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A malignant tumor has the capacity to grow rapidly and to metastasize to the other parts of the body. Ovary has been a common organ for secondaries caused by hematological spread of the tumor and exhibits the same histopathology as that of the primary tumor. Very rarely, it has been found that the patients suffer from two or more histologically distinct, simultaneously detected malignancies, which are called as synchronous tumors or multiple primaries [1]. These multiple primaries can have an impact on cancer treatment (e.g., surgery) and affect the overall prognosis of the patient. Although there is no consensus on the definition of synchronous cancer, commonly two or more primary tumors that occur in a patient closely with respect to the time interval are termed as synchronous tumors [2]. Simultaneous diagnosis of gall bladder carcinoma with ovarian carcinoma with distinct histopathology is rare. A very few cases have been reported so far in literature. We discuss here a rare case that presented with synchronous tumor of gall bladder and the ovary.

This study explores the application of a Multi-Criteria Decision-Making (MCDM) approach based on q-rung orthopair fuzzy numbers to identify the origin of mechanical parts found at vehicle accident scenes. The primary objective is to determine the most likely vehicle to which these parts belong by evaluating key criteria such as compatibility, damage level, serial number matching, and color compatibility. Q-rung orthopair fuzzy numbers offer an advanced method to handle the inherent uncertainty and vagueness associated with forensic evaluations, particularly in scenarios where data is incomplete or imprecise. The proposed methodology involves defining the criteria, assigning membership and non-membership degrees using q-rung orthopair fuzzy sets, and applying an aggregation process to effectively rank alternatives. This approach facilitates flexible decision-making by accommodating different levels of confidence and uncertainty, making it particularly suitable for forensic applications where evidence is often ambiguous. The findings demonstrate that integrating q-rung orthopair fuzzy numbers into the MCDM framework significantly enhances the accuracy and reliability of identifying vehicle components involved in accidents. The proposed methodology provides a systematic tool to support forensic investigations, aiding in the determination of liability and contributing to more robust outcomes in mechanical evidence analysis.

Morbidity and mortality of HIV-infected patients have been improved over the last decades with the advent of combined antiretroviral therapy. As a result, other comorbidities such as chronic kidney and chronic liver diseases have emerged in the HIV population. A considerable percentage of end-stage liver disease (ESLD) in HIV population is attributed to hepatitis C co-infection and reactivation, and a growing need for solid organ transplantation has emerged among those patients. On the other hand, several studies on liver transplantations of patients co-infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) have shown discouraging results both in patient and graft survival rates. As a result, HIV-HCV co-infection has been considered a relative contraindication for liver transplantation. Thankfully, new drugs for HCV treatment have been discovered, acting direct on viral replication of HCV and they have changed the whole clinical course of HCV/HIV co-infected liver transplant recipients. Our case illustrates the long-term efficacy and safety of the new combination of Sofosbuvir/Ledipasvir in HCV/HIV co-infected liver transplant recipients.

The construction sector consists of a collection of activities related to buildings and engineering constructions of all kinds. It is the close relationship between this sectors with other economic sectors, which distinguishes it. Therefore, it is an important indicator of the movement of the national economy, but this sector faces major risks, especially in the construction of luxury residential buildings, and these risks may affect the implementation of the project and may lead to increase costs, affect the quality and sometimes delay delivery. This study was carried out to evaluate the factors affecting the quality of luxury residential buildings in Iran using the fuzzy best-worst method (fuzzy BWM). The BWM method provides a consistent structural comparison of factors through best and worst criteria. And this method extended using a fuzzy set to address the ambiguity from the decision-maker’s judgment. The evaluation consists of five criteria: Strength and stability, physical comfort and mental peace, visual proportions and beauty, safety, security and environment, and welfare and health. To determine the fuzzy criteria’ weights, the nonlinearly constrained optimization problem was applied. The result indicated that the best and the worst criteria were Visual proportions and beauty and welfare and health.

Tardive Dyskinesia (TD) is an iatrogenic complication caused by antipsychotic agents and rarely by other anti-depressive/antiepileptic or anti-nausea medication. It is mostly a benign condition with implications regarding esthetic issues but it can also impact social and emotional well-being. We are reporting a case in which severe TD ensued in an elderly lady with newly diagnosed dementia, who presented to the psychiatric ER with a Capgras syndrome and paranoia accompanied by behavioral disturbances. She was treated with 4 consecutive antipsychotic agents (haloperidol, brexiprazole, risperidone, and olanzapine) due to unresponsive psychosis in conjunction with biperiden and developed a severe case of TD, which was complicated by two successive episodes of jaw subluxation. In spite of the good outcome following the reduction of the subluxation, we emphasize the danger of this rare painful, and bothersome side-effect and recommend how to pharmacologically deal with the TD setting in which it occurred.

