A Comparative Study of Multi-Objective Multi-Period Portfolio Optimization Models in a Fuzzy Credibility Environment Using Different Risk Measures

The purpose of the present research is to compare portfolio optimization models in a fuzzy credibility environment, aimed for end-of-period wealth maximization and risk minimization. The investor’s risk was measured using the Value at Risk (VaR), Average Value at Risk (AVaR) and semi Entropy. In order to get closer to the real world investment model, while allowing for transaction costs and investing part of wealth in risk-free assets, in addition to the cardinal constraints, other constraints including the minimum and maximum amount of wealth assigned to each asset, and the minimum and maximum number of stocks present in portfolio were applied. The results of the multi-period models running by MOPSO algorithm indicated for the models Mean-AVaR, Mean-Semi Entropy, and Mean-VaR, respectively, performed better, in terms of Sharp and Treynor measures

Effect of L-Carnitine on Troponin, IL6 and HS– CRP levels after Coronary Artery Bypass Graft Surgery

Background: L-carnitine seems to be able to prevent complications after heart surgery using Cardiopulmonary bypass (CPB) and the adverse effects of pump usage. This study aimed to evaluates the effects of L-carnitine on cardiac biomarkers and operation characteristics after coronary artery bypass graft (CABG) surgery.Methods and materials: In this randomized triple-blinded, sixty patients undergoing elective CABG surgery were divided into three equal groups to receive 2gr oral L-carnitine (group A), 5gr oral L-carnitine (group B) and placebo (group C) 2 hours before surgery. IL-6, creatinine, and high sensitivity C-reactive protein (HS–CRP) levels, CK-MB, cardiac troponin and inotrope administration in ICU or after CPB were recorded for all patients at baseline levels and at 8 or 24 hours postoperatively.Results: There was an evidence of a significant difference in CPK-MB level and number of red blood cell packed used in group A was lower than group C (p<0.05). The cardiac troponin level 8 hours after surgery significantly decreased in two treatment groups in comparison to group C (p<0.05). The need for inotropic support after weaning from CPB, in B group was statistically higher than C group (p=0.021).Conclusion: Although L-carnitine adjunct therapy appears not to be associated with IL-6 and HS–CRP levels, it had beneficial effects on cardiac troponin and CPK-MB levels.   Keywords: Coronary artery bypass graft surgery, IL-6, HS–CRP levels, L-carnitine, Troponi

بررسی تغییرات علایم حیاتی مصدومان ترومای مولتیپل دچار شکستگی اندام و یا لگن پس از احیا با توجه به دریافت یا عدم دریافت مسکن وریدی

ntroduction: Trauma is among the injuries associated with a high prevalence of pain and little treatment for it. Pain can change vital signs and especially cause tachycardia due to sympathetic activity. This can distort our assessment of the patient’s shock; therefore, the present study evaluates the effect of prescribing analgesics on vital signs and hydration in trauma patients with extremity or pelvic fractures. Methods: 325 trauma patients over the age of 16 with extremity or pelvic fractures and GCS score of 14 or 15 were evaluated regarding changes in vital signs and receiving crystalloid in 2 groups of with and without analgesic administration. Results: 325 patients were divided into 2 groups of with (263 patients) and without (62 patients) analgesic administration. 80.9% of the patients received analgesics. In the group receiving analgesics, on average heart rate decreased from 103 to 95 (p < 0.001). However, it did not affect blood pressure and the respiratory status of the 2 groups receiving analgesics or not showed a significant difference. The group receiving analgesics received more crystalloids. Conclusion: Pain management in trauma leads to improvement in tachycardia and probably our better understanding of presence or absence of shock in the patient. Therefore, it is recommended to move the evaluation and treatment of acute trauma pain from the secondary survey in trauma to the D phase of the primary survey.مقدمه: تروما از آسیب هایی است که با شیوع بالای درد و درمان کم آن همراه است. درد می تواند موجب تغییر علایم حیاتی و به ویژه تاکی کاردی ناشی از فعالیت سمپاتیک گردد. این امر می تواند ارزیابی ما را از شوک بیمار مختل کند، لذا مطالعه ی حاضر تاثیر تجویز مسکن بر علایم حیاتی و هیدراسیون در بیماران ترومایی دچار شکستگی اندام و یا لگن را بررسی می کند. روش کار: 325 بیمار ترومایی بالای 16 سال دچار شکستگی اندام و یا لگن با معیار کمای گلاسکو 14 و 15 در دو گروه با و بدون دریافت مسکن از نظر تغییرات علایم حیاتی و دریافت کریستالویید ارزیابی شدند. نتایج: 325 بیمار در دو گروه با (263 نفر) و بدون (62 نفر) دریافت مسکن تقسیم شدند. 80.9 درصد بیماران مسکن دریافت کردند. ضربان قلب در گروهی که مسکن گرفتند به طور میانگین از 103 به 95 کاهش یافت (P <0.001). البته این کار تاثیری بر فشار خون نداشت و وضعیت تنفسی دو گروه نیز با و یا بدون دریافت مسکن اختلاف معنادار داشت. گروه با دریافت مسکن، میزان بیشتری از کریستالویید دریافت کردند. نتیجه گیری: کنترل درد در تروما موجب بهبود تاکی کاردی و احتمالا برداشت بهتر ما از وجود یا عدم وجود شوک در بیمار می شود. از این رو پیشنهاد می شود که بررسی و درمان درد حاد تروما از ارزیابی ثانویه (Secondary Survey) در تروما به مرحلهD  از ارزیابی اولیه (Primary Survey) منتقل شود

