Coronary artery disease (CAD) is the most common cause of death in the industrialized world. Obesity is one of the risk factor for developing CAD and also postoperative morbidity and mortality. However, in published articles the relationship between body mass index (BMI) and outcome of coronary artery bypass graft surgery depict conflicting results. This study evaluated the relationship between BMI and outcome of isolated coronary artery bypass graft performed in Hospital Universiti Sains Malaysia (HUSM). Cardiothoracic Unit HUSM is a referral centre for east coast of West Malaysia. Data was retrospectively collected from the medical records retrieved from the hospital record office. All patients who underwent isolated CABG in Cardiothoracic Unit, Hospital Universiti Sains Malaysia Kubang Kerian, Kelantan from November 2001 till October 2004 were identified and their demographic and clinical data were collected. Patients were divided into non overweight (BMI= or <25 kg/m2) and overweight (BMI>25 kg/m2) group. Data was then analyzed using SPSS version 12.0. There were 141 patients who underwent isolated CABG over the three year period. There were 80 patients with BMI < or =25 kg/m2 and 61 patients with BMI of >25 kg/m2. The demographic data of the two groups were similar. There was no statistical significant differences in the outcome of isolated coronary artery bypass graft. In conclusion, body mass index does not influence the outcome of isolated coronary artery bypass graft.

Children are much more likely than adults to get serious injuries in car crashes due to their softer bones, weaker neck muscle and fragile bodies. Child restraint system (CRS) can help in reduce injury and prevent fatality in the event of a crash. Thus the aim of this paper is to gauge the prevalence of CRS usage among guardians of children age below 11 years old. A survey to addressed guardians knowledge on CRS usage, practice and their views on fitting child restraints system to their vehicles were carried out among parents and carers who are caring children aged 11 years old and below. Seventy-four percent (74%) out of 500 respondents cited they have used CRS, however only 40% of them is currently using CRS with their children. Respondent in Kuala Lumpur and younger guardians reported twice likely to use CRS. In addition, graduate respondents are 1.5 times more likely to use CRS for their children. In conclusion, high incorrect usage rate and understanding of the CRS could promote additional injury towards the children in a car crash. Many initiatives could be introduced before the implementation of the CRS law in Malaysia such as awareness, community-based programs and CRS clinics that aim to guide guardians on the correct and effective way of installing the CRS device in their car

Intussusception is the most common cause of intestinal obstruction in the first two years of life. The cause is not apparent in most of the cases. Associated conditions that can result in intussusception include polyps, Meckel‟s diverticulum, Henoch-Schonlein purpura, lymphoma, lipoma, parasites, foreign bodies and viral enteritis with hypertrophy of Payer‟s patches. We hereby describe a rare case of sand bezoar induced intussusception in a 9-year-old school girl with pica (geophagia). A description of her presentation and management, along with a review of literature is being presented.

The purpose of this study was to determine the prevalence of defaulters of immunization, and their associated risk factors among children age 12 to 24 months. Materials and Methods: A cross-sectional study was conducted in all government's maternal child health clinics in District of Kota Kinabalu, Sabah. Data was collected using a standardised questionnaire from July to November 2006. Results: The prevalence rate for defaulting immunization was 16.8% from the 315 respondents. Bivariable analysis showed various significant factors associated with defaulters such as mother’s employment status, family mobility, transportation and cost. Nonetheless, multivariable analysis showed only mother’s age, mother employment status and family size were the significant predictors for defaulting immunization. Immunization that had the highest rate of defaulters was DPT–OPV booster dose (56.6%), followed by MMR immunization (43.4 %) and DPT-Hib/OPV and Hep B third dose (37.7%).Conclusion: Employed mothers with bigger family size should be more closely monitored and advised to reduce the chance of defaulting on the immunization. Health promotion activities also should focus to these groups of mothers.

We report a case of a healthy 78 -year- old indonesian man who presented with chronic weight loss, poor appetite and lethargy. CT abdomen showed bilateral adrenal masses. EUS – guided FNA was performed on the left adrenal gland. Histopathology report was Histoplasma Capsulatum. He recovered well with antifungal treatment without any complication. In this case, we found that the role of EUS – guided FNA was not only limited to diagnosis but also helped in the prognosis of the disease since the method was able to assess the general anatomy of the adrenal gland better than other imaging modalities due to its close proximity and direct visualization.

