Exploring the need and potential of ambulatory pharmacy practice for empowering patient and care delivery in India.

In recent years, rapidly changing disease profile patterns, shortage & uneven utilization of healthcare professionals contributed massive burden on the Indian healthcare system, which resulted in varying, fragmented, inconsistent healthcare delivery to the patients and poor patient management. Patients often face and experience many challenges like lack of accessibility, poor patient-healthcare provider relationships, and inadequate quality of care, resulting in unnecessary economic burden in managing their health conditions. Thus Indian healthcare reform is essential in enhancing its capacity to fulfill patients' health needs that can be addressed by focusing on key sustainable strategies and initiatives meant for enhancing coordination of care, expanding services accessibility, redeveloping healthcare infrastructure, implementing workforce innovation and strong governance with the incorporation of core principles such as patient-centeredness, integrated care and collaborative care approaches. The clinical and ambulatory pharmacy practice are fragment of the healthcare delivery which delivers pharmaceutical care and fulfils the needs of patients across healthcare settings. This paper focuses on the present & future perspectives of ambulatory pharmacy practice in India and the factors to be considered for implementing it in patient care.

Ruptured Pulmonary Hydatid Cyst.

A 37-year-old male presented with left-sided hydropneumothorax. After drainage of fluid and air from the pleural cavity, chest radiograph and computed tomography of chest showed characteristic radiological image of ruptured hydatid cyst. The diagnosis was supported by positive echinococcal serology.

Analytical tuning rules for second-order reduced ADRC with SOPDT models.

This paper presents a set of tuning rules for second-order reduced linear active disturbance rejection control for second-Order Plus-Dead-time (SOPDT) models. Rules are developed with a target to achieve a good compromise between tracking and disturbance rejection performances. Subsequently, it is formulated as a multi-objective optimization problem consisting of Integral Absolute tracking and regulatory errors as its objectives with a specified robustness level and a stability condition as constraints. The optimization problem is solved by a Multi-objective Quasi-Oppositional Rao-1 (MOQO-Rao-1) algorithm to generate the required Pareto optimal solutions. A compromised solution is chosen among these Pareto optimal solutions using Grey Relational Analysis (GRA). Finally, the resulting best solutions are used to fit a polynomial model using regression resulting in analytical tuning rules. Separate tuning rules are presented for lag-dominated and delay-dominated SOPDT models. The proposed tuning rules are validated through simulations on standard benchmark systems, power-system load frequency control problems, and experimentally on a temperature control system and DC motor control system. Furthermore, a condition on tuning parameters for closed-loop system stability is presented using the dual-locus method; the same is incorporated as one of the constraints in the proposed tuning framework.

Recent advances, novel targets and treatments for cholelithiasis; a narrative review.

Cholelithiasis is a common and frequent condition all over the world with a high prevalence rate in western countries. Individuals with cholesterol gallstone disease experience intense gastrointestinal symptoms and have a high risk of developing comorbidities like cholecystitis, Gall bladder (GB) cancer and pancreatitis. Multiple risk factors associated with cholesterol gallstones include but not limited to genetics, dietary habits, lifestyle changes, comorbid conditions and various drugs. These factors may lead to alteration in bile, cholesterol & phospholipids homeostasis in the GB, intestine and hepatocytes culminating in cholesterol gallstones formation. Surgical (cholecystectomy) and non-surgical (oral dissolution therapy) treatments are available for the disease, albeit with certain complications and high treatment cost. Thus, there is a need for interventions, complementary or alternative therapies for the treatment and prevention of cholesterol gallstones. Currently available drug therapies used for cholesterol gallstones include statins and ezetimibe. Many patients consider traditional herbal practitioners due to their promise of non-invasive and pain free management of gall stones. This present a positive shift towards generally acceptable safety and cost effectiveness of herbal treatment warranting extensive research for alternative or complementary choice such as herbal plants as an emerging area for their potential therapeutic effects. This review discusses current strategies, latest trends available in the disease pathogenesis, drug development for novel targets, risk management, newer anti-lithogenic drugs and herbal plants that target the different aspects of the disease.

