Displaying publications 361 - 380 of 1147 in total

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  1. 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.
  2. Zolkefli Y
    Malays J Med Sci, 2018 May;25(3):135-139.
    PMID: 30899195 DOI: 10.21315/mjms2018.25.3.14
    Can a lie be justified if it saves a human life or a community, or if another great evil is avoided? The article proposes that health professionals need not always tell the truth, depending on situation; but, this does not refute the significance of telling the truth. It also elucidates the value of telling the truth, and the challenges for telling the whole truth. Two prominent theories of ethics, Deontological and Consequentialism are deliberated, together with the integration of examples to illustrate main areas of interest.
  3. Tewari R, Chopra D, Wazahat R, Dhingra S, Dudeja M
    Malays J Med Sci, 2018 May;25(3):129-134.
    PMID: 30899194 DOI: 10.21315/mjms2018.25.3.13
    Multidrug-resistant (MDR) Acinetobacter baumannii (A. baumannii) bacterium, a nosocomial pathogen associated with a high mortality rate and limited therapeutic options have emerged as a serious problem throughout the world. The present study aimed to assess the current levels of antibiotic susceptibility among the isolates of Acinetobacter species. The sensitivity patterns were analysed from various clinical specimens obtained from both in-patients and outpatients of a teaching hospital. Isolation was performed on 5% sheep blood agar and MacConkey agar. Urine samples were inoculated into CLED agar. Antibiotic susceptibility was performed by the disc diffusion method. A total of 16,452 samples were collected. The total number of samples positive for Acinetobacter species was 67 (0.4%). The highest number of isolates 26 (38.8%) were obtained from urine. Majority 80.3% of the isolates exhibited resistance to three or more classes of antibiotics. All isolates were susceptible to colistin (100%). The susceptibility rate of A. baumannii isolates was 80% for tigecycline and 53.3% for carbapenem. Combination therapies including colistin and tigecycline seem to be the rational treatment for MDR A. baumannii until new alternatives come forward.
  4. Azmoude E, Aradmehr M, Dehghani F
    Malays J Med Sci, 2018 May;25(3):120-128.
    PMID: 30899193 DOI: 10.21315/mjms2018.25.3.12
    Objectives: Midwives have a crucial role in providing optimal care for pregnant women. One of the most important policies for quality improvement in maternity care is implementation of evidence-based practice. However, the application of evidence-based practice within the maternity health care setting faces many challenges. The purpose of this study was to describe Iranian midwives' attitude and perceived barriers of evidence based practice in maternity care.

    Methods: In this descriptive, cross-sectional study, a census sample of 76 midwives from two public hospitals and urban health centers in Torbat Heydariyeh, a city east of Iran were surveyed. Data collection tools were two reliable and valid questionnaires that measure midwives' attitudes and barriers of implementation of evidence-based practice. Data were analysed using SPSS version 16.

    Results: The mean age and years of experience were 29.30 ± 4.86 and 5.22 ± 4.21 years, respectively. The mean score of attitude was 40.85 ± 4.84 (range = 30-60). This study also found time constraints (2.70 ± 0.92), inadequate facilities (2.64 ± 0.72), non-compilation of literature in one place (2.59 ± 0.92), lack of cooperation of physicians (2.48 ± 1.06) and the feeling of inadequate authority (2.45 ± 0.88) as the top five barriers to implementing EBP.

    Conclusion: Survey participants demonstrated a positive attitude toward EBP. Organisational comprehensive strategies such as time efficiency, adequate material and human resources, familiarity with organisations such as the Cochrane Collaboration and managerial support for increasing professional legitimate authority are recommended to promote the use of Evidence-Based Practice in Iran.

  5. Baharuddin IH, Arifin WN, Kueh YC, Rahman NA
    Malays J Med Sci, 2018 May;25(3):111-119.
    PMID: 30899192 DOI: 10.21315/mjms2018.25.3.11
    Background: Many questionnaires have been developed to measure dental anxiety and fear. Among them is the Index of Dental Anxiety and Fear Scale (IDAF-4C+), which consists of a dental anxiety and fear module (IDAF-4C), a phobia module (IDAF-P) and a stimulus module (IDAF-S). The objective of this research was to report the adaptation and validation of the IDAF-4C+ for Malaysian secondary school children.

