ali bozorgi

Acute heart failure is a common clinical syndrome leading to hospital admission, with few evidence-based therapies for managing congestion. This trial aims to assess the efficacy of acetazolamide combined with loop diuretics in achieving decongestion among patients who fail to respond to oral diuretics and progress to acute decompensated heart failure in the absence of injectable furosemide.

This single-center, double-blind randomized controlled trial with a 1:1 allocation ratio aims to evaluate 130 patients admitted to the infusion ward. Participants will receive standard furosemide treatment and be randomized to either oral acetazolamide (250 mg twice daily) or placebo for 3 consecutive days. The primary objective is to assess the efficacy of combined oral acetazolamide and furosemide therapy in achieving decongestion. The prespecified secondary outcomes include the following: N-terminal pro-B-type natriuretic peptide levels on day 30, readmission rates within 3 months, health-related quality of life as assessed by the Heart Failure Quality of Life Questionnaire at 3 months, and changes in weight, creatinine levels, urinary sodium excretion, potassium levels, and hematological indices from the complete blood count on day 3 of the trial.

Diuretic resistance commonly occurs in patients with heart failure, underscoring the urgent need for innovative interventions that can effectively address the limitations of current diuretics, including diuretic resistance and electrolyte imbalances, while enhancing their efficacy in this patient population.

Recent evidence suggests a connection between celiac disease and dilated cardiomyopathy. Herein, we serologically screened for celiac in dilated cardiomyopathy patients and investigated its correlation with ejection fraction. We selected 123 cardiomyopathy patients. Patients were screened for celiac, using anti-tissue transglutaminase (ATA), anti-gliadin (AGA), and anti-endomysial (EMA) immunoglobulin type A (IgA) antibodies. Total IgA levels were also measured.  Of 123 patients, 3 were EMA positive (2.4%), 4 were AGA positive (3.3%) and 5 were ATA positive (4.1%). EMA positive patients had significantly lower EF values compared to EMA negative patients (35±5 vs. 46.52±9.21, p-value: 0.034). Similar results were observed for AGA (32.5±14.34 vs. 46.7±8.8, p-value: 0.002), but not for either ATA positivity (40±10 vs. 46.5±9.21, p-value:  0.126) or IgA deficiency (50±5 vs. 46.14±9.37, p-value:  0.480). No significant difference was observed in the age and gender of seropositive patients compared to seronegative. We observed a higher prevalence of celiac seropositivity among dilated cardiomyopathy patients compared to the general population. EMA and AGA positive patients had significantly lower ejection fractions compared to their negative counterparts.

The decentralized decision-making structure in the design of crisis emergency warehouse network challenges the use of classical optimization models. The aim of this paper is to develop a new multi-follower bi-level optimization model for the emergency warehouse location-allocation problem in terms of national and regional levels. This type of modeling is suitable for countries whose crisis warehouse network design is decentralized. The parameters of the models are based on real data in Iran. Due to the high complexity of the solution, a co-evolutionary approach based on innovative allocation methods and genetic algorithms has been developed to solve the problems with different sizes. The solution structure is designed to be flexible and can be adjusted based on the number of followers and their authority. Finally, an analysis has been done about the change in the number of decision makers and their power to absorb facilities on the objective functions of the bi-level model.

Pricing is one of the most important decisions having significant impact on companies’ profitability. The right price led to attracting customers and increasing their satisfaction. Therefore, the managers are always looking for procedures to compare pricing strategies and choose the best pricing strategy. Since the pricing has uncertain and multi-attribute structure, applying multi-criteria decision-making methods are appropriate in pricing. This paper proposed an interval valued fuzzy decision making method for Laboratory Services Pricing. This approach consists of interval valued fuzzy ANP for calculating the weight of criteria and interval valued TOPSIS for determining the weight of solutions. Finally, by multiplying company weight and a ratio the Laboratory Services price is proposed to the real case company. The result shows the applicability of the proposed approach. Also, the results of validation indicate the accuracy of the proposed model, the effectiveness of interval valued fuzzy uncertainty and interdependence between criteria on pricing issue.

