Stupid fall? or was it a good fall (instead of a crash)

I always have this scary thought. Riding a bike requires precision and 0 error rate all the time, or else you will end up in a fatal or serious crash. It means in riding, you need to be 100% all the time, that is an impossible task no matter how hard you try. Fortunately, referring to airplane disaster, according to aviation experts, a disaster or crash usually happens as a result of a series of mistakes, and not an isolated mistake. I believe it also is true in any vehicle crash, usually is a result of several errors that took place in succession. Therefore, hopefully, everytime you make a mistake, you will not end up in a crash, though of course you must aim to 0 or minimise these mistakes. God is Merciful hence you just have to do your best and keep learning.
So there it goes, this evening I had a fall. Oopss this was one of those so called ‘stupid fall’ (in Malay we called ‘jatuh bodoh’, ie a fall that occurred when it should have not). But I must say it was a potentially much more serious incident, except that somehow I did manage to control the situation, barring keeping the bike upright!
It was around 8pm, I was riding calmly along Jalan 1 Kemensah, on my way home from the mosque. I knew the road well, and the traffic was usually mild, though at times there could be a pile of vehicles moving along the hilly and tortuous road. There are several turns some of which sharp one, like the junction with Jalan 2, and steep one like at the intersection with Jalan 7. I enjoy riding along this road, though usually at a low speed due to the many turns, realising some of the vehicles coming from opposite direction do occasionally overshoot posing serious risk of head on crash.
I passed the Jalan 2 sharp bend and took it elegantly, coming to Jalan 7 intersection. It was my right of way but, usually when there are oncoming vehicles, I would slow down, preparing for the unexpected such as a car turning right without giving signal or even waiting for clearance.

map junction jalan 1 kemensah

Tricky intersection…

Tricky, so it is foolish to take this kind of intersection lightly, next time I will sound the honk when seeing oncoming cars so anyone thinking of making right turn will stop till I pass!
It was dark, two cars climbing uphill towards the intersection, the one in front slowed to almost a halt (this was not necessary, though I noticed frequently many do slow down to a stop (due to the sharp turn uphill). My right of way, I was ready to take the turn when a thought of caution struck me, slow down, my quick thought! How sure am I if both cars were going straight? I was right, just as the first car separated itself from the other, I saw a right turn signal on the second car. But the driver did not bother stopping of course, it sped of, took the right turn heading to Jalan 7. My quick reaction was to pull the brake to a halt. I did fine there, the bike stopped. But alas, it was on a downslope, my left foot barely reaching the ground, while my right foot hanging on the air, ouch before I could react further the bike slid and fell on the right side!
I did not fall or got thrown on the ground. No scractch, nothing, I did not fall at all. There was no loud bang, the bike technically slid under me. Now this 220kg mass is lying still on the ground, the engine shut. It was dark, no one around. Though I did not know too much about the technique of lifting a dropped bike, I felt confident to handle the situation. There was another oncoming car, turning right to Jalan 7, the guy slowed down and stopped his car. By now I was ready to pick up the bike. Coz there was no bar that I could hold in the middle of the bike, I focused my effort on the handle. My first attempt failed as I was relying on ‘lifting’ the bike. Second attempt, with the handle fully locked to the left side, I grabbed both handlebars and slowly pushed the bike upright, it worked! Then I realised that I forgot to pull the stand out….this was where the man who just stopped the car came handy. No worries, I told him, I am ok, just help me to pull the stand. The man was baffled, he had no idea where the bike stand was till I pointed it out. That’s it, the bike was now upright and I was ready to carry on my journey as if nothing had happened! Thank God, something worse could have happened, or a crash, have I not decided to pull the brake and stopped then.
Apart from a bit of aches on my back, I did not feel apprehensive or bewildered, instead I felt elated and more confident now, yeah I have handled the fall well. Though I hope and pray hard, it will never happen again, God willing.

A year on past the Duke crashed incident…introspection: Am I a safer rider?

That is a terribly hard question to answer. Not by fact nor by reality. One can always claim a yes, but the fact that ‘nothing’ had happened since one year had passed did in no way guarantee a secure future. Of course, no one ever knows for certain…but God.

If you are wondering, my posting a year ago on this    vividly told the whole story.

Thank God, I was virtually unhurt, apart from some aches over the back, that qualified for a one week medical leave. The bike was badly damaged and up to date still awaiting completion of repair. Since then, I have changed bike. I already own the STreet Triple, 3 months following the incident, I purchased a Triumph Bonneville T214 classic.

So you know I did not stop riding. Did I change my riding style? Maybe yes, sometimes a no. But I certainly am more careful and calculative on the road. Speed has been somewhat curtailed, especially when riding the Bonnie. On occasions I still do speed up a bit, when riding the Street. There were two particular episodes, once I was in mad rush when one of my private patients was critically ill, I had to make it to the hospital in as little time possible. It was night time, traffic was terribly busy, I managed to filter the traffic and made it to the hospital door within 15 minutes.


Another incident was the ride to Trengganu, accompanying friend who tried to catch up with the MIB convoy to cross the border. 800km ride in total, in which the return journey was undertaken at night, along the much dreaded LPT2. Thank God, the ride went uneventful.

I ride the Bonnie mostly, and my speed has generally been 10-20km/hr lower than when I ride the Street. I have also been reading some books on motorcycle safety, self trained on improving body English when dealing with corners. I kept reading about every fatal accidents, try to draw important lesson from each.

During rides, there were a few unexpected circumstances which required instance evasive action such as hard breaking, extreme leaning or steering control, all handled tactfully. I had also some opportunity to analyse my own ride, via studying the Gopro videos recorded during rides, that helped to understand a bit.

There were a few key things that had made theme in the safe riding zone:

Understand your machine, get familiar with handling it.

Understand your own limitation – good at speeding, weak at cornering, so-so at breaking – means lot more to learn, meanwhile to be alert of all these limits

Defensive riding – basically when on the road, you assume everyone else around is a lunatic and could suddenly come in your path, or crush on to you. Therefore, maintaining a ‘buffer zone’ and keeping alert all the time.

The 12 second, 0.8 second rules – looking 12 second distance ahead (within 0.8 sec) every now and then, while maintaining close view of all vehicles and other potential hazards immediately in front of you

Maintaining safe distance – visibility distance. At ‘high’ speed (referring to speed above 110km/h) it is advisable to ensure a clear view ahead of at least 300m (this could apply to speed above 150km/hr), and once or anytime your forward view if obliterated for any reason – corners, traffic, other obstacles, it is most sensible to slow down and ready for action.

Not to forget is one’s own stamina, or level of alertness, which may be greatly affected by many things like sleepiness, extreme exhaustion (heat/rain), or mental instability!

Wearing protective gears. I emphasise on wearing full face helmet all the time. This is also what I taught the young lad who has the havit of taking things too easy with the ride gears. Having a decent and comfortable helmet is a must esp for long rides. As for other gears like riding jackets, trousers, boots and gloves are the ideal which I ensure them to be in order when going for medium to long rides.

A question which may still linger in many people’s mind is whether or not I stop taking risk? Its almost impossible in short. At any moment when one is on the road be it driving or riding, there is always element of risk taking. So to say that one stops taking risk at all is impossible, unless you stop riding, something that I am not willing to do. All one could do is try to reduce the risk, and the mistakes being made with the hope that the ride will be safer.

May God save me and my son, and friends riders and make us example for others as safe riders.

A TRIUMPH-fan life….from naked Street to a classic rider…

A not so fast review of Triumph Bonneville T214
A bike too many? Here comes a Triumph fan who bought two Triumph machines within a year.
Almost. Exactly 14 months since I owned the first Triumph which is the Street Triple, a radical decision to purchase another of Triumph product, this time classic Bonneville special edition T214 Blue-white.
As it normally goes, a big bike owner usually will upgrade to a bigger bike, or bigger cc bike. In my case it is true by the displacement figure, though power wise, it can be considered a downgrade (from a 105bhp Street Triple to a mere 68bhp Bonneville).
The Bonneville T214 is in principle the same as Bonneville T100 with some make-over to commemorate the historical achievement made by Johnny Allen when he set world record as the fastest motorcycle with his Triumph-powered Texas Ceegar Streamliner, clocking 214.4mph (read it correct, yes 214.4 miles per hour or 343km/hr!). The occassion took place at Utah’s Bonneville Salt Flats back in 1956 (I suppose where they got the name of the bike then). Of course the special edition Bonneville T214 does not have the same performance as the Ceegar, and it is now equipped with modern fuel injected engine (parallel twin).

