Displaying publications 41 - 60 of 358 in total

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  1. Rashizal Sazli MR, Syed Mohamed AF, Wan Mazuan WM, Ling SM, Mahmud A, Amin Nordin S
    Med J Malaysia, 2017 04;72(2):100-105.
    PMID: 28473672 MyJurnal
    INTRODUCTION: The increasing trend of extensively drugresistant gram negative bacteria responsible for nosocomial infections has prompted resurgence colistin usage. Colistin-induced nephrotoxicity is a concern with disparity in the reported rates between previous studies. This study aims to evaluate colistin-induced nephrotoxicity among Malaysian population.

    METHODS: The medical records of ICU patients receiving colistin therapy in Hospital Serdang and Hospital Sungai Buloh from 2010 to 2012 were retrospectively reviewed. Demographics data, treatment characteristic as well as culture result and creatinine level were documented. Nephrotoxicity was determined based on RIFLE criteria.

    RESULTS: A total of 100 patients were included. Median daily dose, cumulative dose and duration of colistin therapy were 3.0 MIU (IQR: 4, range 1-12), 17.8 MIU (IQR: 31.5, range 2-180) and seven days (IQR: 4, range 1-30). Nephrotoxicity was found in 23% of the study population. All cases were reversible but marginally associated with higher mortality. No statistical association exist between age, gender and race as well as administration routes with nephrotoxicity by univariable analysis. The association of dose and duration with nephrotoxicity was also not significant by univariable analysis. After adjustment for confounders, statistical association between the independent variables and dependent variable remains not significant.

    CONCLUSION: Lower dose and shorter duration in local settings contribute to lack of association between colistin therapy and nephrotoxicity in this study. Higher dosing regimen with loading dose application has been introduced in the latest National Antibiotic Guideline. Further evaluation of colistin-induced nephrotoxicity and potential risk factors is therefore warranted.

    Matched MeSH terms: Intensive Care Units/statistics & numerical data*
  2. Loganathan T, Mohamed PY
    Med J Malaysia, 2018 10;73(5):340-341.
    PMID: 30350821 MyJurnal
    In November 2016, a 28-year-old Malay man presented to the emergency department in respiratory distress, with a history of fever and sore throat. A clinical diagnosis of acute diphtheria was made and the patient was isolated and ventilated in the intensive care unit, and received diphtheria antitoxin and intravenous antibiotics. Initial laboratory findings failed to confirm diphtheria, leading to discontinuation of antibiotics and quarantine. Public health measures were reinstated after a reference laboratory cultured Corynebacterium diphtheriae. Although there was no contact with ill persons, investigation revealed incomplete immunisation history, and injection of high dose steroids prior to onset of symptoms.
    Matched MeSH terms: Intensive Care Units
  3. Wan Asyraf WZ, Ah Khan YK, Chung LW, Kee HF, Irene L, Ang CL, et al.
    Med J Malaysia, 2020 05;75(3):311-313.
    PMID: 32467554
    On the 18th of March 2020, the Malaysia government declared a movement control order (MCO) due to the unprecedented COVID-19 pandemic. Although the majority of patients presented with respiratory-related symptoms, COVID-19 patients may present atypically with neurological manifestations and may even have an increased risk of stroke. The Malaysia Stroke Council is concerned regarding the level of care given to stroke patients during this pandemic. During the recent National Stroke Workflow Steering Committee meeting, a guide was made based on the currently available evidences to assist Malaysian physicians providing acute stroke care in the hospital setting in order to provide the best stroke care while maintaining their own safety. The guide comprises of prehospital stroke awareness, hyperacute stroke care, stroke care unit and intensive care unit admission, post-stroke rehabilitation and secondary prevention practice. We urge continuous initiative to provide the best stroke care possible and ensure adequate safety for both patients and the stroke care team.
    Matched MeSH terms: Intensive Care Units
  4. Adam BA, Liam CK, Abdul Wahab AS
    Med J Malaysia, 1989 Jun;44(2):134-9.
    PMID: 2626120
    A scoring system based on therapeutic intervention on critically ill patients called the therapeutic intervention scoring system (TISS) was used to assess the quantity of care provided in a medical intensive care unit. Besides observing the unit census, the severity of illness and the work load were studied. The survival rate was 77 percent. The non-survivors had admission TISS points higher than the survivors and their mean daily TISS was more than 20 points. The survivors at discharge had a mean TISS of five points. The work load showed that a nurse can effectively manage two patients who together may accumulate 24 TISS points per day. TISS points per patient rather than bed occupancy is a better indicator of the nurse's work load. Admission criteria and procedures before death certification are outlined.
    Comment in: Delilkan AE. Therapeutic intervention scoring system in medical intensive care. Med J Malaysia. 1989 Dec;44(4):361-2
    Matched MeSH terms: Intensive Care Units/manpower; Intensive Care Units/standards*
  5. Mirza FT, Saaudi N, Noor N
    Med J Malaysia, 2024 Mar;79(Suppl 1):40-46.
    PMID: 38555884
    INTRODUCTION: Early mobilization and rehabilitation of critically ill patients in the Intensive care unit (ICU) is a topic of growing interest. Current evidence suggests that early mobilization is safe, feasible, and effective at reducing the incidence of ICU-acquired weakness. However, early mobilization is still not the standard of care in most ICUs worldwide. The aim of the study was to determine the level of knowledge, perceptions, and practice among ICU physiotherapists of early mobilization in critically ill ICU patients in Malaysia.