In Defensive R & D centers due to resource constraints, there is no possibility for development of all new defensive products projects, so prioritizing these projects is considered as a necessity. Multi-dimensional decision making is one of the methods that can be used in this regard. To apply this method, one of the basic prerequisites for identifying the appropriate indicators, by taking into account the defense approach, is categorizing and eventually weighing them. In this applied study in terms of purpose, data collected through descriptive-survey method. The statistical population of this research were selected from among the directors and experts of the R&D centers in Defense Industry as well as managers of the product design projects. In this paper, the indices used to prioritize development projects for new defense products explored after reviewing the background of the research and extensive field interview with experts from R&D centers of several Defense Industries in five areas of defense, organization and strategy, knowledge and technology, risk and market. Since the number of identified indicators was widespread, this eventually increased the error of project selection. Therefore, in order to reduce the indicators, the Data Mining technique was used by the Main Component Analysis method. This method was applied on 42 identified indicators, with the help of scores given on 21 projects. Finally the number of indicators was reduced to 25 in 5 areas. Then the title of each cluster was determined according to clustering of the indicators. Also, after weighing, the defensive zone with the weight of 0.29, and the market area with a weight of 0.09, received the highest and lowest priority, respectively.

Closed loop supply chain design is to provide an optimal platform for efficient and effective supply chain management. It is an essential and strategic operation management problem in supply chain management, and usually includes multiple and conflicting objectives. A new mixed integer non-linear programming model for a multi-objective closed loop supply chain network design problem in the paper industry is developed under uncertainty. The objective functions are to minimize the total cost, maximize the total volume flexibility and minimize the total number of vehicles hired in order to fulfill the paper industry’s policies towards a cleaner and green environment. Also, a novel hybrid solution is presented based on stochastic programming, robust optimization and fuzzy goal programming. A numerical example utilizing the real data from the paper industry in East Azerbaijan of Iran is designed and the model performance is assessed. Furthermore, a recently developed Dragonfly Algorithm (DA) employed to solve the given problem in large scales and compared with Genetic Algorithm (GA). The results indicated that the DA achieved better performance compared with the GA.

Hypertension is a major public health issue. With regard to the current trend, it has been estimated that one out of three people will be suffering from hypertension by 2025. This study was designed to provide a better insight into the adherence to treatment and its underlying reasons.
A directed qualitative content analysis approach was conducted in collaboration with 35 hypertensive patients and 3 cardiologists in the form of in-depth interviews and focused group discussions from October 2015 to February 2016. Sampling was carried out from patients with hypertension using purposeful and heterogeneous method. Some of the PRECEDE model structures were applied as the conceptual framework.
The reasons affecting adherence to hypertension treatment were analyzed in three general categories of predisposing, enabling and reinforcing factors based on the model structures. Factors such as “knowledge”, “belief and attitude”, “mental-personality traits”, “culture and lifestyle” were classified as the predisposing factors category. “Access to health service” and “access to facilities in the workplace, home and society” were fit in the enabling factor category. The reinforcing factors category addresses “individuals’ internal incentives” and “family and health service providers’ support”.
Several reasons account for non-adherence to treatment in hypertensive patients. Diversity of these reasons is an indication that design and implementation of different kinds of interventions are required in order to increase the patients’ awareness, empower them and encourage self-efficacy.

In this study a hierarchical hub location problem with two layers is considered. The first layer includes small hubs and the second one includes a star-shaped network central hub. The considered case is a cargo delivery network where there is hierarchy between hubs. All the hubs and links are capacitated and there are three kinds of commodities for each of which there is a special kind of vehicle. The purpose is to determine the optimal cost by locating small hubs (city hubs) and the central hub, allocation of links to the hubs, and finding the optimal number of vehicles for each hub. The model is a mixed integer nonlinear programming. A case study for this model is performed in a cargo delivery network by using published data in Iranian Statistics Organization website, and it is solved by appropriate software.

Supplier selection and order allocation in the process of purchasing relief items during critical conditions are important issues. In this paper, the mixed approach of Multi-criteria decision making and mathematical programming model have been represented in order to select suppliers and allocate orders in the framework of Multi-attribute reverse auction. The suggested approach has been modeled focusing on bid evaluation phase in
Two stage. In the first stage, each participator in the bid is ranked using the Fuzzy-PROMETHEE method as the supplier of assistance items regarding effective quantitative and qualitative criteria. In the second stage, suitable suppliers are selected based on priorities of the first stage, in the frame of a multi-objective fuzzy mathematical model in order to determine the optimal size of ordering. Disruption risk in both distribution centers and suppliers, as well as the uncertainty including major features of the mathematical model have been represented. In this paper, multi-objective robust possibility programming (MORPP) approach has been used in order to eliminate the uncertainty of parameters related to purchasing assistance items within the humanitarian relief supply chains. To solve the multi-objective model the augmented e-constraint method has been considered. Finally, calculation results are indicative of better performance and efficiency of the MORPP approach to solve purchasing assistance items problem.

