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Posted: 23 Mar 2013 07:50 PM PDT

There seems to be a lot of hype over compression sports wear, but does it really work?

COMPRESSION garments have been around for some time now, although it is only of late that interest is picking up.

Since it sits snugly on the skin, compression garments are aimed at helping athletic performance and recovery. These tops, bottoms and socks are designed to apply a certain amount of pressure to specific parts of the body and provide more support for the muscles. By keeping the muscles from vibrating too much, it then helps delay fatigue.

When the muscles are supported, there is an increased supply of oxygen to the muscles, thereby reducing lactic acid buildup, which then leads to a reduction in DOMS (delayed onset muscle soreness).

The tight apparel comes with plenty of claims, some of which have been proven true. Most manufacturers will tell you these garments help improve recovery, improve circulation, reduce fatigue, reduce injury, heighten proprioception and offer protection from harmful UV rays for those exercising outdoors.

It has also been proven to reduce the risk of deep vein thrombosis for those travelling on long flights.

Compression wear for sports mainly acts to keep the muscles warm, prevents muscle strain, chafing and rashes.

A further selling point is that it wicks sweat away from the body and helps regulate body temperature.

According to a news report in www.quick-sport.com, most people are clueless about compression wear until they begin preparing for cosmetic surgery, namely breast augmentation or liposuction.

The surgeon will advise them to purchase compression garments as it is necessary for post-surgical recovery. The physical trauma of most plastic surgeries often causes the affected area to swell, bruise, and feel tender or sore. Compression garments help reduce these symptoms.

Similarly, when the ankle is sprained, the doctor will often recommend a compression stocking to reduce the swelling and to provide support for the joint.

Several studies have been conducted to assess whether compression garments have any impact on athletic performance and recovery. Most results reveal the positive effects of compression are only seen during and after longer bouts of exercise (eg triathlons, bike races, marathons, etc) but minimal impact have been seen on short, explosive exercises.

More research needs to be conducted to substantiate or refute these claims and determine whether it is worthwhile to use these garments before, during and after exercise.

At present, there is only one Malaysian compression wear brand in the market – Breathe™.

Founded by the husband and wife team of Inderjit and Kiran Kaur, Breathe™ apparel was created because the couple were looking for something comfortable to exercise in. Since most foreign compression wear brands were expensive, they sought to find a better, affordable compression wear to help active and sporty people.

"We wanted to create something that benefits everyone, from the supreme athlete to the occasional jogger. We wanted to ensure that everyone can afford Breathe™," says Kiran, who left her job in Tesco to concentrate on her new business venture.

In 2010, they both decided to make a lifestyle change and focused on getting fit. Inderjit enrolled in an outdoor military-inspired training programme three times a week but discovered he always suffered from muscle aches and fatigue the next day.

When Kiran joined the same programme, she was repulsed by how damp her cotton workout shirt would be at the end of the session. The sweat and grass stains on her clothes were a further put off.

Topmost on their minds was to be comfortable while working out. After much research and soul searching, they formed their company, Breathe Apparel Marketing Sdn Bhd, and started marketing the compression garments in 2010. It comes with a money back guarantee.

The couple offered us three pieces from their collection to try out.

My editor was given a blazing red, short-sleeved top. While he found that the compression forced him to improve his posture and walk tall (yeah, he slouches like an osteoporosis patient), he didn't find other benefits.

My verdict: I liked the full-length bottom. It provided me plenty of support and felt like a second skin. Oh, and it helped stopped my bootie from wobbling too much while I was hiking up a hill! Because all Breathe™ garments come with a 35+ UV protection, I also felt safe from the sun and didn't have to slather on sun block.

The long-sleeved top, on the other hand, was a bit of a letdown. I used it for one of my dance classes and every time I'd raise my hands, the top would ride up and cause unsightly creases in my chest area. It was uncomfortable because I had to pull it down constantly. However, it did leave me cool and dry after the two-hour class.

Perhaps it may come in handy during my next diving trip.

Personally, I've been wearing skin-fitting exercise gear for as long as I can remember. From ballet tights to Lycra bottoms and leotards, these were the only staple garments I wore at one time. It was compulsory for all dance majors in university as the professors insisted on checking our alignment and body lines during classes.

