Refeeding syndrome in a Malaysian intensive care unit: an assessment of incidence, risk factors and outcome

Objective: Refeeding hypophosphataemia (RH) is characterised by acute electrolyte derangement following the start of nutrition. Complications associated with this syndrome include heart failure, respiratory failure, paraesthesia, seizure and death. We aim to assess its incidence, risk factors, and outcome in our local intensive care unit (ICU). Methods: This is a preliminary analysis prospective observational study at the ICU of Hospital Tengku Ampuan Afzan Kuantan. The study was registered under the National Medical Research Register (NMRR-14-803-19813) and has received ethical approval. Inclusion criteria includes adult admission longer than 48 hours who were started on enteral feeding in the ICU. Chronic renal failure patients and those receiving dialysis were excluded. RH was considered if plasma phosphate was less than 0.65 mmol/l within 7 days of ICU admission. Results: A total of 108 patients were recruited into the study. Of this, 51 (47.2%) had RH. Patients with RH had higher SOFA score compared to those without RH (7.1±3.0 vs 5.7±3.4, p=0.02). There were no differences in the APACHE II score (16±6 vs 15±6, p=0.30), and in the NUTRIC score (2.9±1.7 versus 2.7±1.7, p=0.63) between patients with and without RH. Patients with RH had lower albumin concentration compared to those without RH (23 vs 25, p=0.04). There were lower trend of magnesium, calcium and potassium concentration, however these were not statistically significant. All four patients with hypomagnesaemia (less than 0.5 mmol/l) had RH (p=0.04). There were no differences in mortality, length of hospital or ICU stay and duration of mechanical ventilation. Conclusion: Refeeding hypophosphataemia is common, occurring in almost half of ICU admission. Patients with RH had higher organ failure score, and lower albumin level. There were no differences in the NUTRIC score and in short-term outcomes. Further studies could evaluate the association between RH and long-term outcome

025 Estimates of glomerular filtration rate in the critically ill with sepsis

Accurate assessment of glomerular filtration rate (GFR) in ICU patients is very important for institution of supportive therapy, preventive therapy, early renal support, drug dosing modification or avoidance of nephrotoxic drugs. Kinetic estimate of GFR (keGFR) takes into account the changes of creatinine over time, creatinine production rate, and the volume of distribution, hence postulated to be a more accurate estimate of GFR in the acute setting, where there are rapidly changing kidney functions as in the critically ill. We evaluated the association of the keGFR with estimated GFR (eGFR) by conventional method

The impact of corporate governance characteristic on tax compliance among public listed companies in Malaysia

Corporate income tax is the largest source of revenue to Inland Revenue Board of Malaysia (IRBM). Hence, the increase of tax non-compliance among corporate taxpayers concerns IRBM and tax authorities globally as the government loses its major revenue which adversely affects the economy. Tax evasion of large corporations using accounting manipulations implies the potential role of corporate governance against tax non-compliance. Therefore, this study attempts to determine the impact of corporate governance characteristic to tax compliance among corporate taxpayers specifically the public listed companies in Malaysia. This study was conducted on 111 tax audited cases of public listed company listed on the main market of Bursa Malaysia that had been finalised by IRBM for year of assessment 2013 and 2014. Data from their annual report were then used to determine the corporate governance characteristic of each public listed companies namely (1) board composition (2) independent director service tenure (3) separation of chairman and Chief Executive Officer (4) audit committee competency (5) non-audit service by external auditor and (6) sourcing internal audit function. Next, three models of tax compliance were developed specifically filing, reporting and payment compliance to better capture different compliance issues. Logistic regression results revealed that director service tenure has significant impact on tax compliance where public listed company with an independent director who have been in service for more than 9 years are more likely to be filing compliant. Whereas public listed company with an independent director who have been in service for less than 9 years are payment compliant. However, this study only sampled a small number of public listed companies. Therefore in order to generalize the findings due care should be exercised. This research findings contributes an added value to tax literature and tax authorities on the impact of corporate governance characteristic to specific type of tax compliance of public listed companies in Malaysia