    MATERIALS AND METHODS: A cross-sectional study was undertaken in 45 public, teaching, and private hospitals in Malaysia that provide ≥ 10 beds in their ICUs. Knowledge, perceived barriers, facilitators, and practice of early mobilization were assessed using a previously validated mobility survey questionnaire.

    RESULTS: Only 35% of ICU physiotherapists reported receiving training/courses on early mobilization in the ICU. 100 (86%) physiotherapists underestimated the incidence of ICU-acquired weakness, and 88 (75%) were unfamiliar with the current literature on early mobilization in the ICU. The need for physician orders before mobilization, medical instability, excessive sedation, and risk of dislodgement of devices or lines were the most common barriers to early mobilization. Nearly half (49 [42%]) of the respondents reported physiotherapist as early mobilization clinical champion in their setting, but the most common physiotherapy treatment techniques in the ICU reported by the respondents' were still chest physiotherapy, range of motion exercises, and bed mobility.

    CONCLUSION: We observed strong enthusiasm for early mobilization among Malaysian physiotherapists. Most respondents believed that early mobilization is important and beneficial to ICU patients. However, there is still a big gap in knowledge and training of early mobilization in ICU patients among Malaysian physiotherapists.

    Matched MeSH terms: Intensive Care Units
  6. Bakar N, Abdullah SS, Sohor NA
    Med J Malaysia, 2024 Mar;79(Suppl 1):29-33.
    PMID: 38555882
    INTRODUCTION: The study's objectives are to investigate the level of knowledge, attitude, and performance (KAP) of nurses on the prevention of pressure ulcers (PUs) prevention in the intensive care (ICU) and also to identify the relationship between nurses' KAP toward the implementation of preventive measures for PUs.

    MATERIALS AND METHODS: This cross-sectional study was conducted among 60 registered nurses in the ICU at Taiping Hospital. to assess the nurses' knowledge and attitude level using the Knowledge and Attitude on prevention of PUs questionnaire. A descriptive analysis and Pearson Correlation were used to analyze the data.

    RESULT: From a total of 60 nurses 36 (60%) of nurses demonstrated a moderate level of KAP, and 17 (28%) demonstrated a high level of knowledge. They also exhibited neutral attitudes towards PUs prevention 49 (82%). The findings revealed a positive relationship between nurses' KAP toward implementing preventive measures on PUs (p=0.04; r=0.3). The findings show that nurses regularly performed the assessment of the risk factors of PUs for all hospitalized patients when performing PUs care. However, the plan for preventive nursing care was not properly reviewed.

    CONCLUSION: This study suggested that appropriate guidelines, education programs, and an environment that makes it possible to provide continuing education should be created for nurses to prevent PUs in the ICU.

