Association between Diabetes Mellitus and Sepsis for the Glycemic Control Outcome of Two Intensive Care Units in Malaysia

Close monitoring and tight glycemic control are required among critically ill patients as they have dynamic metabolism which may precipitate stress-induced hyperglycemia. Clinically, diabetes mellitus (DM) patient with sepsis indicated a high mortality rate. This study investigates the association between DM and non-DM related to sepsis and non-sepsis patients from different insulin infusion therapy management. This study used 128 retrospective data from Hospital A, and 37 retrospective data from Hospital B. ICU patients who received insulin infusion therapy during their stay in the ICU were selected. Both centres implement the sliding scale-based insulin infusion therapy with the target range for blood glucose (BG) level within 6.0 – 10.0 mmol/L. The retrospective clinical data were compared among cohorts for DM and non-DM associated with sepsis and non-sepsis conditions. Findings showed that the DM group had higher insulin sensitivity than non-DM for both cohorts. Meanwhile, cohort B had higher insulin sensitivity than cohort A for all classes. Cohort A (DM+Sepsis) had low insulin sensitivity (66.7 L/(mU.min) and worst condition with sepsis which resulted from the lowest percentage (30.81%) of BG measurement within the target range. The (nonDM+nonSepsis) class had the tightest glycemic control for cohort A (3.4 mmol/L) and cohort B (2.2 mmol/L), as observed by the BG interquartile range. Furthermore, cohort A (nonDM+nonSepsis) had a 41.55% of severe hyperglycemia and 0.12% for severe hypoglycemia. Contrary, cohort B (nonDM+nonSepsis) had the highest percentage within the target range (74.31%) and the lowest percentage of hyperglycemia (18.78%). There was significantly different (p-values <0.05) between cohort A and cohort B in BG level and glucose intake, likewise between sepsis and non-sepsis of non-DM for both cohorts. The findings indicate that a successful glycemic control protocol is much influenced by insulin sensitivity, patient variability, diabetes condition, and patient sepsis status

Insulin sensitivity and blood glucose level of sepsis patients in the intensive care unit

Sepsis and hyperglycemia are highly associated with increases in mortality rates, particularly in the critically ill patients. Sepsis diagnosis has been proven challenging due to delay in getting the blood culture results. Thus, often clinical experiences overrule the protocol to prevent the worsening outcome of the patients. In some cases, the erroneous clinical judgement cause antibiotic resistance and even adverse clinical outcomes. This paper investigates the correlation between two parameters; insulin sensitivity and blood glucose level among sepsis patients. The blood glucose level is measured at the bedside during the patient's stay, whereas insulin sensitivity is obtained using the validated glucose-insulin model. Thus, the insulin sensitivity is a specific parameter of the patient, unregimented of the protocol given to the patient. The same parameters, blood glucose and insulin sensitivity, are also compared to the non-sepsis patients to establish a relationship that can be used for sepsis diagnosis. Given the availability of these two parameters that can be captured rapidly and instantly, a significant relationship can, therefore, help clinicians to identify sepsis at an early stage without second-guessing

Finite Element Based Fatigue Life Prediction of a New Free Piston Engine Mounting

This study presents the finite element based fatigue life prediction of a new free piston linear generator engine mounting. The objective of this research is to assess the critical fatigue locations on the component due to loading conditions. The effects of mean stress and probabilistic nature on the fatigue life are also investigated. Materials SAE 1045-450-QT and SAE1045-595-QT are considered in this study. The finite element modeling and analysis was performed using computer-aided design and finite element analysis codes. In addition, the fatigue life prediction was carried out utilizing the finite element based fatigue code. Total-life approach and crack initiation approach were applied to predict the fatigue life of the free piston linear engine mounting. The results show the contour plots of fatigue life and damage histogram at the most damaging case. The comparison between the total-life approach and crack initiation approach were investigated. From the results, it can be concluded that Morrow mean stress correction method gives the most conservative (less life) results for crack initiation method. It can be seen that SAE 1045-595-QT material gives consistently higher life than SAE 1045-450-QT material for all loading conditions for both methods. TsTov wmrvlfi* Tn'catirrn** lift* finite plpmpnt Gtr*^GG_1iT*^ nrcmtr initicatirwi linear o-*an*at*catrw pnmn

