Browse publications by year: 2006

  1. Borucinska JD, Caira JN
    J Fish Dis, 2006 Jul;29(7):395-407.
    PMID: 16866923
    Lesions associated with two species of tapeworms within the digestive tract of wild-caught specimens of the bull shark, Carcharhinus leucas, and the sicklefin weasel shark, Hemigaleus microstoma, from Malaysian Borneo are described. Portions of the glandular stomach and pyloric gut with parasites were removed and fixed in 10% formalin buffered in sea water. Whole mounts, histological sections of tissues with and without worms in situ, and scanning electron microscopy images of detached worms were examined. Both species of cestodes belonged to the trypanorhynch family Tentaculariidae. Heteronybelinia estigmena was found in large numbers parasitizing the pyloric gut of C. leucas; an unidentified tentaculariid was found in relatively small numbers in both the glandular stomach and pyloric gut of H. microstoma. Both species burrowed their scoleces deeply in the mucosa and attached via hooked tentacles and unciniform microtriches of the scolex. The lesions induced by the parasites were marked in both sharks and ranged from acute necrotizing to chronic granulomatous gastroenteritis. Regenerative hyperplasia and intestinal metaplasia of gastric epithelium were also present. The severity and character of pathology was causally linked to the intensity of infection, the attachment mode of the parasites, and to the anatomophysiological relationships within the gut of the host shark.
    MeSH terms: Animals; Borneo; Cestoda/isolation & purification; Cestoda/pathogenicity*; Cestoda/ultrastructure; Cestode Infections/parasitology; Cestode Infections/pathology; Cestode Infections/veterinary*; Fish Diseases/parasitology*; Fish Diseases/pathology; Sharks/parasitology*; Stomach/parasitology; Stomach/pathology; Gastrointestinal Tract/parasitology*; Gastrointestinal Tract/pathology
  2. Breed AC, Field HE, Epstein JH, Daszak P
    Biol Conserv, 2006 Aug;131(2):211-220.
    PMID: 32226079 DOI: 10.1016/j.biocon.2006.04.007
    Wildlife populations are affected by a series of emerging diseases, some of which pose a significant threat to their conservation. They can also be reservoirs of pathogens that threaten domestic animal and human health. In this paper, we review the ecology of two viruses that have caused significant disease in domestic animals and humans and are carried by wild fruit bats in Asia and Australia. The first, Hendra virus, has caused disease in horses and/or humans in Australia every five years since it first emerged in 1994. Nipah virus has caused a major outbreak of disease in pigs and humans in Malaysia in the late 1990s and has also caused human mortalities in Bangladesh annually since 2001. Increased knowledge of fruit bat population dynamics and disease ecology will help improve our understanding of processes driving the emergence of diseases from bats. For this, a transdisciplinary approach is required to develop appropriate host management strategies that both maximise the conservation of bat populations as well as minimise the risk of disease outbreaks in domestic animals and humans.
    MeSH terms: Animals; Animals, Domestic; Animals, Wild; Asia; Australia; Bangladesh; Chiroptera; Disease Outbreaks; Horses; Humans; Malaysia; Population Dynamics; Swine; Hendra Virus; Nipah Virus; Henipavirus Infections
  3. Maneesh M, Jayalakshmi H, Singh TA, Chakrabarti A
    Indian J Clin Biochem, 2006 Mar;21(1):165-8.
    PMID: 23105591 DOI: 10.1007/BF02913088
    In view of association of diabetes mellitus and male infertility, present study was designed to investigate the functional status of hypothalamic pituitary gonadal (HPG) axis in diabetic men. Thirty-five diabetic men (BMI 22.24±0.21) in the age group 20-40 (30.6±4.7) years were selected. Twenty-five healthy men (BMI 23.85±0.25), in the same age group (29.5±4.8) served as control. Blood samples were collected for hormonal and biochemical estimations. Diabetic men had significantly low serum testosterone with low LH and FSH, hypercholesterolemia, hypertriglyceridemia, hypoalbuminemia and increased oxidative stress. Low serum testosterone in diabetic men was accompanied by low LH and FSH; the inability of the pituitary gland to respond appropriately to a decline in testosterone implying central effect of high serum glucose on the interaction between the nervous and endocrine system. Nutritional deficiency, increased oxidative stress and increased aromatase activity due to excessive body fat might have also contributed to low serum testosterone.
