Zakat Refund Program: a preliminary study of its implementation in PPZ MAIWP

In its efforts to improve zakat collection rates in Wilayah Persekutuan, Malaysia, Pusat Pungutan Zakat (PPZ MAIWP), has implemented an introduced a ‘Zakat Refund’ scheme in which a certain proportion of the zakat paid may be refunded to the payer for him to directly distribute to eligible asnafs. The purpose of this study is to explore the motivation and structure of the PPZ zakat refund program as well as the perception of zakat payers on its implementation. To this end, we employ qualitative approach framed within a case study methodology i.e. of the PPZ and its zakat refund participants. The data were collected through corporate documentation, brochures and semi-structured interviews either through face-to-face or email interviews. Our findings show that since the introduction of the zakat refund program, zakat collections have increased significantly, particularly from companies and high net worth individuals. Our interviews revealed that the companies are enthusiastic about carrying out zakat distribution themselves as an extension of their Corporate Social Responsibility activities. The outcome of the study inaugurates opportunities for future research in large-scale sampling and also the comparison of the zakat refund practices in other states as well as other regions if any

Anaesthetic challenges in emergency surgical repair of acute aortic dissection rupturing into the pericardium in a pregnant patient

Acute aortic dissection in pregnancy is a serious situation, because rapid and appropriate surgical decision making is required to save the life of both mother and baby. Aortic dissection is rare in young women but is likely during pregnancy (third trimester) secondary to the hyperdynamic and hypervolaemic circulatory state associated with pregnancy. A 35 years old 27 weeks pregnant patient weighing 90 kg presented in the emergency with severe chest pain. In the immediate post cardiopulmonary bypass period, the patient started bleeding profusely from the anastamotic sites irrespective of utilization of all the conventional methods of haemostasis including multiple units of whole blood, fresh frozen plasma, platelets, calcium and cryoprecipitates. As a last resort she was given low dose r FVIIa (1.2 mg containing 60 KIU of Factor VII). This stopped the bleeding and the haemodyramics were stabilized

The role of prophylactic intra-aortic balloon pump counterpulsation (IABP) in emergency non-cardiac surgery

Patients with recent myocardial infarction (MI), congestive heart failure, severe angina, or uncorrected multivessel coronary artery disease are at increased risk of cardiac complications after urgent major non-cardiac surgery. Although invasive haemodynamic monitoring and preoperative optimization of cardiac status may lead to some reduction in the rate of perioperative cardiac events, the mortality from such events still remains high. The use of an intra-aortic balloon pump (IABP) may play a role in such patients by improving the function of the injured heart. We report our experience with the use of perioperative IABP in a patient with unstable angina and recent MI who underwent urgent cholecystectomy. There were no perioperative cardiac events while the IABP was in place. The anaesthetic concerns, intraoperative and postoperative monitoring and care and usefulness of IABP will be discussed

Factors affecting reintubations after cardiac and thoracic surgeries in cardiac intensive care unit of a tertiary care hospital

Background: Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark.Methodology: A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries. The study was conducted from January to December 2016. The primary focus was to identify the reasons for reintubation within 72 h of extubation after CICU discharge and its association with outcome.Results: Out of 750 patients who shifted out from CICU following successful extubation, only 32 were readmitted and among them in 25 patients (3.33%) were reintubated and their reasons reintubation were noted. Patients underwent a coronary artery bypass grafting (CABG) with valve replacement had a higher incidence of reintubation 3/39 (7.69%) when compared with CABG 13/517 (2.51%) and 4/135 (2.96%) valve procedure alone. Single cause of endotracheal reintubation was observed in 7 patients (28%), in which 5 patients (20%) had respiratory and 2 patients had (8%) cardiac reason while 18 patients (72%) were observed with multisystem involvement, in which 7 patients (28%) had both respiratory and cardiovascular causes, and 2 (8%) had both respiratory and neurological causes. More than 70% cause of endotracheal reintubation was both respiratory and cardiovascular. The CICU stay after reintubations was 12.88 ± 16.88 days and the hospital stay prolonged to 23.84 ± 21.61 days.Conclusion: Reasons of reintubation were mainly respiratory and cardiac. The rate of reintubations is high when multisystem involvement is there. CICU, hospital stay, and mortality are increases after reintubation

Complications and interventions associated with epidural analgesia for postoperative pain relief in a tertiary care hospital.