The increasing trend in happening natural disasters mandates developing appropriate contingency plans to deal with them. in this paper, a goal programming based model is developed for an integrated pre- and post-disaster operations management while considering the restoration of disrupted routed and warehouses. The model accounts for epistemic uncertainty in input data through a hybrid two-stage scenario-based possibilistic-stochastic programming model. To validate the proposed model and its practicality, an illustrative example is also presented and its numerical results are assessed.

In the present research, a multi-objective model is proposed, which considers equity among the citizens in addition to the cost criterion. Then, the model will be solved using Reservation Level Tchebycheff Procedure (RLTP), which is one of the interactive multi-objective decision-making techniques. Subsequently, the obtained results will be compared with those of the single-objective models to determine the effect of considering and not considering the equity criterion on public facilities location. Results of the present study show that the basic models of public facilities location do not consider the equity criterion; thus, in order to protect citizens’ rights, it is necessary for decision-makers of the urban management and planning to consider the objective of equity, along with other objectives of the project, as a multi-objective model in public facilities location problems. The proposed multi-objective model has also desirable and acceptable performance, which can be used in the public facilities location problems.

Enhanced external counterpulsation (EECP) reduces angina pectoris, extends time to exercise-induced ischemia, and improves quality of life in patients with symptomatic stable angina. We aimed to evaluate the effects of EECP on heart rate recovery in patients with coronary artery disease (CAD).
Between January 2011 and March 2013, a total of 34 consecutive patients (24 male, 70.6%) with symptomatic CAD, who were candidated for EECP, prospectively received 35 sessions of 1-hour EECP therapy per day, 6 days per week. The patients underwent echocardiography and a symptom-limited modified Bruce exercise test before and after EECP. Left ventricular ejection fraction (LVEF), resting and peak exercise heart rates, systolic blood pressure, heart rate at 1 and 2 minutes of recovery, exercise duration, workload, and first- and second-minute heart rate recovery were measured before EECP and compared with those after EECP.
The mean age of the patients (70.6% men) was 64.82 ± 8.28 years. After EECP, exercise duration increased significantly from 6.48 ± 2.76 minutes to 9.20 ± 2.71 minutes (p value The results of the present study showed that exercise duration, maximum workload, and the LVEF might increase significantly after EECP. The increase in the first- and second-minute heart rate recovery after EECP was not statistically significant.

Emergency departments often encounter several risk and health issues which significantly impact on overall healthcare performance. Resilience engineering (RE) enables emergency departments to confront sudden changes and handling health risk issues. Patient trust (PT) is also one of the most effective factors which improve quality of care along with patient satisfaction. This study integrates resilience engineering and trust to enhance the overall performance of emergency departments (EDs). A unique algorithm is introduced to demonstrate the superiority of the proposed integrated approach. It is composed of Z-number data envelopment analysis (DEA), fuzzy DEA, and statistical analysis. The required data are collected using standard questionnaires from a real-life emergency department. The obtained results are verified and validated by FDEA. The results indicate that considering RE and trust increases ED efficiency significantly. Also, flexibility, fault-tolerance, reporting culture, and specialty level are the most effective factors. Moreover, trust and resiliency have similar statistical impacts on overall system efficiency. One of the concerns of medical service providers nowadays is to build an efficient ED capable of providing services to a large number of patients. Therefore, to evaluate the performance of the ED, both concepts of PT and RE which are applicable to enhance the preventive safety and promote the performance, are simultaneously considered for the first time in this study.

World Health Organization (WHO) considered Mental Health Continuum (MHC) as a good instrument for well-being studies. Moreover, gensini score (GS) is an intensity index for coronary artery disease (CAD). The aim of our study was to compare GSs among patients who had coronary artery disease with different well-being states.
This was a cross-sectional study conducted in Tehran Heart Center, Iran, in 2013. The study population consisted of 50 non-depressed patients who were candidates for coronary artery bypass graft (CABG). All of the participants were interviewed according to the Iranian version of Mental Health Continuum (IV-MHC) and were allocated to flourishing, maternal mental health (MMH) and languishing states based on the related classification criteria. GS was calculated for each participant. Data were analyzed by SPSS.
Forty one (82%) patients were in flourishing, 9 (18%) in MMH and nobody was in languishing states. The mean (standard deviation) of GS was 90.43 (44.424) and 89.67 (33.378) for flourishing and MMH ones, respectively (P = 0.962). There was no statistically significant correlation between GSs and well-being states (all Ps > 0.050).
Considering IV-MHC classification, all of our patients were only allocated to flourishing and MMH states. There was no relationship between intensity of CAD and the states (P > 0.050). We recommend further research with larger sample sizes for better evaluation of the Iranian version of the instrument.