Finite element simulation of miniaturized ZnO/Si SAW sensor for rapid detection of dichloromethane gas

Air quality control is very crucial as poor air quality can lead to chronic respiratory organ diseases. Hence, detection of numerous toxic and hazardous gas is utmost significance. A low cost and high sensitivity gas sensor is crucial to monitor the excessive presence of the dangerous gas that can harm human’s health. In recent years, various type of gas sensors have been developed for various applications such as medicine, industry, automotive and environmental monitoring. One of the harmful gas is the dichloromethane gas. Dichloromethane (DCM) gas, CH2Cl2 is widely used in industry due to its organic characteristics. However, the excessive of the amount of the gas could bring harm to human’s health. Hence, a lot of sensing devices have been developed including surface acoustic wave (SAW) gas sensor. This paper presents the 2D finite element simulation of miniaturized ZnO/Si SAW gas sensor for rapid detection of DCM gas. Using a powerful finite element analysis software known as COMSOL Multiphysics, the gas sensor is modelled according to the specific criteria using 2D approach. The effect of different thickness of ZnO thin film as piezoelectric layer is investigated on the SAW propagation characteristics. The resonance frequency of simulated ZnO/Si SAW gas sensor is 300 MHz with wavelength of 11.67μm. The shift in frequency is the measurement used to measure the changes occured to sense the presence or absence of DCM gas. The shift of resonance frequency is observed in the absence and presence of dichloromethane gas. This work has high potential to realize single chip gas sensor due to its silicon compatibility for rapid detection of harmful gas for environmental monitoring

Flexible PVDF thin film as piezoelectric energy harvester

This aim of this paper is to study the potential of Polyvinylidene Fluoride (PVDF) polymeric piezoelectric film as an energy harvester for daily application use. PVDF offers several advantages over other piezoelectric materials such as high chemical strength and stability, high piezoelectric properties and biocompatible. Several investigations were carried out in this project which comprises of simulation, functionality test and application test. For functionality test, the highest voltage produced for a single film PVDF is 0.368 V which charges up a capacitor to 0.219 V in one minute. The highest voltage produced by multiple PVDF films is 1.238 V by stacking 10 films of PVDF in parallel which charges up to 0.688 V in one minute. For application test, 5 pieces of PVDF films were attached to a glove to generate some voltage during fingers bending activity. The highest output voltage recorded is 0.184 V which stores 0.101 V in a capacitor after 200 times of hand bending and releasing. As a conclusion, PVDF has a good potential as an alternative energy for daily application use. Combination of PVDF energy harvester system with proper power optimization circuit will open up rooms of research opportunities in energy harvester system with promising prospect in self-powered wireless electronics devices for Internet of Things application

