A new method for solving linear multi-objective transportation problems with fuzzy parameters

AbstractThere are several methods in the literature for solving transportation problems by representing the parameters as normal fuzzy numbers. Chiang [J. Chiang, The optimal solution of the transportation problem with fuzzy demand and fuzzy product, J. Inform. Sci. Eng. 21 (2005) 439–451] pointed out that it is better to represent the parameters as (λ,ρ) interval-valued fuzzy numbers instead of normal fuzzy numbers and proposed a method to find the optimal solution of single objective transportation problems by representing the availability and demand as (λ,ρ) interval-valued fuzzy numbers. In this paper, the shortcomings of the existing method are pointed out and to overcome these shortcomings, a new method is proposed to find solution of a linear multi-objective transportation problem by representing all the parameters as (λ,ρ) interval-valued fuzzy numbers. To illustrate the proposed method a numerical example is solved. The advantages of the proposed method over existing method are also discussed

Colour image Enhancement using Background Brightness Preserving Histogram Equalization

Histogram Equalization (HE) is generally used to upgrade the image contrast yet it has a tendency to over enhance the image background brightness. BBHE (Bi Histogram Equalization) has broken down and proposed scientifically that it may be preserved original brightness to a certain limit. On the other hand, still cases are not handled well by the BBHE, as they are requiring preservation of higher degree. Particular paper has proposed novel augmentation of BBHE, which alluded to as the MMBEBHE (Minimum Mean Brightness Error Bi Histogram Equalization) to give maximum brightness preservation. BBHE isolates the input image's histogram into two in depend on input mean before leveling with them freely. Enhancement schemes have been presented with minimum defects of the conventional HE, yet the over enhance of the background brightness is still self-evident. A novel methodology of nonlinear HE is displayed, which has the capacity to enhance the image contrast, while preserving the background brightness for images with very much characterized background brightness

Community Medicine Outpatient Department: Patient profile and reasons for bypass of lower-level public health facilities

Background: The General OPD under the department of Community Medicine at LLRM Medical College, Meerut was inaugurated with the vision to improve quality of OPD services by reducing the patient burden and waiting time at specialist OPDs. Aim & Objective: To describe the profile of patients attending the Community Medicine OPD in LLRM Medical College, Meerut and to estimate the extent and reasons for bypass of lower-level public health facility by patients attending the general OPD. Settings and Design: A hospital based descriptive study was conducted in the general OPD. Methods and Material: Data of all patients from 1st July,2023 to 31st August,2023 was collected from the registers maintained in the OPD. A sample of 215 patients were selected by systematic random sampling to study the objective to assess bypass of lower-level public health facility. Statistical analysis used: Descriptive statistics. Results: A total of 2570 patients attended the general OPD from 1st July,2023 to 31st August,2023. Around 12.8% patients required referral to specialist OPDs. Most common presenting complaints were respiratory symptoms (29.8%). It was seen that 58.8% patients had bypassed the lower-level public health system and the most common reasons were non-availability of a facility nearby (26.8%), not satisfied with previous experience (23.7%), non-availability of treatment (21.6%) and investigations (17.5%), and lack of awareness of services available at the public health facility (15.4%). Conclusions: The general OPD serves as a model for other medical colleges to emulate and improve the quality of services at tertiary care centres

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

FH deficient uterine leiomyomas-a case series

Introduction: Fumarate hydratase (FH) deficient uterine leiomyomas account for only 0.4 % of all uterine leiomyomas. They are characterized by some distinct histological features and may be associated with Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome. Methods: Herein we present a series of five cases of FH deficient uterine leiomyomas in patients with a mean age of 30 years. All five patients underwent myomectomy. Three of these cases had an outside histopathologic diagnosis ranging from Smooth muscle tumor of uncertain malignant potential (STUMP) to Leiomyosarcoma while two cases were operated at our centre. All five cases were reported as suggestive of FH deficient leiomyomas and were advised germline testing along with genetic counselling. Results: Immunohistochemically four of the cases showed moderate to strong positivity for 2-SC with a complete loss or reduced expression of FH while one case showed absence of 2-SC staining. Discussion: Mutations in FH lead to reduced enzyme activity and accumulation of fumarate leading to a complete loss or aberrant reduced expression seen on immunohistochemistry, which confirms the diagnosis. It is important to differentiate it from a leiomyosarcoma or other malignant spindle cell tumors as these tumors follow a benign course. Their association with HLRCC also needs to be established for a suitable follow up since HLRCC-associated RCCs are often aggressive. Conclusion: Management of such leiomyomas is myomectomy or hysterectomy with advice of genetic testing to rule out HLRCC. Histomorphology and immunohistochemistry are imperative for a correct and timely diagnosis

Unusual metastasis of medullary thyroid carcinoma to the breast: A cytological and histopathological correlation

Breast metastases are a relatively rare condition and account for approximately 0.5–2% of all breast tumors. Recognition of metastatic tumors in the breast is important because it would prevent unnecessary mutilating surgery and would lead to appropriate treatment of the primary tumor. Breast metastases from medullary thyroid cancer (MTC) are very rare with only 21 reported cases in the literature. Some MTCs mimic primary invasive lobular carcinoma of the breast histopathologically and radiologically, making the distinction between the two diagnostically challenging. We present the case of a 45-year-old female presenting with a lump breast, which was later found out to be metastasis from medullary carcinoma thyroid