Why a classic?
It is a magnificent classic bike. It brings along with it the history, the build, the retro look, and yet its a modern bike disguised in a ‘old’ looking machine.
There is no denying that the greatest reason of buying the classic bike is its look. Yup, I like the retro bike from first sight, but decided against it the first time, for some practical reason. Then I made attempt to come close again, just 9 months after acquiring the STreet, I hired the Bonneville for a trip to Tanjung Piai Johor to ‘test’ the machine, and were impressed by its rideability and easy handling. What more, the special edition comes with a beautifully crafted, hand painted white and caspian blue colour scheme, with predominantly black painted metal instead of pure chrome colour. No doubt it’s an eye catcher anywhere I go there would be people who stopped me and started asking about the bike. Mostly the middle age or older who have experience the nostalgia of the 60’s.
The second reason, which is the most important driving factor, is the desire to ‘slow down’. Ever since I had the ‘accident’ with the Duke, many thought have come to my mind as how I can improve safety further. While speed is not everything, one thing I realised with riding a naked sportsbike is the temptation to sprint fast, indeed it’s a kind of people’s expectation to a naked bike rider, hence the term ‘ride the bike as if you stole it’…With the Bonnie, I would be under no pressure to speed up, if I ride ‘santai’ (Malay word for easy riding), I will not feel ‘guilty’ as the bike is not made for performance anyway. Having said that, the bike is capable enough of sprinting to some extent, enough to keep up with most machines on the road, or during convoys (I had tested the bike performace wise, you see, during the above trip to Tanjung Piai, indeed a few friends were pleasently surprised at its steady performance).

first bonnie
Practicality and ease of riding and handling has to be a big factor too, and this I have testified from the long distance test ride. Since I began serious riding (as you know by now, my main ride interest is commuting to work and short rides), I always yearn for a practical, easy to handle bike that more or less behave like a motorcup (‘kapchai’), however has a big personality. Suitable for public appearance like visiting relatives, frequenting the mosque or other public places and meetings. It has to be highly capable of manouvering daily traffic jam. The bike comes with short rack and trail making it easy to manouver in corners, in fact I had more confident with cornering since riding this bike.

My personal perspective
Aesthetic & build
It is a beautiful bike, if you have a classic mindset, ie for someone who appreciate the build, will be an instant attraction. On the road, it easily turned many heads. Indeed when I first visited the Fastbike hunting for the STreet Triple, my eyes immediately fell on one of the Bonneville. But not everyone likes it, particularly young people. There were a few young lads who really were impressed, but majority of them, given a preference, would rather adore the sportsbike, in this case they would go for the Street.

It is not a superbike
Yeah, it can be considered a big bike, but no way a superbike, in look, handling, performance or any part of it. Though, on the road it could easily catch up with the big bikes, it does not handle like one. If you ride it to a bike festival, the parking staff will instruct you to park along ‘others’ apart from the Superbike. They would lump it along with the Harleys and other easyriders.
So, if you are out looking for a superbike, you will be disappointed.

It certainly is not a sprinter. Though on the road, it would outdo a 250cc Sportsbike, or those low-medium powered 4cylinders 600cc bikes, but it doesn’t feel anyway near a sportsbike. No loud engine hum, it’s not as agile, and it has no ABS – though the brakes are very reasonable and satsfying. On a highway, it would happily cruise to 140-150km/hr anytime. 160km/hr is possible to do in a comfort style once I have fitted the windshield. Beyond that you are asking for too much. I had continuously ridden it at 170km/hr plus, even with two passengers (felt better in fact!), and occasionally could reach 180km/hr or beyond if you are lucky. That will require full throttle shift. What separates it from a sportsbike, is the sprint capability, it could go fast, but wont be as fun as a sports bike. As such, reaching a 180km/hr spee would have made a headline, whereas on a sportsbike, it considered a routine stuff.
Cruising at modest speed of 110-130km/hr is where it is best, you feel comfortable at its upright sitting position, keeping between 4th. to 5th. gear. Settled at 5 between low speed of 50-60km/hr it could sprint all the way beyond 140 without needing any downshift, however if quicker pace is needed, starting at 3rd to 4th. would give better pick up.
What it is good at?
If all you want to do is get from point A to B in good style, smoothly filter the traffic, on a machine that does not look overly agressive (like many of the superbikes), a go-anywhere bike that can blend in a variety of crowd or events, for a short to medium distance convoy ride in a relaxed manner, it offers you the perfect solution. Or having a pillion passenger that can sit truly upright at same level with the rider, then this is the bike. What more it handles easily, good at cornering and capable to keep up with modestly high speed traffic. If sports performance and speed is not your concern, this bike suits you well.

Over 12,000 km fantastic journeys
Within 8 months I have clocked over 12,000km.
Most routine use of the bike – commuting to work. Its just a perfect bike, it does not tire you, due to an upright and low sitting position. This particularly helpful during heavy congestion, maneuvering lane splitting is a doddle, and with its lowish seat height, it gave me more confidence to ride at crawling speed. I would have to play with the clutch more at low gears (comparing to the Street), and the ‘jerk’ that came occasionally would be controllable once you are used to it.
Next is doing a bit further like attending functions, events, lectures and conferences etc which involves riding into the city or a medium distance ride. With its generous luggage capacity I could conveniently carry most of my need. It certainly is less cumbersome to ride into the parking with this bike comparing to a more intrusive sportsbike with loud pipes and agressive look. Occasionally, for very short distance and ‘easy’ riding, I could do without any accessories leaving my gloves, heavy jackets all in the saddle bags, just the helmet and riding boots, making for an open air ride, cool – this is not to be done seriously or at high speed obviously. This kind of ride is often done within the confine of the ‘village’ such as going to the mosque, neighbours or nearby shops.
I had done a number of long rides – Sg. Petani, Alor Star, Kuala Kangsar, Kuantan, Batu Pahat, Malacca. On state (sub-urban) road it performed as a capable and smoooth cruiser, would happily keep up with other riders or drivers, and I had no problem to sprint ahead of the ‘competition’ to keep myself clear of the crowd of vehicles. Negotiating turns and corners is a pleasure which can be accomplished often with much less efforts.
At highways, it is equally capable at moderate speed up to 140-150km/hr. Going beyond this, the windblast is too strong, and sometimes feel impossible. Since I fitted the windshield it felt much more stable, and I was ablet to push my luck beyond the 160km/hr, though a lower speed keeping it below 150km/hr is best for smooth and relaxing ride. At this steady speed I could go on for up to 200km stretch which is just enough distance to be covered before the next refuel.


The dark side?
Am I missing something? Yeah, the fun of a sports or big bike. It doesn’t feel at all like it. Not in performance, appearance or feel. That’s it, it gives you fun in a different manner.
It also gets hot quickly. Since there are many exposed metals especially the long exhaust pipes, I had suffered various kind of burns to my skin, clothes, shoes etc. I like to hang shopping bags on the handles when riding to the neighbouring groceries. Once I hanged a loaf of bread on the handle, without realising, as result of it dangling over the top metal pipe, I reached home to find a perfect roasted slices of bread!
It felt like ‘old’ bike sometimes. The gearshift, the choke, fake carburators, of course the classic looking lights and indicators. On a bad day, you could feel like coming from the 60’s getting lost in the middle of civilisation…surely many of those onlookers who were amazed with the bike retro look could equally be puzzled with the aging bit.
Though I mentioned the bike was easy to handle and ride, it is not so at stationary. It took some effort to move the bike (awefully heavy at 220kg), and trying to manouver it can be very tiring. The stand, which is too much leaning to the left, may be a bit tricky to straighten up the bike at rest, once, I nearly lost control and drop the machine, saved only by the left leg, which felt horribly sore after that!
If I were given a choice to redesign the bike? Well, I keep the classic look, its good enough. All I like to see is a Bonneville fitted with a Street engine perhaps, wow that would amplify the fun in riding this classic machine, though I bet it would make the retro machine rather awkward and kind of out of place. (I am aware of the new Vulcan S easyrider bike from Kawasaki, which is fitted with a sporty engine of ER6). A classic is meant to be ridden like one, or else you might as well ride a different class of bike!

at smds

Whether a short relaxing ride or a medium long ride, you will enjoy a great company with this Bonnie…so long you do not expect too much out of it…

Verdict *****
Great bike once you are prepared to accept it as it is. Then you get endless joy, magnificent looking machine which is so easy to ride and control. Will I keep it – yes, for now, and for a fairly distant future I say. Would I buy another classic bike, hmmm that would give the answer in negative. Yes there are now the more powerful engines and more radical look, and performance from the same line (newer series of classic bikes from Triumph) – but I have to excuse myself as I think owning one is more than enough for now, either I will keep it forever, or trade it in for another class of bike (unlikely), but not for the newer version.

