A Supply Chain Network Design for Managing Hospital Solid Waste

Health care solid wastes include all types of waste that are produced as a result ofmedical and therapeutic activities in hospitals and health centers. About 15% to20% of these waste materials are infectious waste, which falls within the categoryof hazardous materials. Infectious waste is the one that must be treated beforedisposal or recycling. Hence, this paper seeks to develop a bi-objective mixedinteger programming model for the infectious waste management. In the proposedmodel, in addition to minimizing the chain costs, the reduction of risks for thepopulation exposed to the spread of contamination resulting from infectious wasteis also considered. For this purpose, a multi-echelon chain is proposed by takinginto account the green location-routing problem, which involves the location ofrecycling, disposal, and treatment centers through various treatment technologiesand routing of vehicles between treatment levels and the hospital. The routingproblem has been considered to be multi-depot wherein the criterion of reducingthe cost of fuel consumption of heterogeneous cars is used for green routing.Finally, a hybrid meta-heuristic algorithm based on ICA and GA is developedand, following its validation, its function in solving large-scale problems has beeninvestigated. Results show that the proposed algorithm is effective and efficient

Efficacy and Safety of Immunotherapy with Interferon-Gamma in the Management of Chronic Sulfur Mustard-Induced Cutaneous Complications: Comparison with Topical Betamethasone 1%

The present trial investigated the efficacy of immunotherapy with interferon-gamma (IFN-γ) in the treatment of sulfur mustard (SM)-induced chronic skin complications. Forty subjects who were suffering from chronic skin complications of SM and were diagnosed to have severe atopic dermatitis, were assigned to IFN-γ (50 μg/m2) subcutaneously three times per week (n=20) or betamethasone valerate topical cream 0.1% (n=20) every night for 30 days. Extent and intensity of cutaneous complications was evaluated using scoring atopic dermatitis (SCORAD) index, and quality of life using dermatology life quality index (DLQI) at baseline and at the end of trial. SCORAD-A and SCORAD-B scores were significantly decreased in both IFN-γ and betamethasone. However, SCORAD-C score was decreased only in the IFN-γ group. There were significant reductions in overall as well as objective SCORAD scores in both groups. As for the magnitude of changes, treatment with IFN-γ was associated with greater reductions in overall, objective and segmented SCORAD scores compared to betamethasone. DLQI reduction was found to be significantly greater in the IFN-γ group. Promising improvements in quality life and clinical symptoms that was observed in the present study suggest the application of IFN-γ as an effective therapy for the management of SM-induced chronic skin complications

Efficacy of Elaeagnus angustifolia extract in the treatment of knee osteoarthritis: a randomized controlled trial

Osteoarthritis (OA) is one of the most common musculoskeletal disorders all over the world. Available antiarthritic medications have only partial efficacy and their long-term use is associated with adverse events. Elaeagnus Angustifolia (EA) is a medicinal plant with analgesic and anti-inflammatory properties. The present study evaluated the impact of two doses of EA extract compared with ibuprofen on the severity of disease in patients with knee OA. This study was designed as a randomized, double blind, active-controlled and parallel group trial. Patients with OA were randomized to receive 300 mg/day (n=33) or 600 mg/day (n=32) of EA aqueous extract, or 800 mg/day ibuprofen (n=32) for 7 weeks. EA extract contained 0.21 % (w/w) kaempferol according to HPLC. Efficacy of treatment was assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) of pain, Lequesne’s Pain-Function Index (LPFI), and patient’s global assessment (PGA) index. The amount of kaempferol in the extract was determined by HPLC method to be 0.21 % w/w. There were significant reductions in WOMAC, VAS, LPFI and PGA scores by the end of trial with all three interventions. Comparison of the changes in WOMAC, VAS and LPFI scores among the treatment groups did not reveal any significant difference between EA and ibuprofen, and between low and high doses of EA. EA was safe and well tolerated during the course of trial and no adverse event was reported. The present results suggest beneficial effects of aqueous EA extract in reducing the symptoms of OA with an efficacy comparable to that of ibuprofen

Results of a Randomized, Open-Label, Clinical Trial Investigating the Effects of Supplementation with Heracleum persicum

