Islamic Financial Engineering Role in Combating Covid-19 Epidemic Issues: A Case Study of Pakistan

The world and Pakistani economies have suffered from COVID-19.  MSMEs are the main victims of COVID-19.  This paper evaluates the impact of the COVID-19 pandemic on micro, small, and medium enterprises (MSMEs) and offers policy recommendations to help them mitigate economic losses and navigate the crisis.  Financial engineering integrates financial theory, engineering approaches, mathematics, and programming.  Finance also involves using mathematical and computational methods to implement financial tasks. Islamic Financial Engineering (IFE) is crucial in the customer-driven derivatives sector, which involves quantitative modelling, programming, trading, and risk management of derivative products. The  objective of the study  is  tо  exрlоre  whether  the  Islаmiс  finаnсiаl  engineering  соntributes or not  tо  resоlve  the  issues  of  СОVID-19 in  Раkistаn  i.e:  (а)  tо  identify  the  imроrtаnt  rоle  оf  Islаmiс  finаnсiаl  engineering  tоwаrd  СОVID-19  Issues remedies in Раkistаn (b) tо identify the  imроrtаnt  rоle  оf  IFE tо  соmbаt  СОVID-19  issues in  Раkistаn  (с)  tо  exрlоre  mоre  finаnсiаl  рrоduсts  tо  соver  uр  the  dent  оn  рооr  рeорle  due  tо  соvid-  19  (d)  tо  imрrоve  the  rоle  оf  Islаmiс  miсrоfinаnсe  institutiоns with the help of IFE tools  tо  help the  рeорle get rid of роverty (e) tо analyze роliсy imрliсаtiоns under IFE аnd  reсоmmendаtiоn  tо  ассelerаte  in  аttаining  the  revivаl  аfter  СОVID-19. The study focuses on the above discussed objectives by examining the performance of MSMEs during and after COVID-19 pandemic. A comparision is given to depict the main variables in these periods i.e prior - during and after COVID-19 pandemic till July 2021. Recommndations has given to the Government and regulators of financial and non-financial sectors to arm thm to cop ith such plausible issues in future

The Impact of Entrepreneurial Orientation on Business Performance in Star Class Hotels of Sri Lanka

The article studies the relationship between the Entrepreneurial Orientation and Business Performance in star class hotels of Sri Lanka The study has utilized data collected from 215 senior managers employed in the star class hotel sector CFA SEM analysis was performed using AMOS 21 to identify the relationship The quantitative data analysis revealed there is a significant relationship between Entrepreneurial Orientation and Business performance Further it was found Proactiveness Risk Taking Innovativeness Autonomy and Competitor Aggressiveness are dimensions of Entrepreneurial Orientatio

Role of Emergency Decompressive Craniectomy in Patients of Traumatic Brain Injury

Objective: To study the role of emergency decompressive craniectomy in patients of traumatic brain injury. Methodology: This observational study was performed in the department of Neurosurgery, MTI, LRH, Peshawar, from 1st February, 2016 to 31st January, 2017. A total of 28 patients of traumatic brain injury, who underwent emergency decompressive craniectomy within 24 hours of their admission were included in the study after applying the inclusion and exclusion criteria. A questionnaire was used to document the data. Data analysis was performed with the help of SPSS version 20. Results: The total no. of patients were 28, out of which 21 (75%) were male and 7 (25%) were female. The mean age of all the patients was 31 ± 19.84, with a range of 10 – 80 years. The preoperative diagnosis was acute subdural hematoma (ASDH) in 15 (53.6%), large contusion in 6 (21.4%), post-traumatic intracerebral bleed in 3 (10.7%), and ASDH plus small multiple contusions in 4 (14.3%) patients. Dura was left open in all the cases. The preoperative mean GCS was 8.39 ± 3.01. A total of 8 (28.6%) patients expired during the first postoperative week. The mean GCS of the remaining 20 patients at discharge was 10.55 ± 4.05. At 3 months follow-up, 7 (25%) patients were in vegetative state (GOS2), 3 (10.7%) were having major disability (GOS3) and 10 (35.7%) had good (GOS 4 and 5) clinical outcome. Conclusion: The decompressive craniectomy can be very helpful in patients of traumatic brain injury because it can lower the ICP and improve the survival rate in TBI patients. Abbreviations: GCS (Glasgow Coma Scale), GOS (Glasgow Outcome Scale), ICP (Intracranial Pressure)

Psychosocial factors of deliberate self-harm in Afghanistan: A hospital based, matched case-control study