    Methods: This was a cross-sectional validation study. The original English version of the IDAF-4C+ was translated into Malay, back-translated, and then sent for content validation via an expert validation and face validation by the target student population. Three hundred and seventy questionnaires were then distributed among 16-year-old school children. Confirmatory factor analysis (CFA) was conducted for the IDAF-4C module using a bootstrapped maximum likelihood estimator. Spearman's rank correlation was used to assess the relationship between the IDAF-S and IDAF-4C modules. Intraclass correlation (ICC) was used to determine the stability of the IDAF-S and IDAF-4C modules, while kappa values were used for the IDAF-P module.

    Results: The response rate was 86.5% for CFA and 76.9% for stability. CFA showed the existence of only one factor with a reliability estimate of 0.921, obtained via Raykov's procedure. All items in the IDAF-S module were significantly correlated with the IDAF-4C module (P < 0.001). The IDAF-S and IDAF-4C modules were stable, as determined via a two-way mixed model with absolute agreement, a single measure and a Case 3 ICC (A, 1). The IDAF-P module showed satisfactory stability, as assessed via kappa values.

    Conclusion: The Malay version of the IDAF-4C+ is valid and reliable in measuring dental anxiety and fear among Malaysian secondary school children.

  6. Yusoff N, Anuar NN, Reza MF
    Malays J Med Sci, 2018 May;25(3):103-110.
    PMID: 30899191 MyJurnal DOI: 10.21315/mjms2018.25.3.10
    Background: Sex is a psychobiological factor that is important in the process of emotion. This study determines the effect of sex on the electropsychological process of various intensities of emotional arousal.

    Methods: In the Event-related Potential (ERP) session, electroencephalographic (EEG) data was recorded for 90 participants, 60% of whom were females. The participants responded to 30 universal emotional pictures, randomly chosen from the International Affective Picture System (IAPS), which were classified as invoking high, moderate, and low intensity of emotional arousal.

    Results: From the analysis of variance of two-way mixed design, the interaction between sex and emotional intensity was observed in the occipital regions (O2), indexed by the amplitude of P300 and N200 components. Males exhibited higher amplitude of P300 and N200 components (in the occipital region) as responded to high and low emotional arousal stimuli than females.

    Conclusion: Sex is a fundamental factor that modulates psychological states in reaction to emotional stimuli.

  7. Kong CC, Kandasamy R, Haspani S, Idris Z, Abdullah JM
    Malays J Med Sci, 2018 May;25(3):88-102.
    PMID: 30899190 MyJurnal DOI: 10.21315/mjms2018.25.3.9
    Background: Meningiomas are the most common intracranial tumours; they account for 13%-26% of all the primary intracranial tumours. Skull base meningiomas make up 25% of all meningiomas and are one of the most difficult intracranial tumours to be managed surgically. This is due to the fact that it is difficult to approach the lesions which are also close to vital structures such as cranial nerves and major blood vessels. Despite the abundance of these cases in Malaysia, local data on meningiomas is scarce.

    Methods: This is a retrospective study consisting of 199 patients with meningiomas who have been operated at the Kuala Lumpur General Hospital from January 2010-December 2014. They were categorised into skull base and non-skull base groups. Demography, tumour characteristics, and patient outcomes were analysed. Kaplan-Meier survival curves as well as Cox hazard univariable and multivariable regressions for the possible predictors of survival were analysed.

    Results: 97.5% of the patients (n = 194) had WHO grade I meningioma and only five patients had WHO grade II meningioma. There was a female predominance (n = 134; 67.3%), with a male-to-female ratio of 1:2. Some 27.1 % patients had skull base meningiomas. Patients with skull base meningiomas had poorer outcomes and discharge conditions (n = 23; 42.6% P < 0.01), in addition to higher risk of incomplete resections (n = 34; 63% P < 0.01). Multivariate cox hazard regressions showed that the skull base meningioma group had four times the risk of death of the non-skull base group.

    Conclusions: Symptomatic meningiomas can be curative if the tumour is completely removed. Our study has revealed that skull base meningiomas which were operated locally had higher rates of incomplete resection and poorer surgical outcomes as compared to the non-skull base group. Patients with skull base meningiomas had four times the risk of death vis-à-vis non-skull base ones. More local studies are needed to look into skull base meningiomas for the improvement of its surgical outcomes.

