CHAPTER 01: INTRODUCTION

TO ANATOMY

ANALYZING PATIENTS
PROFILE FOR
OPTIMIZING CASE
CLERKING

ERNI KOLOPAKING, SCHOOL OF PHARMACY, MSU

CHAPTER 01: INTRODUCTION

TO ANATOMY

THE UNIVERSITY OF
CHOICE

CHAPTER 01: INTRODUCTION

TO ANATOMY

SCHOOL OF PHARMACY,
MSU

Established on 14th July 2007

Aligned the standard set by the

Malaysian Pharmacy Board (MPB) and
Malaysian Qualification Agency (MQA)
Currently running with 450 students
Course available:
Bachelor of Pharmacy
Diploma of Pharmacy
Diploma in Traditional Chinese Medicine

CHAPTER 01: INTRODUCTION

TO ANATOMY

SIX ACADEMIC UNITS

CHAPTER 01: INTRODUCTION

TO ANATOMY

SIX ACADEMIC UNITS

CHAPTER 01: INTRODUCTION

TO ANATOMY

SIX ACADEMIC UNITS

CHAPTER 01: INTRODUCTION

TO ANATOMY

BPharm (Year 1)

CHAPTER 01: INTRODUCTION

TO ANATOMY

BPharm (Year 2)

CHAPTER 01: INTRODUCTION

TO ANATOMY

BPharm (Year 3)

CHAPTER 01: INTRODUCTION

TO ANATOMY

BPharm (Year 4)

CHAPTER 01: INTRODUCTION

TO ANATOMY

Attachments

1. Hospital Pharmacy Attachment

Year 2 (Semester 4), 4 weeks

2. Community Pharmacy Attachment

Year 3 (Semester 6), 4 weeks

3. Industrial Pharmacy Attachment

Year 4 (Semester 7), 4 weeks

4. Clinical Pharmacy I & II Attachment

Year 4 (Semester 7 and 8), 8 weeks

CHAPTER 01: INTRODUCTION

TO ANATOMY

EXAMPLE

CHAPTER 01: INTRODUCTION

TO ANATOMY

Pharmacy Practice
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Pharmacy Practice
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Pharmacy Practice
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Pharmacy Practice
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Pharmacy Practice
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Pharmacy Practice
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Pharmacy Practice
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Pharmacy Practice
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Pharmacy Practice
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Pharmacy Practice
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Industrial Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Industrial Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

ODAWARA KANEBO
R&D TECHNOLOGY DEPT.

CHAPTER 01: INTRODUCTION

TO ANATOMY

Industrial Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Industrial Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Community Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Community Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Community Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Community Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment
CLINICAL ATTACHMENT
at Hospital Sungai Buloh

Siewert carcinoma of cardia

esophagus

Takeshi Oshizaka
Josai University

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

Clinical Pharmacy
Attachment

CHAPTER 01: INTRODUCTION

TO ANATOMY

OBJECTIVES (1)

1. To prepare students to be able to help

patient in solving their medical
problems (especially with medications).
2. To prepare student to be able to work
together with other people (health
care providers: doctor, nurses,
nutritionists, etc;
as well as with the hospital
management, patients caregivers, and
the community).

CHAPTER 01: INTRODUCTION

TO ANATOMY

OBJECTIVES (2)

3. To teach student to have clinical

knowledge, skill, intuition, and critical
thinking to help patients.
4. To teach student to have the ability to
communicate with other people, in
order to express his/her opinion
regarding patient care, for the best
interest of the patients.
5. To teach students to act in professional
manner, ethically and clinically.

CHAPTER 01: INTRODUCTION

TO ANATOMY

HOW TO HELP PATIENT

A. Pharmacist should analyze three

aspects:
1. Patients profile.
2. Disease(s) profile that patient has.
3. Treatment for disease(s) that patient has.
B. Then to come up with Pharmaceutical
Care Issues (PCI) in order to give the most
appropriate treatment (safe and effective)
for the patient.

CHAPTER 01: INTRODUCTION

TO ANATOMY

1. TO LEARN PATIENTS
PROFILE (1)

1. Be able to read, understand, and

analyze Patients Medical Record (PMR).
2. Be able to read, understand, and
analyze the medical terms and medical
abbreviations.
3. Be able to read, understand, and
analyze all patients data and condition.

CHAPTER 01: INTRODUCTION

TO ANATOMY

Example (1)
The meaning and its implication of
patients
data on gender, age, weight, and
height.
PATIENTS DATA
Name : Mr. X
Sex : Male

Race : A

Age : 43 years old

RN: 00.000.007

Height : 170 cm

Weight : 50 kg

Admission Date: 03/09

Discharged Date: 05/09

CHAPTER 01: INTRODUCTION

TO ANATOMY

Example
(1)
The meaning and its implication of
patients
data on gender, age, weight, and
height.