Background: Deliberate self-harm is not only a major global public health problem but also an important index of psychological distress and a risk factor for suicide.Aims: We aimed to determine the psychosocial risk factors for deliberate self-harm in patients aged ≥ 16 years presenting to tertiary care hospitals in Kabul, Afghanistan.Methods: A matched case-control study was conducted from February 2015 to May 2015. We recruited 185 cases (patients with deliberate self-harm) and 555 age- and sex-matched controls (patients with general medical conditions) from 4 tertiary care hospitals in Kabul. We developed a questionnaire to record the sociodemographic characteristics of the participants, history of domestic violence, drug abuse and details about the act of deliberate self-harm, including the methods used. To assess depression and anxiety, we used the WHO self-reporting questionnaire (SRQ-20). Matched odds ratios with 95% confidence interval using conditional logistic regression were used to determine statistically significant associations between psychosocial factors and deliberate self-harm.Results: Family conflicts, domestic violence, interpersonal arguments and living in extended families were found to be significantly associated with deliberate self-harm.Conclusions: In Afghanistan, deliberate self-harm appears to be predominately related to interpersonal problems and family conflicts. About two-thirds of females and more than half of males scored positive for depression, yet none were receiving treatment for this. These findings have important policy implications for mental health and suicide prevention programmes in the country

Risks of Surgery for Myelomeningocele in Children

Objective: To know about complications in Myelomeningocele (MMC) surgery.Material and Methods: Fifty five children underwent surgical repair of MMCs and represent our experience about complication in surgery for MMC. Retrospective observational study carried out in Neurosurgery ward, Lady reading hospital Peshawar, from 2013 to 2015. Patients suffering from MMC were admitted. The clinical, radiological and laboratory finding of patients were documented on a designed proforma. Moreover ventri-culoperitonial shunting (V/P) was performed for children who had or developed hydrocephalus. Eliptical incision in vertical plane was given in 45 cases and horizontal incision in 6 cases. Plastic surgery unit consulted for very large MMC in rest of 4 cases and transposition of gluteus maximus musculocutaneous unit performed. All patients with MMC of both gender and age range from 1 month to 10 years who were willing and fit for surgery were included in this study and all those who were not willing and fit for surgery were excluded. The study was approved by Institute of Research in Ethics and Biomedicine (IREB).This study will help to make recommen-dations.Results: Patients in this study were in the age range of 1 month to 10 years. Mean age was 1.8 years. Thirty seven patients (67%) were Paraparetic (MRC grade from 1 to 4) and 18 patients (32.72%) were completely paraplegic. Seventeen patients (30.9%) had ruptured MMC at presentation and underwent surgery in emergency. Fifteen patients (27.27%) had V/P shunting before surgery for MMC and 11 patients (20%) developed hydro-cephalus after excision and repair of MMC and V/P shunting carried out. Seven patients (12.72%) developed wound dehiscence and CSF leak and subjected to redo surgery. Three patients (5.45%) had wound infection followed by meningitis and two patients (3.63%) died after surgery.Conclusion: From this study we concluded that wound dehiscence and CSF leak are the most common complication after surgery for MMC and can be prevented by tensionless closure of the wound. In MMC patients with overt hydrocephalus prior to repair and excision of MMC V/P shunting should be performed. If patient develop hydrocephalus after surgery then immediate diversion of CSF should be carried out

Effects of betel nut on cardiovascular risk factors in a rat model

Background: Areca nut (commonly known as betel nut) chewing has been shown to be associated with metabolic syndrome and cardiovascular disease (CVD). The mechanism by which betel nut ingestion could lead to development of CVD is not precisely known; however, dyslipidemia, hyperhomocysteinemia, hypertriglyceridemia and inflammation could be some of the potential risk factors. This study was undertaken to investigate the effects of two dosages of betel nut on homocysteinemia, inflammation and some of the components of metabolic syndrome, such as hypertriglyceridemia, low HDL-cholesterol, obesity and fasting hyperglycemia in a rat model.Methods: Thirty-six adult female Sprague Dawley rats, aged 10–12 weeks were divided into three equal groups. Group-1 served as the control group (n = 12) and received water, whereas groups 2 and 3 were given water suspension of betel nut orally in two dosages, 30 mg and 60 mg, respectively for a period of 5 weeks. At the end of the fifth week, the animals were weighed and sacrificed, blood was collected and liver, kidney, spleen and stomach were removed for histological examination. Plasma/serum was analyzed for glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, homocysteine, folate, vitamin B12 and N-acetyl-β-D-glucosaminidase (NAG) – a marker of inflammation.Results: When the mean concentration values of 3 groups were compared using one way ANOVA followed by Tukey’s HSD-test, there was a significant increase in the concentration of total cholesterol (p = 0.04) in the group receiving 30 mg/day betel nut compared to the control group. However, administration of a higher dose of betel nut (60 mg/day) had no significant effect on the serum concentrations of glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, and NAG. Histological examination of spleen revealed a dose-dependent extramedullary hematopoiesis. No other remarkable change in the tissues (liver, kidney and stomach) was observed. Mean serum/plasma levels of folate, vitamin B12 and homocysteine were not found to be significantly different in all the groups. Betel nut ingestion had no effect on the mean body weights of rats.Conclusions: Low dosage of betel nut is found to be associated with hypercholesterolemia. However, betel nut ingestion is not associated with hyperhomocysteinemia, hypertriglyceridemia, hyperglycemia, inflammation and increase in body weight in a rat model

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700