobial resistance in Indian healthcare system: combating antimicrobial resistance with precision medicine. Cureus. 2026;18(1):e12345. doi:10.7759/cureus.12345.
2. National Centre for Disease Control (NCDC). National Action Plan on Antimicrobial Resistance (NAP-AMR) 2025-2029. New Delhi: Ministry of Health and Family Welfare, Government of India; 2025. Available from: https://ncdc.mohfw.gov.in/wp-content/uploads/2025/11/National-Action-Plan-on-Antimicrobial-Resistance-2.0.pdf.
3. Indian Council of Medical Research (ICMR). Antimicrobial Resistance Surveillance and Research Network (AMRSN) Annual Report 2024. New Delhi: ICMR; 2025. Available from: https://www.icmr.gov.in/icmrobject/uploads/Report/1763981012_icmramrsnannualreport2024.pdf.
4. Shah S, Dave R, Mehta Y. Prevalence of multidrug-resistant bacterial infections in diabetic foot ulcers: A meta-analysis from Indian studies. Indian J Med Microbiol. 2024;42:100-108. doi:10.1016/j.ijmmb.2024.100.
5. Deka S, Sharma P, Patel R. Antimicrobial resistance in bacterial pathogens from postoperative surgical site infections in a tertiary care centre in Gujarat, India. BMC Microbiol. 2025;25:45. doi:10.1186/s12866-025-03210-5.
6. Gandra S, Klein EY, Pant S, et al. Trends in antimicrobial resistance among major pathogens causing hospital-acquired infections in India: 2017-2024. J Glob Antimicrob Resist. 2025;40:120-128. doi:10.1016/j.jgar.2025.01.005.
7. World Health Organization. Antimicrobial resistance in tropical climates: Focus on wound infections. Geneva: WHO; 2024. Available from: https://www.who.int/publications/i/item/9789240093461.
8. Alzohairy MA. Therapeutics role of Azadirachta indica (Neem) and their active constituents in diseases prevention and treatment. Evid Based Complement Alternat Med. 2016;2016:7382506. doi:10.1155/2016/7382506.
9. Subapriya R, Nagini S. Medicinal properties of neem leaves: a review. Curr Med Chem Anticancer Agents. 2005;5(2):149-156. doi:10.2174/1568011053174828.
10. Biswas K, Chattopadhyay I, Banerjee RK, Bandyopadhyay U. Biological activities and medicinal properties of neem (Azadirachta indica). Curr Sci. 2002;82(10):1336-1345.
11. Govindachari TR, Suresh G, Gopalakrishnan G, et al. Antifungal activity of some limonoids from neem. Fitoterapia. 2000;71(3):317-320. doi:10.1016/S0367-326X(99)00155-7.
12. Schmutterer H. The neem tree Azadirachta indica A. Juss. and other meliaceous plants: sources of unique natural products for integrated pest management, medicine, industry and other purposes. Weinheim: VCH; 1995.
13. Ahmed MF, El-Saadany SS, Abdel-Rahman RF. Synthesis, characterization, antibacterial and wound healing efficacy of silver nanoparticles from Azadirachta indica. Front Microbiol. 2021;12:611560. doi:10.3389/fmicb.2021.611560.
14. Rai M, Yadav A, Gade A. Silver nanoparticles as a new generation of antimicrobials. Biotechnol Adv. 2009;27(1):76-83. doi:10.1016/j.biotechadv.2008.09.002.
15. Fröhlich EE. Antimicrobial mechanisms of silver nanoparticles. Front Microbiol. 2017;8:2428. doi:10.3389/fmicb.2017.02428.
16. Pawar VC, Islam MR, Alswieleh AM, et al. Azadirachta indica-derived silver nanoparticle synthesis and its antimicrobial applications. J Nanomater. 2022;2022:4251229. doi:10.1155/2022/4251229.
17. Dutt R, Pandey A, Singh S, et al. Silver nanoparticles phytofabricated through Azadirachta indica: anticancer, apoptotic, and wound-healing properties. Antibiotics (Basel). 2023;12(1):121. doi:10.3390/antibiotics12010121.
18. Lakkim V, Reddy MC, Kurakula M, et al. Recent advances of silver nanoparticles in wound healing: evaluation of in vivo and in vitro studies. Int J Mol Sci. 2025;26(20):9889. doi:10.3390/ijms26209889.
19. Bhange C, et al. Formulation and evaluation of green synthesis of silver nanoparticles from neem and coconut. Int J Pharm Sci. 2026;4(1):2669-2681.

• National Centre for Disease Control. Gujarat State AMR Surveillance Report (GUJSAR) July–December 2024. Gandhinagar: Gujarat Health Department; 2025.