  4. Citation:
    MMC Guideline 009/2006: Clinical Trials and Biomedical Research. Kuala Lumpur: Malaysian Medical Council; 2006
    MeSH terms: Clinical Trials as Topic; Humans; Ethics, Research
  5. Mariana D, Rus Anida A, Hasniah AL, Zaleha AM, Zakaria M, Norzila MZ
    Breathe (Sheff), 2006;3(2):195-198.
    MeSH terms: Bronchiectasis; Child; Esophageal Achalasia; Hospitals, Pediatric; Humans; Malaysia
  6. Khoo SB
    Asia Pac Fam Med, 2006;5(2).
    Background: A community-based general practice course has been developed in the Penang Medical College (PMC) (a joint Ireland-Malaysia venture) that simultaneously satisfies the medical regulatory authorities in Ireland and re-orients the current medical education to the health needs of the Malaysian community. Objectives: This paper describes the community-based general practice course in PMC, explores student evaluation of the various course objectives, student perception of general practice in Malaysia, and whether course experience has any influence on their choice of general practice specialty as a future career. Methods: Two consecutive classes of students (n = 78) were invited to complete anonymous, confidential pre-general practice rotation and post-general practice rotation course questionnaires. Results: Overall responses from both classes were 75/78 (96.1%) for pre-course and 73/78 (93.6%) for post-course questionnaire. Although students had minimal knowledge of Irish and Malaysian primary health care before the course, 60% were keen to learn about Irish primary healthcare and 54.7% expected to learn about the Malaysian healthcare system in the course. Overall, there was a slight reduction of 'No' response and increment of 'Maybe' response after the course with regard to working as a general practitioner in both countries but statistical tests show that there is no significance in the difference. Conclusions: An innovative community-based general practice course has been implemented in PMC but course experience of students does not seem to have any influence on their choice of general practice specialty as a future career. Key words: community, general practice course, Ireland, Malaysia, primary healthcare
    MeSH terms: Career Choice; Cross-Sectional Studies; Education, Medical; Family Practice; Humans; Ireland; Malaysia; Primary Health Care; Students; Students, Medical
  7. Loh KY
    Asia Pac Fam Med, 2006;5(1).
    MeSH terms: Child; Female; Humans; Impetigo; Malaysia; Scabies
  8. Hanafi NS, Ng CJ
    Asia Pac Fam Med, 2006;5(2).
    Aim: To explore primary care practitioners' experiences and feelings about treating their own family members. Methods: A qualitative study was carried out using focus group discussions. Five sessions were held among 22 primary care practitioners (five academic staff members and 17 medical officers). Results: Most participants treated their family members, especially their immediate families. They considered factors such as duration and severity of illness before seeking consultation with other doctors. Some participants felt satisfied knowing that they were able to treat their own families. However, most felt burdened and uncomfortable in doing so, mainly due to the fear of error in diagnosis and management. They were concerned that strong emotions may make them lose objectivity. Many were aware that negative outcomes resulting from their treatment may affect future relationships. Conclusions: While some doctors were comfortable about treating their own families, some faced significant conflict in doing so. Their decisions depended on the interplay of factors including the doctor, the family member and the relationship they share. A doctor needs to consider the potential conflict that may arise when carrying out one's professional role and at the same time being a concerned family member. Key words: doctors, family, Malaysia, primary care, self-treat.
    MeSH terms: Ambulatory Care Facilities; Hospitals; Humans; Malaysia; Physicians, Family; Primary Health Care; Professional Role; Qualitative Research
  9. Ho KT, Chin KW, Ng KS, Alemao E, Rajagopalan S, Yin D
    Am J Cardiovasc Drugs, 2006;6(6):383-91.