PATIENTS DATA
Name : Mrs. Y
Sex : Female

Race : B

Age : 56 years old

RN: 00.000.008

Height : 156 cm

Weight : 82 kg

Admission Date: 12/01

Discharged Date: 27/02

CHAPTER 01: INTRODUCTION

TO ANATOMY

Example (1)
The meaning and its implication of
patients
data on gender, age, weight, and
height.
PATIENTS DATA
Name : Chd. Z
Sex : Male

Race : C

Age : 10 years old

RN: 00.000.009

Height : 125 cm

Weight : 25 kg

Admission Date: 03/12

Discharged Date: not yet discharged

CHAPTER 01: INTRODUCTION

TO ANATOMY

Example (1)

He is a child of more than 2 years old,

his BMI can be calculated with
the formula of "BMI for age"
(having discrepancy in age and gender).
The result: his BMI is 16, it is 36%,
means he has healthy body weight.
(Reference: http://kidshealth.org/
parent/general/body/bmi_charts.html )

CHAPTER 01: INTRODUCTION

TO ANATOMY

Example
(1)
The meaning and its implication of
patients
data on gender, age, weight, and
height.

PATIENTS DATA
Name : Chd. Q
Sex : Female

Race : M

Age : 20 months

RN: 00.000.009

Height : 45 cm

Weight : 9.8 kg

Admission Date: 15/05

Discharged Date: 31/05

CHAPTER 01: INTRODUCTION

TO ANATOMY

Example (1)

She is a child of less than 2

years old,
her healthy weight status can
be
calculated with the formula of :
her minimum weight should be
3 times
of her weight when she was
born.

CHAPTER 01: INTRODUCTION

TO ANATOMY

1. TO LEARN PATIENTS
PROFILE (2)

The meaning and its implication of

patients chief complaint (sign and
symptoms), history of present illness,
past medical history, past medication
history, family history, social history,
allergic history, the results of physical
and laboratory examination at the
time patient arrived at the hospital.

CHAPTER 01: INTRODUCTION

TO ANATOMY

Example (2)

PATIENTS DATA

Name : Mr. X
Sex : Male

Race : A

Age : 43 years
old

RN: 00.000.007

Height : 170 cm

Weight : 50 kg

Admission Date: 03/09

Discharged Date: 05/09

CHAPTER 01: INTRODUCTION

TO ANATOMY

CHIEF COMPLAINTS

Shortness of Breath (SOB)

HISTORY OF PRESENT ILLNESSS

SOB since the morning of 03/09, progressively

worsening, not resolved by MDI (not sure how
many times), coughs with whitish sputum.
Sudden onset, trigger factor was ice drink at
night.

CHAPTER 01: INTRODUCTION

TO ANATOMY

PAST MEDICAL HISTORY

Childhood asthma since 5 years old

daytime symptoms 4-5 times/week
night time symptoms almost daily
+ uses MDI reliever almost daily
Asthmatic attack once per month
COPD (chronic obstructive pulmonary disease)
IV heroin abuser since age 20
PAST MEDICATION HISTORY

MDI Salbutamol 2 puffs PRN since 30 years old.

He had budesonide, however, he did not use.
Not keen for methadone

CHAPTER 01: INTRODUCTION

TO ANATOMY

FAMILY HISTORY
Father and brother have asthma

ALLERGY
NKDA

SOCIAL HISTORY
Smoker 10 cigarettes/day since age of 15

Heroin abuser since age of 20

Working as a lorry driver
Patient married without kids

CHAPTER 01: INTRODUCTION

TO ANATOMY

PHYSICAL AND LABORATORY EXAMINATION

General : alert, conscious, not tachypnoeic, not using

accessory
muscle of respiration, talking in full sentences.
GCS: Eye 4, Verbal 5, Motor 6, Total 15
CVS : BP (blood pressure) 132/62 mmHg

: PR (pulse rate) 78 p/min, RR (respiration Rate)

22 b/min
Lungs : occasional polyphonic wheeze
WORKING
Abdomen
: soft, non tender
DIAGNOSIS
Acute exacerbation of bronchiral asthma probably by
enviromental factors, underlying poorly controlled
asthma
DIFFERENTIAL DIAGNOSIS

None

CHAPTER 01: INTRODUCTION

TO ANATOMY

2. TO LEARN PATIENTS
DISEASE
The meaning of all results of
physical, laboratory and
radiology investigations, etc, on
the second day.