Potential use of angiotensin receptor blockers in skin pathologies

Renin-angiotensin system (RAS) components such as angiotensin II, angiotensin receptors (AT1R and AT2R), and angiotensin-converting enzyme (ACE) are expressed in different cell types of the skin. Through AT1R, angiotensin II increases proinflammatory cytokines contributing to fibrosis, angiogenesis, proliferation, and migration of immune cells to the skin. In contrast, AT2R suppresses the effects mentioned above. Many studies show that angiotensin receptor blockers (ARBs) and angiotensin-converting enzymes (ACEi) reduce the proinflammatory cytokines and fibrogenic factors including transforming growth factor β (TGF-β), Connective tissue growth factor (CTGF), and IL-6. This review article provides a detailed research study on the implications of ARBs in wound healing, hypertrophic scar, and keloids. We further discuss the therapeutic potentials of ARBs in autoimmune and autoinflammatory skin diseases and cancer, given their anti-fibrotic and anti-inflammatory effects

A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions

Safety and efficacy of Favipiravir in moderate to severe SARS-CoV-2 pneumonia

Background: We examined the safety and efficacy of a treatment protocol containing Favipiravir for the treatment of SARS-CoV-2. Methods: We did a multicenter randomized open-labeled clinical trial on moderate to severe cases infections of SARS-CoV-2. Patients with typical ground glass appearance on chest computerized tomography scan (CT scan) and oxygen saturation (SpO2) of less than 93 were enrolled. They were randomly allocated into Favipiravir (1.6 gr loading, 1.8 gr daily) and Lopinavir/Ritonavir (800/200 mg daily) treatment regimens in addition to standard care. In-hospital mortality, ICU admission, intubation, time to clinical recovery, changes in daily SpO2 after 5 min discontinuation of supplemental oxygen, and length of hospital stay were quantified and compared in the two groups. Results: 380 patients were randomly allocated into Favipiravir (1 9 3) and Lopinavir/Ritonavir (1 8 7) groups in 13 centers. The number of deaths, intubations, and ICU admissions were not significantly different (26, 27, 31 and 21, 17, 25 respectively). Mean hospital stay was also not different (7.9 days SD = 6 in the Favipiravir and 8.1 SD = 6.5 days in Lopinavir/Ritonavir groups) (p = 0.61). Time to clinical recovery in the Favipiravir group was similar to Lopinavir/Ritonavir group (HR = 0.94, 95% CI 0.75 � 1.17) and likewise the changes in the daily SpO2 after discontinuation of supplemental oxygen (p = 0.46) Conclusion: Adding Favipiravir to the treatment protocol did not reduce the number of ICU admissions or intubations or In-hospital mortality compared to Lopinavir/Ritonavir regimen. It also did not shorten time to clinical recovery and length of hospital stay. © 2021 Elsevier B.V

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)