Specs: (adapted from

year: 2015
price: RM69k (got special discounted price)
Engine: Air-cooled, DOHC, parallel-twin, 360º firing interval
Transmission: 5-speed
Horsepower @ RPM: 68
Torque @ RPM: 50
Energy: Multipoint sequential electronic fuel injection
Displacement: 865 cc

Weight: 220kg

When the going gets tough….

And the tough get going….

I hope so…

As it turned out to be the most hectic time at my cath lab this week. Among the highlights including a 6 hour long complex and complicated procedure 2 days ago…and overloading of cases including an emergency and, again, a complex case followed by a complication! last night, forcing the team to end the day at midnight…

I left the cath lab like 1230 or so…after performing Isya prayer (aha at least I managed to do all the prayers on time, unlike 2 days prior when I was forced to jamak (combine) prayers due to the prolonged procedure). Heading home, feeling satisfied and looking forward to meet the loved ones. Hmm…of course they were all asleep.

Not forgetting that, last night I had made arrangement for our weekly usrah (study circle) at my home. Poor guys 2 members of the group were left waiting in vain as I never turned up. My deep apology to them.

As it happened, no matter how bad your days (at work) was, it all will be forgotten or you come out rosy, as when everything else including those loved ones at home are so welcoming as well as forgiving for you having owe them their quality time…

On my way home, on the motorbike, I remembered that I supposed to buy the dinner. Dinner? at 1am…well since I had promised, though the wife later she was ok (means she will not need it), as a gesture of keeping promises, I endeavoured to get the dinner anyway. I thought even if they were not consumed right away, they would still be good for breakfast.

So I stopped at Melawati food court…then I realised that I only have RM7 left in my pocket…since it was past midnite, not many ATM are operating, furthermore Maybank and several others are closed for ATM transaction after midnite. Yup, when I walked in to the nearby 7E, indeed the Ambank ATM was offline. So I rode a little distance to the Bank Islam and withdrew $$$, headed out of Melawati and stopped by at the Nasi Kandar. I ordered Roti nan cheese and teh tarik – wife’s favourite. And a coffee for me for take away. While seated waiting for my order I met Aziz, one of the community leaders from Kemensah. We shook hand and Aziz told me he was buying food for someone who had a stroke. My mind lingered, yeah there was a young guy I heard had a bad stroke, came out of it with bad residuals.

We happened to have our orders ready around the same time and were queing at the cashier. I told Aziz I will pay for his orders, and he thanked me. As I walked out, Aziz brought me to the guy. Oh poor him, barely dressed, half of body limped. I learned he was one of the former community heads a long while ago. The guy told me the story how his children have practically neglected him, all his daily needs were barely met, as evidenced by him going out at midnite with neighbour’s help. He said his children are all grown up, sadly, with the exception of one, all have not been good in serving him. Whether they don’t turn up, or get his needs like food etc. done at long delay. Hmmm…my mind wondered again, yeah when you get older, or become incapacitated all you have in this world is your own family. But if your own children don’t care for you that sounds like the end of the world. In this man’s case, his wife had passed away long time ago. I could imagine how lonely and painful is life for him.

So now I rode another short distance for refuel. Then straight home. Yup everyone asleep. I left the foodstuff on the table. Took a quick bath. And the wife came looking fresh, greeted me and we sat at the table. I felt sorry for she gave a gesture of understanding…and said íts ok bang…She barely ate but I was happy at least I have brought her something. And more pleased that, at the end of a very long day, feeling wrecked and drowsy, I have someone who is patiently awaiting for my return, and despite the late arrival, no grouse or complaints heard. Instantly all the exhaustion faded away. Thank God and praise be to Him who has made obedient woman for the husband, and this is the key to a peaceful family life and lasting happiness.


To Die Now or Later? Revisiting the worldly life…


The traffic gets heavier. Streams of vehicle rushing through the three-lane system, tailgating in a long que. He strode through the congestion, moving in between other big vehicles, efficiently overtaking each one with ease. It has been his daily routine since the last 2 months, leaving his Keramat home at 7.35 and reached the hospital at 5 minutes before 8. The brand new Yamaha XJ had radically changed his commuting life, no more headache from traffic jam. Be it peak hours or otherwise, it does not matter. It only matters when it rains. Or of course, when he has to travel outstation as part of his work, when riding on the motor is not a very practical option – especially because navigating by GPS system is not possible while riding.

However, this morning he felt a little awkward. Was it because he got a touch of flue, or due to work stress lately, he wasn’t sure. First of all, he missed the morning prayer at the surau, one of the daily routines which he rarely keeps these days, it therefore has not become a routine, rather an exception. As he only managed to get in bed at 1am, he felt a little drowsy when he woke up. People say that as you get older, you need less sleep, however in his case, it looks like he is needing more. 5 and a half hour seems too little for him, as he could hardly open his eyes at the repetitive whispering of his dear wife. ‘Bang, wake up, say goodbye to your daughter’. For the last 2 days, he had returned home late, when all the children were already asleep. Commitments with the national societies, and long hours at the Operation Room was his excuse. Due to this, he has not met the children for two days, and his wife was good enough to ensure that at least he wakes up to say goodbye to his eldest daughter who leaves for school at 6.30am.

‘Bye ayah…aw you look so awful, I can’t wait for another holiday, you need it so badly!’ grinned Liyana. ‘Come here’ he summoned his daughter close, gives her a hug and a kissed her on the cheek ‘hmmm I really missed you’. Not infrequently he overheard Liyana’s disgruntled, as she ‘rarely sees anyone’ when she wakes up and leaves for school. He was deeply aware of this, but just could not help it himself. Coming home late, and yet he still got loads of works to do, ended up going to bed past midnight. He just felt that his physical strength is diminishing. Erratic meal times, lack of exercise, long working hours plus frequent outstations, all have been his routine – is he getting burnt out syndrome? Sometimes he could not help it but put the blame on other people, for lack of understanding of his overwhelming commitment, or is that the case with everyone else? Despite all that, he rarely complains, and he still enjoys working – well perhaps because many of his close friends are still around, furthermore his private practice has just received a boost, when his income has tripled since last year.

After having a quick shower, he put on his clothes and walked to the lounge. The two boys sat quietly in wait – Zaid, who goes to evening school, and Azam who has morning session primary school, should be leaving home shortly after. As he stepped closer, the two boys stood up and greeted him; then Zaid called the iqamah for the morning prayer. He lead the two rakaah Subuh prayer and recited the Quran fluently. He could well have got Zaid – who recently committed the entire Quran into memory, to lead the prayer – obviously a more deserving ‘imam’, however, as the father he maintains the leadership role. Wife followed behind. Liyana had done hers, on her own, just before the school minibus fetched her for school.

He still felt drowsy, and felt like going back to sleep. Ahh he just cant afford to do that, his morning private clinic session starts at 8am, so he had to keep moving. By now Rina his wife, Adam, Fisha their 5 year old daughter and Iyad, their little baby boy, all are ready to leave. Rina is a head mistress at the preschool, she is on duty this morning so has to be at school by 7.30am. She has to drop Adam to his school, then leave Iyad at the nursery, then drive to her school with Fisha with her. Fisha goes to the preschool year 1 at the same school she is teaching.