    PMID: 17192128
    BACKGROUND: Cardiovascular disease remains a leading cause of death worldwide, with hypercholesterolemia being a major risk factor. Evidence-based consensus guidelines have recommended consideration of increasingly stringent cholesterol-lowering goals, yet most patients do not meet these targets. Coronary heart disease (CHD) event and mortality rates and mean serum cholesterol levels have declined in Singapore in recent years; however, certain groups remain at elevated risk.

    OBJECTIVE: To determine (i) proportions of patients with CHD in Singapore who achieved goals for serum low-density lipoprotein-cholesterol (LDL-C); and (ii) factors influencing goal attainment.

    METHODS: A historical cohort study was conducted using records from the Singapore Cardiac Databank, a national registry of CHD patients. Serum LDL-C goal attainment was assessed in 5174 survivors of acute myocardial infarction or coronary revascularization (i.e. coronary artery bypass graft surgery or percutaneous coronary interventions), of whom 3811 (73.7%) were at very high risk.

    RESULTS: At baseline, the mean patient age was 60.3 years, mean serum value of total cholesterol was 228 mg/dL, and mean LDL-C was 163 mg/dL. Of all CHD patients, approximately 70% did not achieve a serum LDL-C target of <100 mg/dL. Most patients receiving HMG-CoA reductase inhibitor (statin) regimens were treated initially with low- to medium-equipotency regimens and were never titrated to stronger regimens. The vast majority (approximately 94%) of patients at very high risk did not achieve the stringent serum LDL-C target of <70 mg/dL. Patients receiving higher potency statins were significantly more likely to achieve LDL-C goals, whereas those with higher baseline LDL-C levels or Malaysian ethnicity were less likely to achieve LDL-C goals.

    CONCLUSIONS: Most CHD patients in the large group of Singapore residents with CHD in the present study did not achieve recommended LDL-C targets. A more effective disease-management approach, including patient education concerning lifestyle modification (e.g. diet, physical activity), efforts to enhance medication adherence, and more effective, well tolerated therapies such as high-equipotency or high-dose statins and statin combination regimens, may be needed to improve achievement of consensus cholesterol targets. This is the first study of cholesterol goal attainment in a large group of Southeast Asians and serves as a baseline for future evaluations in Asian populations.

    MeSH terms: Anticholesteremic Agents/therapeutic use*; Coronary Disease/blood*; Coronary Disease/drug therapy*; Coronary Disease/epidemiology; Female; Humans; Hypercholesterolemia/drug therapy*; Cholesterol, LDL/blood*; Male; Middle Aged; Retrospective Studies; Singapore/epidemiology; Cohort Studies; Logistic Models; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use*; Asian Continental Ancestry Group
  10. Low WY, Khoo EM, Tan HM, Hew FL, Teoh SH
    DOI: 10.1016/j.jmhg.2006.02.007
    Background: Depression and erectile dysfunction (ED) are common in aging and the two conditions often co-exist. These conditions have been shown to be associated with hormonal changes in men. This paper examines the association between depression, ED, and hormonal status of men aged above 50 years in the Klang Valley, Malaysia.
    Methods: Five hundred men aged 50 years and above were randomly selected via the electoral roll and invited to participate in a community-based study on men's health: 351 men responded. Respondents were interviewed individually based on a self-developed questionnaire, which included information on socio-demographic data. Erectile function was measured using the International Index for Erectile Function-5 (IIEF-5) and depression was measured using the 15 item Geriatric Depression Scale (GDS-15).
