Rhino-orbital Mucormycosis in a COVID-19 Patient: The First Case in Malaysia

Mucormycosis is an aggressive and potentially fatal fungal infection caused by fungi of the order Mucorales. There has been an increase in the number of cases of rhino-orbital mucormycosis in people with COVID-19, particularly in India. Rhino-orbital-cerebral mucormycosis is the most common manifestation of mucormycosis associated with COVID-19. We report the first case of rhino-orbital mucormycosis in a diabetic patient with SARS-CoV-2 infection in Malaysia. The diagnosis of mucormycosis was confirmed by histopathological examination, but the fungal culture and PCR results were negative. He was treated with antifungal therapy and had extensive debridement. Treatment of mucormycosis requires a multidisciplinary approach that includes addressing underlying risk factors, effective antifungal therapy, and surgical debridement.

Understanding the epidemiological HIV risk factors and underlying risk context for youth residing in or originating from the Middle East and North Africa (MENA) region: A scoping review of the literature

Introduction HIV is the second leading cause of death among young people globally, and adolescents are the only group where HIV mortality is not declining. Middle East and North Africa (MENA) is one of few regions seeing rapid increase of HIV infections (31.0%) since 2001. MENA youth are at particular risk of HIV due to dearth of research and challenges in accessing services. Objective The purpose of this scoping review is to establish the epidemiological HIV risk factors and underlying risk context for youth residing in or originating from the MENA region. Methods Online database searches were conducted using combination of search terms. Screening 5,853 citations, published between 1990–2019 with age groups 16 to 29, resulted in 57 studies included across 18 MENA countries. Results ‘Key populations’ engage in risky behaviors, including: overlapping risky behaviors among youth who inject drugs (PWID); lack of access to HIV testing, condomless sex, and multiple sex partners among young men who have sex with men (MSM); and high and overlapping risk behaviors among young sex workers. Challenges facing other youth groups and bridging populations include: peer pressure, inhibition about discussing sexual health, lack of credible sex education sources, low condom use, and lack of access to HIV protection/prevention services, especially testing. Conclusion Poor surveillance coupled with scarcity of rigorous studies limit what is known about epidemiology of HIV among youth in MENA. Homophobia, stigma around PWID, and illegal status of sex work promote non-disclosure of risk behaviors among youth and curtail serving this population.

Strategi Pemasaran Produk Asuransi Syariah di PT. Prudential Life Assurance Cabang Kota Medan

Human life in modern times has various kinds of risks and dangers. Man himself does not know what will happen tomorrow and where he will die world. Insurance is a financial tool for managing home life, both in terms of facing an underlying risk, such as the chance of mortality, and in terms of protecting one's personal belongings. In the marketing process, a strategy is needed essential, the company's main target in a broad market reach. So that a strategy is required before entering the market, all of the plans have been consolidated, comprehensive, And included to make sure that the company's last purpose may be found out via the implementation of the suitable strategy. Study The reason for this observation is to choose and evaluate (segmentation, targeting, and positioning) at PT. Prudential Life Assurance Medan City Branch, in addition to to decide whether or not the advertising plan is carried out according with sharia advertising characteristics. This study employs a qualitative technique while doing descriptive research. The findings revealed that the market segmentation (segmenting) conducted by PT. Prudential Life Assurance Medan City Branch based on per market grouping region. To make it easier for Prudential to meet and greet its customers return. Targeting, in determining the target market covered by PT. Prudential Life Assurance Medan City Branch there is no certain limit, the company serves all market segment. Keywoard : Strategy, Marketing, Sharia Insurance, PT. Prudential Life Assurance Branch Medan City.

Placenta Accreta Syndrome- A Calamitous Diagnosis

Increasing incidence of Placenta accrete syndrome has become a worrisome issue due to its associated life-threatening complications for both the mother and the fetus. The ideal management for PAS disorder remains the matter of debate still. The critical step in its effective management being its suspicion knowing the underlying risk factors and its diagnosis in antenatal period. Still, cesarean hysterectomy remains the gold standard procedure with many newer conservative approaches under evaluation. Our basic aim behind writing this review is to highlight the recent changes in classifying and diagnosing PAS owing to the ever-increasing incidence of this catastrophic entity. Also, it will emphasize the well-established role of radical over conservative management and also all modalities used in conservative management so far.

Managing PVR in the Era of Small Gauge Surgery

Proliferative vitreoretinopathy (PVR) is the leading cause of failed rhegmatogenous retinal detachment (RRD) surgery. Based upon the presence of clinical features and due to associated underlying risk factors, it is classified into various grades based upon its severity and extent of involvement. Despite excellent skills, flawless techniques, and high-end technology applied in the management of RRD, PVR still occurs in 5–10% of cases. Due to the advancements in wide angle viewing systems, advance vitrectomy machines and fluidics, early identification, use of long-term heavy silicon oil tamponades, high-speed cutters, small-gauge vitrectomies, use of perfluorocarbon liquid (PFCL), and small-gauge forceps and scissors, the success rate in the management of PVR has increased leading to improved anatomical outcomes. However, functional outcomes do not correlate well with improved anatomical outcomes. Various complications occur after RRD repair that are responsible for re-retinal detachment and recurrence of PVR. This article highlights causes, risk factors, classification, grading, diagnosis, and approach to management of PVR and post-PVR surgery complications.

Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England

Background The Covid-19 case fatality ratio varies between countries and over time but it is unclear whether variation is explained by the underlying risk in those infected. This study aims to describe the trends and risk factors for admission and mortality rates over time in England. Methods In this retrospective cohort study, we included all adults (≥18 years) in England with a positive Covid-19 test result between 1st October 2020 and 30th April 2021. Data were linked to primary and secondary care electronic health records and death registrations. Our outcomes were i) one or more emergency hospital admissions and ii) death from any cause, within 28 days of a positive test. Multivariable multilevel logistic regression was used to model each outcome with patient risk factors and time. Results 2,311,282 people were included in the study, of whom 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days. There was significant variation in the case hospitalisation and mortality risk over time, peaking in December 2020-February 2021, which remained after adjustment for individual risk factors. Older age groups, males, those resident in more deprived areas, and those with obesity had higher odds of admission and mortality. Of risk factors examined, severe mental illness and learning disability had the highest odds of admission and mortality. Conclusions In one of the largest studies of nationally representative Covid-19 risk factors, case hospitalisation and mortality risk varied significantly over time in England during the second pandemic wave, independent of the underlying risk in those infected.

Automated Interpretable Discovery of Heterogeneous Treatment Effectiveness: A Covid-19 Case Study

Testing multiple treatments for heterogeneous (varying) effectiveness with respect to many underlying risk factors requires many pairwise tests; we would like to instead automatically discover and visualize patient archetypes and predictors of treatment effectiveness using multitask machine learning. In this paper, we present a method to estimate these heterogeneous treatment effects with an interpretable hierarchical framework that uses additive models to visualize expected treatment benefits as a function of patient factors (identifying personalized treatment benefits) and concurrent treatments (identifying combinatorial treatment benefits). This method achieves state-of-the-art predictive power for Covid-19 in-hospital mortality and interpretable identification of heterogeneous treatment benefits. We first validate this method on the large public MIMIC-IV dataset of ICU patients to test recovery of heterogeneous treatment effects. Next we apply this method to a proprietary dataset of over 3000 patients hospitalized for Covid-19, and find evidence of heterogeneous treatment effectiveness predicted largely by indicators of inflammation and thrombosis risk: patients with few indicators of thrombosis risk benefit most from treatments against inflammation, while patients with few indicators of inflammation risk benefit most from treatments against thrombosis. This approach provides an automated methodology to discover heterogeneous and individualized effectiveness of treatments.

The Short-Term Impacts of the Registration-Based IPO Reform in China: Towards a More Sustainable Equity Market

The sustainable development of a modern equity market heavily relies on an effective IPO system that can properly reflect the underlying risk, demand, and supply in the IPO market. Recently, China has implemented an unprecedented IPO reform that transforms the previous approval-based IPO system to a registration-based one. Despite its importance, the impacts of the reform still remain unexplored. Using firm-level data from the Chinese A-shares market, we show that the recent IPO reform significantly increases IPO cost and reduces the degree of IPO underpricing. We also investigated the impacts of the reform on the market structures in different IPO service markets. Overall, our findings are consistent with the hypothesis that the registration-based IPO reform makes the IPO system in China more market-oriented. To our best knowledge, this is the first empirical study that sheds light on the short-term impacts of the adoption of a registration-based IPO system.

Contamination of multi dose eyedrops in the intra and perioperative context

In this study, we examined the rate of contamination of multi-dose ophthalmic solutions in the operating theatre and the underlying risk for infection by examining the microbiological load on the tips of the dispenser bottles. A total of 245 samples of eye drop bottles were collected and analysed between June 2018 and January 2019. All were collected in the operating theatre of the University Eye Hospital Hamburg-Eppendorf. Contamination of the dropper tip occurred in 2% of the samples. Although the prevalence of contamination was low, the results of this study reveal the possibility of contamination of multi-dose eyedrops even when used by health care professionals in the controlled environment of an operating theatre. Following these results, we recommend the use of single-dose eyedrops in the pre- and intraoperative context.

Burden of Malnutrition among Children and Adolescents with Cerebral Palsy in Arabic-Speaking Countries: A Systematic Review and Meta-Analysis

Background: We aimed to estimate the burden and underlying risk factors of malnutrition among children and adolescents with cerebral palsy in Arabic-speaking countries. Methods: OVID Medline, OVID Embase, CINAHL via EBSCO, Cochrane Library, and SCOPUS databases were searched up to 3 July 2021. Publications were reviewed to identify relevant papers following pre-defined inclusion/exclusion criteria. Two reviewers independently assessed the studies for inclusion. Data extraction was independently completed by two reviewers. Descriptive and pooled analysis has been reported. Results: From a total of 79 records screened, nine full-text articles were assessed for eligibility, of which seven studies met the inclusion criteria. Study characteristics, anthropometric measurements used, and nutritional outcome reported varied between the studies. The included studies contained data of total 400 participants aged 1–18 years. Overall, (mean: 71.46%, 95% confidence interval: 55.52–85.04) of children with cerebral palsy had at least one form of malnutrition. Severe gross motor function limitation, feeding difficulties, cognitive impairment and inadequate energy intake were the commonly reported underlying risk factors for malnutrition among children with cerebral palsy. Conclusions: The burden of malnutrition is high among children with cerebral palsy in Arabic-speaking countries. More research is needed for better understanding of this public health issue in these countries.