Rina started the X5 engine, ushered Adam and Fisha in and carries Iyad in her hands to be seated at the child seat in the middle row. He usually helps little, more so when needed, this makes him guilty in retrospect, leaving his wife managing most of the childcare. Most of the time his wife does the shopping with the children’s help, she does her own cooking proudly even though they have their own maid. After work, she sends Liyana and Adam to tuition, later in the evening just before sunset she would go to Zaid’s school to fetch him – an act that she rarely asks her husband to help, knowing his business. She will also attends the parents meeting, send their cars to the garage by herself whenever services are due. She even takes care of all their pets, that includes taking their cats to the vets, something that is needed almost monthly. Excepting the many bills that he conveniently paid online, his wife does the rest – that includes renewing the car insurance, settling the children school fees and related etc. He happily gave his wife his bankard which she can draw as much money needed for the home maintenance.

Often, he wonders, what’s his role at home, apart from being the bread winner – of which he’s proud of, as he is earning 30 times as much as his wife. But money can’t buy everything, and with so little time left for the family, his wife rather have him spend quality time with her and children, than doing any of the house chore. How kind, he thought. He promised himself that Rina is the only woman in his life, though as Muslim, he is allowed another 3, he had never given that a thought. There are many beautiful and intelligent women he frequently meets or get acquainted to, seductive and charming – but he is fully aware that those women are good to look at, but in his home, there is a room just for one, and he is content with that.

‘Screecheeeeeeed, a hasty Wira driver behind him pulled his emergency break, as the car in front changed lane suddenly therefore blocking its passage. A Nissan Vannette van who tailgated behind made a swift move to the fast lane, almost crashing to the Kancil car in front. The Wira driver was obviously enraged. He floored the accelerator and swayed his passage to the left lane, charging at projectile speed. The sudden move was obviously against his favour, as he suddenly realised that there were a group of motorists riding by the lane, three or four of them. Salem was positioned second behind the Kawasaki, he was riding at 90km/h. The XJ body was just slightly protruding towards the middle of the lane as he was ready to overtake the Kawasaki. This put the Wira driver in dilemma, as to his right there was a long trailer, making it impossible for him to pull right. His right foot pumped the break pedal, trying to cool the speeding car down. This did him no good, as the Wira suddenly swerved leftward, almost touching the XJ. He manourvered right a bit, but he was too close to the trailer. He sounded the horn, but it was too late. Just as the critical procession has now reached the top of Shamelin bridge, there was a big thunder.

Salem’s helmet suddenly popped out of his head – his head now exposed bare. His body was thrown mid-air, his XJ was plunged to the middle of the highway, landed just right in front of the slow moving trailer. And the next thing, he saw darkness.

From 'M3 multivehicle

At 7.46am, at Shamelin bridge along the Middle Ring Road II, there was a harrowing scene of a multivehicle accident. A Wira car crushed under a trailer and the driver was trapped under the wheel axle. The back of the trailer had swayed to the fast lane, rammed by a Vannetta van, and an E class Mercedes crumpled to the rear of the van. Crushed under the bonnet of the trailer, was a Yamaha XJ, without its rider. There was a commotion. The already congested three lane traffic now had come to a halt. Several drivers have parked their vehicles along the hard shoulders, trying to assess the scene or offer any help. And the immediate thing they saw was a Wira car burning under the trailer. About ten metres ahead, on the left lane, the body of a young man lied on the ground, motionless. His head was covered in blood.

‘O my God, O my God, Hell, help, its disaster, Mayday!’ cried a woman who just came out of her 3 series bimmer.

Crowd of spectators started to gather. Some move around, trying to do what they think is appropriate. The police, ambulance service, and the fire brigade had been called, it will take at least 30 minutes before help arrived, in this dense jungle of traffic. Meanwhile it is all left to the good Samaritans to help the victims of the accident. Not the Wira driver anyway, left burning under the body of the trailer, there was little can be done, in fact the whole crowd are now keeping well away from it, in case its going to explode. The driver of the van and the Mercedes escaped unhurt, and speedily ran away from the scene, leaving behind their vehicles and all its content which has meant nothing more than their own lives now. The trailer driver also was unhurt, however, his door was jammed. He would not try escaping from the other door, as the trailer now has tilted slightly, leaving the passenger door facing the open air.

What a tragedy, most harrowing. Suddenly there was explosion, and a huge fire went off, ripping the middle body of the trailer. The truck driver was frantic, he still could not escape. He tried breaking the window but it proved stronger than his hands which are partly injured. He jumped up and down in the hope of drawing help. But no one dare to come closer, with the flame threatening to kill, no wise person will attempt a heroic deed now. All they can do is try to salvage the motor rider who is lying unconscious, that is, if he is still alive.

The truck driver now started to feel breathless. His legs were trapped under the seat, his both arms injured, he lost all might to fight the impending doom. He shouted unwavering voice, which only himself can hear. ‘Cut me, cut my leg, just break the door, get me out!!’ if only any person could hear his desperate scream.

Some of the spectators have turned their faces away and tried to move away further – perhaps did not have the strength to witness the driver burned alive, or perhaps afraid if the fire could suddenly turn wild and throw shrapnel or arson at them. The driver of the bimmer, the van driver who survived the accident, and another two people who were motorists riding behind the RX, were the only people trying to help now. They have wisely decided to avoid the truck and the Wira, now they marched to Salem. “Too much blood” commented the woman. She was right, as the van driver bravely touched Salem’s head and tried to turn it aside, they saw a huge laceration on his cheek extending all the way to the scalp. He was lying on his back, and the back of his head was heavily bleeding, in fact the skull frame felt flattened now. No motion, no eye opening, speechless, just occasional breath. CPR? Sure one of them knew, either the bimmer driver, or one of the motorists but perhaps not the van driver, who did not even complete his primary six. Uneducated be he, but kind hearted enough, leaving all those others supposedly more intelligent and capable spectators doing nothing, not even witnessing the event due to fear. He just shrugged his shoulder and shook his head, as if implying that they are dealing with hopeless situation.

Finally he stood up, firm. ‘Look’, he said firmly, ‘the police or ambulance are not here, and they may not reach here for another 20 minutes. Every minutes count for this young man. I don’t know whether he is still alive or not, but I must take him to the hospital myself!’ Then he remembers that he did not even have a vehicle to drive. His van is lying there, stuck to the trailer’s body, perhaps awaiting the fire to engulf it.

The van driver’s act had brought consciousness to the woman bimmer driver. She quickly gather her thought, and without hesitation, blurted out: “You got no car right…I will take him, you just need to help me get him into the car, then we drive him to Ampang Hospital, the nearest place we can get to.” Without second thought the van driver waved at the two motorists signalling them to help lifting the lifeless body to the car. Several spectators who have now learned about small deeds, moved in to help. The woman drove her car slowly, closing on the body. This time the spectators were again made speechless, as they saw, a young Chinese woman, driving a brand new, all singing all dancing 3 series BMW, volunteered to help a Malay motorist who had become a victim of a horrific crash. Little did she hesitated to have her brand new car littered with the blood of a stranger. And moreover, a stranger whom they know have little or no chance to survive, judging by the severity of the injury sustained. So now, the BMW is moving away, driven by a young Chinese woman, helped by an Indian Van driver and a young Malay student, on their journey to save the life of an unfortunate young Malay man – what a true 1Malaysia spirit. After all, they are all human, servants of God. An act of kindness on this bright Friday morning, may pave their way to the future heaven.


A young girl is playing outside the house. She clumsily tries to climb the scooter, gives it a push and rides on, not for long, before it stops and she fumbles. ‘Alaaa…’ she sounded frustrated everytime she fumbles. Not giving up, she keeps trying. All around it looks so quiet. No one can be seen around the neighbourhood. The girl has got all the compound to herself. It’s getting sunnier now, she still keeps practising her scooter. Then she takes a new move. She started to move a little away from the house compound, out of the gate. The road is uneven, and leading away from the house, it takes a downhill course. Salem always reminded his kids to be careful when cycling down the lane, as the slope is drastic and had caused a few serious falls. But for Fisha, today is her first time trying the downhill slope, on her own. Whatever happens with her other brothers and sister, may be they are busy with homeworks, or are they getting engrossed with browsing the net, or watching favourite TV programs.

The road is dry and no obvious obstacle or dangerous objects along the way. Fisha in her casual style, started riding, bit by bit. Suddenly she lost control, just as she strides along with both legs on the scooter, it sharply glided fast, and faster. She held on tight to the handle, but could not think of what else to do. Now the scooter has glided about 30 meters away from the house gate, passing several neighbours front gates. Still no signs of people around. Fisha felt nervous, and surge of cold blood tracks up her throat, she panicked. Now the scooter hit a bumper, and the small wheel was too unstable to climb over the big bumper, as a result, it jolted and spinned sideways. Fisha scream, and the next thing, she fell on the ground, face down.