Analytical tuning rules for Reduced-order Active Disturbance Rejection Control with FOPDT models through Multi-Objective optimization and multi-criteria decision-making.

Active Disturbance Rejection Control (ADRC) emerged as a promising control solution in various engineering domains. However, increased ADRC order makes it difficult to implement and tune in practice. On the other hand, Reduced-order ADRC (RADRC) structure solves this issue with the appropriate tuning of its parameters to achieve the desired performance. This paper aims to develop analytical tuning rules for RADRC for processes approximated as First-order plus dead-time models (FOPDT). These rules meet the conflicting goals of tracking and disturbance rejection restricted by robustness specification. The tuning rules are derived based on a multi-stage approach. In the first stage, the tuning problem is formulated as a multi-objective optimization problem with appropriate constraints. A Multi-objective Quasi-Oppositional Rao-1 (MOQO-Rao-1) Algorithm solves the optimization problem to produce a collection of Pareto-optimal solutions (alternatives) in the second stage. In the third stage, using the Best-Worst based PROMETHEE method, the best one is chosen among the available options. Finally, using linear regression, analytical tuning rules are developed. Separate tuning rules are proposed for lag-dominated and dead-time dominated cases. Simulation experiments on benchmark industrial processes are performed, and the findings assess the efficacy of the suggested tuning rules relative to the methods recently published. The proposed tuning rules are experimentally validated to assess their applicability in the practical scenario. Besides, the closed-loop system's stability with the suggested tuning rules is confirmed by the small-gain theorem and the dual-locus process.

An AHP based optimized tuning of Modified Active Disturbance Rejection Control: An application to power system load frequency control problem.

This paper presents Modified Active Disturbance Rejection Control (MADRC) scheme and a systematic procedure to tune its tuning variables via. observer and controller gains. The problem of tuning is formulated as a constrained multi-objective optimization problem. Depending upon the application appropriate objective functions are chosen, and a unified objective is developed based on weighted sum approach. Five different weight combinations are considered, which result in five objective functions. Each objective function is individually optimized using Teaching-Learning Based Optimization (TLBO), this leads to five sets of tuning variables. Best among five alternatives will be selected based on Analytical Hierarchy Process (AHP). The effectiveness of this approach is validated through its application to a power system with load frequency control problems. Different simulation examples involving single-area and multi-area power systems are considered in the presence of sudden load disturbances, model uncertainties, and parameter variations. Further stability analyses are carried out in a standard two-degree of freedom Internal Model Control (IMC) framework.

Treatment of seafood processing wastewater using upflow microbial fuel cell for power generation and identification of bacterial community in anodic biofilm.

Tubular upflow microbial fuel cell (MFC) utilizing sea food processing wastewater was evaluated for wastewater treatment efficiency and power generation. At an organic loading rate (OLR) of 0.6 g d(-1), the MFC accomplished total and soluble chemical oxygen demand (COD) removal of 83 and 95%, respectively. A maximum power density of 105 mW m(-2) (2.21 W m(-3)) was achieved at an OLR of 2.57 g d(-1). The predominant bacterial communities of anode biofilm were identified as RB1A (LC035455), RB1B (LC035456), RB1C (LC035457) and RB1E (LC035458). All the four strains belonged to genera Stenotrophomonas. The results of the study reaffirms that the seafood processing wastewater can be treated in an upflow MFC for simultaneous power generation and wastewater treatment.

Investigation on antimicrobial activity of root extracts of Thespesia populnea Linn.

