Mechanistic modeling of twin screw wet granulation for pharmaceutical formulations: Calibration, sensitivity analysis, and model-driven workflow.

Wet granulation, a particle size enlargement process, can significantly enhance the critical quality attributes of powders and improve the ability to form tablets in pharmaceutical manufacturing. In this study, a mechanistic-based population balance model is applied to twin screw wet granulation. This model incorporated a recently developed breakage kernel specifically designed for twin screw granulation, along with nucleation, layering, and consolidation. Calibration and validation were performed on Hydrochlorothiazide and Acetaminophen formulations, which exhibit different particle size and wettability characteristics. Utilizing a compartmental experimental dataset, a comprehensive global sensitivity analysis identified critical inputs impacting quality attributes. The study revealed that the nucleation rate process model, effectively represented particle size distributions for both formulations. Adjustments to nucleation and breakage rate parameters, influenced by material properties and screw configuration, improved the model's accuracy. A model-driven workflow was proposed, offering step-by-step guidelines and facilitating PBM model usage, providing essential details for future active pharmaceutical ingredient (API) formulations.

Spatial distribution and source identification of metal contaminants in soil and rice grain samples: a study on exploration of soil quality and risk assessment.

The present study aims to assess soil quality and potential health risks associated with soil pollution of the Batala region of Punjab, India. Physico-chemical parameters such as pH (6.69-7.43), electrical conductivity (0.17-0.33 mS/cm), and total organic carbon (1.01-5.94%) were observed to be within permissible limits. The maximum mean content (mg/kg) of heavy metals in soil was found as Fe (4060.93), Zn (444.33), Mn (278.5), Pb (23.16), Cu (21.78), Ni (20.16), Co (7.14), and Cd (1.85) which were below the prescribed limits but beyond the geochemical background limits of world soil. For rice grain samples, metal content (mg/kg) was seen as Fe (307.01) > Zn (12.41) > Mn (7.43) > Cu (4.57) and was below the permissible limits. The mean bioaccumulation factor for various metals was in the order as Zn > Cu > Fe > Mn. Single and integrated soil pollution indices revealed that among 18 sites, six were highly contaminated. The ecological risk index (Er) has shown that contamination of soil with Cd, Zn, and Ni was higher than that of other metals studied. The estimated daily intake of metal (EDI), hazard quotient (HQ), and hazard index (HI) were higher for children than those for adults. Spatial variability based on metal pollution load and soil quality was also determined using cluster analysis (CA) and principal component analysis (PCA). During CA, soil samples from 18 sites formed three statistically significant clusters based on the level of metal pollution at the specific site. PCA showed that all variables were reduced into two main components 1 and 2 with eigenvalues as 3.82 (47% variance) and 1.53 (19.7% variance), respectively.

Clinico-epidemiological Aspects of Cutaneous Lesions in Injecting Drug Users Visiting an Oral Substitution Therapy Centre in Northern India: A Cross-Sectional study.

Introduction: Drug abuse has been taking a great toll on the health and well-being of the community for the past few decades. Substance abuse can lead to several cutaneous manifestations as direct injuries by the offending drug or the practices of drug usage cause secondary damage to the skin. The early recognition of these signs is of utmost importance to prevent long-term complications. Objectives: To study the clinical-epidemiological profile of the skin diseases in Injecting Drug Users (IDU) attending an Oral Substitution Therapy (OST) Center in Northern India and to assess the psychological impact of skin conditions in IDUs attending OSTs. Methods: This cross-sectional observational study involved 100 IDUs enrolled from the OST center who were subjected to brief history taking and clinical and dermoscopic evaluation of skin lesions. Dermatological quality of life index (DLQI), Depression, Anxiety, Stress Scale (DASS), and WHO-quality of life (QoL) questionnaire were used to evaluate the impact of skin lesions on psycho-social health and QoL of IDUs. Results: Cutaneous lesions ranged from track marks to severe ulcerations and scarring. Mucosal lesions also took a toll on several patients. The patients had varying degrees of anxiety, depression, and mental stress. Conclusions: Injecting Drug Abusers are prone to acquire skin diseases due to injury caused by drugs as well as by drug practices adopted and the degree of neglect may worsen these conditions. These cutaneous lesions hamper QoL and cause psychosocial disturbances.