    Results: Sixty-nine percent of the men were diagnosed with ED. Mean GDS score was 3.33 (SD = 3.29). Nineteen percent (n = 67) of the men had abnormal levels of testosterone (≤11 nmol/l) and this comprised 73% of men with ED (n = 49) and 27% of men without ED (n = 18). There was no significant association between testosterone level and ED (χ2 = 0.68, p = 0.41). Significant association was found between depression (GDS ≥ 5) and men with ED (χ2 = 6.07, p = 0.014). Sex hormone binding globulin and luteinising hormone were negatively correlated with erectile function. Results of the multiple linear regression showed that age and depression are predictors of erectile function.
    Conclusion: Depression and ED should be screened for when either exists in the male patient and treatment directed accordingly. © 2006 WPMH GmbH.
    MeSH terms: Adult; Aged; Depression; Humans; Erectile Dysfunction; Luteinizing Hormone; Malaysia; Male; Comorbidity; Prevalence; Men's Health
  11. Koitabashi T, Vuddhakul V, Radu S, Morigaki T, Asai N, Nakaguchi Y, et al.
    Microbiol. Immunol., 2006;50(2):135-48.
    PMID: 16490932
    Nine Escherichia coli O157: H7/- strains isolated primarily from non-clinical sources in Thailand and Japan carried the stx(2) gene but did not produce Stx2 toxin in a reversed passive latex agglutination (RPLA) assay. A strain (EDL933) bearing a stx(2) phage (933W) was compared to a strain (Thai-12) that was Stx2-negative but contained the stx(2) gene. To study the lack of Stx2 production, the Thai-12 stx(2) gene and its upstream nucleotide sequence were analyzed. The Thai-12 stx(2) coding region was intact and Stx2 was expressed from a cloned stx(2) gene using a plasmid vector and detected using RPLA. A lacZ fusion analysis found the Thai-12 stx(2) promoter non-functional. Because the stx(2) gene is downstream of the late promoter in the stx(2) phage genome, the antitermination activity of Q protein is essential for strong stx(2) transcription. Thai-12 had the q gene highly homologous to that of Phi21 phage but not to the 933W phage. High-level expression of exogenous q genes demonstrated Q antitermination activity was weak in Thai-12. Replication of stx(2) phage was not observed in Stx2-negative strains. The q-stx(2) gene sequence of Thai-12 was well conserved in all Stx2-negative strains. A PCR assay to detect the Thai-12 q-stx(2) sequence demonstrated that 30% of O157 strains from marketed Malaysian beef carried this sequence and they produced little or no Stx2. These results suggest that stx(2)-positive O157 strains that produce little or no Stx2 may be widely distributed in the Asian environment.
    MeSH terms: Animals; Base Sequence; Cattle; Cloning, Molecular; DNA, Bacterial/genetics; DNA, Bacterial/chemistry; Escherichia coli Infections/microbiology*; Food Microbiology; Humans; Latex Fixation Tests; Bacteriophage lambda/genetics; Promoter Regions, Genetic; Sequence Homology, Nucleic Acid; Viral Proteins/genetics; Polymerase Chain Reaction; Sequence Alignment; Electrophoresis, Gel, Pulsed-Field; Escherichia coli O157/genetics*; Escherichia coli O157/metabolism*; Shiga Toxin 2/biosynthesis*; Shiga Toxin 2/genetics*; Shiga Toxin 2/metabolism
  12. Das Gupta E, Goh EML, Gun SC, Hussein H, Shahril NS, Yeap SS
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A53.
    Background: In the ageing population, osteoporosis (OP) is becoming an increasingly common medical condition. Effective interventions are available that should enable clinicians to limit the magnitude of the burden but this will require the proper knowledge of OP and its management. Objective: To explore family physicians' perceptions of OP and to identify their educational needs in this area.
    Method: Self administered questionnaires about OP knowledge and management were distributed to attendees of Rheumatology Workshops for primary care physicians between March and November 2005, in Malaysia.
