PIP:
Health workers in Malaysia randomly assigned either a low-dose triphasic or a low-dose monophasic oral contraceptive (Triquilar and Marvelon, respectively) to 198 women to examine discontinuation rates and reasons for discontinuation. 15.3% of Triquilar women and 9.1% of Marvelon women forgot to take 1 pill at some time during the study while 6.1% and 3% forgot to take at least 3 consecutive pills. There were more complaints and/or complications among Triquilar women than among Marvelon women. The most serious complication was severe headaches (only 1 woman from each group). 2 women in the Marvelon group complained of either generalized itchiness or digestion impairment. Complaints of women in the Triquilar group included localized and generalized itchiness, weight gain, digestion impairment, dryness of vagina, and numbness of extremities. Women in the Triquilar group were more likely to have menstrual complaints than those in the Marvelon group (14.3% vs. 9.1%). The leading menstrual complaint in both groups was spotting (6.1% vs. 4%). No Marvelon women reported menorrhagia, scanty menses, or intermenstrual pelvic pain or discomfort while at least 1 woman did from the Triquilar group. The percentage of women with changes in complaints since admission were the same for both groups. Total discontinuation rates which included lost to follow ups were 46.9% and 40%, respectively. The most common reason for discontinuation for both groups was desired method change (11.2% Triquilar and 14.1% Marvelon). Method unrelated reasons (unable to return to clinic, moving/travel, and not interested in the study) were the next most common reason for discontinuation. 3 women conceived while taking Triquilar. These pregnancies were attributed to method failure, perhaps due to incomplete pituitary suppression. There were no accidental pregnancies in the Marvelon group.
PIP: Marvelon, a monophasic oral contraceptive (OC) containing 30 mcg of ethinyl estradiol and 150 mcg of desogestrel, has been available to Malaysian women through the national family planning program since 1982. To assess the safety, effectiveness, and side effects associated with this OC, 247 women who requested the pill were enrolled in a multicenter prospective study that included follow-up after the first, third, and sixth cycles of use. 81% of participants had never used any form of contraception before Marvelon. 194 women (79%) completed the 6-month study. There were no pregnancies recorded. Although women reported a slightly increased incidence of nausea, breast tenderness, and headache in the first treatment cycle, these side effects had abated by the end of the third cycle. After six cycles, mean body weight had decreased by an average of 0.4 kg. Both systolic and diastolic blood pressure were unaffected. An unexpected finding was a decrease in the severity of acne with continuous use of Marvelon. Although both spotting and breakthrough bleeding increased slightly in the first two cycles, irregular bleeding returned to pretreatment levels by the third cycle. The length of the withdrawal bleed in the pill-free week was reduced. The incidence of irregular bleeding and other side effects was substantially lower in this sample of Malaysian women than in Asian and Caucasian Marvelon users surveyed in other studies.
According to the World Health Organization (WHO), COVID-19 has caused more than 6.5 million deaths, while over 600 million people are infected. With regard to the tools and techniques of disease analysis, spatial analysis is increasingly being used to analyze the impact of COVID-19. The present review offers an assessment of research that used regional data systems to study the COVID-19 epidemic published between 2020 and 2022. The research focuses on: categories of the area, authors, methods, and procedures used by the authors and the results of their findings. This input will enable the contrast of different spatial models used for regional data systems with COVID-19. Our outcomes showed increased use of geographically weighted regression and Moran I spatial statistical tools applied to better spatial and time-based gauges. We have also found an increase in the use of local models compared to other spatial statistics models/methods.
This paper mainly forecasts the daily closing price of stock markets. We propose a two-stage technique that combines the empirical mode decomposition (EMD) with nonparametric methods of local linear quantile (LLQ). We use the proposed technique, EMD-LLQ, to forecast two stock index time series. Detailed experiments are implemented for the proposed method, in which EMD-LPQ, EMD, and Holt-Winter methods are compared. The proposed EMD-LPQ model is determined to be superior to the EMD and Holt-Winter methods in predicting the stock closing prices.
Many researchers documented that the stock market data are nonstationary and nonlinear time series data. In this study, we use EMD-HW bagging method for nonstationary and nonlinear time series forecasting. The EMD-HW bagging method is based on the empirical mode decomposition (EMD), the moving block bootstrap and the Holt-Winter. The stock market time series of six countries are used to compare EMD-HW bagging method. This comparison is based on five forecasting error measurements. The comparison shows that the forecasting results of EMD-HW bagging are more accurate than the forecasting results of the fourteen selected methods.
Facial nerve paralysis in children is a rare clinical condition that can lead to serious complications. Due to their rare occurrence, tumours, especially in the cerebellopontine angle, may be overlooked. We report a case of cerebellopontine angle tumour in an 8-year-old boy who presented with a right-sided lower motor neuron type of facial nerve palsy. Further examination showed a mild bilateral nystagmus. However, misled by the initial diagnosis of Bell's palsy, there was a delay in performing diagnostic magnetic resonance imaging of the brain, which showed a large mass in the cerebellopontine. Subsequently, six weeks after his initial presentation, the boy succumbed to the disease. This case illustrates that careful clinical examination, even in a seemingly simple case, is imperative to avoid diagnostic errors.