It wasn't quite compression wear, but it was definitely a tight fit. For performances, those with extra jiggles were urged to wear three layers of tights to keep the muscles from bouncing too much. Such was the attention to aesthetics.

Now, when I go on that occasional jog outdoors, especially in our humid weather, I'd rather wear a tee-shirt and shorts or track bottoms. I need my skin to breathe after wearing tight clothing for hours.

Of course, loose fitting clothes flop around and do not tuck the bulges in as well, but hey, it's a good way to hide the obscenities from the world!

I've taken part in many 10km runs, alternating between loose, comfortable attire and compression wear and have not witnessed much muscle fatigue with either. Compression wear didn't improve my timing in the race.

My theory is that if you're reasonably fit and wear whatever makes you feel good and comfortable, you will perform well. One has to take note that there are also other factors such as proper nutrition, lifestyle, training methods, hydration and sleep that affect athletic performance.

The writer is a certified fitness trainer who tries to battle gravity and continues to dance, but longs for some bulk and flesh in the right places. Right now, she is vegetating from a badly sprained ankle.

Sterilising a woman

Posted: 23 Mar 2013 07:49 PM PDT

As a vasectomy (male sterilisation) is simpler and has fewer risks, it should always be considered first before female sterilisation.

PREGNANCY occurs if an egg is fertilised by a sperm. This occurs when both partners produce eggs and sperms optimally, the fallopian tubes are patent, and sexual intercourse occurs about the time an egg is released by the ovary. It takes only one sperm to fertilise an egg.

When the egg is prevented from meeting the sperm by cutting, blocking or sealing the fallopian tubes, fertilisation cannot occur.

The types of female sterilisation are tubal occlusion by abdominal surgery and hysteroscopic sterilisation.

Considerations

Female sterilisation should always be viewed as permanent. Reversal is sometimes possible with microsurgery to re-join the blocked or severed fallopian tubes. However, a successful operation does not mean that it is possible to have a pregnancy.

A discussion with the doctor about the family circumstances and wishes is vital in making the correct decision. The doctor will provide the relevant information and counselling before carrying out the procedure.

As a vasectomy is simpler and has fewer risks, it should always be considered first before female sterilisation.

Sterilisation should only be considered if there is an absolute certainty that any, or any more, children are not wanted. If there is any doubt, another contraceptive method should be used until one is absolutely sure.

If either partner has any doubts or concerns, it is advisable to use some other reversible contraceptive method, which is almost or just as effective as sterilisation.

Decisions about sterilisation should never be made during or after a major event in one's life, eg after childbirth or miscarriage.

A discussion with one's spouse or partner is helpful prior to a decision on sterilisation. It would be preferable if the couple both agree to the procedure, although it is not a legal requirement to have the spouse's or partner's consent.

Female sterilisation can be performed at any age. However, doctors are generally reluctant to carry out sterilisation in individuals below 30 years of age, especially if they do not have children, because there is an increased likelihood of regret.

Advantages

Female sterilisation is effective, with more than 99% chance of preventing pregnancy. Abdominal surgical methods – blockage of (tubal occlusion) or removal of the fallopian tubes (salpingectomy) – is effective immediately.

Hysteroscopic sterilisation is effective after about three months, with 96% of sterilised women reported to have blocked tubes by then.

The reproductive organs will continue to function just like before the procedure. The ovaries will continue to produce eggs, which will be absorbed by the body.

Female hormone production is unaffected as the hormones are released directly into the blood.

Sterilisation does not affect sex drive or the enjoyment of sex. In fact, many women report improved sexual enjoyment, as there is no longer the fear of an unplanned pregnancy.

Intercourse can take place any time it is comfortable to do so, but doctors usually advise use of contraceptives until the first period after the procedure.

Disadvantages

Female sterilisation methods require procedures that are more complex than male sterilisation. Like all other procedures, there is a very small risk of bleeding, infection or damage to internal organs.

The abdominal surgical sterilisation methods can fail, ie the fallopian tubes may re-join on their own. This occurs rarely, with only about one in 200 women getting pregnant in their lifetime after a female sterilisation procedure.