Many medicinal plants have been used for centuries in daily life to treat microbial diseases all over the world. In this study, the in vitro antibacterial activity of aqueous and ethanol root extracts of Thespesia populnea Linn were investigated. Antimicrobial properties of T. populnea Linn was evaluated against five pathogenic bacteria and two fungi. Disc diffusion method and minimum inhibitory concentration (MIC) were determined by broth serial dilution method. The ciprofloxacin (5 µg/ml) and flucanozole (100 units/disc) were used as positive controls for bacteria and fungi respectively. Different concentrations (50, 100, 150 µg/ml) of ethanolic and aqueous root extracts of T. populnea were checked for the dose dependent antibacterial activity. Thespesia populnea showed broad spectrum antimicrobial activity against gram positive and gram negative bacteria and maximum inhibition by ethanolic extract was observed at higher dose (250 µg/ml) as 27±0.2mm. The MIC of the ethanol extract was 10 µg/ml for Staphylococcus aureus and 750 µg/ml for Candida albicans. The antifungal activity offered against S. aureus by the ethanolic extract is more than the aqueous extract. The results concluded that the anti-microbial activity of T. populnea was dose dependent. As the concentration increased the inhibition zone also increased. Flavonoids and tannins present in the extracts may be responsible for the antimicrobial activity.

Design and in vitro evaluation of effervescent gastric floating drug delivery systems of propanolol HCl / Diseño y evaluación in vitro de sistemas de administración de tabletas flotantes gástricas everfescentes de HCl propanolol

The purpose of this research was to develop and evaluate effervescent gastric floating tablets of propranolol HCl. The oral delivery of antihypertensive propranolol HCl was facilitated by preparing an effervescent floating dosage form which could increase its absorption in the stomach by increasing the drug’s gastric residence time. In the present work, effervescent floating tablets were prepared with a hydrophilic carrier such as polyethylene oxide (PEO WSR N 60K and PEO WSR 303) as a release retarding agent and sodium bicarbonate as a gas generating agent. The prepared tablets were evaluated for all their physicochemical properties, in vitro buoyancy, drug release and rate order kinetics. From the results, P9 was selected as an optimized formulation based on their 12 h drug release, minimal floating lag time and maximum total floating time. The optimized formulation followed first order rate kinetics with erosion mechanism. The optimized formulation was characterized with FTIR studies and no interaction between the drug and the polymers were observed.

El propósito de la presente investigación fue desarrollar y evaluar tabletas flotantes, efervescentes de HCL propranolol. La administración oral del antihipertensivo HCL propranolol se facilitó mediante la preparación de una forma de dosificación flotante y efervescente que permitiría su absorción en el estómago, mediante el aumento del tiempo de residencia gástrico de la droga. En el presente trabajo, las tabletas flotantes efervescentes fueron preparadas con un portador hidrofílico, tal como el óxido de polietileno (PEO WSR N 60K and PEO WSR 303), como agente retardador y bicarbonato de sodio como un agente generador de gas. Se evaluaron todas las propiedades fisicoquímicas de las tabletas preparadas, su flotación in vitro y su tasa de orden cinético. Se seleccionó el P9 a partir de los resultados obtenidos, como una fórmula óptima, basados en la liberación de la droga a las 12 h, tiempo mínimo de retraso para flotación y máximo tiempo total de flotación. La formulación optimizada siguió una tasa cinética de primer orden con mecanismo de erosión. Esta fórmula óptima se caracterizó mediante estudios FITR y no se observó ninguna interacción entre la droga y los polímeros utilizados.

Potter's Sequence.

Potter's sequence is a rare fatal disorder that occurs in sporadic and autosomal recessive forms with an incidence of 1 in 4000 births. Babies born with this condition are either still born or die very early within the neonatal period. We report a case of Potter's sequence with the typical physical findings and histological findings.

Mucormycosis associated with juvenile diabetes.

Mucormycosis is one of the most rapidly progressing and lethal form of fungal infections in humans which usually begins in the nose and paranasal sinuses. The fungus assaults the arteries, leading to thrombosis that subsequently causes necrosis of hard and soft tissues. The purpose of this article is to describe a rare case of maxillary necrosis due to mucormycosis in a 12-year-old diabetic patient and emphasizes on early diagnosis and timely management of this potentially fatal fungal infection.