The present study evaluated the potential benefit of supplementation with Heracleum persicum as an adjunctive therapy to atorvastatin in dyslipidemic subjects. In a randomized, open-label, clinical trial, 100 dyslipidemic subjects were randomly assigned to: (1) H. persicum group (n = 50, completers = 18), receiving H. persicum extract (500 mg/day) + atorvastatin (10 mg/day) for 8 weeks, or (2) atorvastatin group (n =50, completers= 34), receiving only atorvastatin (20 mg/day) for 8 weeks. Weight, body mass index (BMI), lipid profile, and biomarkers of hepatic and renal injury were determined at baseline and at the end of the trial. There were significant reductions in serum total cholesterol and LDL-C in both the H. persicum (p = 0.001) and atorvastatin (p 0.05). Serum triglyceride levels remained statistically unchanged by the end of the trial in both groups (p > 0.05). Serum alanine (p = 0.049) and aspartate aminotransferase (p = 0.013) levels rose in the atorvastatin, but not the H. persicum (p > 0.05) group. In comparison with baseline values, no significant change was observed in weight and BMI, as well as serum levels of creatinine, blood urea nitrogen, and fasting blood sugar in either of the groups (p > 0.05). Apart from HDL-C, the effects of atorvastatin (20 mg/day) on other lipid profile parameters do not appear to be significantly superior to those achieved by combination therapy with H. persicum + atorvastatin (10 mg/day)

Oral health status among Iranian veterans exposed to sulfur mustard: a case-control study

Background: Sulfur mustard (SM) is a chemical warfare agent that has been repeatedly used since World War I. SM has chronic and deleterious effects on different body organs such as lungs, skin and eyes. Objectives: To determine dental and oral health status of chemical victims of SM who were exposed to SM during the Iraqi-Iran war. Material and Methods: In this case-control study, 100 male subjects exposed to SM were chosen as cases, and 100 non-exposed volunteers were chosen as controls. These groups were selected randomly according to their referral number, and were matched regarding age. Collection of information was performed using Oral Health Assessment Form designed by the World Health Organization. Quantitative and qualitative data were compared between the groups using independent samples t-test and Chi-square test, respectively. Results: There was a significant difference between the case and control groups with respect to the frequencies of oral candidiasis, pharyngeal erythema and/or hyperplasia, hairy tongue and reflux disease, being higher in the former group. There was also a positive association between the frequency of candidiasis and the percentage of disability; pharyngeal erythema and/or hyperplasia and use of salmeterol spray; and between hairy tongue and antibiotic use in the case group. Conclusions: Exposure to SM and the use of drugs for controlling long-term complications does not increase the risk of tooth decay, tooth loss, and intra and/or extra oral lesions in patients, but may be associated with increased incidence of oral candidiasis, pharyngeal erythema and/or hyperplasia, hairy tongue and reflux disease

Effects of Iranian herbal Zofa® syrup for the management of clinical symptoms in patients with COVID-19: A randomized clinical trial

Objective: The objective of this study was to determine the role of Iranian herbal Zofa® syrup in improving the clinical symptoms of patients with COVID-19. Materials and Methods: This randomized clinical trial was conducted on 105 patients with COVID-19. Patients were randomly assigned to the intervention (n=35) group (received 10 ml of Zofa® syrup every 8 hours/seven days plus standard treatment) or the control (n=70) group (received only standard treatment). Assessments were performed before and after treatment. Results: The groups were comparable regarding age (p=0.980), gender (p=0.584), comorbidities (p=0.318), or drug history (p=0.771). There was no difference between patients' recovery status at the time of discharge (p=0.327) or two weeks post-discharge (p=0.165) in the intervention and control groups. No patient was hospitalized to the intensive care unit (ICU) for supplemental oxygen therapy and no patient died in the intervention group. However, in the control group, three (4.5%) patients were transferred to the ICU, and two (3.03%) patients died. Conclusion: Considering the better recovery status of the patients at the time of discharge and the absence of patient deaths in the intervention group, more additional studies are needed to confirm these findings and elucidate the role of Zofa® in COVID-19

Stomach-Specific Drug Delivery of Clarithromycin Using aSemi Interpenetrating Polymeric Network Hydrogel Made ofMontmorillonite and Chitosan: Synthesis, Characterization and InVitro Drug Release Study