Should pregnancy occur after female sterilisation, there is an increased likelihood that it will be sited outside the uterus (ectopic pregnancy), usually the fallopian tubes.

An ectopic pregnancy is a potentially life threatening condition. As such, a pregnancy test should be done if a period is missed after such a procedure.

If it is positive, an ultrasound scan is needed to check whether the pregnancy is sited inside or outside the uterus. Immediate medical attention must be sought if the period is delayed or light or there is sudden or unusual lower abdominal pain.

There is a small likelihood of pregnancy after hysteroscopic sterilisation. Other possible problems include post-operative pain (about eight in 10 women), bleeding after the procedure, and incorrect insertion of the implants (about two in 100 women).

Female sterilisation does not provide protection against sexually transmitted infections (STIs). If one is at increased risk of STIs – one has multiple sexual partners or one is unsure about one's sexual partner – then it is advisable to use condoms even after sterilisation.

Tubal occlusion

Here, the fallopian tubes are cut, sealed or blocked in an operation, thereby preventing the egg and sperm from meeting.

The tubes can be approached by a laparoscopy or a mini-laparotomy. The former is a common approach. It involves a small incision under the umbilicus and the insertion of a flexible tube with a lens (laparoscope) that is connected to a light source. This enables the gynaecologist to see the fallopian tubes.

Another incision is made in the abdominal wall between the umbilicus and pubic bone to insert an instrument to carry out the procedure. The latter involves making a small incision in the lower abdomen between the navel and pubic bone. This permits access to the fallopian tubes by the gynaecologist.

The choice of approach is influenced by factors such as obesity, previous abdominal or pelvic surgery, and previous infections of the uterus and fallopian tubes (pelvic inflammatory disease).

There are different ways of tubal occlusion: application of plastic or titanium clamps or silicone rings to the fallopian tubes, tying (ligation) or cutting off a segment of the tubes (excision) or sealing (cauterisation or diathermy).

A laparoscopy or mini-laparotomy is usually carried out under general anaesthesia, although it is sometimes done under local anaesthesia.

If tubal occlusion has been unsuccessful or the fallopian tubes are diseased, the tubes may be partially or totally removed (salpingectomy).

Both laparoscopy and mini-laparotomy require hospitalisation for a day or two.

Hysteroscopic sterilisation

This method is not widely available. It involves insertion of a hysteroscope – a narrow tube with a telescope at one end – into the uterus through the vagina and cervix. After identifying the opening of each fallopian tube into the uterus, a metallic piece is then inserted into each tube with a guide wire. The scar tissue that forms around the implant eventually blocks off the tubes.

There is no need to make any surgical incisions with hysteroscopic sterilisation (which is carried out under local anaesthesia), and sometimes, a sedative is given as well.

Other contraceptive methods have to be used until there is confirmation by imaging that both fallopian tubes are blocked. The imaging techniques are hysterosalpingram, which is an x-ray done after a dye is injected through the cervix to confirm that the tubes are blocked, or hysterosalpingo-contrast-sonography, which is an ultrasound carried out after dye is injected into the tubes.

Recovery

There should be information provided about what to expect and what to do after discharge, including a telephone contact if there are any problems or questions.

It is not uncommon to feel some discomfort for a few days post-operatively. Returning to work is possible after a few days, depending on one's general health. Most doctors advise avoiding heavy lifting for about a week.

There may be slight vaginal bleeding and some abdominal discomfort after the procedure. The discomfort should be relieved with the painkillers prescribed.

If the pain or bleeding worsens, medical attention should be sought.

Stitches for the abdominal incisions may or may not need to be removed. Dissolvable sutures would disappear by itself. An appointment will be given if the stitches need to be removed. The wound dressing can usually be removed a day after the procedure.

Doctors usually advise usage of another contraceptive method until the first period after tubal occlusion; and for about three months after hysteroscopic sterilisation following imaging confirmation that the tubes have been blocked off. Condoms should be used if there is need for protection against STIs.

Sex can be resumed as soon as it is comfortable to do so.

Reversal

Female sterilisation can be reversed, but it is a very difficult process involving removal of the blocked part of the tubes and re-joining the ends.