Following the occurrence of unexpected events and natural disasters, a highly important relief operation is the transferring of relief commodities from the distribution centers (CDs) to shelters. In this paper, a three-level network consisting of depot of vehicles, distribution centers and shelters has been considered for routing and scheduling of relief vehicles through introducing a multi-objectivemodel. The first objective function represents the total arrival time of vehicles to CDs and shelters. The second objective function illustrates the number of vehicles used. We use the TH method to deal with the multi-objective problem. During the relief commodities distribution, issues such as the feasibility of getting servicefrom each distribution centerwith multiple vehicles, and heterogeneous fleet of vehicles has been regarded. In order to solve the proposed model and represent its efficiency, we select the fourth region of Tehran city as a case study, run the model on it, and present solution results.

The aim of the study was to evaluate the relationship between the serum levels of androgens and Coronary Artery Disease (CAD) in an Iranian population. Male individuals admitted to Tehran Heart Center and Sina Hospital, Tehran, Iran from 2011-2012 were categorized into CAD and control groups based on selective coronary angiography. Baseline demographic data, including age, BMI, diabetes, and a history of hypertension were recorded. Patients were also assessed for their serum levels of total testosterone, free testosterone, estradiol, dehydroepi and rosterone sulfate (DHEA-S), and Sex Hormone Binding Globulin (SHBG). Data analysis was carried out chi-square and ANOVA tests as well as logistic regression analysis. Two hundred patients were in the CAD group and 135 individuals in control group. In the CAD group, 69 had single-vessel disease, 49 had two-vessel diseases, and 82 had three-vessel diseases. Statistically significant differences were observed between the individuals in the two groups with respect to age (P<0.0001), diabetes (P<0.0001), and a history of hypertension (P=0.018). The serum levels of free testosterone (P=0.048) and DHEA-S (P<0.0001) were significantly higher in the control group than in the CAD group; however, the serum level of SHBG was higher in the CAD group than in the control group (P=0.007). Results of the logistic regression analysis indicated that only age (P=0.042) and diabetes (P=0.003) had significant relationships with CAD. Although the serum levels of some of the androgens were significantly different between the two groups, no association was found between androgenic hormone levels and the risk of CAD, due mainly to the effect of age and diabetes.

Lean thinking is management strategy that is applicable to all organizations including health care organizations, and its main idea is to eliminate waste. Finding a suitable location for treatment facilities in the health chain plays an important role in the implementation of this idea in the organization, because on the one hand, proximity to suppliers of medical centers ensures rapid and low-cost supply of patient needs. On the other hand, locating health centers near the population areas leads to quick and affordable access to them. Thus locating health centers in a right position can largely reduce the waste of time and money. In this paper, a multi objective mathematical model was developed to locate and allocate Services provided at the clinics and hospitals. The model combines facility location model and DEA simultaneously to provide high quality services at reasonable costs to the clients. The proposed model has been solved using epsilon constraint method, besides locating provided services in Amol hospitals and assigning them to population areas has been done as a case study.

In time of natural and man-made disasters, the supply of some commodities which are directly related to human life are very critical. In the real-world, supply systems are exposed to various disruptions in their facilities and these disruptions can essentially affect systems performance and can lead to shortage in the supply and importance of this subject is much more expressed in the blood supply case. In this paper, a multi–objective mathematical model is proposed for the collection of temporary blood facilities and allocation of blood donators to these places. The goals of the model are to minimize the maximum blood shortage in the blood bank and also to minimize the total cost in the worst case scenario in disruptions. In order to demonstrate the applicability of the proposed model, the epsilon constraint method is solved and analyzed on numerical examples.

In this paper, a hierarchical p-hub median problem is considered that all the nodes and arcs on the network have limited capacities. Proposed model has three-level where the complete network at the top level consists of the central hubs. The second and third levels consist of hub and demand nodes respectively, which are connected through star networks. Also, delivery time restriction is taken into account. The problem is to decide on the locations of a predetermined number of hubs and central hubs among the available nodes in order to minimize the total costs. Numerical experiments demonstrate the efficiency and applicability of the proposed model for actual decision-making problems.