Fatigue Life Prediction of Two-Stroke Free Piston Engine Mounting Using Frequency Response Approach

This paper describes a vibration fatigue analysis techniques to predict the fatigue life using the frequency response approach. The life prediction results are useful for improving the component design at a very early development stage. The finite element modeling and frequency response analysis have been performed using the finite element analysis software. In addition, the fatigue life prediction was carried out using both the time domain and frequency response methods. From the results, it is observed that the Dirlik method gives the best comparable results pseudo-static time domain approach with the frequency response techniques. This paper also describes how this technique can be implemented in the finite element environment to rapidly identify critical areas in the structure. This approach is capable of determining premature products failure phenomena

Multiple linear regression model analysis in predicting fasting blood glucose level in healthy subjects

Diabetes mellitus referred to inability to produce or respond to hormone insulin resulted in elevated blood glucose level in human body. The purpose of this study was to investigate the relationship between fasting blood glucose, cholesterol and blood pressure levels in healthy subjects. 211 subjects having age between 23-66 years old were randomly selected among UMP's residents from April 2017 to May 2018. Mann-Whitney Ranksum test determine the significant differences between overall and diabetics subjects. Pearson Correlation compute the associations between fasting blood glucose, lipid profile substances and blood pressure. Linear regression analysis verified the relationship between fasting blood glucose and other parameters, with 95%CI. Fasting blood glucose are significantly difference (p<0.05) with blood pressure and others lipid profile substances except for total cholesterol. All lipid profile substances are significantly difference (p<0.05) with blood pressure level. There is 59%(R 2 -value) chances in getting correct prediction of diabetes using high density lipo-protein cholesterol, low density lipo-protein cholesterol, triglyceride, systolic blood pressure and triglyceride based on fasting blood glucose value. However, a larger and well-spread cohort with different backgrounds and demographics however is required to validate the finding of this study

Mathematical modeling of glucose-insulin system behavior in Hospital Tengku Ampuan Afzan intensive care unit patients

Mathematical modeling of glucose-insulin system is significantly important to understand the body regulation control, to analyze experimental data based on clinical trials, to identify and quantify relevant physiological parameters, to design proper clinical trials and to assess diabetes therapies. In general, critically ill patients with blood glucose concentrations between 10.0 to 12.2 mmol/l is identified to develop an acute hyperglycaemia or high blood glucose (BG). Thus, to monitor hyperglycaemia among critically ill patients, this study is focused on observing the glucose-insulin system behaviour based on 40 patients’ clinical data collected in Hospital Tengku Ampuan Afzan, Kuantan, Pahang with clinically validated mathematical glucose-insulin model. By using this model, a critical model-based parameter known as insulin sensitivity (SI) that illustrates patient’s severity were identified hourly for all patients whose on insulin infusion therapy protocol for average four to six days. The results show that a BG normal distribution is attained with median kurtosis of 2.72. While, the 40 patient-specific SI indicate that an outliers-prone distribution occurred as kurtosis 3.96. Thus, abrupt changes in SI is basically due to chaotic interaction between blood glucose and insulin concentrations in bloodstreams. Also, the glucose-insulin behavior pattern among these 40 critically ill patients might be varied due to their main diagnotics illness such as acute kidney failure, cardiovascular disease, etc. Overall, these results might assist clinicians and researchers to understand the glucose-insulin behavior based on patient’s severity illness and helps to inform glycaemic control protocol development in a larger group of critically ill patients

Abstracts of the International Halal Science Conference 2023

This book presents the extended abstracts of the selected contributions to the International Halal Science Conference, held on 22-23 August 2023 by the International Institute for Halal Research and Training (INHART), IIUM, Malaysia in collaboration with Halalan Thayyiban Research Centre, University Islam Sultan Sharif (UNISSA), Brunei Darussalam. With the increasing global interest in halal products and services, this conference is timely. Conference Title:  International Halal Science ConferenceConference Acronym: IHASC23Conference Theme: Halal Industry Sustainability Through ScienceConference Date: 22-23 August 2023Conference Venue: International Islamic University (IIUM), MalaysiaConference Organizer: International Institute for Halal Research and Training (INHART), International Islamic University (IIUM), Malaysi