  8. Chean KY, Rahim FF, Chin JS, Choi XL, Liew KW, Tan CC, et al.
    Malays J Med Sci, 2018 May;25(3):78-87.
    PMID: 30899189 MyJurnal DOI: 10.21315/mjms2018.25.3.8
    Background: Many smokers have undiagnosed chronic obstructive pulmonary disease (COPD), and yet screening for COPD is not recommended. Smokers who know that they have airflow limitation are more likely to quit smoking. This study aims to identify the prevalence and predictors of airflow limitation among smokers in primary care.
    Methods: Current smokers ≥ 40 years old who were asymptomatic clinic attendees in a primary care setting were recruited consecutively for two months. We used a two-step strategy. Step 1: participants filled in a questionnaire. Step 2: Assessment of airflow limitation using a pocket spirometer. Multiple logistic regression was utilised to determine the best risk predictors for airflow limitation.
    Results: Three hundred participants were recruited. Mean age was 58.35 (SD 10.30) years old and mean smoking history was 34.56 pack-years (SD 25.23). One in two smokers were found to have airflow limitation; the predictors were Indian ethnicity, prolonged smoking pack-year history and Lung Function Questionnaire score ≤ 18. Readiness to quit smoking and the awareness of COPD were low.
    Conclusions: The high prevalence of airflow limitation and low readiness to quit smoking imply urgency with helping smokers to quit smoking. Identifying airflow limitation as an additional motivator for smoking cessation intervention may be considered. A two-step case-finding method is potentially feasible.
    Study site: primary care clinic (outpatient clinic), Pulau Pinang, Malaysia
  9. Yun TC, Ahmad SR, Quee DKS
    Malays J Med Sci, 2018 May;25(3):56-66.
    PMID: 30899187 DOI: 10.21315/mjms2018.25.3.6
    Background: Young adults are at risk of developing obesity, especially when transitioning into university life as they become responsible for their daily eating and lifestyles. This study estimates the prevalence of overweight/obesity and explores the eating patterns and lifestyle practices of university students.

    Methods: A cross-sectional study was conducted at Universiti Brunei Darussalam (UBD). A total of 303 students participated. Data was collected from January to April 2016. Self-designed questionnaires comprised questions pertaining to current weight, self-reported height data, information on eating habits, exercise and knowledge of the food pyramid. The collected data were used to compare and contrast eating habits and lifestyle practices among overweight/obese students with those of non-overweight/obese students.

    Results: The prevalence of overweight/obesity was 28.8% (95% CI: 24.0%, 34.0%). The majority ate regular daily meals, but more than half skipped breakfast. Frequent snacking, fried food consumption at least three times per week and low intake of daily fruits and vegetables were common. The frequency of visits to fast food restaurants was significantly higher in the overweight/obese. 25.4% of the students exercised at least three times per week. Almost all students are aware of balanced nutrition and the food pyramid.

    Conclusions: Most university students had poor eating habits, although the majority had good nutrition knowledge. By way of recommendation, the university is encouraged to provide a multi-disciplinary team specialising in health promotion that includes nutrition and physical activity programmes to increase the awareness among the university students.

  10. López-Muñoz F, Povedano-Montero FJ, Chee KY, Shen WW, Fernández-Martín P, García-Pacios J, et al.
    Malays J Med Sci, 2018 May;25(3):40-55.
    PMID: 30899186 DOI: 10.21315/mjms2018.25.3.5
    Objective: We carried out a bibliometric study on the scientific papers related to second-generation antipsychotic drugs (SGAs) in Malaysia.

    Methods: With the SCOPUS database, we selected those documents made in Malaysia whose title included descriptors related to SGAs. We applied bibliometric indicators of production and dispersion, as Price's law and Bradford's law, respectively. We also calculated the participation index of the different countries. The bibliometric data were also been correlated with some social and health data from Malaysia (total per capita expenditure on health and gross domestic expenditure on R&D).

    Results: We found 105 original documents published between 2004 and 2016. Our results fulfilled Price's law, with scientific production on SGAs showing exponential growth (r = 0.401, vs. r = 0.260 after linear adjustment). The drugs most studied are olanzapine (9 documents), clozapine (7), and risperidone (7). Division into Bradford zones yields a nucleus occupied by the Medical Journal of Malaysia, Singapore Medical Journal, Australian and New Zealand Journal of Psychiatry, and Pharmacogenomics. Totally, 63 different journals were used, but only one in the top four journals had an impact factor being greater than 3.

    Conclusion: The publications on SGAs in Malaysia have undergone exponential growth, without evidence a saturation point.