    Matched MeSH terms: Intensive Care Units
  7. Neufeld VR, Hall JH, Hoo AA
    Med J Malaya, 1966 Dec;21(2):164-8.
    PMID: 4227388
    Matched MeSH terms: Intensive Care Units*
  8. Lim Say Wan, Gunendran A
    Med J Malaya, 1969 Dec;24(2):128-37.
    PMID: 4244138
    Matched MeSH terms: Intensive Care Units
  9. Nazni WA, Jeffery J, Lee HL, Lailatul AM, Chew WK, Heo CC, et al.
    Malays J Pathol, 2011 Jun;33(1):53-6.
    PMID: 21874753 MyJurnal
    A 73-year-old Chinese man was admitted to the Accident and Emergency Premorbid Ward of a local hospital in Malaysia. The patient complained of shortness of breath with cough and was in a semi-conscious state. He was later admitted to an intensive care unit (ICU) of the hospital. Six days after admission 5-6 maggots were recoverd from the nasal cavity. The maggots were identified as the third-instar larvae of Lucilia cuprina Wiedmann (Diptera: Calliphoridae) based on the morphological characteristics. This patient was classified as having nosocomial myiasis. The presence of the third instar larvae indicated that the infestation was not more than three to four days. An adult sarcophagid identified as Parasarcophaga ruficornis (Fabricius) caught in the ICU where the patient was warded provided further evidence of the potential for the nosocomial infestation.
    Matched MeSH terms: Intensive Care Units*
  10. Hanifah YA, Yusof MY
    Malays J Pathol, 1991 Jun;13(1):33-5.
    PMID: 1795559
    A total of 676 patients were admitted to the intensive care unit, University Hospital, Kuala Lumpur between January 1989 and March 1990. Fifty-one hospital-acquired infections were recorded, giving a rate of 7.6%. The most frequent site of infection was the respiratory tract (41.2%), followed by the urinary tract (27.5%). Most of the pathogens were gram-negative bacilli (71%). The three most common pathogens were Klebsiella species, Pseudomonas aeruginosa and Staphylococcus aureus.
    Matched MeSH terms: Intensive Care Units*
  11. Boo NY, Ang EBK, Neoh SH, Ang EL, Chee SC
    Malays J Pathol, 2022 Dec;44(3):443-459.
    PMID: 36591712
    OBJECTIVES: To determine the incidence, causative pathogens, morbidities, mortality, and risk factors associated with blood culture-positive early-onset sepsis (EOS, ≤72 hours of age) in symptomatic neonates admitted to the neonatal intensive care units (NICUs) of a middle-income country.

    STUDY DESIGN: Retrospective cohort study using data submitted prospectively to the Malaysian National Neonatal Registry (MNNR).

    SETTING: 44 Malaysian NICUs.

    PARTICIPANTS: All neonates born in 2015- 2020.

    RESULTS: EOS was reported in 991 neonates. The annual incidence of EOS increased from 0.46 to 0.49/1000 livebirths over the six years. The most common pathogen was Streptococcus agalactiae or Group B haemolytic streptococcus (GBS) (n=388, 39.2%), followed by Escherichia coli (E. coli) (n=80, 8.1%), Klebsiella spp (n=73, 7.4%), coagulase negative staphylococcus (CONS) (n=73, 7.4%), Pseudomonas spp (n=44, 4.4%) and methicillin-sensitive Staphylococcus aureus (n=34, 3.4%). The incidence of EOS due to GBS increased from 0.17 to 0.22/1000 livebirths. Morbidities and mortality were higher in those with EOS than without EOS. Multiple logistic regression analysis showed that Indian ethnic group, chorioamnionitis, gestation≥37weeks, female, spontaneous vaginal delivery, instrumental delivery, and surfactant therapy were significantly associated with increased risk of EOS due to GBS. Four factors were significantly associated with increased risk of non-GBS EOS (outborns, birthweight lt;1000 g, vaginal delivery, and surfactant therapy). Early continuous positive airway pressure was associated with significantly lower risk of EOS.

    CONCLUSION: The incidence of EOS showed an increasing trend in Malaysian NICUs. GBS was the most common causative pathogen. Several modifiable risk factors associated with EOS have been identified.