    Results: A total of 134 primary care physicians participated in this survey comprising 53% private practitioners, 44% government doctors, 2.2% from academic institutions and 0.7% not stated. The majority 73 (54.4%) had practiced for more than 10 years, 29 (21.6%) under 5 years and 32 (23.9%) between 5 and 10 years. 127 (94.4%) of them saw patients with osteoporosis. Those who had qualified for over 10 years were more likely to treat OP (p = 0.012). 82% felt that osteoporosis was under-diagnosed whereas 14.9% thought it was over diagnosed. This was not related to specialty or years qualified. Regarding the reasons for under-diagnosis of osteoporosis, 71% stated that they had no access to DXA screening, 74% had no access to heel ultrasound, 66% felt the disease was asymptomatic, 37% felt that investigations were costly and only 11% perceived the problem as a lack of referral for specialist opinion. Majority of respondents recognized the risk factors for OP such as increasing age (93%), post menopausal state (90%), positive family history (70%) and a previous low trauma fracture (65%). 7% were not sure how to further investigate a case of OP. For all categories of bone density, under 50% would advise changes in life-style measures. For osteopenia, 65.7% recommended calcium, 54.5% activated vitamin D products. For OP, 79.1% would use bisphosphonates, 50% calcium. In established OP, 80.6% would use bisphosphonates, 44% calcium. Usage of HRT and SERMs ranged between 20% and 30% in all categories. 63% were aware of the Malaysian Clinical Practice Guidelines on Osteoporosis. 22% would not refer to a specialist, whereas 50.4% would refer severe cases only. Almost all (98%) requested for further continuing medical education on OP.
    Conclusions: In this study, the majority of primary care physicians had a reasonable working knowledge of the management of OP. However, 71% had no access to DXA. Therefore, awareness needs to be supplemented by adequate facilities to further improve the management of OP in the community.
    MeSH terms: Adult; Cross-Sectional Studies; Education, Continuing; Humans; Health Knowledge, Attitudes, Practice; Malaysia; Osteoporosis; General Practitioners; Physicians, Primary Care
  13. Yeap SS, Goh EML, Das Gupta E, Lee JK
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A125-A126.
    DOI: 10.1111/j.1479-8077.2006.00199_20.x
    Aims: The aim of this study was to determine the depth of knowledge about osteoporosis (OP) among the public in Malaysia. Methods: A self-administered questionnaire was distributed to attendees of selected health-related public forums in the Klang Valley and Seremban between the months of May to October 2005. Results: 483 questionnaires were returned from 600 given out (80.5%). There were 139 (28.8%) male, 338 (70%) female respondents and 6 (1.2%) not stated. 87.1% respondents had heard of OP. Significantly more women than men had heard of OP (p = 0.015). Mean age was 50.15 ± 14.6 years, 56.7% in the range of 45-64 years. There was no significant difference in the ages of those who had heard of OP and those who had not. 180/338 (53.3%) were postmenopausal females. Those with >10 years of schooling were more likely to have heard of OP (p RM 1000/month (US$270) were more likely to have heard of OP (p =0.022). 22.6% had a positive family history of OP. 63.1% exercised regularly at an average of 4.26 ± 2.78 hours/week. 4.8% were smokers with a median of 10 cigarettes/day. 24.4% drank alcohol with a median of 1 drink/week. However, 70.9% of respondents said that OP led to falls. 89.6% were concerned about osteoporosis. 90.7% agreed that osteoporosis would make daily activities more difficult. The majority obtained their information about osteoporosis from the printed word; newspapers 55.7%, magazines 46.4%, posters/brochures 30.2%, followed by public talks 30%, relatives 29.6%, television 22.8%, medical clinic 22.6% and internet 11.4%. The majority would ask for more information on osteoporosis from their general practitioner 30.6%, followed by other medical specialists such as orthopaedic surgeons 28.4%, hospital specialists 23.8%, rheumatologists 22.4%, followed by friends 15.9%, relatives 14.3% and pharmacists 11.4%. In this self-selected population, knowledge of OP was better among women, the better educated and those earning a higher level of income. Almost 90% of respondents were concerned about getting OP. Their knowledge of OP was obtained from the printed word, which is an important consideration when considering health promotion activities. General practitioners and orthopaedic surgeons need to have a good knowledge of OP.