Introduction: Epidural analgesia is one of the commonly used methods of postoperative pain control despite its associated complications. Early recognition and intervention is required to minimize the effect of these complications. Present audit was conducted to find out the incidence of complications and type of interventions required to change the outcome. MethodOLOGY: The record of all the Patients who had epidural catheter placed for postoperative pain management reviewed from the departmental acute pain management register. Parameters included level of insertion, drugs used, number of days infusion continued and complications like nausea, vomiting, motor block, sedation, dural tap, catheter pull out, hypotension and itching. In addition, the intervention done to manage these complications was also recorded. Results: Total 1706 entries of epidurals were recorded in study period 2001 to 2007. The overall incidence of the complication was 26.6%. The common complications were motor block (13.4%), dural tap (1.2%), ineffective pain control (2.4%), accidental catheter pull outs (3.8%) and problems associated with the delivery system of drug (1.7%). The 12% of Patients required intervention for the particular complications. The regime was discontinued in 28%, drug concentration changed in 21.5% while the other modes of pain management were used in 19% of Patients. 0.9% of Patients required epidural blood patch while 2% of Patients required catheterization for urinary retention. Conclusion: This audit shows the importance of regular assessment and early intervention to manage epidural related complications in improving outcome

Economic Contribution of Copyright-based Industries in Pakistan

The copyright-based industries contribute substantially to the national economy in the form of value addition, tax revenues, trade and employment. This study highlights both the core and non-core copyright-based industries in Pakistan. With the technical guidance of World Intellectual Property Organisation (WIPO) and National Institute of Cultural Studies (NICS), we conducted the first ever survey of the copyright-based industries in Pakistan. The estimates of contribution to GDP, tax revenues, trade and employment were also validated through focus group discussions and key informant interviews. Our findings reveal that copyright-based industries contributed Rs 136 billion to GDP (on 1999-2000 base year prices of Pakistan Bureau of Statistics). These industries also contributed Rs 18 billion to the government in indirect taxes. On the trade side, the exports of these industries totalled $943 million and imports amounted to$2130 million in 2007-08. In terms of job creation one of the core sub-sectors i.e. electronic media employed around 47,000 persons by the end of 2011. JEL Classification: 034, F10, E24 Keywords: Copyright, Economic Growth, Trade and Employmen

Whistle-blowing as an aspect of amar ma’aruf nahi munkar in institutional governance

A key challenge in preventing and fighting corruption is to detect and expose bribery, fraud, theft of public funds and other acts of wrongdoing. One of the most direct methods of exposing corruption in corporate or public institutions is whistleblowing. Many countries have introduced whistleblowing provisions to help deter corrupt behaviour and guide formal investigations into them. However, Muslim countries still lag far behind in this respect, perhaps out of structural inertia as well as the false belief that public disapprobation is not the way Muslims deal with one another. We argue that within reasonable limits whistleblowing is perfectly ingrained in Islam’s ‘‘amr bi-l-ma’ruf wa-nahy ‘an al-munkar” i.e., ‘enjoining good and forbidding wrong’ principle of social behaviour and is an important contributor to the society’s overall Maqasid al-Shariah. It is also interesting that while many academic studies have established the link between cultural and ethical values and whistle-blowing motivations, very few specifically study whistle-blowing within the Islamic moral philosophy framework. This paper attempts to fill this void by drawing from important Muslim writings why whistleblowing should not be downplayed and suggests several codes of conducts principles which can be useful in guiding the crafting of whistleblowing systems. An implication for modern-day managers is that by leveraging on member’s feelings of God-consciousness as well as awareness of whistleblowing obligations in religion, an organization’s internal control can be greatly strengthened

Postoperative cognitive dysfunction following general anaesthesia in patients undergoing elective non-cardiac surgery