    Matched MeSH terms: Intensive Care Units, Neonatal
  12. Wan Hanifah W, Lee J, Quah B
    Malays J Med Sci, 2000 Jan;7(1):33-40.
    PMID: 22844213
    Nosocomial infection is a common problem in the Neonatal Intensive Care Unit (NICU) and a knowledge of the pattern of nosocomial infection will contribute greatly to the intensification of infection control measures and the development of antibiotic policies in the NICU. This study aims to compare the incidence and clinical characteristics of neonates with nosocomial infection in NICU of both Kuala Terengganu Hospital (HKT) and Universiti Sains Malaysia Hospital (HUSM). Neonates who had both clinical signs of sepsis and positive blood cultures, 48 hours after admission to NICU, from 1(st) January to 31(st) December 1998, in both hospitals were retrospectively studied. Among neonates admitted to NICU, 30 (5.4%) in HKT and 65 (3.6%) in HUSM had nosocomial infection (p = 0.07). The mean duration of hospitalisation was shorter (HUSM 37 days, HKT 49 days; p = 0.02), and the number of neonates with predisposing factors for infection is higher (HUSM 100%, HKT 73.3%; p < 0.001) in HUSM compared with HKT. There were no differences in gestation, mean age of onset of infection and mortality between both hospitals. The most common organism isolated from the blood in HKT was Klebsiella pneumoniae (33.3%), and in HUSM Klebsiella aerogenes (24.6%). Half of Klebsiella pneumoniae isolates were resistant to cephalosporins and aminoglycosides in HKT and a similar number of Klebsiella aerogenes isolates were resistant to piperacillin and aminoglycosides in HUSM. In conclusion nosocomial infection is a common problem in both hospitals. Except for more frequent predisposing factors for infection in HUSM, and a longer duration of hospital stay among neonates in HKT, the clinical characteristics of neonates with nosocomial infection in both hospitals were similar.
    Matched MeSH terms: Intensive Care Units, Neonatal
  13. Güvenir M, Otlu B, Tunc E, Aktas E, Suer K
    Malays J Med Sci, 2018 Mar;25(2):40-49.
    PMID: 30918454 DOI: 10.21315/mjms2018.25.2.5
    Background: Stenotrophomonas maltophilia is a non-fermentative gram-negative bacillus which is widely recognised as an important nosocomial pathogen causing pneumonia, blood-stream, wound and urinary tract infections, particularly in immunosuppressed patients. The aim of this study was to evaluate a nosocomial outbreak of by S. maltophilia in an intensive care unit of a tertiary hospital and evaluate unexpected multiclonality.

    Methods: A total of 11 isolates from respiratory cultures in intensive care unit of a 24 bed tertiary hospital obtained over a one months period and one isolate obtained from the nebuliser during environmental screening were investigated. The bacteria were identified by Phoenix 100 system. The clonal relatedness was evaluated by PFGE and semi-automated repetitive sequence-based PCR. Genotyping tests were repeated for 10 serial subcultures.

    Results: PFGE and DiversiLab yielded 10 genotypic profiles for 12 isolates. Four to eight different genotypes were observed from 10 subcultures of the same isolate.

    Conclusion: We conclude that, high genetic diversity and supposed multiclonal appearance of the outbreak isolates may be due to changing profiles during subcultures most probably depending on hypermutation.

    Matched MeSH terms: Intensive Care Units
  14. Omar J, Isa S, Ismail TST, Yaacob NM, Soh NAAC
    Malays J Med Sci, 2019 Jul;26(4):61-69.
    PMID: 31496894 MyJurnal DOI: 10.21315/mjms2019.26.4.7
    Background: As an early recognition of neonatal sepsis is important for triggering the initiation of treatment, this study was thus designed to assess the diagnostic performance and discrimination value of procalcitonin (PCT) in neonatal sepsis cases.

    Methods: This cross-sectional study, which was carried out at the Paediatric Intensive Care Unit of Hospital Universiti Sains Malaysia (HUSM) in Kelantan, Malaysia, had involved 60 neonates admitted for suspected sepsis. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and the area under receiver operating characteristics curve (AUC) for PCT were determined at initial presentation (0 h) as well as 12 h and 24 h after presentation in comparison to blood culture as the gold standard.

    Results: The study consisted of 27 (45.0%) male and 33 (55.0%) female neonates with a mean (SD) age of 76.8 (48.25) h. At cut-off PCT value of > 2 ng/mL, the sensitivity, specificity, PPV and NPV were 66.7%, 66.7%, 33.3% and 88.9% at 0 h. The respective parameters were 83.3%. 56.3%, 32.3% and 93.1% at 12 h and 83.3%, 52.1%, 30.3% and 92.6% at 24 h. AUC was 71.6%, 76.6% and 71.7% at 0 h, 12 h and 24 h.