We report a case of a healthy 78-year-old indonesian man who presented with chronic weight loss, poor appetite and lethargy. CT abdomen showed bilateral adrenal masses. EUS-guided FNA was performed on the left adrenal gland. Histopathology report was Histoplasma Capsulatum. He recovered well with antifungal treatment without any complication. In this case, we found that the role of EUS -guided FNA was not only limited to diagnosis but also helped in the prognosis of the disease since the method was able to assess the general anatomy of the adrenal gland better than other imaging modalities due to its close proximity and direct visualization.

Child restraint system (CRS) can protect children in the event of crash and reduce the severity of injuries. As such, it is crucial to understand the prevalence of CRS usage and knowledge attributes on CRS usage among drivers. This study aims to assessdrivers’ knowledge on CRS usage.A semi-structured questionnaire was developed and pilot tested to verify its validity and reliability. The questionnaireaddressesdrivers’ knowledge about CRS currently available in the Malaysian market, the types of restraints used and views on fitting restraints to passenger vehicles. Seventy four percentfrom 500 respondents cited that they are usingor theyhave used CRS,64% knowabout CRS and its function, and 43% areawareof ISOFIX. In short, majority of the respondents are aware of CRS use and functions. Awareness and education program should berigorously introduced to public towards the implementation of the CRS law.
Child restraint system ; children passenger safety ; road traffic accident ; child injury

Pedestrians’ fatality trend in road crashes has been improving in recent years though it remains third in rank behind motorcyclists and car occupants. Based on the statistics, young pedestrians were the most affected group and the commonest injury regions were head and legs. Pedestrian crashes occurred primarily in rural areas and straight roads and at low light environment, and often involve cars and motorcycles. In addition to existing issues of careless and illegal crossing practices, there are potential new hazards face by pedestrian, which are mobile electronic device use and electric vehicle, especially when crossing roads. Road safety programs and interventions shall consider these new issues.
pedestrian safety ; pedestrian distraction ; Malaysia

INTRODUCTIONLiver biopsy is considered the definitive investigation in the diagnosis and management of liver disease. This study describes the experience of performing transjugular liver biopsy (TJLB) over the last 9 years in a local single centre.

MATERIALS AND METHODSA retrospective review of consecutive TJLB procedures performed at our institution was conducted. A total of 152 patients (74 males and 78 females), with a mean age of 47.4 years (range, 13 to 83 years) underwent a total of 154 TJLB procedures at our institution between March 2003 and November 2011. The principal indication for TJLB was severe coagulopathy in over 80% of patients. The technical success, number of passes, histological adequacy and complication rates were analysed.

RESULTSThe procedural success rate was 98.7% (152 out of 154 procedures). Adequate material for diagnosis was obtained in 149 out of 152 (98.0%) technically successful procedures. There was procedure related morbidity in 8 patients (5.2%) of which all but one were self-limiting requiring no further intervention. We also performed hepatic venous pressure gradient (HVPG) measurements in 19% of patients at the time of TJLB.

CONCLUSIONTJLB performed at our institution is a safe and reliable technique in patients in whom traditional percutaneous liver biopsy may be hazardous. TJLB has a high technical success rate as well as a high diagnostic yield with a low complication rate. TJLB also has the added benefit of performing HVPG, which is of increasing importance in management and prognostication of chronic liver disease.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy ; methods ; Female ; Humans ; Jugular Veins ; Liver ; pathology ; Liver Diseases ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Malaria is one of the most dangerous infectious diseases due to its high infection and mortality rates, especially in the tropical belt. Plasmodium falciparum (P. falciparum), the most virulent malaria parasite in humans, was recently reported to develop resistance against the final efficient antimalarial drug, artemisinin. Little is known about the resistance mechanisms, which further complicates the problem as a proper counteraction is unable to be taken. Hence, the understanding of drug mode of action and its molecular target is valuable knowledge that needs to be considered to develop the next generation of antimalarial drugs. P. falciparum protein kinase (Pf PK) is an attractive target for antimalarial chemotherapy due to its vital roles in all P. falciparum life stages. Moreover, overall structural differences and the presence of unique Pf PKs that are absent in human kinome, suggesting specific inhibition of Pf PK without affecting human cells is achievable. To date, at least 86 eukaryotic protein kinases have been identified in P. falciparum kinome, by which less than 40 were validated as potential targets at the erythrocytes stage. In this review, recent progress of the furthest validated Pf PKs; Pf Nek-1, Pf CDPK1, Pf CDPK4, Pf PKG, and Pf CLK-3 will be briefly discussed.