    MeSH terms: Female; Humans; Health Knowledge, Attitudes, Practice; Malaysia; Male; Osteoporosis*
  14. Yuslina MY, Shahnaz M, Too CL, Hussein H, Wahinuddin S, Eashwary M, et al.
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A187-A188.
    Background: Anti-cyclic citrullinated peptide autoantibodies (anti-CCP) is a new serological test for the diagnosis of rheumatoid arthritis (RA). It is an enzyme immunoassay (EIA) for the detection of antibodies directed toward citrullinated peptides. Studies show this test has an improved diagnostic value compared to rheumatoid factor (RF). Objective: To determine the sensitivity and specificity of anti-CCP in patients with rheumatoid arthritis and other rheumatic diseases. Method: 227 serum samples for rheumatology clinics (Putrajaya, Taiping, and Ipoh Hospital) were tested for the presence of anti-CCP and rheumatoid factor (RF). These included 171 patients diagnosed with RA and 56 from other rheumatic diseases. Patient demographic data, clinical diagnosis, radiographic information and other laboratory data were obtained from the patients' clinical notes. Results: Anti-CCP antibodies were detected in 76.6% (131/171) patients with RA and 17.9% (10/56) patients with other arthritis. The sensitivity and specificity of anti-CCP reactivity at the optimal cut off values were 66.1% and 87.5% respectively. The sensitivity of anti-CCP was higher than that for RF (41.8%). However, the presence of either anti-CCP or RF improved the sensitivity to 76.2%. Conclusion: The detection of anti-CCP alone maybe useful in the diagnosis of RA. However, when used concomitantly with RF, it can improve the diagnostic ability significantly.
    MeSH terms: Antibodies; Arthritis; Arthritis, Rheumatoid; Autoantibodies; Diagnosis; Hospitals; Immunoassay; Laboratories; Malaysia; Outpatient Clinics, Hospital; Peptides; Rheumatic Diseases; Rheumatoid Factor; Sensitivity and Specificity
  15. Sulaiman W, Othman M, Mokhtar AM, Rosman A, Ong SG, Soo IS, et al.
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A54-A55.
    DOI: 10.1111/j.1479-8077.2006.00199_24.x
    Objective: To determine the number of RA cases and to evaluate the demographic patterns in all 4 Rheumatology Referral Centers under the Ministry of Health Malaysia. Materials and methods: One thousand and eighty-four rheumatoid arthritis patients from all 4 centers i.e. Hospital Selayang, Putra Jaya, Seremban and Taiping which are situated in the west coast of West Malaysia, using rheumatoid arthritis database comprising of basic clinical and patient questionnaire, until the end of year 2004 were analysed. Results: At the time of documentation, 88.6% were female at all range of ages especially between age of 25 and 54 years (77.6%) with female to male ratio 8 :1. 52.1% were housewives. Mean age of onset of RA was 49.6 ± 11.8 SD with female 49.3 ± 11.7 SD and male 52.0 ± 12.0 SD (p < 0.05). Indian was the predominant ethnic group (54.5%), followed by Malay (31.4%), Chinese (11.6%) and others (27%). Majority had their education up to secondary level (50.8%), followed by primary (32.6%), and tertiary (6.3%) levels while 10.3% of cases had not received any formal education in their lives. 74.4% were seropositive and 87.3% fulfilled at least 4 out of 7 American College of Rheumatology (ACR) revised criteria for rheumatoid arthritis. 74% were diagnosed RA within 2 years after the onset of arthritis. Seropositivity was not significantly related to gender. Positive rheumatoid factor was dominated by Indian followed by Malay and Chinese. 83.3% were married. 23.3% female and 33.9% male between age group 25-54 were employed. 7.4% had achieved their retirement at time of entry whilst 8.9% were unemployed. Employment status was statistically significant across gender (p < 0.001). The cases differed between rheumatology centers as well as individual practices. Conclusion: There are increasing numbers of RA cases in Malaysia. Results from this study did not reflect the true prevalence of RA in Malaysia. Hence, a larger and more comprehensive database on RA with collaboration of all Government and Private Hospitals in the whole nation will provide better information about the patient case mix in different healthcare settings, treatment practice as well as disease complications. The implementation of rheumatology centers with better regional cooperation, will lead to better treatment and outcome in terms of identification of early as well as established RA cases. Early referral to the centers will be made possible for proper treatment institution and rehabilitation. Hence, improve quality of life including socio-economic status especially among those within the productive age.
    MeSH terms: Arthritis, Rheumatoid; Employment; Female; Hospitals; Malaysia; Male; Quality of Life; Rehabilitation; Rheumatoid Factor; Prevalence; Age of Onset
  16. Hee CS, Gun SC, Naidu R, Das Gupta E, Somnath SD, Radhakrishnan A
    MeSH terms: Arthritis, Rheumatoid; Humans
  17. Gun SC, Loh YL, Das Gupta E
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A185.
    Background: Rheumatoid arthritis (RA) is an inflammatory disease. Predictors of disease activity include presence of joint inflammation, blood investigations such as erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP). ESR is said to be imprecise as it is affected by aging, female sex, obesity, pregnancy, anaemia and polycythaemia. But it is inexpensive and easy to perform. CRP is produced as an acute phase reactant by the liver in response to interleukin 6 and other cytokines. CRP is more specific but costs more than ESR. Both tests are done in the rheumatology clinic of Hospital Seremban. Objective: To compare the usefulness of ESR and CRP as a predictor of disease activity in rheumatoid arthritis (RA) patients. Method: This was a retrospective study. The medical records of 248 RA patients who attended the rheumatology clinic, Hospital Seremban between 1 January 2004 and 31 Dec 2004 were reviewed. The following data were obtained: joint swelling and tenderness, other clinical features which indicate inflammation secondary to infection or trauma and inflammation of soft tissue, ESR, CRP, FBC and UFEME. Results: Data was analysed and the results showed that a total number of 248 patients were seen. There were 13 defaulters. Of the 248 patients there were 929 patients' visits. Of the total number of patients' visits where patients clinically had active disease, 80.2% had raised ESR while 88.8% had raised CRP. As for visits where patients had quiescent disease clinically, 57.3% had normal ESR and 36.5% had normal CRP. Conclusion: CRP is more sensitive but less specific than ESR. This suggests that we still should use both tests as they complement each other. ESR can serve as a countercheck for CRP and vice versa.
    MeSH terms: Anemia; Arthritis, Rheumatoid; Blood Sedimentation; C-Reactive Protein; Female; Hospitals, General; Humans; Malaysia; Outpatient Clinics, Hospital; Outpatients; Retrospective Studies
  18. Eashwary M, Hussein H
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A89.
    DOI: 10.1111/j.1479-8077.2006.00199_15.x
    Introduction: Gout is a clinical syndrome resulting from the deposition of monosodium urate monohydrate crystals. Recent studies have shown gout to be a significant metabolic disorder. However, there has been insufficient information on the clinical spectrum in the Malaysian population.
    Objective: This study is conducted to review the clinical characteristics of patients with gout. Study methods: In this cross-sectional study 52 patients with gout were recruited. The records of 13 patients from National University of Malaysia Hospital and 39 patients from Putrajaya Hospital, attending the rheumatology clinic between October and December 2005 were reviewed. Results: Gout was found predominantly among ethnic Malays 83%, and Chinese 17% in these centers. The male to female ratio was 12 :1. The peak age of onset of the disease was less than 40 years in 46% of the subjects. Primary gout in females was seen after menopause. 37% cases had a definitive hereditary incidence. At the first presentation 83% had acute monoarthritis and 17% acute polyarticular arthritis. Podagra was seen in 62%. Peripheral joints involvement was seen in 81% patients. Tophaceous gout was seen in 42%. In 85% cases the disease had a chronic polyarticular course, whereas in 15% the disease remained only at a single joint. In 10% cases, there was associated sero-negative arthritis. Associated disorders included hypertension (65%), diabetes mellitus (33%), dyslipidemia (56%), ischemic heart disease (23%), urate nephropathy (39%), uric acid nephrolithiasis (2%). In 88% of cases, there was associated hyperuricaemia. Most of the patients were overweight with body mass index 25-29 (39%) and obese with body mass index 30-70 (36%). Conclusions: Gout is not an unusual disorder in our centre. The age of onset of gout occurred much earlier with forty-six per cent of patients having their first attack of gout before the age of 40. Primary gout in females was seen after menopause. Majority of patients first presented with acute monoarthritis, of which sixty-two per cent presented with podagra. The incidence of tophi was high. Patients with gout should be screened for other associated disorders like diabetes mellitus, hypertension, dyslipidemia and obesity.
    MeSH terms: Arthritis; China/ethnology; Cross-Sectional Studies; Diabetes Mellitus; Female; Gout; Hospitals, University; Humans; Hypertension; Malaysia; Malaysia/ethnology; Male; Obesity; Outpatient Clinics, Hospital; Outpatients; Uric Acid
  19. Mohd A, Gun SC, Das Gupta E, De'Souza B
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A89.
    Objective: To determine the epidemiological, clinical and laboratory features of the patients with gout, on follow up in Rheumatology Outpatient Clinic, Hospital Seremban.
    Methods: This was a retrospective study. Case notes of all our existing gout patients were reviewed, and data on demography, clinical features, associated conditions, and laboratory findings were noted.
    Results: 54 patients were studied, 48 (89%) were male and 6 (11%) were female at the ratio of M : F = 8:1, 30 (57%) of them had the onset of symptoms at their 3rd and 4th decades of life. The majority were the Malays 39 (72%), followed by the Indians 11 (20%) and the Chinese 4 (8%). Commonly associated conditions were hypertension in 37 (68.5%), obesity (BMI of 30 and above) in 36 (66.7%) and hyperlipidaemia in 36 (66.7%) of them. Mixed hyperlipidaemia (High TG and LDL cholesterol) were found in 19 (53%). Underlying history of diabetes mellitus 7 (13%), alcohol consumption 8 (15%), smoking habits 22 (40%) and family history of gout 18 (33%). Half of our patients 27 (50%) had at least 2 or more joints involvement. 28 (52%) of them had tophaceous gout. Among those with tophaceous gout, 18 (64%) had renal impairment with serum creatinine of .150mmol/l. 6 (31.5%) of the patients with renal impairment found to have renal calculi on ultrasonography.
    Conclusion: There was male predominance in our group of patients which was consistent with other reported epidemiological studies. Hypertension, mixed hyperlipidaemia and obesity were common associated conditions while diabetes mellitus, smoking and family history of gout were not. The majority of gout patients in our clinic were Malays and due to religious reasons, alcohol was not a common associated factor. Half of our patients had multiple joints involvement and more than half also had tophaceous gout. There was high incidence of renal impairment seen in patients with tophaceous gout. These could be due to delay in seeking medical treatment, present of renal calculi and possibly contributed by associated hypertension and diabetes mellitus.
    MeSH terms: Calculi; China/ethnology; Cholesterol; Diabetes Mellitus; Female; Gout; Hospitals, General; Humans; Hypertension; India/ethnology; Malaysia; Malaysia/ethnology; Male; Obesity; Outpatient Clinics, Hospital; Outpatients; Retrospective Studies; Smoking
  20. Davatchi F
    DOI: 10.1111/j.1479-8077.2006.00177.x
    MeSH terms: Asia; Australia; Bangladesh; China; Fibromyalgia; Gout; India; Indonesia; Iran; Kuwait; Malaysia; Osteoarthritis; Pacific Islands; Pakistan; Philippines; Primary Health Care; Thailand; Prevalence; Low Back Pain; Neck Pain; Shoulder Pain
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