Background‘Smoker’s paradox’ is a controversial phenomenon of an unexpected favourable outcome of smokers post acute myocardial infarction. There are conflicting evidences from the literature so far. We investigate for the existence of this phenomenon in our post acute myocardial infarction patients.Methods We analysed 12,442 active smokers and 10,666 never-smokers diagnosed with STEMI and NSTEMI from the Malaysian National Cardiovascular Database-Acute Coronary Syndrome (NCVD-ACS) year 2006–2013 from 18 hospitals across Malaysia. Comparisons in the baseline characteristics, clinical presentation, in-hospital treatment and short term clinical outcome were made between the two groups. To compare the clinical outcome, an extensive multivariate adjustment was made to estimate the allcause mortality risk ratios for both groups.ResultsThe active smokers were younger (smokers 53.7 years vs non-smokers 62.3 years P < 0.001) and had lower cardiovascular risk burden and other co-morbidities. STEMI is more common in smokers and intravenous thrombolysis was the main reperfusion therapy in both groups. Smokers had a higher rate of in-hsopital coronary revascularisation in NSTEMI group (21.6 % smokers vs 16.7 % non-smokers P < 0.001) but similar to non-smokers in the STEMI group. Multivariate adjusted mortality risk ratios showed significantly lower mortality risks of smokers at both in-hospital (RR 0.510 [95 % CI 0.442–0.613]) and 30-day post discharge (RR 0.534 [95 % CI 0.437–0.621]).ConclusionSmoking seems to be associated with a favourable outcome post myocardial infarction. The phenomenon of ‘smoker’s paradox’ is in fact a reality in our patients population. The definitive explanation for this unexpected protective effect of smoking remains unclear.

The five-year survival of cervical cancer patients in this study was low. The survival of those diagnosed at an advanced stage was low compared to early stages. In addition, those who underwent surgery had higher survival than those who had no surgery for primary treatment.

BACKGROUNDThe administration of evidence-based pharmacotherapy and timely primary percutaneous coronary intervention have been shown to improve outcome in ST elevation myocardial infarction (STEMI). However, implementation remains a challenge due to the limitations in facilities, expertise and funding.OBJECTIVESTo investigate adherence to guideline-based management and mortality of STEMI patients in Malaysia.DESIGNRetrospective analysis.SETTINGSSTEMI patients from 18 participating hospital across Malaysia included in the National Cardiovascular Database-Acute coronary syndrome (NCVD-ACS) registry year 2006 to 2013.PATIENTS AND METHODSPatients were categorized into four subgroups based on the year of admission (2006 to 2007, 2008 to 2009, 2010 to 2011 and 2012 to 2013). Baseline characteristics and clinical presentation, in-hospital pharmacotherapy, invasive revascularization and in-hospital/30-day mortality were analysed and compared between the subgroups.MAIN OUTCOME MEASURE(S)Rate of in-hospital catheterization/percutaneous coronary intervention.RESULTSThe registry contained data on 19 483 patients. Intravenous thrombolysis was the main reperfusion therapy. Although the overall rate of in-hospital catheterisation/PCI more than doubled over the study period, while the use of primary PCI only slowly increased from 7.6% in 2006/2007 to 13.6% in 2012/2013. The use of evidence-based oral therapies increased steadily over the years except for ACE-inhibitors and angiotensin-receptor blockers. The adjusted risk ratios (RR) for in-hospital mortality for the four sub-groups have not shown any significant improvement. The 30-day adjusted risk ratios however showed a significant albeit gradual risk reduction (RR 0.773 95% CI 0.679–0.881, P<.001).CONCLUSIONAdherence to evidence-based treatment in STEMI in Malaysia is still poor especially in terms of the rate of primary PCI. Although there is a general trend toward reduced 30-day mortality, the reduction was only slight over the study period. Drastic effort is needed to improve adherence and clinical outcomes.LIMITATIONRetrospective registry data with inter-hospital variation.

Higher education institutions (HEIs) are increasingly being held accountable for maintaining quality in their activities by governments, industry, students, and the community as a whole. Accreditation agencies formulate assessment criteria covering the entire range of HEI activities so that the quality of HEI activities can be measured. However, as the perceptions of stakeholders varies of what makes a good HEI, it is crucial to investigate their opinions about the standards set by these agencies. This study uses focus group discussions involving Omani HEI stakeholders, including students, HEI staff, and employers, to gain insights into their perceptions on the most significant standards set by Oman Academic Accreditation Authority (OAAA) in measuring the quality of HEIs. It was found that stakeholders’ views of the key standards that measure HEI quality varies. Students were in favor of the standards related to the quality of teaching and learning. Students also show a good level of awareness about employers’ priorities. Employers were more concerned about the research skills of graduates and their industry and community involvement. There was also some agreement between staff and employers on the importance of governance and management. This study provides HEIs, OAAA, and partner universities insights into stakeholder priorities and concerns.

Generalized linear models (GLMs) are used in understanding the impact of predictors on a dependent variable. The aim of this study is to fit GLMs to daily rainfall totals using potential predictors. First, the appropriate probability distributions within a specific family, the Tweedie family, were determined for daily rainfall totals from four stations of Peninsular Malaysia from 1983 to 2012. Within the Tweedie family, the Poisson Gamma (PG) distribution was found appropriate to model both components: occurrence (dry/wet days) and amount (rainfall totals on wet days) of rainfall simultaneously. Then, the PG‐GLMs were fitted to rainfall data with a sine term, a cosine term, lagged rainfall, NINO3.4 and Southern oscillation index (SOI) as predictors. Finally, the models were compared using the Likelihood ratio test and the Akaike information criterion. Initially, considering the cyclic pattern of rainfall data, models with only sine and cosine terms (the base model) were fitted. Then the lagged rainfall and climatological variables were added each time to the base model. Diagnostic QQ plots indicate that the models fit the data well. The models were fitted using the first 60% of data and validated using the remainder. The models capture the various characteristics of observed datasets reasonably well. Including single climatological variables in the model significantly improves the fit compared to the base model with lagged rainfall (except for the south‐east coastal station, Mersing), however, including both climatological predictors in the same model does not improve the model significantly. The model with SOI is only favoured for the east coastal station, Kuala Terengganu, and the model with NINO3.4 fits better to the inland and west coastal stations. The models are useful in understanding the impact of the studied climatological variables and to predict the amount and probability of rainfall.