PENDAPAT IMAM IBNU KATSIR DALAM MENGUNGKAP PERBEDAAN QIRAAT TERHADAP PENAFSIRAN JUZ I AL-QUR’AN

Skripsi ini berjudul: “PENDAPAT IMAM IBNU KATSIR DALAM MENGUNGKAP PERBEDAAN QIRA’AT TERHADAP PENAFSIRAN JUZ I AL-QUR’AN”. Apabila kita berbicara tentang para mufassirr, tidak lengkap kiranya jika kita tidak mendiskusikan tentang Imam Ibnu Katsir. Kitab tafsir beliau yang terkenal, yaitu Tafsir al-Qur’an al-‘Azim, yang lebih dikenali dengan nama Tafsir Ibnu Katsir, sering menjadi rujukan dan referensi di kalangan pencinta ilmu-ilmu agama. Keberadaan kitab tafsir ini telah menempatkan tafsir ini sebagai tafsir kedua terbaik dalam aliran yang bercorak Tafsir bil Ma’tsur setelah kitab Tafsir ath-Thabari yang ditulis oleh Ibnu Jarir al-Thabari. Akan tetapi, keahlian beliau sebagai seorang qari yang menguasai ilmu qiraat jarang sekali disinggung dalam penulisan-penulisan mengenai beliau. Padahal, beliau sering memasukkan perbahasan tentang qiraat dalam tafsir beliau. Maka, pada penelitian ini akan dikaji bagaimana metode Imam Ibnu Katsir dalam mengungkap perbedaan qiraat, dan bagaimana cara beliau menyelesaikannya. Setelah melakukan pengkajian terhadap tafsir beliau, maka disimpulkan bahwa Metode Imam Ibnu Katsir dalam mengungkapkan perbedaan qiraat, yakni dengan cara memulai dengan menyebutkan qiraat yang biasa dibaca oleh jumhur. Kemudian beliau menerangkan tentang adanya qiraat lain dengan membawa periwayatan tentang qiraat tersebut. Sekiranya bacaan qiraat itu adalah sahih, baliau menerangkan alasan tentang bacaan qiraat tersebut dari segi nahu. Sekiranya bacaan tersebut syaz, beliau menerangkannya dan menolak riwayat tersebut. Namun, beliau jarang memberi pendapat sendiri tentang manakah qiraat yang lebih utama, sebaliknya, hanya mencukupkan dengan menyampaikan pandangan mufassir terdahulu atau para sahabat dan tabi’in. Metode Imam Ibnu Katsir dalam menyelesaikan perbedaan qiraat adalah dengan cara merujuk kepada ayat-ayat lain yang beredaksi sama, sunnah, pendapat sahabat dan pendapat tabi’in. Sehingga penafsiran tersebut tidak menyalahi maknanya

Dysphagia caused by an aberrant right subclavian artery

An aberrant right subclavian artery is the commonest aortic arch anomaly. Majority of them were asymptom- atic. An aberrant subclavian artery is a rare cause of dysphagia in adults. This condition is also known as dys- phagia lusoria. We report a case of dysphagia in a 49-year-old woman from an aberrant right subclavian artery. Diagnosis of her condition was made with barium swallow and MDCT (multidetector computed tomography) scan. She was managed conservatively

Magnetically plucked piezoelectric energy harvester via hybrid kinetic motion

Piezoelectric energy harvesting is a possible breakthrough to reduce the global issue of electronic waste as they can efficiently convert the ambient vibration to the electrical energy without any additional power. This work presents the design and development of a piezoelectric energy harvester that is capable of transforming vibration from ambient sources into electricity. It focuses on a magnetically plucked piezoelectric beam as an alternative to the mechanically induced harvesters, as the latter are subjected to wear and tear. A prototype comprising of a 40 mm PZT-5H piezoelectric beam with a permanent magnet mounted at one end of the beam, as well as a series of permanent magnets of same types attached on an eccentric rotor was developed along with a National Instruments® data acquisition device. Mean output voltages of 2.98 V, 1.76 V and 0.34 V were recorded when the eccentric rotors were slowly rotated at 8.4 rad/s with increasing distances of 5 mm, 7.5 mm and 10 mm respectively, between the magnets on the rotor and the beam. These results have proven that voltage could also be generated by magnetically plucking the piezoelectric beam, and by reducing the distance between magnets, the amount of voltage generated will be higher. The outcome of this work signifies the possibility for implementation of energy harvesters that are capable of powering electronic devices from hybrid kinetic motion, with a reduced risk of equipment fatigue. © 2019, International Islamic University Malaysia-IIUM