  11. Lah MHC, Reza F, Begum T, Abdullah JM
    Malays J Med Sci, 2018 May;25(3):27-39.
    PMID: 30899185 MyJurnal DOI: 10.21315/mjms2018.25.3.4
    Background: Previous studies from animal models have shown that pre-synaptic NMDA receptors (preNMDARs) are present in the cortex, but the role of inhibition mediated by preNMDARs during epileptogenesis remains unclear. In this study, we wanted to observe the changes in GABAergic inhibition through preNMDARs in sensory-motor and visual cortical pyramidal neurons after pilocarpine-induced status epilepticus.

    Methods: Using a pilocarpine-induced epileptic mouse model, sensory-motor and visual cortical slices were prepared, and the whole-cell patch clamp technique was used to record spontaneous inhibitory post-synaptic currents (sIPSCs).

    Results: The primary finding was that the mean amplitude of sIPSC from the sensory-motor cortex increased significantly in epileptic mice when the recording pipette contained MK-801 compared to control mice, whereas the mean sIPSC frequency was not significantly different, indicating that post-synaptic mechanisms are involved. However, there was no significant pre-synaptic inhibition through preNMDARs in the acute brain slices from pilocarpine-induced epileptic mice.

    Conclusion: In the acute case of epilepsy, a compensatory mechanism of post-synaptic inhibition, possibly from ambient GABA, was observed through changes in the amplitude without significant changes in the frequency of sIPSC compared to control mice. The role of preNMDAR-mediated inhibition in epileptogenesis during the chronic condition or in the juvenile stage warrants further investigation.

  12. Wanandi SI, Ningsih SS, Asikin H, Hosea R, Neolaka GMG
    Malays J Med Sci, 2018 May;25(3):7-16.
    PMID: 30899183 DOI: 10.21315/mjms2018.25.3.2
    The growth of tumour cells is closely related to cancer-associated fibroblasts (CAFs) present within their microenvironment. CAFs, the most abundant cells in tumour stroma, secrete growth factors that play pivotal roles in tumour cell proliferation, metabolism, angiogenesis and metastasis. Tumour cells adapt to rapid environmental changes from normoxia to hypoxia through metabolic interplay with CAFs. In this mini review, we discuss the role of lactate dehydrogenases (LDHs) and monocarboxylate transporters (MCTs) on the metabolic interplay between tumour cells and CAFs under hypoxia compared to normoxia. The LDHs catalyse the interchange of lactate and pyruvate, whereas MCTs facilitate the influx and efflux of monocarboxylates, especially lactate and pyruvate. To sum up, tumour cells switch their metabolic state between glycolysis and oxidative phosphorylation through metabolic interplay with CAFs, which exhibit the Warburg effect under hypoxia and reverse Warburg effect under normoxia.
  13. Hoe TW
    Malays J Med Sci, 2018 May;25(3):1-6.
    PMID: 30899182 DOI: 10.21315/mjms2018.25.3.1
    The use of serious games as digital medicine started in recent years as the United States Food and Drug Administration granted Class 1 or 2 device clearance to serious games or game-like technologies. This encouraging trend motivates interdisciplinary cooperation between experts in the medical sciences and the game industry because the Northern American pharmaceutical revenues have exceeded USD1 trillion globally since 2014. The potential of this lucrative business opportunity may attract fund providers and venture capitalists to support game-related research and development projects. The author elaborates his activities and experiences in the United States in FY2017/2018 as a Humphrey fellow from Malaysia. Specifically, the research and development trend of serious games for cognitive function in the academic and the game industry has positive impact on how medical doctors and practitioners in low- and middle-income countries may use or develop games as digital medicine.
  14. Latif WA, Ggha S
    Malays J Med Sci, 2019 Jan;26(1):147-156.
    PMID: 30914902 DOI: 10.21315/mjms2019.26.1.14
    Psychiatric disorders are prevalent throughout the world and causes heavy burden on mankind. Alone in US, billions of dollars are used for treatment purposes annually. Although advances in treatment strategies had witnessed recently, however the efficacy and overall outcome weren't quite promising. In neurobehavioural sciences, old problems survive through ages and with psychiatric disease, the phenomenon turns intensely complex. While our understanding of brain is mostly based on concepts of particle physics, its functions largely follow the principles of quantum mechanics. The current therapeutics relies on understanding of brain as a material entity that turns to be one of the chief reasons for the unsatisfactory therapeutic outcomes. Collectively, as mankind we are suffering huge loss due to the least effective treatment strategies. Even though we just begin to understand about how brain works, we also do not know much about quantum mechanics and how subatomic particles behave with quantum properties. Though it is apparent that quantum properties like particle and wave function duality coincides with the fundamental aspects of brain and mind duality, thus must share some common basis. Here in this article, an opinion is set that quantum mechanics in association with brain and more specifically psychiatry may take us towards a better understanding about brain, behaviour and how we approach towards treatment.
  15. Kuan G, Abdullah N, Kueh YC, Ismail M, Shafei MN, Morris T
    Malays J Med Sci, 2019 Jan;26(1):138-146.
    PMID: 30914901 MyJurnal DOI: 10.21315/mjms2019.26.1.13
    Background: The purpose of the study was to compare the motives for participating in physical activity (PA) through the different types of co-curricular activities chosen by health sciences undergraduate students at Universiti Sains Malaysia (USM), Malaysia.