Chronotherapeutic drug delivery systems: an approach to circadian rhythms diseases.

The purpose of writing this review on chronotherapeutic drug delivery systems (ChrDDs) is to review the literatures with special focus on ChrDDs and the various dosage forms, techniques that are used to target the circadian rhythms (CR) of various diseases. Many functions of the human body vary considerably in a day. ChrDDs refers to a treatment method in which in vivo drug availability is timed to match circadian rhythms of disease in order to optimize therapeutic outcomes and minimize side effects. Several techniques have been developed but not many dosage forms for all the diseases are available in the market. ChrDDs are gaining importance in the field of pharmaceutical technology as these systems reduce dosing frequency, toxicity and deliver the drug that matches the CR of that particular disease when the symptoms are maximum to worse. Finally, the ultimate benefit goes to the patient due the compliance and convenience of the dosage form. Some diseases that follow circadian rhythms include cardiovascular diseases, asthma, arthritis, ulcers, diabetes etc. ChrDDs in the market were also discussed and the current technologies used to formulate were also stated. These technologies include Contin® , Chronotopic®, Pulsincaps®, Ceform®, Timerx®, Oros®, Codas®, Diffucaps®, Egalet®, Tablet in capsule device, Core-in-cup tablet technology. A coated drug-core tablet matrix, A bi-layered tablet, Multiparticulate-based chronotherapeutic drug delivery systems, Chronoset and Controlled release microchips.

Modified assay procedure for the estimation of serum glucose using microwell reader.

Determination of blood glucose levels is very important to know the physiological condition of the human beings as the hormonal imbalance may cause abnormalities in glucose metabolism. The traditional methods of glucose estimation by colorimetric and titrimetric methods were involved with huge expenditure and time. The modified colorimetric microwell reader method proposed in the present study was performed with small quantities of sample and reagents with the same linearity that was observed in the normal colorimetric analysis. The modified method not only reduces the cost of the test to almost one third of the normal colorimetric method but also provide an opportunity to screen the large number of samples in a short duration of time.

Overcoming a kinked peel-away sheath during central line implantation.

In pediatric patients, central line implantation via the subclavian vein can be complicated by the presence of a kink in the peel-away sheath. A technique is described, which has been used on 62 occasions to overcome this problem. Reinserting the catheter through the kinked peel-away sheath in concert with a guidewire that extends 3 to 4 cm beyond the catheter tip can ensure successful placement.

Megacystis microcolon intestinal hypoperistalsis syndrome: late sequelae and possible pathogenesis.

Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is characterized by hypoperistalsis in the presence of ganglion cells, malrotation, microcolon, bladder distension, and female predilection. We draw attention to the long-term management of a patient with MMIHS and propose a pathogenetic mechanism to account for this syndrome. We propose that the initial event in the pathogenesis of MMIHS is an intramural inflammatory process that affects the gastrointestinal and urinary tracts. This leads to extensive fibrosis which destroys the intestinal neural network, producing hypoperistalsis. The same process causes neuromuscular incoordination in the bladder wall, resulting in irregular bladder contractions against a "closed sphincter" leading to bladder distension. The enlarged bladder then interferes with the rotation of the intestine causing malrotation.

Management of pulmonary blastoma in children.

Pulmonary blastoma is a rare neoplasm, accounting for 0.5 per cent of all primary malignant pulmonary tumors. The clinical features, radiologic findings, and management of five children with pulmonary blastoma are described. The female/male ratio was 4:1. Mean age at presentation was 34 months, with a mean duration of symptoms of 1.8 months. Fever and cough were the most common symptoms. Opacification of the right lung field with mediastinal shift to the left was the predominant roentgenologic feature. The tumor involved the right chest in all patients. Thoracotomy was performed in all patients to establish the diagnosis. Two patients underwent complete resection at the initial operation, an incomplete resection was performed in one patient. Delayed complete resection was performed in another patient. All the patients received combination chemotherapy and one patient also received radiotherapy for primary disease. Two patients with histologic and immunohistochemical evidence of striated muscle differentiation were treated as rhabdomyosarcomas. Both these patients have survived for 24 and 67 months after diagnosis. The tumor recurred in three patients. Recurrence was treated with a combination of surgery, chemotherapy, and radiotherapy. Overall disease-free survival rate was 40 per cent. Long-term follow-up and additional patients are required to provide prognostic information.

Growth hormone reverses impaired wound healing in protein-malnourished rats treated with corticosteroids.

Corticosteroid (CS) administration amplifies the inhibitory effect of protein malnutrition (PM) on wound healing. Abdominal surgery in protein malnourished patients receiving corticosteroids (eg, advanced malignancy, transplant recipients) may be complicated by wound dehiscence or anastomotic breakdown. Although preoperative parenteral nutrition can reduce the incidence of these complications, this is not possible in patients requiring urgent surgical intervention. In a previous report we demonstrated that postoperative growth hormone (GH) administration could restore normal wound healing in PM rats. This study evaluates the effect of GH on wound healing in PM rats treated with CS. Forty-eight female Sprague-Dawley rats weighing 180 to 210 g were divided into four groups: (1) normally nourished; (2) PM only; (3) PM + CS; and (4) PM + CS + GH. PM rats (groups 2 to 4) received 5.5% protein chow every other day for 8 weeks. Control rats (group 1) received 23.4% protein chow for the same duration. Group 3 and 4 rats received prednisolone (2 mg/kg, intramuscularly) during the last 3 weeks of PM. All animals underwent precise 5-cm midline celiotomies. Postoperatively, rats in all groups were given 23.4% protein chow. Group 3 and 4 rats continued to receive CS postoperatively. Group 4 rats were given GH (0.5 mg/d, intraperitoneally) postoperatively for 5 days. Wound testing was performed on the 6th postoperative day after removal of the sutures. A balloon inserted into the peritoneal cavity through the vagina was gradually inflated. The pressure at which the wound disrupted was recorded as the wound bursting strength.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of bilateral Wilms' tumor: comparison of initial biopsy and chemotherapy to initial surgical resection in the preservation of renal mass and function.

The National Wilms' Tumor Study 3 (NWTS-3) recommended treatment of bilateral Wilms' tumor with initial biopsy followed by chemotherapy with subsequent operation to resect the remaining tumor. This study was performed to determine if this approach preserves renal mass and function when compared with initial surgical resection followed by chemotherapy. Over a 20-year period (1970 to 1990), 15 patients with synchronous bilateral Wilms' tumor were treated at the Childrens Hospital of Los Angeles. Eight patients in the surgical group underwent initial unilateral nephrectomy with contralateral biopsy, wedge resection, or partial nephrectomy and subsequent chemotherapy. The seven patients in the chemotherapy group underwent bilateral tumor biopsy, followed by chemotherapy and subsequent tumor resection. Patients were assigned to each group in a nonrandomized manner according to the preference of the attending oncologist and surgeon. Comparison of the two groups showed no significant differences in sex distribution, initial renal function, tumor histology, dose and field of radiotherapy, presence or absence of positive surgical margins, and local recurrence rates. Patients in the surgery group were slightly older than those in the chemotherapy group: 3.6 +/- 2.2 versus 2.3 +/- 2.2 years. The percent of renal mass involved by tumor for the surgery group was 52 +/- 12 versus 73 +/- 16 for the chemotherapy group (P = .03). The percent of renal mass preserved following all operations, local recurrence rates, incidence of metastases, and survival was nearly identical between the two groups. There were three cases of renal failure in the surgery group and one case of renal failure in the chemotherapy group.(ABSTRACT TRUNCATED AT 250 WORDS)