There is no guarantee of pregnancy after a sterilisation reversal.

The success rates of reversal depend on factors like age and the method used in the original operation.

For example, if the tubes were clamped rather than tied, successful reversal is more likely. The current success rate of reversal is between 50 to 60%, ie 50 to 60 of 100 women who have a reversal will have patency of their tubes restored. This should not be equated to pregnancy rates.

There are no long-term effects from male and female sterilisation. A vasectomy should be considered first as it is simpler and there are fewer risks. Although both operations are minor procedures, the decision to have either operation has far reaching implications and it should be made only after the couple is sure that they do not want any more children or never want any children.

Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Tuberculosis: An infectious killer

Posted: 23 Mar 2013 06:25 PM PDT

As the world marks World TB Day today, we review mankind's current battle with this ancient disease, which remains one of our top infectious killers.

MYCOBACTERIUM tuberculosis is one tenacious and crafty bacteria.

It has been hanging around inside humans and causing the disease now known as tuberculosis (TB), along with all its associated complications, for thousands of years.

Archaeologists have even found evidence of spinal TB in ancient Egyptian mummies.

With 23,000 new cases in 2011 and 1,700 deaths, this infectious disease is still a fairly common problem in Malaysia.

The large majority of Malaysians will remember receiving their compulsory BCG vaccinations at the age of 12, although probably not the one they got at birth, between the years of 1961 and 2001.

From 2001 onwards, the vaccination was only given at birth, as research had found no evidence to indicate that the booster shot provided extra coverage against the disease.

The Bacille Calmette-Guérin (BCG) vaccine – currently the only vaccine available for use against TB – consists of a weakened live strain of Mycobacterium bovis, a close sibling of M. tuberculosis more commonly found in cattle.

This weakened bacterium is sufficient to stimulate the body's immune system to produce its own antibodies to protect against further invasions of similar Mycobacterium species, including M. tuberculosis, while being too weak to cause actual disease.

While the BCG vaccine is the most widely administered vaccine in the world, reaching over 80% of babies and children in countries that have a national immunisation programme, its effectiveness varies according to geographical regions.

On the other hand, TB is also a treatable and curable disease, albeit through an intensive and strict drug regimen that lasts at least six months for those without the multi-drug and extremely resistant versions of the disease. Those who have drug-resistant forms of TB have a more complicated regime, which takes at least 18 months to complete.

In fact, the World Health Organisation (WHO) reports that the death rate from TB has dropped by 41% since 1990, and that the estimated number of people falling ill with this airborne disease each year is declining – although very slowly – which means that the world is on track to achieve the Millennium Development Goal of reversing the spread of TB by 2015.

As such, is it possible that we will be able to eradicate this disease from humankind within our lifetimes?

That is certainly the hope – and the challenge – of the two-year World TB Day campaign, Stop TB in My Lifetime, which marks its second year today.

Current danger

According to the WHO, TB is the number two killer of humans due to a single infectious agent.

It is second only to HIV/AIDS, and is, in fact, the leading cause of death for HIV/AIDS patients themselves, resulting in about one quarter of deaths.

There were 8.7 million new cases of TB reported in 2011, while 1.4 million died from the disease in the same year, according to the WHO Global Tuberculosis Report 2012.

More worrying is the fact that multi-drug resistant TB (MDR-TB) is present in virtually all of the countries in the WHO survey.

Médecins Sans Frontières' (MSF, also known as Doctors Without Borders) Access Campaign executive director Dr Manica Balasegaram opines that drug-resistant TB in particular, represents an uncovered, and likely, growing epidemic.

According to the Report, around 3.7% of new TB cases and one-fifth of previously treated cases have MDR-TB, and almost 60% of these cases occur in China, India and the Russian Federation alone.

However, the WHO estimates that currently, only one of every five MDR-TB cases is being diagnosed, leaving the other 80% undiagnosed, under-treated or untreated at all, and free to spread their more dangerous version of TB around.

Says Dr Manica: "Access to diagnosis may be even worse for low-income countries and certain high-burden countries like India and China.

"We are only seeing the tip of the iceberg in terms of the true burden of MDR-TB."