    Methods: The participants were university students at USM's Health Campus, who were invited to volunteer and complete two measures: a demographic form, including the types of co-curricular activities in which the students chose to enrol (sports, uniform and art), and the Physical Activity and Leisure Motivation Scale (PALMS).

    Results: A total of 588 university students (female = 79.1%, male = 20.9%) with a mean age of 19.77 (SD = 1.39) participated in the study. The results showed significant differences in the motives of affiliation (P < 0.001), appearance (P = 0.008) and physical condition (P = 0.010) across the types of co-curricular activities in which the students participated. The students who enrolled in sports generally showed higher motives of affiliation, appearance and physical condition for participating in PA than other types of co-curricular activities.

    Conclusion: The study findings can provide further insights into the motives for participating in PA among health sciences students and encouragement for students to integrate PA into their daily routines.

  16. Idris IB, Barlow J, Dolan A, Surat S
    Malays J Med Sci, 2021 Feb;28(1):125.
    PMID: 30914900 MyJurnal DOI: 10.21315/mjms2021.28.1.18
    [This retracts the article DOI: 10.21315/mjms2019.26.1.12.].
  17. Chai S, Kueh YC, Yaacob NM, Kuan G
    Malays J Med Sci, 2019 Jan;26(1):115-124.
    PMID: 30914899 MyJurnal DOI: 10.21315/mjms2019.26.1.11
    Background: Understanding the individual aspirations of exercise participation is important for promoting physical activity. However, there is a lack of evidence to validate a measurement instrument for exercise-based goal content among Malaysian populations. The purpose of this study was to determine the validity and reliability of the Malay version of the Goal Content in Exercise Questionnaire (GCEQ) for a sample of Malaysian undergraduates.

    Methods: The original English version of the GCEQ underwent forward and backward translation into the Malay language. A cross-sectional study was conducted. The finalised Malay version was administered to 674 undergraduate students at the Health Campus of the Universiti Sains Malaysia (USM) with a mean age of 20.27 years (SD = 1.35 years). Confirmatory factor analysis (CFA) was conducted for the psychometric evaluation.

    Results: The measurement model consisted of 20 observed items and five latent factors. CFA demonstrated adequate fit to the data: comparative fit index = 0.929; standardised root mean square residual = 0.052; root mean square error of approximation = 0.061 (90% CI = 0.056, 0.067). The composite reliability coefficients for the five latent factors ranged from 0.777 to 0.851. All the correlations between the factors were less than 0.85, so discriminant validity was achieved.

    Conclusion: The findings suggested that the Malay version of the GCEQ is valid and reliable for assessing goal content in the exercise context of undergraduates at the Health Campus, USM.

  18. Hitam SAS, Hassan SA, Maning N
    Malays J Med Sci, 2019 Jan;26(1):107-114.
    PMID: 30914898 MyJurnal DOI: 10.21315/mjms2019.26.1.10
    Background: Foot infection is a major complication of diabetes mellitus (DM) and its agents are usually polymicrobial. This study aims to describe the agent and determine the association between polymicrobial infections and the severity of diabetic foot infections (DFI) and their outcomes.

    Methods: This retrospective cohort study was conducted during one year and it involved 104 patients. Their records were reviewed and assessed. The causative agents and its sensitivity pattern were noted. The results were presented as descriptive statistic and analysed.