“Fisha! Fisha!” Salem called. Poor little girl. Her nose was bleeding, she bleeds from the lip as a result of accidental bite from her upper teeth, during the sudden fall. She cried louder, but no one heard. “Oh, Fisha, you poor little girl” Salem came close, stretched his hand out, tries to help her daughter get up. But no hand can be seen, and no voice can be heard by the girl. She continues to cry, and once she was able to get up, she ran straight to the house.

Salem moved closer to the house, his house, which he now does not belong to. The single storey bungalow is a handsome building, brightly painted, surrounded by a well maintained garden which grows a variety of flowers and shrubs. There is a small fish pond at the left inner side of the entrance gate. There is a spacious driveway lined with marbles, facing the verandah, that can easily accommodate 4 large cars. The 3 series bimmer is parked, and he thought it must have not been used much. The X5 which is his wife favourite car, is not there, means Rani must have been out somewhere, leaving the kids at home to look after themselves. The Audi TT is parked closest to the house entrance, which it has always been. The hot hatch which they brought home from London, is rarely driven and despite its age appears immaculate and plushed. The grass which grows around the pond shows sign of recently being cut. Salem carefully moves closer to the door, which is ajar, left open by Fish when she rushed in. He spotted the house number, of course he knows it well and he does not need permission. After all no one will be aware of his presence. In a flash of wind he is already in at the lounge. Now he can clearly hear Fisha’s voice talking to the brothers, who are sitting in their rooms. He peeked inside.

QIL Winter sadness website

The two boys were busy playing Playstation – Tekken 5 game. The console is kept in their room, so they could spend all day there playing. Liyana’s room is vacant, Salem scan around the house but she could not be seen anywhere. Rina and the baby neither, perhaps she went out for a meeting. Rina holds several key posts in the national NGOs as well as community organisation. She also conducts weekly circles with the students from the Technology Institute. Even when Salem is around, and occasionally had free weekends, he found his wife was busier than him, having at least one long meeting every weekend. 2 or three evenings of her weekdays filled with either meetings or student circles. Even at home, she spends time designing the school planning or online meeting with people in or outside the country. She still does her own cooking though, and that fact alone never fails to leave impact on Salem’s mind. No doubt she is a good wife, despite her busy commitment, she never neglected the children.

However, today was a bit different. Salem wonders how she is now, managing without a husband? Life must be different, he could not wait to see her face, what signs is she showing, of frustration, unending grief, or is she holding strong?

Fisha sits at the lounge, alone, still crying. She had gone in to her brothers, who kept on playing despite hearing her cries. Her eyes swells with tears. No one to talk to, she sobbed “I want dad…where is dad…dad, when are you coming home”. Salem could not hold his emotion, draws himself close and tries to give her a hug. It’s all vacant. He can’t feel or touch her, and she can’t see or hear him. Now Fisha moves towards the computer, and still sobbing, said to herself “I wanna see Upin dan Ipin”. Upin dan Ipin is her favourite TV series, she has watched all the series numerous times, but it never bored her. Now she had the CD on her hand, she press the button but nothing happens. Obviously the DVD player is turned off, and the cable not connected. It really pities him seeing his daughter cries and not getting what she wants, just simple thing like watching her favourite DVD. Maybe, this is what has been happening all this while, but he never realised it, due to his business at work. Only now he has the luxury of time seeing his children in action, which before he has not seen – like what are the kids doing when both their parents are away. But now, it’s too late, nothing that he can do. Not even helping his daughter turning the DVD on, let alone calm her down when she is crying from the fall.

Fisha went to her brothers again and demanded their help. “Fisha! Just press the button, the thing will pop up, there, you just slide in the CD!” shouted Adam. She left the room sobbing even harder. “Come dear, I’ll help you” Salem whispers. Oh, what a pain, he sees everything, he hears everything and yet he can do nothing. Fisha threw herself on the sofa, and sobbed again “ayah….ayah…nak ayah…(dad…I want dad…)”.

“This is not fair!” Salem jerked, and went to his sons’ room. “Zaid, Adam, help your sister…please” suddenly it took him by surprise. A Deja Vu? How so familiar, yes he always uttered the same sentence, all the time, not long ago. Sitting in his sofa, busy tapping his laptops keyboard, writing scientific articles, or reading his students’ case reports or research proposal, he could not be bothered by his kids behaviour. And each time Fisha demands something from him, he will just summon one of the other kids to attend to her request. What’s the difference now? You such a hypocrite, Salem scowl at himself. If he WAS alive now, and sitting at the sofa, busy with his works, will he have attended to his daughter’s request promptly? Not, judging from his past behaviour. No other greater regret than having to blame oneself for neglecting such small deeds could make a difference to a kid’s happiness.

The sobbing had eased off, but she is clearly in pain, her nose and lips were bleeding, and smears of blood can be seen on the leather sofa. Poor Fisha having to bear all these torment herself. Finally she regained her energy, got up, walked to the corner of the lounge, where her school bag is kept. She unzips the bag and took a drawing pad and her pencil case. She began drawing. She is drawing something peculiar. At first it did not seem to make sense, but as she continues sketching, now it became clear what she is drawing. Figure of a man, crooked, jagged here and there, but a near perfect drawing for a 5 year old. Beside, she drew another figure, much smaller, a girl, with pony tail, then she drew her face, smiling face, and her right hand, reaching her father’s. How symbolic. Then she wrote under the figure – ayah, I love you. Does she understand where her father is? Did she know what happened? What does death mean, to a 5 year old? It’s a real pity, at her age, she is perhaps the most unfortunate of the family member to have lost her father, Salem thought. She is too young to understand, and yet she is big enough to remember her father and of course to keep wondering of his whereabout. The baby, is still too small, it makes no big difference to him, since at this age, he is fully dependent on the mother. As to his older kids, they would have understood, and by now, 2 months since the incident, they must have recovered. Or, have they forgotten their father? Are they still praying for him?

Fisha wipes the blood on her lips with her sleeve. Then she stood up, reached for a tissue, and pressed it on her face. Next, she walked towards the kitchen. Her gait is steady, as if she has forgotten all that has happened a few minutes ago. At the kitchen, she took a stool, climbed on it in order to reach the top cabinet and got hold of a plastic cup. Then she went to the fridge, again took the stool with her, climbed up, opened the fridge door and poured a few ice cubes from the freezer compartment. Next she walked to the dinner table, where a jug of plain water is to be found. Slowly Fisha reached for the jug that is full with water, grabbed it and tilted it sideways, towards the plastic cup that is now half filled with ice cubes. The jug felt heavy on her hand, and as it tilted further, it just slipped of her hand and gushed out its content on the table. Fisha quickly caught the nearly empty jug, now she held it tighter, that it had lost most of its content, she could easily handled it and poured the water into her cup. Finally, after a long struggle, she manages to enjoy a cup of chilled water. Just as she made the first few steps away from the table, her right foot landed on the wet floor, that had been sprayed with water from the falling jug. The wet marbled floor was too slippery to hold her feet and she slipped to her right side, banged her head on the table edge and fell under the table. Salem could only watched in horror. How much more accident his little girl has to suffer, and he could only watched in silence, helpless.

Strangely, the table accident did not seem to affect her, and Fisha swiftly got up and walked again. Now she looked so tired that she reached for the sofa and lied face down, probably trying to sleep. In less than ten minutes, she fell asleep.

The whole house seems so quiet. The boys now have stopped playing, they stepped out of the room, and Zaid suggested to his brother to play badminton. Adam went to the storeroom and took out a pair of badminton rackets and a box of shuttlecocks. “Look, I got ayah’s racket, Im going to use it today, I know ayah loved playing badminton…if only he is around now” Adam remarked. “What are you talking about?” Zaid was a little hurt. They ran outside, put on their shoes and began playing. They started long rally of play, both are getting good with the game now. “Aaah it so boring, just the two of us…if ayah…” Adam could not continue his sentence. “Adam, stop it…you can’t bring ayah back, you know that” Zaid tried to live up to reality. They played for another 15 minutes, now both are exhausted. They stepped inside and walked to the kitchen. “Zaid, look, this must be Fisha, she drop the jug and the whole floor is wet, I could have fallen” Adam was quick to point his finger on his sister. As if realising their own fault of neglecting their sister, both were now quiet. Zaid took the mop and dried the floor with it.