    Conclusions: Diagnostic performance and discrimination values of PCT for diagnosis of neonatal sepsis varied with time of obtaining the blood samples. The PCT result at 12 h demonstrates the most optimal diagnostic performance and discrimination values.

    Matched MeSH terms: Intensive Care Units, Pediatric
  15. Shukeri WFWM, Hassan MH, Hassan WMNW, Zaini RHM
    Malays J Med Sci, 2018 Sep;25(5):158-159.
    PMID: 30914872 DOI: 10.21315/mjms2018.25.5.15
    Anastomotic leak after bariatric surgery is a rare complication with a recent prevalence ranging from 0.8% to 1.5%. The complication nevertheless can result in morbidity and even mortality. The purpose of this paper is to present a patient who suffered from an anastomotic leak presenting 2 days after laparoscopic sleeve gastrectomy in our intensive care unit. Review of the current literature regarding this complication from critical care perspective is also attempted.
    Matched MeSH terms: Intensive Care Units
  16. Mohamad N, Abd Halim NN, Ahmad R, Baharuddin KA
    Malays J Med Sci, 2009 Apr;16(2):33-7.
    PMID: 22589656 MyJurnal
    Theophylline toxicity is a life-threatening toxidrome that can present to an emergency department. To ascertain an immediate provisional diagnosis in toxicology at the emergency department is very challenging, especially when the patient presents with altered mental status, because the clinical features of several toxidromes overlap. We report a case of survival of undiagnosed theophylline toxicity that required intubation for two days in the intensive care unit. This was the first case to have been reported from our department. Accurate diagnosis of a toxidrome by gaining adequate history and conducting a thorough physical examination and early serum toxicology screening, coupled with good knowledge of toxicology, will lead to better patient outcomes.
    Matched MeSH terms: Intensive Care Units
  17. Hassan MH, Hassan WMNW, Zaini RHM, Shukeri WFWM, Abidin HZ, Eu CS
    Malays J Med Sci, 2017 Oct;24(5):83-93.
    PMID: 29386975 MyJurnal DOI: 10.21315/mjms2017.24.5.9
    Background: Normal saline (NS) is a common fluid of choice in neurosurgery and neuro-intensive care unit (ICU), but it does not contain other electrolytes and has the potential to cause hyperchloremic metabolic acidosis with prolonged infusion. These problems may be reduced with the availability of balanced fluid (BF), which becomes a more physiological isotonic solution with the presence of complete electrolyte content. This study aimed to compare the changes in electrolytes and acid-base between NS and BF (Sterofundin® ISO) therapy for post-operative severe traumatic brain injury (TBI) patients in neuro-ICU.

    Methods: Sixty-six severe TBI patients who required emergency craniotomy or craniectomy and were planned for post-operative ventilation were randomised into NS (n = 33) and BF therapy groups (n = 33). The calculation of maintenance fluid given was based on the Holliday-Segar method. The electrolytes and acid-base parameters were assessed at an 8 h interval for 24 h. The data were analysed using repeated measures ANOVA.

    Results: The NS group showed a significant lower base excess (-3.20 versus -1.35, P = 0.049), lower bicarbonate level (22.03 versus 23.48 mmol/L, P = 0.031), and more hyperchloremia (115.12 versus 111.74 mmol/L, P < 0.001) and hypokalemia (3.36 versus 3.70 mmol/L, P < 0.001) than the BF group at 24 h of therapy. The BF group showed a significantly higher level of calcium (1.97 versus 1.79 mmol/L, P = 0.003) and magnesium (0.94 versus 0.80 mmol/L, P < 0.001) than the NS group at 24 h of fluid therapy. No significant differences were found in pH, pCO2, lactate, and sodium level.

    Conclusion: BF therapy showed better effects in maintaining higher electrolyte parameters and reducing the trend toward hyperchloremic metabolic acidosis than the NS therapy during prolonged fluid therapy for postoperative TBI patients.