    Results: A total of 133 microorganisms were isolated with 1.28 microorganisms per lesion. The microorganism isolated were 62% (n = 83) GN (Gram-negative) and 38% (n = 50) GP (Gram-positive). GN microorganisms include Pseudomonas spp (28%), Proteus spp (11%), Klebsiella spp (8%) and E. coli (4%). Staphylococcus aureus (54%) was predominant among GP, followed by Group B Streptococci (26%) and Enterococcus spp (6%). Thirty patients (28.8%) had polymicrobial infections. The association between the quantity of microorganisms and severity of DFI was significant. Among severe DFI cases, 77.8% with polymicrobial microorganisms underwent amputation compared to 33.3% with monomicrobial infection.

    Conclusion: GN microorganisms were predominantly isolated from DFIs and remained sensitive to widely used agents. Polymicrobial infections were associated with DFI severity.
  19. Khuna L, Mato L, Amatachaya P, Thaweewannakij T, Amatachaya S
    Malays J Med Sci, 2019 Jan;26(1):99-106.
    PMID: 30914897 DOI: 10.21315/mjms2019.26.1.9
    Background: Decreased rehabilitation time may increase the need for walking devices at the time of discharge to promote levels of independence among ambulatory individuals with spinal cord injury (SCI). However, using walking devices could create adverse effects on patients. This study explores the proportion of walking devices used, potential for walking progression, and associated factors among ambulatory individuals with SCI.

    Methods: Fifty-seven participants were assessed for their demographics and functional ability relating to the requirement for walking devices, including the Timed Up and Go Test (TUGT) and lower limb loading during sit-to-stand (LLL-STS).

    Results: Thirty-five participants (61%) used a walking device, particularly a standard walker, for daily walking. More than half of them (n = 23, 66%) had potential of walking progression (i.e., safely walk with a less-support device than the usual one). The ability of walking progression was significantly associated with a mild severity of injury, increased lower-limb muscle strength, decreased time to complete the TUGT, and, in particular, increased LLL-STS.

    Conclusion: A large proportion of ambulatory individuals with SCI have the potential for walking progression, which may increase their level of independence and minimise the appearance of disability. Strategies to promote LLL-STS are important for this progression.

  20. Lim SC, Rahman A, Yaacob NM
    Malays J Med Sci, 2019 Jan;26(1):87-98.
    PMID: 30914896 MyJurnal DOI: 10.21315/mjms2019.26.1.8
    Background: Pre-hospital delay is currently a major factor limiting early reperfusion among ST-elevation myocardial infarction (STEMI) patients worldwide. This study aims to determine pre-hospital factors affecting symptom-to-door time among STEMI patients in Malaysia.

    Methods: This cross-sectional study included 222 STEMI patients admitted to two tertiary hospitals in Malaysia. By determining symptom-to-door time, the study population was categorised into two definitive treatment seeking groups: early (≤ 3 h) and delayed (> 3 h). Data was collected focusing on socio-demographical data, risk factors and comorbidities, clinical presentation, situational factors and action taken by patients.

    Results: The mean age of our patients was 58.0 (SD = 11.9) years old, and the population consisted of 186 (83.8%) males and 36 (16.2%) females. Our study found that the median symptom-to-door time was 130.5 (IQR 240) min, with 64% of subjects arriving early and 36% arriving late. Pre-hospital delays were found to be significant among females (adj OR = 2.42; 95% CI: 1.02, 5.76; P = 0.046), patients with recurrence of similar clinical presentations (adj OR = 2.74; 95% CI: 1.37, 5.46; P = 0.004), patients experiencing atypical symptoms (adj OR = 2.64; 95% CI: 1.11, 6.31; P = 0.029) and patients who chose to have their first medical contact (FMC) for their symptoms with a general practitioner (adj OR = 2.80; 95% CI: 1.20, 6.56; P = 0.018). However, patients with hyperlipidaemia (adj OR = 0.46; 95% CI: 0.23, 0.93; P = 0.030), self-perceived cardiac symptoms (adj OR = 0.36; 95% CI: 0.17, 0.73; P = 0.005) and symptoms that began in public places (adj OR = 0.21; 95% CI: 0.06, 0.69; P = 0.010) tended to seek treatment earlier.

    Conclusion: The symptom-to-door time among the Malaysian population is shorter in comparison to other developing countries. Nevertheless, identified, modifiable pre-hospital factors can be addressed to further shorten symptom-to-door time among STEMI patients.

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