CHAPTER 01: INTRODUCTION

TO ANATOMY

THE RESULTS OF LABORATORY

INVESTIGATIONS
Paramet
ers

Units

Normal
range

Remark
s

Results
on 3/09

Renal profile
2.7

Normal

64-122

82

Normal

80-120

80
(indicated
)

Normal

Urea

mmol/L

1.7-8.3

SCr

umol/L

CrCl

ml/min

CHAPTER 01: INTRODUCTION

TO ANATOMY

Electrolytes
Sodium

mmol/L

135-145

Potassiu
m

mmol/L

3.5-5.0

Calcium

mmol/L

2.142.58

n.a

Corrected mmol/L
calcium

2.142.58

n.a

Phosphat mmol/L
e

0.8-1.45

Magnesiu mmol/L
m

0.7-1.3

Chloride

mmol/L

96-106

141

Normal

7.7

High

n.a
n.a
107

High

CHAPTER 01: INTRODUCTION

TO ANATOMY

Full Blood Count

WBC

x109/L

4.0-11.0

9.19

Normal

Hb

g/dL

11.515.5

14.5

Normal

RBC

x109/L

4.2-5.4

4.32

Normal

Hct

36.052.0

n.a

Plt

x109/L

150-400

n.a

Coagulation Profile
PT

second
s

10-13.5

n.a

APTT

second
s

26-42

n.a

<1.5

n.a

INR

CHAPTER 01: INTRODUCTION

TO ANATOMY

Liver Profile
Total
Protein

g/L

Albumin

g/L

T.
Bilirubin

umol/L

ALT

IU/L

AST

IU/L

ALP

IU/L

66-87

70

Normal

35-50

37

Normal

<20

12

Normal

<32

14

Normal

n.a
53-141

54

Normal

CHAPTER 01: INTRODUCTION

TO ANATOMY

Cardiac Profile
CK
Trop-T

IU/L

24-195

n.a

<0.1

n.a

LDH
IU/L
100-210
Lipid Profile
C- Total mmol/
<5.7
L
C- TG mmol/
<1.7
L
C- HDL mmol/
>1.7
L
C- LDL mmol/
<3.9
L

n.a
6.84

High

0.70

Normal

1.19

Slightly low

5.33

High

CHAPTER 01: INTRODUCTION

TO ANATOMY

VITAL SIGNS CHART

Date Time Temperatur
e
Norm
al

Value

37

37

Blood
Pressure

Pulse Rate

Respiratory
Rate

Norm
al

Value

Norm
al

108/7 105/5
9
8

62

112

20

Norm
al

Value

Value

03/0
9

02:3
3

04/0
9

02:5
4

108/7 119/6
9
3

62

60

20

04/0
9

15:4
5

108/7 103/7
9
1

62

75

21

CHAPTER 01: INTRODUCTION

TO ANATOMY

3. TO LEARN TREATMENT
PROFILE
1. To learn progress note
2. To learn diagnose test
3. To learn treatment plan

CHAPTER 01: INTRODUCTION

TO ANATOMY

PROGRESS REPORT SUMMARY

Date Progress & Plan

&
Time
03/09 Progress:
02:33 Presented with SOB since early this morning,
sudden onset
Unrelieved even though he used his MDI
salbutamol multiple
times (not sure how many times)
Trigger factor: took an ice drink last night
Has intermittent cough, productive whitish
sputum
No chest pain
Presence of reduced effort tolerance
No fever
Still actively chasing heroine, last taken the night

CHAPTER 01: INTRODUCTION

TO ANATOMY

PROGRESS REPORT SUMMARY

Date Progress & Plan

&

Time
03/09 Plans:
02:33 Neb salbutamol 2 hourly, Neb Atovent Ventolin
Normal
saline 4hourly,
T predonisolone 30 mg od 5/7 (for 5 days)
Renal Profile, Liver function
BUSE BD review K + level to supplement K + if
<4
NP O2 3L/min
PEFR pre and post neb
MDI salbutamol 2 puffs pm, MDI budesonide 2
puffs BD
Pharmacist to assess MDI technique

CHAPTER 01: INTRODUCTION

TO ANATOMY

PROGRESS REPORT SUMMARY

Date Progress & Plan

&
Time
03/09 Progress:
11:12 Still having cough
Less SOB
He agreed for methadone therapy
Plans:
Refer to psychiatry for methadone therapy
For infectious screening-HIV, hepatitis screening
Refer to hepatologist for hepatitis C upon
discharge
Off neb combivent (salbutamol & ipratropium
bromide)
Change to neb salbutamol 6 hourly