PIP: In 1986, single puncture laparoscopic application of the Filshie clip was introduced into Malaysia's National Population and Family Development Board's female sterilization program for an evaluation. A total of 42 female sterilizations were performed by this method between June 1986 and December 1986. Laparoscopy was performed on an outpatient basis under local anesthesia. In 37 cases, the sterilization was interval. Filshie clips were successfully applied to the fallopian tubes of 40 women; in the remaining 2 cases, the latching mechanism jammed and Falope rings were used instead. The average time from application of 1st clip to skin closure was 10 minutes. During clip application, technical problems (faulty applicator, clip fell into the pelvic cavity, failure of latching mechanism) were encountered in 4 cases and surgical difficulties (poor visualization, hydrosalpinx, and tubal adhesions) occurred in 10 cases. In general, complications were minimal: 1 patient developed cynosis after anesyhesia (Pethidine) injection, the omentum was torn during introduction of the trocar in another, and a 3rd patient developed thrombophlebitis at the intravenous site. Only 1 pregnancy was recorded during the follow-up period; this occurred 15 months postoperatively and was intrauterine. Given the facts that this procedure is easy to learn, fast and simple, associated with no more complications than other laparoscopic procedures, and is cosmetically more acceptable to women, its more widespread application is recommended.
The economic production quantity (EPQ) model for delayed deteriorating items considering two-phase production periods, exponential demand rate and linearly increasing function of time holding cost is proposed to solve a production problem similar to the one caused by the Covid-19 pandemic. Without shortages, the necessary and sufficient conditions for optimality of this model are characterized through a theorem and lemmas while a solution methodology based on differential calculus is adopted. This paper determines the best replenishment cycle length corresponding to the optimal total variable cost and production quantity of imperfect production industry. To illustrate this model, a numerical experiment is conducted. The results demonstrate that a higher carrying charge decreases the production quantity and a longer demanding period decreases the total variable cost of an industry with a distracted production period. Finally, managerial insights are discussed using sensitivity analysis and future research directions are exposed.
This research employs the gradient descent learning (FIR.DM) approach as a learning process in a nonlinear spectral model of maximum overlapping discrete wavelet transform (MODWT) to improve volatility prediction of daily stock market prices using Saudi Arabia's stock exchange (Tadawul) data. The MODWT comprises five mathematical functions and fuzzy inference rules. The inputs are the oil price (Loil) and repo rate (Repo) according to multiple regression correlation, and the Engle and Granger Causality test Engle RF, (1987). The logarithm of the stock market price (LSCS) in Tadawul reflects the output variable. The correlation matrix reveals that there is no collinearity between the input variables, and the causality test demonstrates that the input variables significantly influence the outcome variable. According to the multiple regression, there is a substantial negative influence between Loil and LSCS but a significant positive effect between Repo and output. For the 80% dataset under ME (0.000005), MAE (0.003214), and MAPE (0.064497), the MODWT-LA8 (ARIMA(1,1,0) with drift) for the LSCS variable performs better than other WT functions. In the novel hybrid model MODWT-FIR.DM, each function's approximation coefficient (LSCS) is applied with input variables (Loil and Repo). We evaluate the performance of the proposed model (MODWT-LA8-FIR.DM) using different statistical measures (ME, RMSE, MAE, MPE) and compare it to two established models: the original FIR.DM and other MODWT-FIR.DM functions for forecasting 20% of datasets. The outcomes show that the MODWT-LA8-FIR.DM performs better than the traditional models based on lower ME (3.167586), RMSE (3.167638), MAE (3.167586), and MPE (80.860849). The proposed hybrid model may be a potential stock market forecasting model.
Background The coronavirus disease 2019 (COVID-19) pandemic has impacted the emergency department (ED) due to the surge in medical demand and changes in the characteristics of paediatric visits. Additionally, the trend for paediatric ED visits has decreased globally, secondary to implementing lockdowns to stop the spread of COVID-19. We aim to study the trend and characteristics of paediatric ED visits following Malaysia's primary timeline of the COVID-19 pandemic. Methods and materials A five-year time series observational study of paediatric ED patients from two tertiary hospitals in Malaysia was conducted from March 17, 2017 (week 11 2017) to March 17, 2022 (week 12 2022). Aggregated weekly data were analysed using R statistical software version 4.2.2 (R Foundation for Statistical Computing, Vienna, Austria) against significant events during the COVID-19 pandemic to detect influential changepoints in the trend. The data collected were the number of ED visits, triage severity, visit outcomes and ED discharge diagnosis. Results Overall, 175,737 paediatric ED visits were recorded with a median age of three years and predominantly males (56.8%). A 57.57% (p<0.00) reduction in the average weekly ED visits was observed during the Movement Control Order (MCO) period. Despite the increase in the proportion of urgent (odds ratio (OR): 1.23, p<0.00) and emergent or life-threatening (OR: 1.79, p<0.00) cases, the proportion of admissions decreased. Whilst the changepoints during the MCO indicated a rise in respiratory, fever or other infectious diseases, or gastrointestinal conditions, diagnosis of complications originating from the perinatal period declined from July 19, 2021 (week 29 2021). Conclusion The incongruent change in disease severity and hospital admission reflects the potential effects of the healthcare system reform and socioeconomic impact as the pandemic evolves. Future studies on parental motivation to seek emergency medical attention may provide insight into the timing and choice of healthcare service utilisation.