Enhanced external counterpulsation (EECP) is a noninvasive technique used for patients with refractory angina pectoris. There are controversial data on the effectiveness of EECP in improving patients with refractory stable angina. The aim of the present study was to evaluate the effectiveness and safety of EECP for the treatment of patients with refractory angina pectoris. Twenty consecutive patients with refractory angina pectoris were treated with EECP, and their symptoms, echocardiographic measures, treadmill exercise test parameters, and Canadian Cardiovascular Society Class were evaluated before and immediately after EECP. The patients were followed up for 6months post treatment. There were significant differences regarding total exercise time before and after treatment (p value < 0.001). The patients showed a significant reduction in angina classes III and IV immediately after EECP (p value < 0.001); for most of the patients, these beneficial effects were sustained for 6 months (p value = 0.010). There was no significant improvement in the echocardiographic parameters. EECP decreased symptoms and increased total exercise time in our study population. These beneficial effects were sustained for 6 months.

Defining the infarct related artery in acute myocardial infarction helps in better and faster management of patients. Therapeutic choices may differ according to the culprit lesion.. This study aimed to evaluate multiple electrocardiography (ECG) criteria and one algorithm in defining the culprit artery in single vessel inferior ST elevation myocardial infarction (I-STEMI). A new criterion based on posterior leads was also proposed.. In this retrospective study from June 2007 to July 2012, ECG and angiography films of patients with acute inferior STEMI were reviewed. From a total of 138 studied patients, 25 had 3-vessel disease and 37 had two occluded arteries. Remaining 76 patients were diagnosed with single vessel acute I-STEMI, 56 had right coronary artery (RCA) occlusion [22 (29.3%) proximal RCA, 24 (32%) middle RCA, and 10 (13.3%) distal occlusion of RCA], 19 had left circumflex artery (LCx) lesion and one had middle left anterior descending (LAD) artery occlusion.. Prediction of the RCA as culprit lesion using Tierala''s algorithm was 86% sensitive and 50% specific. Prediction of LCx occlusion based on ST-elevation ≥ 1 mm in V6 was 87% specific (P = 0.005). Sum of ST elevation in leads V5 and V6 more than 2.5 mm, was a good marker of LCx prediction (P = 0.044). ST-elevation in V4R was 48% sensitive and 89% specific for RCA prediction (P = 0.004). Wellens'' criterion was 82% sensitive and 47% specific for proximal RCA prediction (P = 0.002). Our new criterion ''Sum of ST elevation in posterior leads (V7 - V8 - V9) < 3 mm'' was 82% sensitive and 50% specific for RCA prediction (P = 0.017). We also revised Tierala’s algorithm by adding the presence of ST-elevation in V3 and V4 to the first step (when STe II ≥ III), which increased the specificity and PPV of LCx prediction (86% vs. 84% and 53% vs. 50%).. Although several criteria and algorithms were previously suggested, they could not reliably determine the site of occlusion. Right and posterior leads may be needed in order to increase the accuracy of prediction..

Low plasma level of vitamin D is linked to the increased risk of cardiovascular diseases such as hypertension, diabetes, dyslipidemia and peripheral vascular diseases. Vitamin D deficiency is a worldwide problem that involves Iranian population. To the best of our knowledge, this was the first investigation on venous thromboembolism (VTE) subjects that assessed the correlation of vitamin D level with plasma P-selectin, hs-CRP, and risk factors of thrombosis. In this prospective study, patients with diagnosis of acute deep vein thrombosis and or pulmonary eboembolism were enrolled. All patients’ clinical data, demographics and risk factors of thrombosis were evaluated. Plasma level of P-selectin and hs-CRP were measured by ELISA method. Radio immune assay method was used to determine plasma level of 25-hydroxy vitamin D. In this study, 60 subjects were included. The mean ± SD plasma 25-hydroxy vitamin D level (25(OH) D) of participants was 21.4 ± 14.6 ng/mL. The vitamin D deficiency was reported in 60% of patients. No significant relation was found between the plasma 25(OH)D level and P-selectin and hs-CRP. In multiple regression analysis, there was a significant relationship between the level of 25(OH)D and the patients’ age (beta = 0.452; p = 0.001), diabetes (beta = 0.280; p = 0.036) and positive family history of cardiovascular diseases (beta = 0.373; p = 0.003). Vitamin D deficiency is a frequent problem in Iranian VTE patients. Moreover, Plasma level of vitamin D is not associated with increase level of P-selectin and hs-CRP in VTE patients.