They both went back to the room to watch TV. The biggest looser is on and it is one of their favourite series. They have been playing the game all morning, and now they are going to watch TV, up to the evening? What a waste. Salem knew he could do nothing, not that he would have done anything before either. There were time when he sat at home, engaged with various office paperworks, and the children were let alone to do whatever they want. If the mother was at home, she will impose a schedule on them. Salem tended to be a liberalist, or perhaps due to preoccupation with his works, he just could not be bothered. Rather he just let them do what they want. How spoilt are they, now that they have made TV and internet as their main routine. Everyday has to be filled with at least 2 hours or more of watching their favourite programs – from the Biggest Looser, Wipe out, football etc, the list goes endless. If nothing too exciting, they just flip the remote control button from one channel to another until they come across something worth watching.

The whole house is quite again except the murmur from the television set in the boys room can be occasionally heard. The silence of the scene is so engaging, this is interspersed with the ticking from the cuckoo clock that Salem had bought from Geneva last year. The hallway looked so gloomy without the light on. Now he has the opportunity of entering his room, which now does not belong to him. The room has been cleaned, the bedsheet has just been changed. Everything is in order. Salem noticed a huge chandelier hanging from the ceiling. Was it there before, he could not quite recall, but it looks so beautiful, Salem wonders how it looks when the lights is on. He scanned the other corner of the room, there sits the office table. What used to be his table. The mahogany furniture purchased from Mid Valley shopping centre has been his working desk since ever. His wife never work on a desk anyway, though at times she has a lot of writing and typing to do. She just sit on the sofa, or rather works from her bed. That is, when he is not around. When he is home, she just prefer to sit by him, watching TV or just getting huddled quietly, while watching him does his work. To her, the husband must spend a quality time, that is with his wife and children.

The bathroom door is left ajar, fresh smell of air freshener can still be detected. A strange feeling awakes him, there is no sign that the bathroom has been used. The floor is dry, the sink looks untouched. All the toiletries are put in such order as if they have not been disturbed for so long. Has the wife not been using this room since? He has no idea, and suddenly there is this urge to know. Then he moves out to the hallway again, down the kitchen. The rear room which used to be the maid’s room, is also empty, Perhaps they have not had a maid since he left. Salem had a peek anyway, and he could clearly see, the wardrobe, which is half open, contains a few piece of his wife’s dress. And the dressing table too, is lined with a few simple make up set, all belongs to his wife. Salem knew instantly now, that his wife has now taken up this small room. How about the baby? He still was not sure.

…to be continued…

Panduan Menghadapi Jerebu

Jerebu terhasil dari pencemaran udara yang menggabungkan berbagai gas seperti ozone, carbon monoksida, sulfur dan partikel (habuk) kecil. Ia berpunca dari pembakaran terbuka, kilang, asap kenderaan dan lain-lain bentuk pencemaran udara. Ianya menyebabkan halangan pada sinaran matahari yang menyebabkan pudar pandangan.

Partikel kecil ini bila disedut dalam udara melalui pernafasan akan memasuki paru-paru lalu menghasilkan berbagai kesan tidak baik samada jangka pendek maupun jangka panjang. Kadangkala partikel halus (berukuran kurang dari 2.5micron) ini yang paling berbahaya kerana boleh menyerap masuk ke dalam sel paru-paru ataupun aliran darah.

Apakah kesan-kesan buruk jerebu

Kesan langsung pada paru-paru – sesak nafas, sakit dada, batuk, radang paru-paru, memburukkan penyakit paru-paru kronik, serangan asthma, bronkitis atau jangkitan kuman pada paru-paru.

Jantung – mengganggu pesakit jantung kronik, lemah jantung, aritmia dan boleh menyebabkan serangan jantung

Mata berair dan pedih

Hidung berair atau kerap bersin

Tekak kering dan pedih

Kulit terasa gatal/pedih, terutamanya untuk pengidap penyakit kulit seperi eczema

Kesan jangka panjang – selain kesan-kesan serta merta di atas, seseorang yang terdedah kepada jerebu pada tahap tidak sihat secara berterusan boleh membawa kepada penyakit jantung kronik, penyakit paru-paru kronik, kanser, mengurangkan jangka hayat, gangguan terhadap janin atau ibu mengandung.

Jelasnya jerebu ini boleh memberi kesan buruk kepada orang yang sihat, apalagi kepada yang berisiko. Golongan warga emas, OKU, kanak-kanak, pesakit-pesakit jantung dan paru-paru, ibu mengandung adalah contoh golongan yang berisiko dan perlu lebih berhati-hati terhadap gejala jerebu ini. Selain itu, perokok atau mereka yang bekerja di lapangan juga lebih berisiko dari orang biasa.


Langkah-langkah menangani jerebu

  1. Jika anda mengalami batuk, sesak nafas atau sakit dada berterusan, atau penyakit kronik seperti asthma, bronkitis terasa bertambah teruk, dapatkan pemeriksaan/rawatan doktor dengan segera.
  2. Tutup pintu dan tingkap rumah rapat-rapat untuk menghalang jerebu masuk terutamanya bila tahap IPU melebihi 100 (kadar tidak sihat)
  3. Bila memandu pastikan tingkap tertutup rapat. Penghawa dingin boleh digunaka. Set kitaran udara kereta anda tertutup (untuk halang udara luar masuk).
  4. Buat penunggang motosikal/basikal, sebaiknya elakkan perjalanan jarak jauh atau lama, dan pakai penutup muka (mask) contohnya N95 serta helmet yang lengkap menutup keseluruhan muka (penunggang motorsikal).
  5. Pesakit-pesakit yang berisiko seperti disebut di atas, hendaklah mengurangkan keluar rumah, dan bila tahap IPU melebihi 100 elakan keluar rumah seboleh mungkin. Sekiranya perlu keluar rumah pastikan anda memakai penutup muka (mask) contohnya N95.
  6. Penggunaan penutup muka – N95 adalah yang paling elok dan dapat membantu menghalang partikel kecil dari disedut masuk. Jenis-jenis penutup muka lain (surgical mask dll) boleh digunakan tetapi mungkin kurang berkesan. N95 tidak digalakkan untuk anak-anak kecil (tiada saranan boleh dipakai untuk usia kecil) oleh itu lebih baik hindarkan mereka keluar rumah.
  7. Banyakkan pengambilan air minum (2 liter sehari), elakkan alkohol dan rokok atau kopi yang berlebihan.

Ketahui IPU Di Kawasan Anda

Apa itu IPU? IPU ialah indeks pencemaran udara, satu ukuran tahap pencemaran berdasarkan kandungan gas-gas dan partikel kecil (dalam bahasa Inggeris API – Air pollutant index atau PSI – Pollutant standards index). Lebih tinggi bacaan IPU, lebih serious lagi tahap pencemaran udara, menurut kategori seperti dalam jadual. Tindakan perlu diambil, bergantung kepada risiko seseorang.

Julat Bacaan IPU Status Orang yang sihat (1) Orang tua, mengandung atau kanak-kanak kecil (2) Orang berpenyakit paru-paru kronik, sakit jantung (3)
0-50 Sihat Aktiviti seperti biasa Aktiviti seperti biasa Aktiviti seperti biasa
51-100 Sederhana Aktiviti seperti biasa Aktiviti seperti biasa Aktiviti seperti biasa
101-200* Tidak sihat Kurangkan aktiviti luar yang berlebihan atau berpanjangan Minimakan (jika perlu sahaja) aktiviti luar berlebihan atau berpanjangan.

