Ultrasound findings of plasma leakage as imaging adjunct in clinical management of dengue fever without warning signs

@#ed as outpatients. Ultrasonographyevidence of plasma leakage either pleural effusion,thickened gallbladder wall, ascites or pericardial effusionwere compared with clinical findings and laboratoryparameters for plasma leakage. Results: Of the 83 dengue patients, eventually 72.3% haddengue fever with warning signs and 6.0% had severedengue fever. There were 38 patients who had subclinicalplasma leakage at initial presentation, 84.2% and 7.9% ofthem then progressed to dengue fever with warning signsand severe dengue respectively. There was a minimalagreement between serial bedside ultrasound andhaematocrit level in the detection of plasma leakage(observed kappa 0.135). Conclusions: Serial bedside ultrasound is an adjunctprocedure to physical examination and may detect plasmaleakage earlier compared to haemoconcentration. The earlyusage of serial ultrasound is of paramount importance indetecting dengue patients who are at risk of progressing tosevere dengue.

Pre-Hospital Factors Influencing Time of Arrival at Emergency Departments for Patients with Acute ST-Elevation Myocardial Infarction

@#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 symptomto- 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.