Aeras (a non-profit product development organisation dedicated to the development of effective tuberculosis vaccine regimens that will prevent TB infection in all age groups and will be affordable, available and adopted worldwide) vice-president and acting chief medical officer Dr Ann Ginsberg agrees, saying: "Tuberculosis largely affects people living in poverty, but because the disease is airborne, anyone can be infected.

"Recent trends show an increase in multi-drug resistant tuberculosis, which is much more difficult and costly to treat."

The cost to treat MDR-TB cases can be 200 times more expensive than the normal drug-susceptible strains, she says, with the treatment time at least two to three times longer, and the side effects, more severe.

But it is the regular TB treatment that is itself also contributing to the growth of drug-resistant TB, says Global Alliance for TB Drug Development (TB Alliance) president and chief executive officer Dr Mel Spigelman.

"First, the current options to treat the disease are inadequate, and difficult to administer properly and adhere to, which leads to incomplete treatment, and is fuelling the growth of even more deadly and difficult-to-treat drug-resistant forms of TB," he says.

"The second aspect of the disease I'd stress is that it is a truly global disease.

"It is spread through the air, and therefore, it knows no bounds – TB does not respect national borders. TB exists all throughout the world, and is an even greater threat wherever poverty exists."

According to the WHO, over 95% of TB deaths occur in low- and middle-income countries, and it is among the top three causes of death for women aged 15 to 44.

Says Dr Ginsberg: "TB mostly strikes people during their most productive years, so it has a major impact on families, communities and economies.

"When a parent has TB, they are often unable to work, trapping them and their family in a cycle of poverty."

Treatment problems

A standard TB treatment regimen, as recommended by the WHO, consists of four drugs – isoniazid, rifampicin, pyrazinamide, and ethambutol or streptomycin – taken daily and/or three times a week for six months.

This regime, according to Dr Spigelman, whose non-profit organisation focuses on discovering and developing better, faster-acting and affordable TB drugs, is far from ideal.

"The standard TB treatment is too long and complicated, creating undue burdens on patients and treatment providers alike.

"This leads to patients receiving incomplete treatment, which not only doesn't achieve cure, but leads to the development of drug-resistant forms of TB," he says.

The treatment of MDR-TB is even more complex, requiring the use of at least four drugs that the doctor determines based on the patient's condition, and usually lasts 18-24 months.

According to Dr Manica, whose international non-profit medical humanitarian aid organisation treated 26,600 TB patients in 39 countries in 2011 – 1,300 of whom had drug-resistant TB, such regimes can involve taking up to 20 pills a day and enduring eight months of daily painful injections.

The drugs used, which include injectable capreomycin, cycloserine, ethionamide, moxifloxacin, pyrazinamide and para-aminosalicylic acid, also often cause severe side effects like constant nausea, psychosis, depression and permanent deafness.

Even worse, he says: "Cure rates using these drugs in current regimens are dismal; in MSF programmes, the treatment success rate is only 53% for MDR-TB – or little better than one in two, and a dire 13% for cases of extensively drug-resistant TB (XDR-TB).

"Globally, the average is even worse, with only 48% of MDR-TB patients being successfully cured. This is clearly unacceptable, and must be significantly improved."

There are also other factors that affect a patient's access and adherence to TB treatment regimes.

Aside from the harsh side effects that make it hard for patients to stay on their medication, drug resistance testing, which is particularly crucial in cases of MDR-TB, is often incomplete or not done quickly enough, leading to critical delays in starting appropriate therapy.

Dr Manica adds that quality and cost of drugs also play major roles in this matter.

"Because TB is a disease of the poor, there are relatively few drug manufacturers that produce quality-assured supplies of some of these medicines, because there is no market and no money to be made.

"In some countries, a lack of supply and stock-outs of some medicines are not unknown.

"Because the market is small and there is often a lack of competition, some of the medicines are therefore very expensive; a course to treat MDR-TB can cost as much as US$6,000 (RM18,651)."

Dr Ginsberg also shares a study published last month in the International Journal of Tuberculosis and Lung Disease, which reported that fake and poorly made pills, which do not contain enough of the active ingredient to kill M. tuberculosis, were widely available in 17 countries where TB is prevalent.

And while many national TB control programmes provide treatment for free, she says: "In many areas, people must travel significant distances to get to treatment centres.

"This time commitment can prevent them from working, meaning many people must choose between seeking treatment, or maintaining their normal routines and jobs to ensure an income to provide food for their family."

What's needed

It is not surprising then that all three doctors agree that the present most crucial need is better and faster ways of treatment and diagnosis.

Says Dr Manica: "The need for shorter and more effective treatment for TB, especially drug-resistant forms, is critical. Patients are forced to endure long, and often, harsh treatment regimens.

"An ideal regimen should be all-oral, shorter – potentially only six months – and be much better tolerated by patients.

"New regimens also need to be more effective than what we currently have; today's cure rates of only 50% are unacceptably low.

"Such a simplified and safer regimen will also allow treatment to be decentralised, and make it easier for more patients to start and stay on their medications."

Dr Spigelman agrees, saying: "The standard TB treatment is too long and complicated, creating undue burden on patients and treatment providers alike.

"This leads to patients receiving incomplete treatment, which not only doesn't achieve cure but leads to the development of drug-resistant forms of TB.

"The MDR-TB pandemic is a man-made problem resulting from inadequate TB treatments, and can only be reversed with the development of new TB treatments that can cure drug-resistant TB, and improve the treatment of TB to prevent the development of new drug resistance."

Meanwhile, as a non-profit product development organisation dedicated to developing new TB vaccines, Aeras believes that a new TB vaccine is the key to defeating the disease.

"To defeat tuberculosis, we need to develop and deliver new tools, including new vaccines.

"A vaccine that effectively prevents tuberculosis disease in adults and adolescents would have the greatest global health impact on the TB burden," says Dr Ginsberg.

Going forward

She shares that after 90-odd years of complacently relying on the BCG vaccination, researchers finally kicked into high gear over the last 10 years, trying to develop new vaccines.

"In the past decade, researchers have advanced over a dozen novel candidates into clinical testing.

"There are also approximately 25 novel vaccine constructs in early stage research or preclinical development," she says.

The most advanced candidate, MVA85A, was recently reported to have rather disappointing results in last month's issue of The Lancet.

The results of the phase IIB clinical trial, which tested the vaccine's ability to boost the protection given by the BCG vaccine in about 2,800 South African infants, showed that while the vaccine was well-tolerated and showed no signs of harm to the participants, it was not effective in providing extra protection against TB infection.

The drug front shows more promise, however, with entirely new classes of drugs that work in different ways from existing medications being developed.

December saw the accelerated approval of bedaquiline by the US Food and Drug Administration for treatment of adult pulmonary MDR-TB in combination with other drugs – the first new anti-TB drug to receive approval in 50 years, and the first and only one specifically indicated for MDR-TB.

The third and final phase of clinical trials for bedaquiline is expected to start this year.

Another drug, delamanid, is currently awaiting approval from the European Medicines Agency.

An eight-country phase III clinical trial to study this drug is currently recruiting participants.

Says Dr Manica: "As these new drugs represent entirely new classes of TB medication, the likelihood of resistance is very low, and these drugs have been shown to be more effective than existing drugs, in particular against MDR-TB.

"In trials, use of these drugs has shown more rapid and better eradication of Mycobacterium tuberculosis, while also appearing to be better tolerated than many of the agents currently used."

Meanwhile, Dr Spigelman is excited about other new treatment regimens in development, especially the combination of another new drug, PA-824, with pyrazinamide and moxifloxacin, to treat both drug-susceptible and drug-resistant TB.

PA-824 is currently being studied in various phase I and II clinical trials for safety and efficacy when used in combination with several other drugs.

As exciting as these developments are however, they are hollow if they do not reach those who need them.

As Dr Manica says: "Innovation without access is meaningless to our patients. Manufacturers, countries and donors must work aggressively to ensure these drugs reach the patients most in need of them."

A crucial point indeed when the WHO reports that there is a US$3bil (RM9.3bil) funding gap for TB care and control in low- and middle-income countries, and that research and development funding in recent years has only achieved about 32% of its target.

Kredit: www.thestar.com.my

Ahad, 24 Mac 2013

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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