Anak-anak kecil dinasihatkan tidak bermain di luar rumah

Elakkan (jika perlu sahaja) aktiviti luar berlebihan atau berpanjangan
201-300** Sangat tidak sihat Elakkan (jika perlu sahaja) aktiviti luar berlebihan atau berpanjangan Minimakan sebarang bentuk aktiviti luar Elakkan aktiviti luar
Lebih 300 Merbahaya Minimakan sebarang bentuk aktiviti luar Elakkan aktiviti luar Elakkan aktiviti luar
  • * Pemakaian tutup muka spt N95 diperlukan untuk golongan berisiko (2 & 3) pada tahap IPU ini
  • ** Pemakaian tutup muka spt N95 diperlukan untuk semua pada tahap IPU ini

Di Masa Jerebu Lebihkan Masa Di Dalam

Bila tahap IPU mencecah 101 ke atas, lebih baik kurangkan aktiviti luar yang kurang perlu. Walaupun beriadah dan bersukan adalah aktiviti sihat, tetapi bila tahap jerebu meningkat (lebih 100 untuk yang kurang sihat, atau lebih 200 untuk yang sihat), adalah lebih baik minimakan aktiviti tersebut, atau buat secara dalaman (indoor).

Inilah ketika untuk lebihkan masa di rumah atau di dalam bangunan, ruangkan waktu ini bersama keluarga/sanak saudara/rakan, banyak aktiviti produktif yang boleh dikongsikan seperti membaca, mengemas rumah beramai-ramai atau apa-apa aktiviti untuk menambahkan ilmu dan merapatkan silaturrahim. Semoga kita semua terpelihara dari kesan pencemaran jerebu.

Inilah ketika untuk lebihkan masa di rumah atau di dalam bangunan, ruangkan waktu ini bersama keluarga/sanak saudara/rakan, banyak aktiviti produktif yang boleh dikongsikan seperti membaca, mengemas rumah beramai-ramai atau apa-apa aktiviti untuk menambahkan ilmu dan merapatkan silaturrahim. Semoga kita semua terpelihara dari kesan pencemaran jerebu.

What I have learned from ESC London 2015

esc-congressFinally ESC (European Society of Cardiology)  Congress London 2015 that took place at Excel London, came to a close today, after a full 5 days of lectures, symposiums, debates, exhibitions and abstract presentations and other varieties of fulfiling showcases of today and tomorrow’s cardiology. 32,000 over delegates from all over the world, making this congress one of the largest, if not the largest gathering of Cardilogists in the world.
‘Environment and the Heart’ was chosen as this year’s theme. 5 new ESC guidelines were launched namely on Non-ST Elevation Acute Coronary Syndrome, Pulmonary Arterial Hypertension, Pericarditis, Endocarditis and Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.
All of these presentations can be followed or downloaded from the website.
Many things have been highlighted. From my perspective the most important highlights are one the new treatment of hyperlipidaemia (PCSK 9 antibodies) where both of the new agents have recently received approval, a new biomarkers protocol to further improve the diagnostic accuracy of acute coronary syndrome, and rejevenation of potassium sparing diuretic/s in the treatment of resistant hypertension.
From my impression, the many so called late breaking trials or discoveries that had been ‘promised’ in the opening of the Congress were unfortunately disappointing, due to mostly neutral or negative result. Nevertheless, in fairness one would be more interested with the quality of the studies rather than the positive result since, a well conducted study will bring equally important clinical implication whether positive or negative! In this regard the Congress certainly can pride itself for maintaining the tradition by presenting a wealth of researches that come from all corners of the world.
Highlight of each subspecialities of cardiology are presented here briefly.



Data on the long term efficacy of catheter based treatment of atrial fibrillation was presented. In general AF ablation is effective while addition of short medical therapy with antiarrhythmic did not influence the long term result in patients who had the ablation (no difference in arrhythmia recurrence).
Interestingly, a small study had found weight loss as an effective way of maintaining sinus rhythm. Another study suggested that LAA isolation in addition to PV isolation during the AF ablation therapy will improve the long term success rate.
Leadless pacing with St. Jude’s nanostim was proven to be safe and effective, as the result of LEADLESS II had shown. 6 month safety & efficacy of the procedure were examined in non-randomised series of 300 patientsn – 96% success rates of implant, freedom from serious adverse event due to implant (SADE) 93%, it showed good pacing performance, with battery longevity of 15years. Bear in mind the current system is single chamber VVIR only.
A study looking at Environmental effects of patients on PPM & ICDs were presented, which found that exposure to cellphone is safe as long as it is held at 15cm away. Household security system is safe, however with Electronic security patients are advised not to linger for too long. Ear phones used are to be kept at 3cm distance, therefore the general rule is keep calm, keep distance!
CRTP or CRTD implantation in patients having the indication for CRTP?
It was postulated that CRTP patients would benefit from CRTD as well due to its benefit in preventing fatal arrhythmia. The study involved 535 patients undergoing CRTP, 1170 CRTD by French doctors. Surprisingly the SCD mortality were identical in both groups.
As more patients are undergoing pacemaker implant, there are cases when lead extraction is required. ELECTRa study looked 12 months result of patients undergoing lead extraction which found it to be safe with low 12m mortality at 6.7%. In addition, among these patients, after 1yr 1/5 of them did not get new lead implant!

In the PROMPT trial presented by G. Stone post ACS patients were assigned with the implantation of LV pacing or control. It was hypothesised as perinfarct pacing in narrow QRS (120ms QRS) to reduce the LV remodelling. There were a total of 126 patients post STEMI who underwent the implantation of LV pacing however, 18m followup failed to show benefit comparing to control.

In the ALBATROSS study – among patients with AMI (STEMI/NSTEMI) who were randomised within the first 72 hours to receive intravenous K canrenoate then spironolactone prior to undergoing PCI. The objective was to determine whether treatment with aldosterone antagonist could reduce remodelling due to the infarct in this group of patients. At the study end, no difference was observed between treated subjects and placebo, though there was trend towards benefit among the STEMI group.
A new Mineralocorticoid antagonist Finerenone was tested head to head against eplerenone in the ARTS-HF trial among patients worsening HF, the result indicated that finerenone was non-inferior to eplerenone.
Sleep disordered breathing has been thought to be a common detrimental factors among patients with heart failure due to systolic dysfunction. The SERVE-HF study examined the role of assisted mechanical breathing among subjects with Central Sleep Apnoea. However, the result did not show any significant benefit, indeed there were excess death among the subjects receiving the intervention.

One of the major highlights this time was on the advances in diagnosis of ACS assisted by the highly sensitive Troponin. As shown in SWEDE HEART the new test resulted increased in improved diagnostic accuracy. The BACC study compared 1 hour strategy with hsTNI versus 3 hours. The bottom line is using new cut off value of 6ng/L rather than the 99 percentile (used for the 3 hours). The one hour rule out protocol has resulted in higher patients survival, overal the 0/1 hour rule-in/rule-out strategies better than 0/3 hour. This is reassuring given Roche hsTNT has also been shown to provide higher accuracy in the TRAPID study. One caveat though, you must check which or who is your hsTN source, as there are differences between different manufacturers, therefore you need to establish your own lab value!
Now we are back talking about REPERFUSION INJURIES. Researches in the CIRCUS study tested the hypothesis that Cyclosporin could prevent reperfusion injury among AMI patients undergoing PCI, as had been shown in a previous study. Patients presenting up to 12 hours were given ciclomulsion (cyclosporin) (or matching placebo) prior to undergoing emergent PCI. Unfortunately the result was neutral at one year, no reduction in infarct size was observed.
Dual antiplatelet therapy in ACS is still topical particularly regarding ideal treatment duration. An analysis of the PEGASUS study, among stable patients with history of MI one to 3 years with additional risk factors were included, randomised to ticagrelor 60mg or 90mg BD, or placebo (receiving aspirin only). There was overall benefit observed in both ticagrelor treated groups (albeit increased bleeding), though researchers concluded that the benefit was confined to those patients that stopped the DAPT within 30 days of AMI. For those who have been on aspirin monotherapy for more than a year, no benefit was observed.

