The current study examined how the trends in childhood vaccination refusal in Kedah, Malaysia, changed over a 4-year period (2013-2016). Data contributed by 60 public health centers were used to determine the annual incidence rates (per 1000 newborns) of vaccination refusal, and to identify the reasons for refusal among the mothers. The trend analysis revealed a 2.2-times increment in the incidence rates of vaccination refusal from 4.72 in 2013 to 10.51 in 2015, followed by a 52.2% reduction to 5.02 in 2016 ( P = .046). Besides, the proportion of mothers who refused vaccination because of religious belief reduced from 78% between 2013 and 2015 to 67.1% in 2016 ( P = .005). Overall, the finding confirms the positive impact of the educational and religious interventions introduced by the State Health Department of Kedah since January 2016; nonetheless, efforts to strengthen the existing strategies and thereby to maximize the vaccination coverage in Kedah are warranted.

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Objective: To define the correlation of clinical features with the angiographic findings in young patients (≤40 years) who presented to our institute with angina symptoms and also have an idea of disease burden in our community. Methods and results: A retrospective study was conducted over a 5 year period from 2010 to 2015. One hundred and twenty nine consecutive patients <40 years of age were admitted for evaluation and were reviewed. The mean age was 37.7 years (range 28-40), 76.7% (99) were males and 23.3% (30) were females. This was similar to the figures for more than 40 years cohort, 74.1% males and 25.9% females. Sixty two percent were urban and 13.2% were non-Kashmiri security forces. Predominant presentation was acute myocardial infarction (47.3%) followed by angina on effort (44.2%), atypical chest pain (7%), and unstable angina (1.6%). Among males 59.5% had angiographically documented coronary artery disease while only 23% of females had coronary artery disease documented. Three females presented with anterior wall myocardial infarction secondary to infective endocarditis, spontaneous left main coronary dissection and takotsubo cardiomyopathy respectively. Conclusion: The study focuses our attention on rising prevalence of coronary artery disease in young individuals from urban communities. Symptomatic males may need thorough early evaluation, young females presenting with myocardial infarction should be evaluated for non-atherosclerotic etiologies. Keywords: Myocardial infarction; young population; coronary artery disease

Demographics for breast cancers vary widely among nations. The frequency of germline mutations in breast cancers, which reflects the hereditary cases, has not been investigated adequately in Pakistani population. In the present study, germ-line mutations in twenty-seven breast cancer candidate genes were investigated in eighty-four sporadic breast cancer patients along with the clinical correlations. The germ-line variants were also assessed in two healthy controls. The most frequent parameters associated with hereditary cancer cases are age and ethnicity. Therefore, the clinico-pathological features were evaluated by descriptive analysis and Pearson χ2 test (with significant p-value <0.05). The analyses were stratified on the basis of age (<40 years vs >40 years) and ethnicity. The breast cancer gene panel assay was carried out by a genomic capture, massively parallel next generation sequencing assay on Illumina Hiseq2000 assay with 100bp read lengths. Copy number variations were determined by partially-mapped read algorithm. Once the mutation was identified, it was validated by Sanger sequencing. The ethnic analysis stratified on the basis of age showed that the frequency of breast cancer at young age (<40 years) was higher in Sindhis (n=12/19; 64%) in contrast to patients in other ethnic groups. Majority of the patients had stage III (38.1%), grades II and III (46.4%), tumor size 2-5cm (54.8%), and invasive ductal carcinoma (81%). Overall, the analysis revealed germ-line mutations in 11.9% of the patients. The mutational spectrum was restricted to three genes: BRCA1, BRCA2, and TP53. The identified mutations consist of seven novel germ-line mutations, while three mutations have been reported previously. All the mutations are predicted to result in protein truncation. No mutations were identified in the remaining twenty-four candidate breast cancer genes. The present study provides the framework for the development of preventive and treatment strategies against breast cancers in Pakistani population.