    Matched MeSH terms: Intensive Care Units
  18. Hassan WMNW, Nasir YM, Zaini RHM, Shukeri WFWM
    Malays J Med Sci, 2017 Oct;24(5):73-82.
    PMID: 29386974 MyJurnal DOI: 10.21315/mjms2017.24.5.8
    Background: The choice of anaesthetic techniques is important for the outcome of traumatic brain injury (TBI) emergency surgery. The objective of this study was to compare patient outcomes for target-controlled infusion (TCI) of propofol and sevoflurane anaesthesia.

    Methods: A total of 110 severe TBI patients, aged 18-60, who underwent emergency brain surgery were randomised into Group T (TCI) (n = 55) and Group S (sevoflurane) (n = 55). Anaesthesia was maintained in Group T with propofol target plasma concentration of 3-6 μg/mL and in Group S with minimum alveolar concentration (MAC) of sevoflurane 1.0-1.5. Both groups received TCI remifentanil 2-8 ng/mL for analgesia. After the surgery, patients were managed in the intensive care unit and were followed up until discharge for the outcome parameters.

    Results: Demographic characteristics were comparable in both groups. Differences in Glasgow Outcome Scale (GOS) score at discharge were not significant between Group T and Group S (P = 0.25): the percentages of mortality (GOS 1) [27.3% versus 16.4%], vegetative and severe disability (GOS 2-3) [29.1% versus 41.8%] and good outcome (GOS 4-5) [43.6% versus 41.8%] were comparable in both groups. There were no significant differences in other outcome parameters.

    Conclusion: TCI propofol and sevoflurane anaesthesia were comparable in the outcomes of TBI patients after emergency surgery.

    Matched MeSH terms: Intensive Care Units
  19. Mahyiddin NS, Mohamed R, Jan Mohamed HJ
    MyJurnal
    Family members' satisfaction has become an important measurement in determining the quality of care of patients in the critical care setting. The aims of the study were to determine the satisfaction level of family members, to determine the reliability of family satisfaction and its subscales, to identify mean of each question and their subscales. A cross-sectional study was conducted on 30 family members who accompanied patients during intensive care admission. The study was conducted in a critical care setting in
    a high dependency unit (HDU) and cardiac intensive care unit (CCU), Hospital University Sains Malaysia (Hospital USM). The data was collected from October 2012 to January 2013. The Critical Care Family Satisfaction Survey (CCFSS) Malay version was used to measure family satisfaction in addition to the collection of demographic data. The statistical analysis used a descriptive approach. Ethical approval was obtained prior to data collection. Majority of the respondents were female: 23 (76.7%). Mean age was 35.67 years (SD=12.83) and the score of overall satisfaction level was 78.80 (SD=13.88). The Cronbach's alpha was 0.96. A majority of the respondents, 19 (63.3%) were satisfied with the care provided. This study showed that a majority of family members were slightly satisfied with the care that was provided in a critical
    care setting at HUSM. It also showed that families play an important role in giving support and hope to patients.
    Study site: HDU and CCU, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
    Matched MeSH terms: Intensive Care Units
  20. Mortell, Manfred, Khatijah L. Abdullah, Chean Ahmad, Al Mutair, Adel F.M.
    MyJurnal
    Introduction: Patient advocacy is a central concept for the profession of nursing as it assures patient rights and safety. This article presents the findings from a study which explored the perceptions of patient advocacy from Muslim ICU nurses. Methods and participants: Our study utilized a constructivist grounded theory approach. Thirteen registered intensive care nurses from an adult critical care setting in a tertiary academic teaching hospital in Riyadh, Saudi Arabia, participated in the study. The researcher employed semi-structured interviews that were digitally recorded and transcribed verbatim, with an additional data collection strategy of reflective journaling. A reflective journal was provided to all study participants following each interview. Results: The study generated codes which connected to vulnerable patients, and subsequently identified a core category of “Caring critically” which was exemplified by six additional inter-related advocacy categories of “Essential caring”; “Vulnerable-acy”; “Familial-acy”; “Cultural-acy”; “Religion-acy”; and “Human-acy”. These categories generated the model for patient advocacy. Conclusion: The pyramid of patient advocacy can be applied in clinical practice to guide Muslim nurses, in addition to being utilized in the educational setting as a standard to teach registered nurses about the role and responsibilities of a patient advocate.
    Matched MeSH terms: Intensive Care Units
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