Not solely confined to ACS, in the interventional cardiology world the issue of DAPT treatment duration seems to remain topical. The OPTIDUAL study compared DAPT duration of 48m or 12m (clopidogrel/aspirin) among subjects undergoing PCI with DES. Unfortunately the study had to be terminated early due to problem with resources, resulting in failure to recruit targeted number of subjects. At the end of the study, there was no significant difference in term of thrombotic complications between the two arms.
The MATRIX study comparing transradial vs trans femoral access for NSTEMI/STEMI is still ongoing, however they presented the antithrombotic arm in which patients were randomised between bivaluridin (bolus and extended treatment) vs heparin, there were no difference in the primary endpoint between the two treatment strategies.
As for stenting strategy, the ABSORB STEMI TROFI II looked at Healing score (using OCT) among subjects undergoing PCI with the bioabsorbable Absorb BVS vs EES. The Absorb was non inferior in term of healing compared to EES, with trend to superiority
Further to this, the ABSORB JAPAN examined the long term outcome between subjects treated with BVS vs Cobalt Chromium EES, there was no difference in late loss or target lesion failure, no stent thrombosis.
A study looking at the differences between new generation vs older generation DES was presented, dissecting the result among 6000 plus patients in total with 2 years follow up. There was clear superiority favouring the new generation DES in term of CV death, MI and stent thrombosis.
The Transradial British Columbia Canada study that incorporated 83,659 patients proved that radial strategy should be the preferred access in PCI, showing 30d mortality, blood transfusion favouring radial (0.8, 0.49)
FAME FFR STRATEGY 5YR FOLLOW UP showed the difference favouring FFR strategy remain, though it’s no longer statistically significant, convergent in the MACE between the two strategies were observed at 3 years.
There was a study called PRESERVATION: looking at the effect of injecting bioabsorbable cardiac matrix during PCI among AMI subjects, which failed to show any benefit.
A Japanese study analysing result of emergency advanced resuscitation among cardiac arrest patients suggested that the optimal timing to observe benefit among these patients was at 35 minutes, ie there is no or minimal benefit for subjects who were revived beyond this time.

On the subject of BP control among hypertensive, the registry study showed that among the Europeans, barely within 35% which therefore exposing majority of hypertensive patients to all sort of long term consequence from uncontrolled hypertension. New treatment strategies in resistant hypertension? The answer might had been around the corner for long, till more and more convincing data come to surface now.
The PATHWAY 2 showed that Spironolactone is better than bisoprolol or doxazosin whether singly or combined in reducing blood pressure. If all resistant hypertension were treated with this regime, only 15 out of the 300 resistant hypertension subjects would need intervention with renal denervation. Monitoring K+ is a must though as this complication is observed more frequently comparing to other regimes.
Another study, PATHWAY 3 tested the three different diuretic regime Amiloride vs Amilo+hctz vs hctz in hypertensives with uncontrolled BP & one component of metabolic syndrome, with value of OGTT as primary endpoint. The findings confirmed treatement with HCTZ raise OGTT value most, compared to combination or amiloride alone. As regard BP reduction, the combination of amiloride/HCTZ gives the best BP reduction. It also showed that high dose of amiloride was as effective as HCTZ in reducing BP. The combination treatment result in neutral potassium changes.
Meanwhile, LCZ, which was pronounced as blockbuster drug discovery in heart failure last year, came up in another study on hypertensive subjects, called PARAMETER – in this study, ARNI resulted in Central pressure & pulse pressure reduction compared to olmesartan. 24hour ABPM – also proved the superiority of LCZ (mainly reduction in nocturnal BP). The study also showed reduced ntProBNP greater with LCZ, as well as urinary cGMP


VALVULAR DISEASES & Pulmonary Arterial Hypertension (PAH)
The GRIPHON TRIAL on Selexipag – a new prostacyclin receptor agonist in PAH treatment had been presented elsewhere however this time it was presented as a poster, which received the best poster presentation award. It looked at the effect of the drug in naive, or patients already on 1 or 2 treatment for PAH. The result showed consistent reduction of endpoint of death/morbidity up to 40% among all the subgroups. Therefore this is going to be a promising future for patients with PAH.
RAAS BLOCKADE in Aortic Stenosis? A retrospective study involving 23120 patients diagnosed with aortic stenosis, a nationwide propensity score matched study in Denmark, divided those receiving either drug, or those who were not on either, showed consistently lower mortality among patients treated with ARB or ACEI. The result was consistent encompassing all cause mortality, CV mortality and AVR. ARBs were found to be more effective in reducing mortality comparing to ACEI.
Doing MRI in Aortic stenosis subjects may help detect myocardial fibrosis (infarct pattern or midwall fibrosis), which may predict higher mortality in this group of patients, as shown in one study. However, it could not ascertain confounding factors like the effect or early surgery on these patients.
BICUSPID AoValve morphology – bicuspid without raphe – associated with eft dominance coronary and hence more prevalent CAD in this group. Regarding effect of gender, it showed that men with bicuspid valve tended to have higher event rate
A study on Acute onset Infective Endocarditis showed deferred surgery may lead to higher mortality, therefore an urgent surgery in this group considered to be a better strategy. Less pronounced effect among those with non-acute onset.
As more centres are performing percutaneous aortic valve implant (TAVI), now a study that looked at procedures performed under local anaesthetic, among those with balloon expandable vs self expandable, 570 patients received local anaesthetic, only 0.7% needed GA, another 3.7% deep sedatio, the study also showed both Corevalve and Edward Sapien were comparable.
UK TAVI REGISTRY compared various access in performing TAVI, when femoral approach was not possible – Transapical vs direct aortic vs subclavian, it showed that Subclavian access was next best to femoral in term of safety and success.
Atrial fibrillation onset post TAVI may be associated with adverse outcome. 13795 patients underoing TAVI were studied in a meta analysis which showed new AF predicted CVA in short term with hazard ratio (HR) of 2.86. It also affected long term mortality with 1.68 HR
Transcatheter mitral valve implant in high risk pts w degenerated bioprosthesis or ring annuloplasty – 37 pts underwent this procedure – 30m overal survival 60%, 6 month survival was 92%. Therefore this herald a good future for percutaneous mitral valve intervention.
Howe about Native Mitral valve replacement percutaneously? (ie when surgery deemed very high risk or unsuitable) – This could be fought with heavily calcified annulus as the main culprit. In a series of 13 patients undergoing such procedures, the 30 days outcome was promising, with 1 death and 11 of them had improvement of symptoms and NYHA, 1 patient had stroke, and another required PPM.
Functional MR w reduced EF has been successfully treated with mitral clip intervention. In one study 25/56 subjects ie 45% improved following the treatment. The registr of Mitraclip (TRAMI) showed 30 day survival of 95%, and one year of almost 80%. Predictors of event – severe symptoms, anaemia, prev AV intervention, PAD, EF <30%
Cardioband is a study looking at percutaneous annuloplasty for MV repair, result is awaited.

FFR CT (PLATFORM trial) CT FFR vs INVASIVE ICA & FFR could improve the referral rate for invasive coronary angiography among those subjects that have significant CAD.
Perfusable tissue index may predict LV function recovery after AMI
EchoCRT – persistent LV dyssynchrony among subjects with narrow QRS was related with worse prognosis, (albeit, previous study had failed to prove any benefit of CRT among these subjects).
LGE MRI / MIBG SPECT – intergration of myocardial scar and innervation imaging could refine risk stratification among heart failure patients.
Lastly there is a growing research in fusion imaging and 3D printing of valve anatomy.

EUROASPIRE III, IV showed over 80% prevalence of obestiy or overweight among the CV subjects at risk. Rate of obesity was 44%, BP control 45% and appalingly, lipid 18%! This goes to show that CV risk factors not adequately managed in primary care and hence need more effort
With the proliferation of DPP4 inhibitors as one of the new treatment of type II DM, question lingers on safety, previous study with Saxagliptin raised concern with increased heart failure event. TECOS (trial evaluating CV outcome with Sitagliptin) result was presented. This was a study involving more than 14000 subjects treated with either Sitagliptin or placebo. There was similar CV outcome between the two arms at the end of 2 years followup, and no increase in heart failure or hospitalisation for HF was observed among patients treated with Sitagliptin.
A re-analysis of IMPROVE -IT study on the efficacy of Simvastatin/Ezetimibe among ACS subjects was presented. The study that showed an absolute reduction of 2% in primary endpoint favouring the combination. Now the study examined the incidence of new onset DM among these subjects, and concluded that there was no increase among those receiving the treatment. Additional finding showed that higher events occurred among DM subjects, which was further reduced by Vytorin. Therefore DM subjects are the special group that need more aggressive lipid lowering.
Finally WHICH trial that studied 1226 patients compared standard vs nurse led multidisciplinary home based treatment among patients with CVD. It was concluded that home based intervention give better survival & all cause mortality by 44% but more so in patients with high clinical complexity score, hence home based therapy particularly beneficial in high risk patients