Wetting boundaries for a ternary high-density-ratio lattice Boltzmann method.

We extend a recently proposed ternary free-energy lattice Boltzmann model with high density contrast [Phys. Rev. Lett. 120, 234501 (2018)PRLTAO0031-900710.1103/PhysRevLett.120.234501] by incorporating wetting boundaries at solid walls. The approaches are based on forcing and geometric schemes, with implementations optimized for ternary (and, more generally, higher-order multicomponent) models. Advantages and disadvantages of each method are addressed by performing both static and dynamic tests, including the capillary filling dynamics of a liquid displacing the gas phase and the self-propelled motion of a train of drops. Furthermore, we measure dynamic angles and show that the slip length critically depends on the equilibrium value of the contact angles and whether it belongs to liquid-liquid or liquid-gas interfaces. These results validate the model capabilities of simulating complex ternary fluid dynamic problems near solid boundaries, for example, drop impact solid substrates covered by a lubricant layer.

A comparison of dexmedetomidine with propofol versus esmolol with propofol to attenuate the hemodynamic stress responses after electroconvulsive therapy.

BACKGROUND: Modified electroconvulsive therapy (ECT) under anesthesia is an important modality in the treatment of severe, persistent depression; bipolar disorder and schizophrenia; especially in cases resistant to pharmacologic therapy. AIM: The aim of the present study is to compare the effects of dexmedetomidine and esmolol on patients' hemodynamics, motor seizure duration, and recovery times following ECT. MATERIALS AND METHODS: Ninety cases aged between 18 and 50 years of the American Society of Anesthesiologists grade I and II; were randomly divided into three groups of 30 each. Group A received normal saline (placebo), Group B received dexmedetomidine 1 µg/kg, and Group C received esmolol 1 mg/kg; followed by induction with propofol 1 mg/kg and muscle relaxation with succinylcholine 0.75 mg/kg. Hemodynamic parameters at baseline, after study drug infusion, after induction, and after ECT application were recorded at different time intervals. The motor seizure duration using arm isolation method and recovery times using postanesthesia discharge scoring system were noted. RESULTS: The maximum increase in hemodynamic parameters was seen following the ECT current application. Post-ECT rise in mean arterial blood pressure and heart rate in dexmedetomidine group was significantly less as compared to esmolol and control group at 2, 4, 6, and 8 min using unpaired t-test. There was no significant difference in motor seizure activity duration, emergence, and recovery times among the three groups. CONCLUSIONS: Both dexmedetomidine and esmolol attenuate the hyperdynamic response to ECT without affecting the seizure duration, but dexmedetomidine has a more favorable response in view of stable vitals, smooth emergence and no adverse effect on recovery duration.

Anesthesiologist's Role in Relieving Patient's Anxiety.

INTRODUCTION: Anesthesia and surgery have proved to be highly anxiety provoking and with the rise of elective surgery, its aspect of patient's experience has become prominent in time. However, our fault as anesthesiologists is that we have not made people get versed with what we people as anesthesiologist do in the operating room. Hence, keeping in view all this, a study was carried out, in which video information/images regarding anesthesia and surgical procedure was shown to patients on PowerPoint Presentation. Different images showing previous patient's hospital journey were shown to educate patients. METHODS: Two hundred patients scheduled to undergo elective surgery were taken and were divided into two groups of 100 each. Patients (study group or Group I) were shown video clippings/images of other previously operated patients and their hospital journey including surgery and anesthesia for which patient came in hospital. The study was carried out on the patient in each group while Group II was treated in normal way and not shown any type of images/videos. Hamilton Anxiety Rating Scale was used as a criterion to measure the level of anxiety in Group I and II at four different intervals that are before pre anesthetic check up (PAC), after showing videos and images in Group I, 1 h before surgery and 8 h after surgery. STATISTICAL ANALYSIS: The results of observation of both the groups at different intervals time were statistically compared and analyzed. These characteristics were analyzed using the "Chi-square tests" and "unpaired t-test." RESULTS: Video and images information if done preoperatively have been shown to reduce patient's anxiety, although little is known regarding the effects of the method. CONCLUSION: Showing videos/images of hospital journey for educating the patients before the operation is beneficial to patients undergoing elective surgery.