Most underwater explosions show characteristics of a bubble pulse and reverberation effects. To specifically identify the cause of an underwater explosion, it is most important to find a bubble pulse and reverberation effects using spectral and cepstral analyses. For a very shallow underwater explosion, spectral analysis is preferable to cepstral analysis. Time-domain analyses show bubble pulses as well as positive polarities of the first P-wave arrivals on the vertical component, and frequency-domain spectral analyses also clearly reveal the bubble pulse and reverberation effects. This study includes comparative studies including a Russian underwater nuclear explosion and US Navy shock trials. The ROKS Cheonan sinking was a shallow underwater explosion that occurred near the surface showing a bubble jet characteristic resulting in splitting the ship into two pieces including a bubble pulse and reverberation effects. The findings of a bubble jet and a toroidal bubble deformation including a bubble pulse are highlighted for a shallow underwater explosion in this study. The ROKS Cheonan sinking took place off the Baengnyeong Island in the Yellow Sea of the Korean Peninsula at a depth of about 8 m in the sea depth of 44 m on March 26, 2010. The explosive charge weight was estimated at 136 kg TNT which is equivalent to one of the abandoned land control mines (LCM) that were deployed near the Northern Limited Lines (NLL) in the Yellow Sea in the late 1970s.

Basic control theory equations are developed showing conventional exponential system response of refraction vs. time R (t) with a characteristic system time constant, in response to a step change of near work environmental conditions. Details from preliminary experimental design using reading glasses at the U.S. Naval Academy at Annapolis are discussed. The conclusion is that (+) add lenses, used as reading glasses during study, can prevent the development of myopia for college students in pilot training.

Ranitidine is a widely used drug in Europe and its intake is usually well tolerated. Hypersensitivity reactions due to ranitidine are uncommon. The immediate mild reactions type are the most prevalent. In some special cases a delayed type reaction such as contact dermatitis or severe reactions with systemic involvement have been reported. In the present paper, a case report of a 78-year old patient who experienced a maculopapular eruption after 7 days of oral treatment with ranitidine is described. Patch tests were performed twice with ranitidine with positive results confirming the diagnosis. In order to discard a double sensitization and a possible cross-reactivity phenomenon, patch test was performed once with famotidine, with a negative result. This is the first maculopapular exanthema reported as type IV hypersensitivity reaction to ranitidine confirmed by patch testing. Moreover, there are only two reported cases showing a double sensitization to ranitidine and to other H2-receptor antagonists by patch testing after a delayed reaction due to ranitidine, the other being H2-receptor antagonists involving cimetidine and nizatidine, not famotidine.

Depression is currently one of the main barriers to further civilizational development. Despite intensive efforts, it is a growing health, social and economic problem. We still lack clarity regarding the ethology of depression and treatment is still mainly symptomatic. The authors postulate that depression has similarities with anxiety and from an evolutionary perspective is an archaic defence mechanism. Formerly, through the agency of complex psychological, biological and social mechanisms, healing was facilitated in conditions of an intense, short-term nature. Adverse civilizational and environmental changes have caused pathological changes in both the mechanism of depression and corresponding defence mechanisms such as the induction of an anxiety state. Related to depression is the mechanism of thanatosis, concerning chronic biological and psychosocial dysfunctions. It is a mechanism for activating self-eliminating processes to free the community from the burden of a dysfunctional individual.

Introduction: Post-dilution online hemodiafiltration is the most efficient extracorporeal depurative treatment of CKD. Recently a new type of membrane has been developed, with a higher cut-off point also called a medium cut-off point, which has the capacity to eliminate higher molecular weight molecules in hemodialysis. The hemodialysis performed with these membranes has been called “Expanded Hemodialysis”.Objective: Compare the purifying efficacy of medium and high molecular weight molecules in patients dialyzed with high-flux hemodialysis, VitaPES 210HF, and with patients treated with expanded hemodialysis with the medium cut-off dialyzer, Elisio-HX.We also assessed the effect that the increased removal of inflammatory mediators by MCO hemodialysis had on fecal Calprotectin levels.Patients and methods: This is a prospective observational cross-over study in which 8 prevalent hemodialysis patients were followed for two months. Blood levels of IL-6, C-reactive protein (CRP), β2-microglobulin, Kappa and Lambda immunoglobulin light chains, and serum albumin were determined before and after each hemodialysis session.Results: The percentage of reduction of medium and higher molecular weight molecules: β2microglobulin, IL-6, Kappa and Lambda chains and CRP were higher with the Elisio-21HX dialyzer compared to the VitaPES 210HF dialyzer. There was no difference in albumin clearance between the two dialyzers.Fecal calprotectin levels were lower in patients dialyzed with Elisio-21HX.Conclusion: The medium cutoff dialyzer, Elisio-HX, is more efficient in the elimination of medium/high molecular weight molecules than the VitaPES HF high-flux dialyzer, with the same albumin elimination.Improving inflammation at the local intestinal level with lower levels of fecal Calprotectin.