Purpose: In this study, we aimed to prepare an extended drug delivery formulation ofclarithromycin (CAM) based on a semi-interpenetrating polymer network (semi-IPN) hydrogel.Methods: Synthesis of semi-IPN hydrogel nanocomposite made of chitosan (CS), acrylicacid (AA), acrylamide (AAm), polyvinylpyrrolidone (PVP), and montmorillonite (MMT) wasperformed by free radical graft copolymerization method. Swelling kinetic studies were done inacidic buffer solutions of hydrochloric acid (pH = 1.2), acetate (pH = 4), and also distilled water.Also, the effects of MMT on the swelling kinetic, thermal stability, and mechanical strengthof the hydrogels were evaluated. Moreover, in vitro release behavior of CAM and its releasekinetics from hydrogels were studied in a hydrochloric acid buffer solution.Results: Fourier transform infrared spectroscopy (FTIR) results revealed that synthesis of semi-IPN superabsorbent nanocomposite and CAM incorporation into hydrogel was performed,successfully. Introducing MMT into hydrogel network not only improved its thermal stabilitybut also increased mechanical strength of the final hydrogel product. Also, in comparisonwith neat hydrogel (1270 g/g), hydrogel nanocomposite containing 13 wt% MMT exhibitedgreater equilibrium swelling capacity (1568 g/g) with lower swelling rate. In vitro drug releaseexperiments showed that CS-g-poly(AA-co-AAm)/PVP/MMT/CAM formulation possesses asustained release character over extended period of time compared with CS-g-poly(AA-co-AAm)/PVP/CAM formulation.Conclusion: In the presence of MMT, the effective life time of drug is prolonged, demonstrating asustained release property. The reason is that interlinked porous channels within superabsorbentnanocomposite network hinder penetration of aqueous solutions into hydrogel and subsequentlycause a slower drug release

A Randomized Comparative Trial on the Therapeutic Efficacy of Topical Aloe vera and Calendula officinalis on Diaper Dermatitis in Children

Introduction. Diaper dermatitis (DD) is a common inflammatory disorder among children and infants. The objective of the present randomized and double-blind trial was to compare the therapeutic efficacies of Aloe vera cream and Calendula officinalis ointment on the frequency and severity of DD in children. Methods. Sixty-six infants with DD (aged < 3 years) were randomized to receive either Aloe cream (n = 32) or Calendula ointment (n = 34). Infants were treated with these drugs 3 times a day for 10 days. The severity of dermatitis was graded at baseline as well as at the end of trial using a 5-point scale. The adverse effects of study medications were assessed during the trial. Results. Although improvement in the severity of DD was observed in both treatment groups (P < 0.001), patients receiving Calendula ointment had significantly fewer rash sites compared to Aloe group (P = 0.001). No adverse effect was reported from either of the medications. Discussion. The evidence from this study suggests that topical Aloe and in particular Calendula could serve as safe and effective treatment for the treatment of diaper dermatitis in infants

Intensive care unit-acquired urinary tract infections in patients admitted with sepsis: etiology, risk factors, and patterns of antimicrobial resistance

SummaryObjectivesThe objective of the present study was to evaluate the etiology, risk factors, and patterns of antimicrobial resistance of intensive care unit (ICU)-acquired urinary tract infections (UTIs) in patients admitted with sepsis.MethodsIn this observational study, 100 septic patients hospitalized in a general ICU were selected. Demographic, clinical, and outcome data were obtained by chart review. Antibiotic resistance/susceptibility was determined using the minimal inhibitory concentration (MIC) technique.ResultsA UTI was present in 28 (28%) patients; the male to female ratio was 19:9 and the mean age of the patients was 58.71±19.45 years. From the total of 28 isolates, 27 were resistant to ciprofloxacin, 23 to amikacin, 27 to meropenem, 28 to cefepime, 26 to ceftazidime, and 27 to ceftriaxone.ConclusionsOn the basis of our results, the rate of multidrug-resistant UTIs may be very high in some ICUs in patients admitted with sepsis. This antimicrobial susceptibility/resistance should be determined, and a special antimicrobial treatment protocol should be planned based on the results for each ICU. The use of antibiotics for treating UTIs should be guided only through this protocol because of the different spectra of pathogens and susceptibility patterns in each ICU

The role of magnesium sulfate in the intensive care unit

Magnesium (Mg) has been developed as a drug with various clinical uses. Mg is a key cation in physiological processes, and the homeostasis of this cation is crucial for the normal function of body organs. Magnesium sulfate (MgSO4) is a mineral pharmaceutical preparation of magnesium that is used as a neuroprotective agent. One rationale for the frequent use of MgSO4 in critical care is the high incidence of hypomagnesaemia in intensive care unit (ICU) patients. Correction of hypomagnesaemia along with the neuroprotective properties of MgSO4 has generated a wide application for MgSO4 in ICU