Objective: To determine frequency of early postoperative cognitive dysfunction (POCD) in patients aged 40 to 60 years, following general anaesthesia in patients undergoing elective, non-cardiac surgery.Study design: Descriptive study.Place and duration of study: Department of Anaesthesiology, The Aga Khan University Hospital (AKUH), Karachi, from December 2015 to May 2016.Methodology: After obtaining approval from Ethical Review Committee of AKUH and informed consent, ASA I and II patients, aged between 40 to 60 years of either gender, undergoing general anaesthesia for elective non-cardiac surgical procedures, were recruited. Patients were assessed preoperatively by using mini-mental state examination (MMSE); and patients having a score equal to or greater than 23 (maximum 30) were included in the study. All patients were reassessed at 24 hours postoperatively by MMSE. Both the MMSE evaluations were performed by primary investigator on predesigned data collection form.Results: A total of 150 patients were enrolled in the study. Preoperative MMSE score ranged from 24 to 30 while postoperative MMSE score (at 24 hours) was between 25 and 30. Thus, no patient developed POCD following general anaesthesia for elective, non-cardiac surgery in this study.Conclusion: Early POCD was not found in the presently studied population of middle aged patients having elective non-cardiac surgery under general anaesthesia. Key Words: Postoperative cognitive dysfunction (POCD), General anaesthesia, Non-cardiac surgery, Mini- mental state examination

Factors influencing the use of postoperative bilevel positive airway pressure (BiPAP) in patients undergoing adult cardiac surgery: A retrospective cohort study

Background and aims: Respiratory complications are one of the biggest challenges following cardiac surgery, which can lead to hypoxia and acute respiratory failure (ARF). The aim of this study to identify the factors led to BiPAP application for postoperative respiratory complications and its effectiveness as the main outcome measures after cardiac surgery.Methods: It was a retrospective cohort study with consecutive sampling technique. A total of 335 postcardiac surgery patients medical record was reviewed who were underwent for surgery from November 1, 2018 to November 30, 2019. 265 patients were finalized for the recruitment, five patients were excluded before the final analysis. Data of 260 patients were analyzed for compiling of results.Results: The mean age was 59 years. 196 (75.4%) patients were males and females were 64 (24.6%). Mean weight was 72 kg and mean body mass index (BMI) 26.67 kg/m2 . BiPAP application was in 38 (14.6%) patients and significantly high in with high BMI, (p \u3c 0.05). There are significant associations of BiPAP application patients with COPD (p \u3c 0.05). Patients with positive fluid balance, cardiac dysfunction, and required inotropic support were significantly associated with BiPAP need (p \u3c 0.05), respectively.Conclusion: BiPAP is effective to treat ARF and other respiratory complications after adult cardiac surgeries. High BMI, atelectasis, and pneumonia are also the independent factors causing ARF. BiPAP can be a successful tool for preventing the adverse effects of postoperative pulmonary complications after cardiac surgery

Comparison between Tramadol and Pethidine in Patient Controlled Intravenous Analgesia

Objective: To compare the efficacy and side effects related to Tramadol with Pethidine in patient controlled intravenous analgesia (PCIA) after total abdominal hysterectomies. Methods: A total of 60 patients were randomized to receive either Tramadol or Pethidine by PCIA (30 in each group) after total abdominal hysterectomy. Pain assessments were recorded one hour after starting the PCIA and then at 6, 12, and 24 hours by using visual analogue scale (VAS). Nausea vomiting score and sedation score were also recorded. Good attempts, total attempts and total drug consumption was noted from PCIA pump at the end of the study period. Results: The analgesia achieved in Tramadol group was comparable to Pethidine. The incidence of nausea and vomiting was similar in both groups. Tramadol causes significantly less sedation than Pethidine (p \u3c 0.05). Mean drug consumption, total attempts and good attempts were also significantly less in Tramadol group than Pethidine group (p \u3c 0.05). Conclusion: Tramadol produces equivalent analgesia and less sedation and can be used as an alternative to Pethidine in Patient Controlled Intravenous Analgesia for postoperative pain relief after Total Abdominal Hysterectomy (TAH