The utility of biomarker excretion rates in acute kidney injury

INTRODUCTION: The concentration of urinary biomarkers of acute kidney injury (AKI) is influenced by variation in urinary concentration within and between individuals.1 Normalisation to urine creatinine concentration is commonly used to account for this variation.2 The accuracy of this method is compromised by tubular secretion of creatinine, and variations in urine creatinine excretion in non-steady state when glomerular filtration rate (GFR) changes.1 Alternatives to normalisation to creatinine include using the absolute biomarker concentration or quantifying the biomarker excretion rate. Intuitively, the excretion rate may also account for variation in water reabsorption and urine flow rate. In addition, total biomarker excretion in AKI might more accurately reflect the mass of injured tubular cells, a function of both severity and duration, parameters associated with long-term mortality.3 OBJECTIVE: To compare the performance of biomarker excretion rate and the absolute and normalized biomarker concentration in diagnosis of AKI, prediction of AKI, death and the need for renal replacement therapy (RRT) in adult intensive care patients. This will assists in the comparison of biomarkers between trials and guide clinicians on how it should be utilized in clinical practice. METHODS: Urinary concentrations of alkaline phosphatase (AP), γ-glutamyl transpeptidase (GGT), cystatin C (CysC), neutrophil gelatinase-associated-lipocalin (NGAL), kidney-injury molecule-1 (KIM 1), and interleukin-18(IL-18) were measured on ICU admission, at 12 and 24 hours in the EARLYARF trial.4, 5 The average urine flow rate was calculated from 4-hour creatinine clearance measurements obtained at the same time points, which allowed calculation of biomarker excretion rate. The normalised biomarker concentrations were derived by dividing the biomarker concentration by the urinary creatinine concentration. The total excretion over 24 hours for each biomarker (i.e. integration of excretion rate with respect to time) was determined using the trapezoidal rule. The performance of absolute and normalised biomarker concentration, and biomarker excretion rate on admission to the ICU in diagnosis or prediction of outcome was assessed by comparison of the area under the curve (AUC) of receiver-operator characteristic curves (ROC) for each parameter using the DeLong method.6, 7 The association of total biomarker excretion with AKI severity (maximum AKIN stages within 48 hours), and 1-year survival were assessed with one-way ANOVA and Kaplan Meier survival analysis. RESULTS: Of 528 recruited patients, 484 had 4h-creatinine clearance measurements on ICU admission from which urine output volumes could be obtained for the calculation of biomarker excretion rates. For diagnosis of AKI on ICU admission, biomarker concentration performed better than normalised concentration or excretion rate. Normalised concentrations performed best in prediction of 7-day mortality and the need of RRT. Excretion rate did not diagnose or predict outcomes better than absolute or normalised concentration. In the cohort of patients without AKI on ICU admission (n=339), there were no differences in performance between absolute and normalised biomarker concentration in prediction of development of AKI within 48 hours (AKIN48) or sustained AKI within 7 days of admission (RIFLE 24). However, here also the normalised concentrations had higher AUCs than excretion rates (Figure 1). The total biomarker excretion in the first 24 hours increased with severity of injury for all biomarkers except AP. For NGAL alone, post-hoc analysis also demonstrated significant differences between successive AKIN stages of increasing severity AKI (p≤0.02) (Figure 2). Patient survival was assessed according to extent of biomarker excretion ranked by tertiles Only NGAL demonstrated a significant association between total excretion and survival over 365 days (log-rank test, p=0.04). After adjusting for age, gender, sepsis, APACHE II and SOFA scores, patients with higher excretion of NGAL (higher tertile, total excretion >184µg) had a higher 1-year mortality compared to those with a lower tertile of NGAL excretion (total excretion of <40µg) (Hazard ratio of 2.15 (95% CI: 1.23 to 3.73), p=0.007) (Figure 3). . CONCLUSIONS: Normalisation to urine creatinine provides no advantage in diagnosis of AKI, but improves prediction of AKI and outcome. Periodic excretion rates did not improve performance, but total excretion in the first 24hr was strongly associated with AKI severity, and for NGAL with survival. The ideal method for standardizing urinary AKI biomarkers depends on the outcome being assessed

Design and hardware implementation of conditioning circuit for accurate reading from transducers with nonlinear responses

This chapter is about design and hardware implementation of a signal conditioning circuit that has the ability to read the output response of a non-linear sensor and produce corresponding linear results. This design is based on piecewise linearization technique. First the non-linear output of the sensor's curve divided into the linear segment each segment is identified by its corresponding slope. A couple of comparators has used for selecting the individual line segment (voltage range) and then by the help of instrumentation amplifier circuit the input voltage interpret into desired output voltage. The simulation of the whole circuit is done in order to make everything easy to understand and visible