Psychiatric and anesthetic implications of substance abuse: Present scenario.

Substance abuse has crossed all social, economic, and geographic borders and is spreading its fangs in each and every sphere of society irrespective of age, gender, caste, creed, and religion. These days, we encounter several patients of substance dependence who visit different hospitals for elective surgical procedures or in emergency (e.g., roadside accidents and with various complications associated with substance abuse). These patients at that time may be either addicted to them or are intoxicated by them or on de addiction treatment. Acute or chronic use of these drugs affect the respiratory, cardiovascular, central nervous, renal, hematological, and hepatic system variably in individuals thus due to diverse clinical presentations a complete understanding of the path physiology and anesthetic implications of drug abuse is essential to tailor a safe anesthetic plan for these high-risk group of patients.

Conflicts in operating room: Focus on causes and resolution.

The operation theater (OT) environment is the most complex and volatile workplace where two coequal physicians share responsibility of one patient. Difference in information, opinion, values, experience and interests between a surgeon and anesthesiologist may arise while working in high-pressure environments like OT, which may trigger conflict. Quality of patient care depends on effective teamwork for which multidisciplinary communication is an essential part. Troubled relationships leads to conflicts and conflicts leads to stressful work environment which hinders the safe discharge of patient care. Unresolved conflicts can harm the relationship but when handled in a positive way it provides an opportunity for growth and ultimately strengthening the bond between two people. By learning the skills to resolve conflict, we can keep our professional relationship healthy and strong which is an important component of good patient care.

Anaesthesia provider's perception of law: Focus on preventive measures.

Anaesthesiology is a speciality that delivers most prompt and positive results in medical field. This naturally leads to high expectations among the general public. In the past, patients used to subject themselves to surgery after signing a simple willingness form. But in the present scenario, if any catastrophe occurs, it grabs news headlines, negligence is suspected by laymen in such cases, and these cases land up in a court of law. In the courts, decisions are left to judiciary, which can be potentially influenced by the opinon of general public. This leaves a lot of subjectivity in these decisions. There has been a rising trend in medical negligence cases registered in consumer courts after the decision of the Supreme Court, that the services provided by an anaesthesiologist come under the word "service" of Consumer Protection Act (1986). So the apprehension amongst the anaesthesiologists regarding the legal issues is rising. This article underlines the standard of care, protocols by which anaesthesiologists should abide to avoid legal consequences. Doctors should have legal awareness so that they can defend their cases in courts properly. There is a need to maintain healthy doctor-patient relationship, good record keeping, and to provide a reasonable standard of care. Doctors should keep abreast with the latest development in the medical field.

Psychiatric patient and anaesthesia.

Many patients with psychiatric illnesses are prescribed long-term drug treatment, and the anaesthesiologist must be aware of potential interactions with anaesthetic agents. Psychotropic drugs often given in combination with each other or with other non-psychiatric drugs generally exert profound effects on the central and peripheral neurotransmitter and ionic mechanisms. Hence, prior intake of these drugs is an important consideration in the management of the patient about to undergo anaesthesia and surgery. This article highlights the effects of anaesthetics on patients taking antipsychotics, tricyclic antidepressants, monoamine oxidase inhibitors and lithium carbonate. The risk that should be considered in the perioperative period are the extent of surgery, the patient's physical state, anaesthesia, the direct and indirect effects of psychotropics, risk of withdrawal symptoms and risk of psychiatric recurrence and relapse.