Browse publications by year: 2019

  1. Tan KL
    Med J Malaysia, 2019 Oct;74(5):389-393.
    PMID: 31649214
    BACKGROUND: Physical inactivity remains the most important modifiable risk factor in preventing a variety of noncommunicable diseases (NCDs) and has been identified to be a risk factor for obesity, heart disease and cancers. This study examined the prevalence and factors associated with physical inactivity among the suburban adult population in Port Dickson district, Negeri Sembilan, Peninsular Malaysia.
    MATERIAL AND METHODS: This was a community based cross-sectional study involving 397 adult respondents conducted in February 2016. Data was collected by face-to-face interview using a structured questionnaire. Data regarding socio-demographic factors (age, gender, ethnicity, education level, marital status and monthly income, working hours), current behavioural stage of physical activity and perceived benefits and barriers to physical activity were collected. Physical activity measured using the International Physical Activity Questionnaire (IPAQ) with the cut-off point of less than 600 met-min per week was considered to be physically inactive.
    RESULTS: The prevalence of physical inactivity among adult population was 36.3%. Factors significantly associated with physical inactivity included age, gender, marital status, working hours and current behavioural stage of physical activity.
    CONCLUSION: Physical inactivity is high among the adult community in Negeri Sembilan district, Peninsular Malaysia and was strongly associated with age, gender, marital status, working hours and current behavioural stage of physical activity. It is important to identify individuals with physical inactivity and its associated factors early as this could severely affect the quality of life of the individuals.
    Study site: Six housing areas in Port Dickson District, Negeri Sembilan, Malaysia
    MeSH terms: Adult; Cross-Sectional Studies; Health Surveys; Heart Diseases; Humans; Malaysia; Neoplasms; Obesity; Quality of Life; Surveys and Questionnaires; Risk Factors; Exercise; Prevalence; Marital Status
  2. Kow RY, Low CL, Ruben JK, Zaharul Azri WMZ, Mor Japar Khan ESK
    Med J Malaysia, 2019 Oct;74(5):394-399.
    PMID: 31649215
    INTRODUCTION: Diabetic foot infection, a complication that is associated with lower-limb amputation, incurs a huge economic burden to the hospital and health care system of Malaysia. The bacteriological profile of pathogens in diabetic foot infections in Malaysia has been sparsely studied. We investigated the microbiology of diabetic foot infections in patients admitted to the district hospitals on the east coast of Malaysia.

    METHODS: A retrospective analysis was conducted in three district hospitals (Hospital Kuala Lipis, Hospital Bentong and Hospital Raub) in Malaysia from 1st of January 2016 to 31st December 2016. The clinical specimens were cultured using Clinical and Laboratory Standards Institute (CLSI) guidelines. Antibiotic sensitivity testing to different antibiotics was carried out using the disc diffusion method.

    RESULT: A total of 188 pathogens were isolated from 173 patients, with an average of 1.09 pathogens per lesion. Majority of the pathogens isolated were gram negative pathogens (73.4%). The most commonly isolated pathogens were Staphylococcus aureus (17.5%). This was followed by Klebsiella spp. (17%), Pseudomonas spp. (15.4%) and Proteus spp. (13.8%). Gram positive pathogens were sensitive to most of the antibiotics tested except penicillin and fusidic acid. Gram negative pathogens were sensitive to all antibiotics tested except ampicillin and amoxicillin/clavulanic acid. Amikacin provide coverage for all gram negative pathogens in DFI.

    CONCLUSION: For the management of patient with infection in diabetic foot, the choice of antibiotic therapy depends on the sensitivity of the pathogens, the severity of the infection, the patient's allergies history, toxicity and excretion of the antibiotics.
    MeSH terms: Amikacin; Ampicillin; Amputation; Anti-Bacterial Agents; Fusidic Acid; Hospitals, District; Humans; Klebsiella; Malaysia; Penicillin G; Penicillins; Proteus; Pseudomonas; Retrospective Studies; Staphylococcus aureus; Diabetic Foot; Amoxicillin-Potassium Clavulanate Combination
  3. Pramudji H, Demes CM, Dewi K, Tasmini T, Ahmad HS
    Med J Malaysia, 2019 Oct;74(5):400-404.
    PMID: 31649216
    BACKGROUND: Interleukin-6 (IL-6) and C-Reactive Protein (CRP) are mediators of inflammatory responses and increase in people who are obese . The increase of IL-6 and CRP levels is modified by polymorphism of -174 G>C IL-6 gene.

    AIM: The purpose of this study was to investigate the relationship between -174 G>C IL-6 polymorphism gene on the level of IL-6 and CRP in the population of western Indonesia obese who are obese.

    METHODS: In this study, we examined 178 subjects consisting of 89 who are obese with BMI> 25, and controls with BMI between 18.5 and 23. Fasting blood was taken from each subject for the examination of IL-6 and CRP levels by the ELISA method. Determination of genotype -174 G>C IL-6 gene was examined by Polymerase Chain reaction- Restriction Fragment Length Polymorphism (PCR-RFLP) methods.

    RESULTS: The results of this study showed increased levels of IL-6 and CRP in the obese group compared to the controls. In the obese group, CC genotype had higher CRP and lower IL-6 levels than the GC and GG genotypes. The frequency of CC genotype in the obese group was 47.2% compared with 28.1% in controls and this genotype was considered a risk factor for obesity. Carriers of the C genotype as a dominant or a recessive model had greater risk of obesity.

    CONCLUSION: It was concluded that the polymorphism - 174G>C IL-6 gene is a risk factor for obesity and is associated with increased levels of IL-6 and CRP in an obese group of the Western Indonesian ethnic population.

    MeSH terms: C-Reactive Protein; Enzyme-Linked Immunosorbent Assay; Fasting; Genotype; Indonesia; Obesity; Polymorphism, Genetic; Polymorphism, Restriction Fragment Length; Risk Factors; Interleukin-6; Body Mass Index; Polymerase Chain Reaction
  4. Vidthya S, Sherina MS, Rampal L, Fadhilah SI, Ummavathy P
    Med J Malaysia, 2019 Oct;74(5):405-412.
    PMID: 31649217
    INTRODUCTION: The number of cancer cases in Malaysia has increased from 32,000 cases in 2008 with to 37,000 in 2012 (check figures in text). This number is expected to rise to 56,932 by 2025. Cancer patients undergoing chemotherapy experience low to moderate level of self-esteem.

    OBJECTIVES: To determine the self-esteem among oncology patients receiving chemotherapy in selected government state hospitals, Peninsular Malaysia.

    METHODS: A cross-sectional study was conducted using selfadministered questionnaires. 953 respondents were given questionnaires which included socio-demographic profile, physical effect, depression, anxiety, quality of life and self esteem. Inferential analysis was done by using Independent T-test or Pearson's Correlation and the level of significance was p<0.05. Multivariate logistic regression was then used to determine the predictors using Statistical Package for Social Sciences software version 22.0 RESULTS: All 953 respondents selected participated in this study. The overall mean self-esteem in this study was 22.67, SD=4.98. The significant predictors of self-esteem where pvalue was <0.05 were age; gender; marital status; working status; anxiety; depression; nausea; anemia; hair loss; skin and nail changes; overall quality of life and psychological domain of quality of life. The finding of this study indicates that predictors of selfesteem among patients undergoing chemotherapy should be taken into account to improve their quality of life. Guidelines on how to manage self-esteem in a chemotherapy patient can be done using this study as the baseline.

    MeSH terms: Alopecia; Anemia; Anxiety; Anxiety Disorders; Cross-Sectional Studies; Depression; Depressive Disorder; Government; Hospitals, State; Humans; Malaysia; Nausea; Quality of Life; Surveys and Questionnaires; Self Concept; Software; Logistic Models; Marital Status
  5. Muhammad Adil ZA, Nur Zawani J, Hazariah AH, Rao G, Zailiza S, Mohd Nasir H
    Med J Malaysia, 2019 Oct;74(5):413-417.
    PMID: 31649218
    INTRODUCTION: A methanol outbreak occurred in the district of Hulu Langat on 16 September 2018. The Hulu Langat District Health Office received 25 notifications of a suspected methanol poisoning from Kajang and Ampang Hospital. An outbreak investigation was done to determine the source followed by a preventive and control measure.

    METHOD: Active case detection was done on cases living quarters and workplaces. Patients were interviewed, and their blood and urine samples were sent for methanol analysis. Samples of suspected alcoholic beverages were also sent for analysis. A suspected case was defined as any person presented with clinical symptoms with a history of consuming alcoholic beverages within five days before symptoms and high anion gap metabolic acidosis. A confirmed case was defined as a suspected case with positive blood and urine methanol.

    RESULTS: In total, there were 25 suspected cases, of which 12 cases were confirmed. The calculated attack rate was 48%. There were six mortalities (50%) secondary to severe metabolic acidosis. The most common presenting symptom was vomiting (75%) and abdominal pain (41.7%). These cases were linked to consumption of illicitly produced alcohol. Samples of the alcoholic drinks were positive containing high level of methanol.

    CONCLUSION: The methanol outbreak in the Hulu Langat was successfully managed. Appropriate control and prevention measures were taken, including health promotion and joint enforcement activities. Steps were taken successfully through collaborations with multiple agencies and cooperation with Selangor Health Departments and the Ministry of Health. Continuous surveillance on the product of liquor, and health promotion are essential to prevent a similar outbreak from happening again in future.

    MeSH terms: Acid-Base Equilibrium; Acidosis; Alcohol Drinking; Methanol; Alcoholic Beverages; Disease Outbreaks; Health Promotion; Humans; Vomiting; Abdominal Pain; Workplace
  6. Nik Hisamuddin NAR, Wan Mohd Zahiruddin WN, Mohd Yazid B, Rahmah S
    Med J Malaysia, 2019 Oct;74(5):418-424.
    PMID: 31649219
    INTRODUCTION: The purpose of this study was to investigate the effect of hyperbaric oxygen therapy (HBOT) towards diabetic foot ulcer (DFU) patients in addition to the standard wound care management.

    METHODS: Fifty-eight diabetic patients with ulcers at Wagner Grade 2 and above involved in this study after presented at two study centres of tertiary teaching hospitals. The assigned patients received conventional wound care with additional HBOT given at 2.4 ATA for 90 minutes. Patients in the control group who received conventional wound care only were treated and observed for 30 days. The progress of wound healing was observed and measured at day 0, 10, 20 and 30 of study. The data collected were analysed using SPSS software (ver. 22) to study the association of HBOT towards healing of the diabetic foot ulcers.

    RESULTS: Repeated Measures ANOVA analysis with Greenhouse-Geisser correction indicated that the means of wound size over time points (Day 0, 10, 20 and 30) among patients under HBOT group were statistically significantly different [F(1,61)=30.86, p<0.001)] compared to conventional therapy group. Multiple logistic regression analysis showed that HBOT group has nearly 44 times higher odds to achieve at least 30% wound size reduction within the study period (95%CI: 7.18, 268.97, p<0.001).

    CONCLUSION: The results obtained in this study indicated that as an adjunctive therapy to conventional wound care, HBOT affected the rate of healing in diabetic foot ulcers significantly in terms of wound size reduction when compared to administering the conventional wound care alone.

    MeSH terms: Analysis of Variance; Hospitals, Teaching; Humans; Hyperbaric Oxygenation; Nerve Tissue Proteins; Software; Wound Healing; Logistic Models; RNA-Binding Proteins; Diabetic Foot; Control Groups
  7. Doris G, Devaraj NK, Shakirin SR, Sahimi M, Noraini M
    Med J Malaysia, 2019 Oct;74(5):425-430.
    PMID: 31649220
    BACKGROUND: Direct oral anticoagulants (DOACs) especially dabigatran, have gain popularity for their efficacy, fixed dosing and favourable safety profile. A dabigatran prescribing checklist has been prepared by the Ministry of Health, Malaysia (MOH) to ensure rational and safe prescribing of dabigatran. This study therefore aimed to audit the utilization and documentation of this checklist and use of dabigatran in the government healthcare facilities.

    METHODS: This is a nationwide retrospective audit on the documentation of Dabigatran Prescribing and Dispensing Checklist for a period of two years from January 2013 till December 2014. Data from these Dabigatran Checklists (indication, dose, duration, renal function and adverse drug reactions encountered) were extracted by the pharmacist at MOH healthcare facilities.

    RESULTS: A total of 52 out of 56 (92.9%) of MOH facilities complied to usage of checklist at their centres involving a total of 582 patients of which 569 (97.7%) patients were initiated on dabigatran for the approved indications. The recommended dose of dabigatran was used correctly in 501 (99.6%) of patients. Reason for switching to DOACs use was only documented in 76.7% (131/171) of patients. The most common reason for switching from warfarin was poor INR control (n=39), history of bleeding/overwarfarinisation (n=22) and unable to attend regular INR clinic (n=21). There were 75 cases of adverse events reported. The most common adverse event reported were abdominal discomfort (n=10) followed by gum bleeding (n=9) and dizziness (n=5).

    CONCLUSIONS: Compliance to the dabigatran check list was high with 70% of patients prescribed the appropriate dosing.

    MeSH terms: Dabigatran; Anticoagulants; Dizziness; Documentation; Gingiva; Gingival Hemorrhage; Government; Hemorrhage; Humans; Malaysia; Pharmacists; Retrospective Studies; Vertigo; Warfarin; International Normalized Ratio; Checklist; Drug-Related Side Effects and Adverse Reactions
  8. Low QJ, Hatta Z, Cheo SW, Syed RSH, Goh KS
    Med J Malaysia, 2019 Oct;74(5):431-432.
    PMID: 31649221
    Haemothorax refer to the bleeding in the pleural space. It is commonly due to iatrogenic, blunt or penetrating chest trauma. Non-traumatic haemothorax is a rare entity that can potentially lead to life threatening complications. The initial management of both traumatic and non-traumatic haemothorax includes resuscitation and stabilisation of the patient. We would like to present two cases of non-traumatic haemothorax secondary to an avulsed bullae vessel.
    MeSH terms: Blister; Hemorrhage; Hemothorax; Humans; Iatrogenic Disease; Thoracic Injuries; Wounds, Penetrating; Pleural Cavity
  9. Lim IH, Alias R, Umapathy T, Samsudin A
    Med J Malaysia, 2019 Oct;74(5):433-435.
    PMID: 31649222
    Ocular chemical injury is a true ophthalmic emergency requiring immediate medical intervention. Damages can be devastating and potentially resulting in blindness, corneal perforation and phthisis bulbi. We describe here a successful treatment outcome in a patient who sustained Roper-Hall Grade 4 injury to both eyes. Patient received medical therapy followed by serial ocular surgeries with eventual visual recovery in one eye from counting finger to 6/15 after a decade. In conclusion, after maximum medical therapy, a carefully planned serial surgeries of cultivated oral mucosal epithelial transplantation (COMET) and PK has proven beneficial for this patient with advanced limbal stem cell deficiency (LSCD).
    MeSH terms: Burns, Chemical; Eye; Eye Injuries; Humans; Stem Cells; Treatment Outcome; Corneal Perforation
  10. Anwar A, Chan KMJ, Awang Y, Ping DC
    Med J Malaysia, 2019 Oct;74(5):436-438.
    PMID: 31649223
    Anomalous Aortic Origin of a Coronary Artery (AAOCA) is a rare anomaly of the coronary artery with a considerable risk of sudden cardiac death due to ischaemia of the heart. Symptoms may include chest pain on exertion, breathlessness or dizziness. We encountered a case of a 46- year-old female who complained of exertional chest pain with a positive-stress test and subsequently diagnosed with AAOCA through CT angiography (CTA). She successfully underwent a coronary artery bypass graft (CABG) surgery using a saphenous vein graft with uneventful recovery. Right internal mammary artery (RIMA) was not used as it was flimsy and the flow was very poor.
    MeSH terms: Coronary Artery Bypass; Chest Pain; Coronary Vessels; Dizziness; Dyspnea; Exercise Test; Physical Exertion; Female; Mammary Arteries; Saphenous Vein; Vertigo; Death, Sudden, Cardiac; Computed Tomography Angiography
  11. Cheo SW, Low QJ
    Med J Malaysia, 2019 Oct;74(5):439-440.
    PMID: 31649224
    Systemic lupus erythematosus (SLE) is a common autoimmune disease that we see in our daily clinical practice. It can involve almost every organs in the body. Cardiac manifestations of SLE include pericarditis, myocarditis, heart block, coronary artery disease and others. Here, we report a case of SLE with an uncommon presentation of massive pericardial effusion as initial presentation. Here we also highlight that massive pericardial effusion can also be associated with other complications of SLE such as heart failure and lupus nephritis.
    MeSH terms: Coronary Artery Disease; Heart Block; Heart Failure; Lupus Erythematosus, Systemic; Lupus Nephritis; Myocarditis; Pericardial Effusion; Pericarditis
  12. Tee Evelyn Wy Yap CT, Evelyn Yap WY
    Med J Malaysia, 2019 Oct;74(5):441-442.
    PMID: 31649225
    Subcutaneous Panniculitis-like T-cell Lymphoma (SPTL) is a rare cutaneous neoplasm of mature cytotoxic T cells, first described in 1991 by Gonzalez et al. The incidence of SPTL in Asian countries ranges from 2.3% to 3%. In Malaysia, only 5 cases were reported from 2001 to 2004 in Hospital Kuala Lumpur, Malaysia. SPTL typically presents as skincoloured or erythematous subcutaneous nodules, most often on the extremities and trunk, but it can also involve the face, back and neck. Diagnosis of SPTL is made based on correlation of clinical findings and subcutaneous tissue biopsy along with immunohistochemical staining patterns.
    MeSH terms: Asia; Biopsy; Malaysia; Skin Neoplasms; Staining and Labeling; T-Lymphocytes; Panniculitis; Incidence; Lymphoma, T-Cell; Subcutaneous Tissue; Subcutaneous Fat
  13. Mak WW, Adrian MM, Ahlam K
    Med J Malaysia, 2019 Oct;74(5):443-344.
    PMID: 31649226
    Brucellosis is a rare zoonotic infection caused by small, fastidious Gram-negative coccobacilli of the genus Brucella that may be associated with haemolytic complications including thrombotic microangiopathy and haemolytic anaemia. We describe a patient with culture confirmed brucellosis who presented with malaise, high grade fever, hepatosplenomegaly and Coombs-positive autoimmune haemolytic anaemia. The patient was successfully treated with combination of doxycycline and rifampicin with no further episodes of relapses or haemolysis. Although rare, the possibility of brucellosis should always be kept in mind in patients with risk factors who present with haemolysis and endemic area.
    MeSH terms: Anemia, Hemolytic; Anemia, Hemolytic, Autoimmune; Animals; Brucella; Brucellosis; Doxycycline; Hemolysis; Hepatomegaly; Humans; Recurrence; Rifampin; Risk Factors; Zoonoses; Thrombotic Microangiopathies
  14. Low QJ, Cheo SW, Wong WH, Goh KS
    Med J Malaysia, 2019 Oct;74(5):445-446.
    PMID: 31649227
    Catamenial pneumothorax is a rare condition. We report a case of a 36-year-old female who presented with dyspnoea every time before she had her regular menses. Further investigation confirmed that she had catamenial pneumothorax. With this case we wish to highlight this rare diagnostic entity that every clinician should keep in mind.
    MeSH terms: Dyspnea; Female; Menstruation; Pneumothorax
  15. Lim TH, Yap E, Norhatizah BS
    Med J Malaysia, 2019 Oct;74(5):447-449.
    PMID: 31649228
    PHACE syndrome describes the association of large segmental haemangioma with extracutaneous features (posterior fossa anomalies, arterial, cardiac, eye and endocrine anomalies). We report a case of segmental facial infantile haemangioma with PHACE syndrome treated successfully with oral propranolol without neurological sequelae.
    MeSH terms: Face; Hemangioma; Propranolol; Hemangioma, Capillary
  16. Tamilselvi R, Tang IP, Linger S, Mohd Soffian MS
    Med J Malaysia, 2019 Oct;74(5):450-451.
    PMID: 31649229
    Cervico facial cystic hygroma and tongue lymphagioma is rare representative of spectrum of lymphatic malformations. Conservative management with sclerosants alone has proven to be successful. However, sudden enlargement of these cervico facial lymphangiomas leads to catastrophic airway obstruction leading to debility in feeding and speech. Therefore, surgery is indicated in such case to prevent such a catastrophic problem. We report here the case of a 3-yearold boy with cervico facial hygroma involving the tongue. We successfully treated him with a combination of surgery and OK432 injection.
    MeSH terms: Airway Obstruction; Humans; Lymphangioma; Male; Picibanil; Sclerosing Solutions; Speech; Tongue; Lymphangioma, Cystic; Lymphatic Abnormalities; Conservative Treatment
  17. Fadzullah NA, Kasthuri S, Basiron N
    Med J Malaysia, 2019 Oct;74(5):452-453.
    PMID: 31649230
    According to the Malaysian Department of Statistics motor vehicle accidents are the third leading cause of death in Malaysia and accounts for 7.4% of premature deaths in 2016. With the invention of the airbag, the number of serious injuries and fatalities have been reduced significantly. However, there has also been a corresponding increase in the number of injuries attributable to these devices. The patient narrated in this case report sustained a mixed dermal thickness burn over the upper limb as a result of an airbag deployment. She recovered without other life threatening injuries.
    MeSH terms: Accidents, Traffic; Burns; Cause of Death; Death; Female; Humans; Malaysia; Air Bags; Motor Vehicles; Narration; Mortality, Premature; Inventions
  18. Arivalagan P, Husain MS, Subramaniam K, Kaslan MRM
    Med J Malaysia, 2019 Oct;74(5):454-455.
    PMID: 31649231
    Neonatal death due to inborn error of metabolism (IEM) is rare in Malaysia. We report a sudden neonate death just a few hours after being discharged from the hospital. The deceased was a two-day-old baby boy and was asymptomatic until his demise. He was fed with expressed breast milk and formula milk. Autopsy revealed fatty changes of the liver and an enlarged heart. Laboratory investigation confirmed very long chain Acyl-CoA dehydrogenase deficiency which resulted in his death. Autopsy of sudden unexpected death in neonate should include investigation for inborn error of metabolism. Fatty liver and enlarged heart could give a clue for the diagnosis.
    MeSH terms: Animals; Autopsy; Fatty Liver; Female; Cardiomegaly; Humans; Infant; Infant, Newborn; Lipid Metabolism, Inborn Errors; Malaysia; Male; Milk, Human; Muscular Diseases; Mitochondrial Diseases; Acyl-CoA Dehydrogenase, Long-Chain; