An identification of optimal waste disposal method for dumpsite remediation using the Fermatean fuzzy multi-criteria decision-making method.

Improperly managed wastes that have been dumped in landfills over the years pose various challenges, but they also offer potential benefits. The feasibility of recycling such waste depends on the type of wastes, the condition of dumpsites, and the technology implemented for disposal. The selection of an alternative waste disposal method from the many available options for dumpsite remediation is a complex decision-making process among experts. The primary aim of this study is to assist in an extended multi-criteria decision-making (MCDM) method to reduce complexity in the proposed dumpsite remediation problem influenced by multiple criteria and to identify the optimal waste disposal method. Data uncertainties are managed with the proposed Fermatean fuzzy preference scale, and the importance of all socio-economic criteria is assessed using the full consistency method (FUCOM). The final ranking results of the weighted aggregated sum product assessment (WASPAS) method identify that the Waste-to-Energy (WtE) process could play a significant role in the disposal of land-filled unprocessed wastes, promoting sustainable waste management. Meanwhile, the methodology explores the idea that financial and logistical constraints may limit the feasibility of large-scale recycling efforts. This combination of environmental science and decision science addresses real-world challenges, helping municipal solid waste management authorities implement sustainable waste management practices.

Understanding conflicts of interest in rational drug prescription in a developing country: A stakeholder analysis, healthcare guidelines and ethical public health issues.

Background: Rational drug prescription (RDP) is one of the main components of the healthcare systems. Irrational prescribing can bring about numerous negative consequences for the patients and governmental agencies. This study aims to analyze the involvement of stakeholders in rational drug prescribing, their position (opponent or proponent), and the rationale behind it. Methods: This was a qualitative study conducted in 2019. Semi-structured face-to-face interviews were conducted with 40 stakeholders. Purposive and snowball sampling techniques with maximum heterogeneity were adopted to select the interviewees. Data was analyzed by MAXQDA software using thematic approach. Results: Iranian Food and Drug Administration employs the highest authority on the rational prescribing policy. Although the Ministry of Health and Medical Education, the Social Security Organization as one of the main health insurance organizations, pharmaceutical companies, and the Medical Council of the Islamic Republic of Iran, are among agencies that have great authority to improve rational prescribing, they fail to act professionally as they have conflicting interests. Remarkably, the Iran Food and Drug Administration, insurance organizations, family physicians, and patients, highly support the rational prescribing policy while the pharmaceutical companies display the least support for it. Conclusions: To make the prescription and using drugs more rational, policy makers should focus on different sources of conflicts of interest that different actors have. They should devise legal, behavior and financial policies accordingly to lessen or at least neutralize these conflicting interests, otherwise achieving RDP would be impossible in short and long terms.

Acute respiratory distress syndrome after spontaneous rupture of a large pulmonary hydatid cyst in a 17-year-old male: A case report.

Pulmonary hydatid cysts (PHC) and their complications are still a health concern in endemic countries. Here we described a 17-year-old male presented with a large PHC with a spontaneous rupture. He developed acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. He was treated with albendazole, broad-spectrum antibiotics, and corticosteroids. The patient's general condition did not allow any attempt for surgical resection of the cyst. He was discharged in stable condition after one month and referred to a thoracic surgeon for resection of the cyst. As far as we know ARDS after hydatid cyst rupture was rarely reported, and through this case report we aimed to raise awareness of this possible life-threatening complication.

Bone Scan With Pulmonary Uptake in Scleroderma.

ABSTRACT: We present a 61-year-old woman with a history of scleroderma and suspicion of osteomyelitis in her left wrist. She underwent a 3-phase bone scan for evaluation of osteomyelitis. Incidentally, the scan showed bilateral pulmonary MDP uptake, especially in lower lobes, which was proven to be due to the nonfibrotic form of nonspecific interstitial pneumonia.

Pulmonary vein thrombosis associated with metastatic uterine leiomyosarcoma: a case report.

BACKGROUND: Pulmonary vein thrombosis (PVT) is rarely associated with malignancies. Leiomyosarcoma, a malignant tumor originating from smooth muscles, has never been reported as the etiology of PVT. CASE PRESENTATION: In this case report, we described a 43-year-old Kurdish woman with a known case of leiomyosarcoma who presented with hemoptysis, dyspnea, and pleuritic chest pain. Chest computed tomography (CT) angiography revealed a thrombus in the left infero-posterior pulmonary vein. She was successfully treated with unfractionated heparin administered intravenously followed by orally administered warfarin. At the end of the article, we describe and compare other reports of malignancy-related PVT. CONCLUSIONS: While malignancies are not a common cause of PVT, both primary lung tumors and metastatic cancers could be associated with PVT. Delay in diagnosis may lead to serious complications and even death. Therefore, clinicians should be aware of the possibility of the development of PVT in different malignancies for appropriate diagnosis and treatment.

Periapical dental X-ray image classification using deep neural networks.

This paper studies the problem of detection of dental diseases. Dental problems affect the vast majority of the world's population. Caries, RCT (Root Canal Treatment), Abscess, Bone Loss, and missing teeth are some of the most common dental conditions that affect people of all ages all over the world. Delayed or incorrect diagnosis may result in mistreatment, affecting not only an individual's oral health but also his or her overall health, thereby making it an important research area in medicine and engineering. We propose a pipelined Deep Neural Network (DNN) approach to detect healthy and non-healthy periapical dental X-ray images. Even a minor enhancement or improvement in existing techniques can go a long way in providing significant health benefits in the medical field. This paper has made a successful attempt to contribute a different type of pipelined approach using AlexNet in this regard. The approach is trained on a large dataset of 16,000 dental X-ray images, correctly identifying healthy and non-healthy X-ray images. We use an optimized Convolutional Neural Networks and three state-of-the-art DNN models, namely Res-Net-18, ResNet-34, and AlexNet for disease classification. In our study, the AlexNet model outperforms the other models with an accuracy of 0.852. The precision, recall and F1 scores of AlexNet also surpass the other models with a score of 0.850 across all metrics. The area under ROC curve also signifies that both the false-positive rate and false-negative rate are low. We conclude that even with a big data set and raw X-ray pictures, the AlexNet model generalizes effectively to previously unseen data and can aid in the diagnosis of a variety of dental diseases.

Study of Fractional Order SEIR Epidemic Model and Effect of Vaccination on the Spread of COVID-19.

In this manuscript, a fractional order SEIR model with vaccination has been proposed. The positivity and boundedness of the solutions have been verified. The stability analysis of the model shows that the system is locally as well as globally asymptotically stable at disease-free equilibrium point E 0 when R 0 < 1 and at epidemic equilibrium E 1 when R 0 > 1 . It has been found that introduction of the vaccination parameter η reduces the reproduction number R 0 . The parameters are identified using real-time data from COVID-19 cases in India. To numerically solve the SEIR model with vaccination, the Adam-Bashforth-Moulton technique is used. We employed MATLAB Software (Version 2018a) for graphical presentations and numerical simulations.. It has been observed that the SEIR model with fractional order derivatives of the dynamical variables is much more effective in studying the effect of vaccination than the integral model.

Pregnancy, Preeclampsia, and COVID-19: Susceptibility and Mechanisms: A Review Study.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters cells through angiotensin converting enzyme 2 (ACE2), which expression of its gene increases during pregnancy that is resulted in an enhanced level of the ACE2 enzyme. It might enhance the risk of SARS-CoV-2 infection and its complications in the pregnant women. Although, pregnancy hypertensive disorders and severe infection with SARS-CoV-2 are correlated with high comorbidity, these two entities should be discriminated from each other. Also, there is a concern about the risk of preeclampsia and consequently severe coronavirus disease 2019 (COVID-19) development in the pregnant women. So, to answer these questions, in the present review the literature was surveyed. It seems there is higher severity of COVID-19 among pregnant women than non-pregnant women and more adverse pregnancy outcomes among pregnant women infected with SARS-CoV-2. In addition, an association between COVID-19 with preeclampsia and the role of preeclampsia and gestational hypertension as risk factors for SARS-CoV-2 infection and its complications is suggested. However, infection of the placenta and the SARS-CoV-2 vertical transmission is rare. Various mechanisms could explain the role of COVID-19 in the risk of preeclampsia and association between preeclampsia and COVID-19. Suggested mechanisms are included decreased ACE2 activity and imbalance between Ang II and Ang-(1-7) in preeclampsia, association of both of severe forms of COVID-19 and pregnancy hypertensive disorders with comorbidity, and interaction between immune system, inflammatory cytokines and the renin angiotensin aldosterone system and its contribution to the hypertension pathogenesis. It is concluded that preeclampsia and gestational hypertension might be risk factors for SARS-CoV-2 infection and its complications.

An Analysis for Variable Physical Properties Involved in the Nano-Biofilm Transportation of Sutterby Fluid across Shrinking/Stretching Surface.

In this article, we explore how activation energy and varied transit parameters influence the two-dimensional stagnation point motion of nano-biofilm of Sutterby fluids incorporating gyrotactic microbes across a porous straining/shrinking sheet. Prior investigations implied that fluid viscosity as well as thermal conductance are temperature based. This research proposes that fluid viscosity, heat capacity and nanofluid attributes are all modified by solute concentration. According to some empirical research, the viscosity as well as heat conductivity of nanoparticles are highly based on the concentration of nanoparticles instead of only the temperature. The shooting approach with the RK-4 technique is applied to acquire analytical results. We contrast our outcomes with those in the existing research and examine their consistency and reliability. The graphic performance of relevant factors on heat, velocity, density and motile concentration domains are depicted and discussed. The skin friction factor, Nusselt number, Sherwood number and the motile density are determined. As the concentration-dependent properties are updated, the speed, temperature, concentration and motile density profiles are enhanced, but for all concentration-varying factors, other physical quantities deteriorate.

A Secure and reliable RFID authentication protocol using digital schnorr cryptosystem for IoT-enabled healthcare in COVID-19 scenario.

The Internet of Things (IoT) plays an important role in various healthcare applications. Radio Frequency IDentification (RFID) is widely used as a leading identification technology in a variety of IoT-health applications. In 2020, the number of cases of novel Corona Virus Disease 2019 ( n COVID-19) was increased rapidly throughout the world. Herein, IoT-Health enables the more convenient ways to access remotely and efficiently the medical services for the patients, also provides health monitoring by the doctors, physicians, and nurses over the Internet. However, security and privacy are considered key concerns in RFID-based IoT-health systems due to wireless communication over the channel. There could be huge risks of leakage of the patient's sensitive information, medical data, privacy of the patients, and so forth. To overcome these shortcomings, we have put forward a secure and reliable RFID authentication protocol using Digital Schnorr Cryptosystem for IoT-Health in COVID-19 patients care named S R 2 AP-DSC. Compared with the similar existing protocols, the security analysis followed by the performance evaluation of our proposed protocol demonstrates the minimal computation overheads and also provides resistance to various well-known security attacks. The AVISPA and Scyther simulation results confirm that the proposed protocol is safe under active and passive attacks. The overall analysis shows that the S R 2 AP-DSC is relatively superior to the other similar existing protocols.

Efficacy and safety of sofosbuvir/velpatasvir versus the standard of care in adults hospitalized with COVID-19: a single-centre, randomized controlled trial.

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the COVID-19 pandemic. The majority of patients experience asymptomatic to mild self-limited disease, but some cases progress to respiratory and multi-organ failure. However, so far, no approved antiviral therapy has been available for treatment of COVID-19. Sofosbuvir/velpatasvir (SOF/VEL) is an approved anti-HCV drug that is capable of suppressing other families of positive-sense RNA viruses with conserved polymerase and may be effective against SARS-CoV-2. This study was conducted to evaluate the efficacy of the SOF/VEL combination in addition to the national standard of care versus the national standard of care alone (hydroxychloroquine and lopinavir/ritonavir as well as supportive care) in patients with moderate to severe COVID-19 infection. METHODS: This single-centre, randomized, open-labelled, prospective clinical trial was done in patients with moderate to severe COVID-19 admitted to Farabi Hospital in Kermanshah Province, Iran. Eligible patients were randomly assigned in a 1:1 ratio to the SOF/VEL arm (SOF/VEL plus the national standard of care) or the control arm (the national standard of care alone). The main outcome of the study was the mortality on Day 28 after randomization. Secondary outcomes were time from the start of medication to clinical improvement, hospital length of stay, need for mechanical ventilation, duration of mechanical ventilation and conversion of RT-PCR results from positive to negative from the time of randomization to discharge. Adverse events were evaluated in all patients who started their assigned treatment. RESULTS: Between 11 April and 8 June 2020, 80 patients were recruited and randomly assigned into the SOF/VEL (n = 40) and control (n = 40) arms. The primary outcome was not significantly different between the two arms (P = 1.00). Secondary outcomes, including time to clinical improvement, hospital length of stay, need for mechanical ventilation, duration of mechanical ventilation and RT-PCR conversion, were not significantly different between arms either (P > 0.05). SOF/VEL treatment and the national standard of care were tolerated similarly. CONCLUSIONS: Although treatment with SOF/VEL was safe, adding SOF/VEL to the standard of care did not improve the clinical status or reduce mortality in patients with moderate to severe COVID-19. However, larger randomized clinical trials including more parameters are needed for accurate estimation of the efficacy of SOF/VEL.

p53 p.Pro72Arg (rs1042522) and Mouse Double Minute 2 (MDM2) Single-Nucleotide Polymorphism (SNP) 309 Variants and Their Interaction in Chronic Lymphocytic Leukemia(CLL): A Survey in CLL Patients from Western Iran.

Background: Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. The MDM2 and p53 are interacting proteins that play crucial roles in cell biology. Genetic variations of p53 and MDM2 have been identified in many cancers including CLL; among which are SNP309 in the promoter of MDM2 and SNP codon72 in p53. Materials and Methods: In this study, we sought to find the impact of two SNPs of p53 and MDM2 in the pathogenesis of CLL. A total of 100 CLL patients and 102 healthy controls were recruited. Genomic DNA was extracted, and genotyping was performed using the PCR-RFLP method. The allele and genotype associations were analyzed using the χ2 test. The gene-gene interaction analysis was studied using GMDR v0.9. Results: Our study found the absence of a significant difference between CLL patients and controls related to the allelic frequencies or genotypic distributions for both MDM2 SNP309 and p53 codon72. A significantly higher frequency of p53 C allele was found in patients with disease duration of more than 36 compared to those less than 36 months. However, GMDR analysis suggests genetic interaction between the genes under study. Conclusion: Our findings indicated each polymorphism of p53 codon72 and MDM2 (SNP309) was not a risk factor for CLL but the p53 C allele could be associated with the disease duration. Besides, the interaction between p53/MDM2 genotypes may confer susceptibility to CLL. Our study could be useful in genetic association studies of CLL and the role of gene-gene interactions in the susceptibility to the disease.

The effects of shock wave and dry needling on active trigger points of upper trapezius muscle in patients with non-specific neck pain: A randomized clinical trial.

BACKGROUND: Chronic neck pain is associated with various myofascial trigger points (MTrPs). OBJECTIVE: A single-blind randomized clinical trial was designed to compare the effects of extracorporeal shock wave therapy (ESWT) with dry needling (DN) techniques on the upper trapezius muscle trigger point in patients with non-specific neck pain (NSNP). METHODS: Seventy patients with NSNP and active MTrPs of the upper trapezius muscle were randomly divided into two groups: an ESWT group (n= 35) and a DN group (n= 35). Treatment sessions were performed for three weeks and all participants received related intervention once a week. The outcome measures were pain intensity, measured by a numeric pain rating scale (NPRS), pain pressure threshold (PPT), measured with a digital algometer, and functional disability, evaluated by using the neck disability index (NDI). RESULTS: NPRS and NDI were significantly decreased in the DN group and ESWT group (P< 0.05). Also, the PPT was significantly increased in the DN group and ESWT. However, there was no significant difference in pain intensity, NDI, and the PPT between the two groups (P⩾ 0.05). CONCLUSION: Both ESWT and DN can be employed to treat MTrPs of the upper trapezius muscle in patients with NSNP.

Nandrolone decanoate negatively reverses the beneficial effects of exercise on cardiac muscle via sarcolemmal, but not mitochondrial K(ATP) channel.

ATP-sensitive potassium channels are supposed to have a substantial role in improvement of cardiac performance. This study was performed to evaluate whether nandrolone decanoate (ND) and (or) exercise training could affect the expression of cardiac K(ATP) channel subunits. Thirty-five male albino Wistar rats were randomly divided into 5 groups, including sedentary control (SC), sedentary vehicle (SV), sedentary ND (SND), exercise control (EC), and exercise and ND (E+ND). Exercise training was performed on a treadmill 5 times per week. ND was injected (10 mg/kg/week, i.m.) to the rats in the SND and E+ND groups. Following cardiac isolation, the expression of both sarcolemmal and mitochondrial subunits of K(ATP) channel was measured using Western blot method. The expression of sarcolemmal, but not mitochondrial, subunits of K(ATP) channel (Kir6.2 and SUR2) of EC group was significantly higher compared with SC group while ND administration (SND group) did not show any change in their expression. In the E+ND group, ND administration led to decrease of the over-expression of sarcolemmal Kir6.2 and SUR2 which was previously induced by exercise. There was no significant association between the mitochondrial expression of either Kir6.2 or SUR2 proteins and administration of ND or exercise. Supra-physiological dosage of ND negatively reverses the effects of exercise on the cardiac muscle expression of sarcolemmal, but not mitochondrial, K(ATP) channel subunits.

Expression of α4, αv, ß1 and ß3 integrins during the implantation window on blastocyst of a mouse model of polycystic ovarian syndromes.

BACKGROUND: It has been hypothesized that blastocyst integrin expression changes can affect the spontaneous miscarriage in polycystic ovarian syndromes (PCOS). OBJECTIVE: In this study, the profile of integrin genes and proteins was investigated on blastocyst of the PCOS experimental mouse model. MATERIALS AND METHODS: 30 NMRI female mice were equally divided into 3 groups: control, experimental [PCOS that was injected estradiol valerate (40 mg/kg)]. After 8 weeks, each group was hyper stimulated by PMSG and HCG. Vaginal plaque was checked, and mice were investigated 5 days after the test. Progesterone and estradiol levels were determined; α4, αv, ß1 and ß3 integrin genes and protein of blastocysts were examined by real time PCR method and immunohistochemistry, respectively. RESULTS: Estradiol level was significantly increased (p≤0.035) in PCOS group. Based on our finding, the ratio of genes' expressions αv, ß3, ß1 and α4 in PCOS to control group was 0.479±0.01, 0.5±0.001, 2.7±0.4 and 1.023±0.2 respectively. Genes expression showed a great difference (p≤0.001) between ß3, ß1 and αv in PCOS compared to other groups. αv and ß3 integrin proteins expressed in all groups but intensity of these proteins in PCOS groups, was lower than other groups. CONCLUSION: Pattern of αv and ß3 integrins expression on the mouse blastocyst surface has an important effect during the implantation window. This pattern has changed in PCOS model and might have a great influence on implantation failure. Therefore, this experimental study suggests that a great attention to this problem may be essential in patients who are involved.

Valproic Acid attenuates disease symptoms and increases endogenous myelin repair by recruiting neural stem cells and oligodendrocyte progenitors in experimental autoimmune encephalomyelitis.

BACKGROUND: inefficient remyelination of demyelinated plaques in multiple sclerosis (ms) leads to secondary axon degeneration and progressive disability. therapies that potentiate remyelination would be of immense help for managing MS. OBJECTIVE: Here, we report the effects of valproic acid (VPA) on focal experimental autoimmune encephalomyelitis (fEAE). METHODS: fEAE was induced in Wistar rats by immunizing the animals with guinea pig spinal cord homogenate emulsified in complete Freund's adjuvant and with pertussis toxin (PT) injection into the spinal cord at the level of T8 vertebra on day 18 after immunization. VPA 300 mg/kg was applied for 4 days after or 8 days before PT administration. Behavioral evaluation, histological assessment and immunohistofluorescence assays were used to evaluate the outcomes. RESULTS: VPA administration had no effect on the development of symptoms, but after discontinuing VPA, animals showed faster recovery. Eight days of pretreatment with VPA accelerated the recovery phase of EAE and increased the number of remyelinated axons in the lesion area. VPA pretreatment also increased the recruitment of neural stem cells and oligodendrocyte precursors within the lesion. CONCLUSIONS: Results suggest VPA as a potential therapy for remyelinating the lesions in MS and for faster recovery from disease relapses. The effect of VPA seems to be mediated by endogenous progenitors recruitment.