CHAPTER 01: INTRODUCTION

TO ANATOMY

PROGRESS REPORT SUMMARY

Date Progress & Plan
&

Time
04/09 Progress:
02:54 Minimal SOB
Claim unable to sleep due to excessive sleeping
during day
time
Cough on and off
No fever
Plan:
Cont methadone 20 mg OD (in ward only)
To trace infectious screening HIV, hepatitis
screening
Refer to Selayang hepatologist for hep C upon

CHAPTER 01: INTRODUCTION

TO ANATOMY

PROGRESS REPORT SUMMARY

Date Progress & Plan

&

Time
04/09 Progress:
15:45 Comfortable
Speaks in full sentences
No SOB, wheezing, chest pain
No fever, Min cough, No abd pain
PEFR (Peak expiratory flow) 200 L/min
Plan:
Allow discharge
Cont MDI Salbutamol 2 puffs PRN and MDI
Budesonide 2
puffs
AFP, LFT, Hep C genotype

CHAPTER 01: INTRODUCTION

TO ANATOMY

CURRENT MEDICATIONS
Date

Drug Regimen

Indication

Started

Stopped

Name, dose, frequency, time, duration

03/09

05/09

Tab Predonisolone 30 mg, once daily

To prevent inflammation
in the airways

03/09

05/09

Inhalation of Budesonide 2 puffs (400

mcg), Twice daily

To control inflammation
in the airways

03/09

05/09

Inhalation of Salbutamol
MDI 2 puffs (200 mcg), when necessary

Used as a bronchodilator

03/09

05/09

Solution Salbutamol 0.5% Inhalation

solution when necessary

Used as a bronchodilator

03/09

05/09

Syrup Methadone, 20 mg, once daily

Used for anti-addictive

for opioid

03/09

05/09

Tab Simvastatin 20 mg, at night

To control elevated
cholesterol

CHAPTER 01: INTRODUCTION

TO ANATOMY

4. TO COME UP WITH PCI

To give opinion to the other health
care team members regarding issues
from the pharmacist point of view.
To give suggestions to overcome the
issues.

CHAPTER 01: INTRODUCTION

TO ANATOMY

PHARMACEUTICAL CARE ISSUES

Date

Issues

Suggestion

Results

03/09

Patient is noncompliance to
budesonide

To counsel patient
with the stressed
on compliance

03/09

Patient has poor

MDI technique

To suggest buying
aero chamber

03/09

Simvastatin has
adverse effects,
i.e.:
Rhabdomyolysis
, Hepatitis, and
Gastrointensitin
al tract
disturbance

To counsel patient
to be more alert of
these adverse
effects

03/09

Patient is
addicted to
heroin, he needs
to use

To counsel in how
important in using
methadone for him,
and how to use it.

CHAPTER 01: INTRODUCTION

TO ANATOMY

PHARMACEUTICAL CARE ISSUES

Date

Issues

Suggestion

Results

03/09

Patients has to To monitor

achieve the
efficacy of all
objective of
drugs that have
the
been given to the
treatments.
patient

03/09

Patients has to
be prevented
from ADRs,
Drug
Interactions,
etc.

To monitor
Adverse effects
of Simvastatin,
i.e.:
Rhabdomyolysis,
Hepatitis, and
Gastrointensitinal
Tract disturbance

CHAPTER 01: INTRODUCTION

TO ANATOMY

SUMMARY

CHAPTER 01: INTRODUCTION

TO ANATOMY

1. Step ONE

1. REVIEWING PATIENT'S
MEDICAL CHARTS

CHAPTER 01: INTRODUCTION

TO ANATOMY

REVIEWING PMR

Read PMR
and assess
the data

CHAPTER 01: INTRODUCTION

TO ANATOMY

2. Step TWO

2. BUILDING A
PHARMACISTS PATIENT
DATA BASE

CHAPTER 01: INTRODUCTION

TO ANATOMY

COLLECTING PATIENTS DATA

BASE (1)
From PMR, nurses

Ward round with doctor

CHAPTER 01: INTRODUCTION

TO ANATOMY

COLLECTING PATIENTS DATA

BASE (2)
Interview with
npatient and their
care giver

CHAPTER 01: INTRODUCTION

TO ANATOMY

COLLECTING PATIENTS DATA

BASE
(3)
With tools:

CHAPTER 01: INTRODUCTION

TO ANATOMY

3. Step THREE

3. CONSTRUCTING A
PATIENT'S
DRUG THERAPY PROBLEM
LIST

CHAPTER 01: INTRODUCTION

TO ANATOMY

4. Step FOUR

4. DESIGNING AND
RECOMMENDING A
PHARMACIST S CARE PLAN

CHAPTER 01: INTRODUCTION

TO ANATOMY

5. Step FIVE

5. MONITORING
PHARMACISTS CARE
PLAN

CHAPTER 01: INTRODUCTION

TO ANATOMY

MONITORING
Patients
interview

Physical examination

CHAPTER 01: INTRODUCTION

TO ANATOMY

Steven Johnson's
Syndrome

CHAPTER 01: INTRODUCTION

TO ANATOMY

Steven Johnson's
Syndrome

CHAPTER 01: INTRODUCTION

TO ANATOMY

Red mans
syndrome

CHAPTER 01: INTRODUCTION

TO ANATOMY

NaBic injeksi

CHAPTER 01: INTRODUCTION

TO ANATOMY

TOOLS WHICH ARE

NEEDED
1.
2.
3.
4.
5.
6.

Patient Medical Record (PMR)

Understanding PMR
Clinical Practice Guidelines
Drug Use Guidelines
Results of recent clinical trials
Professional communication
with other health care providers

CHAPTER 01: INTRODUCTION

TO ANATOMY

CRITICAL APPRAISAL

A method of assessing and interpreting

the evidence by systematically
considering its validity, results and
relevance to the area of work considered.
Balance assessment of the
benefit/strengths and flaws/weaknesses
of a study
Assessment of research protocol
Consideration of quantitative and
qualitative aspects

CHAPTER 01: INTRODUCTION

TO ANATOMY

CRITICAL APPRAISAL
CHECKLIST

CASP (Critical Skills Appraisal Programme)

http://www.phru.nhs.uk/casp/critical_appraisal_tools.htm

JAMA Users Guides to the Medical Literature

http://www.cche.net/usersguides/main.asp

Greenhalgh T (2001) How to Read a Paper, BMJ

Books, London
Crombie I (1996) The Pocket Guide to Critical
Appraisal, BMJ Books, London

BestBETs CA database
http://www.bestbets.org/cgi-bin/browse.pl?~show=appra
isal

CHAPTER 01: INTRODUCTION

TO ANATOMY

HIERARCHY OF
EVIDENCE

Evidence is presented in many forms, and it is important

to understand the basis on which it is stated. The value
of evidence can be ranked according to the following
classification in descending order of credibility:
I. Strong evidence from at least one systematic
review of multiple well-designed randomised
controlled trials.
II. Strong evidence from at least one properly
designed randomised controlled trial of appropriate
size.
III. Evidence from well-designed trials such as nonrandomised trials, cohort studies, time series or
matched case-controlled studies.
IV. Evidence from well-designed non-experimental
studies from more than one centre or research
group.
V. Opinions of respected authorities, based on

CHAPTER 01: INTRODUCTION

TO ANATOMY

SOURCES OF SYSTEMATIC
REVIEWS
The Cochrane Library www.library.nhs.uk
DARE (in Cochrane Library Other reviews)
Health Technology Assessments (in
Cochrane Library Technology Assessments)
Medline, Cinahl, Embase search on
systematic review in title, abstract
PubMed Systematic Review in Limits >
Topic
TRIP www.tripdatabase.com

CHAPTER 01: INTRODUCTION

TO ANATOMY

The Evidence Pyramid

Time Spent in Critical Appraisal

Validity/Strength of Inference

CHAPTER 01: INTRODUCTION

TO ANATOMY

CHAPTER 01: INTRODUCTION

TO ANATOMY

CLINICAL PRACTICE
GUIDELINES (CPG)

Ministry of Health Malaysia.

Management of Type 2 Diabetes
Mellitus, Malaysian MOH, May 2009.
World Health Organization, CDC, NICE,
Association of Medical Specialty.

CHAPTER 01: INTRODUCTION

TO ANATOMY

THE CLINICAL PRACTICE

GUIDELINES
CPG of Palliative Care

CHAPTER 01: INTRODUCTION

TO ANATOMY

DRUG USE GUIDELINES

Antibiotic Guidelines
Analgesic Guidelines
Respiratory Drugs Guidelines
Cardiology Drugs Guidelines
Endocrine Drugs Guidelines
Psychiatry Drugs Guidelines
Standard Operating Procedures

CHAPTER 01: INTRODUCTION

TO ANATOMY

EXAMPLE OF AN EDUCATION BOOKL

CHAPTER 01: INTRODUCTION

TO ANATOMY

TERIMAKASIH

CHAPTER 01: INTRODUCTION

TO ANATOMY

PLEASE VISIT MALAYSIA !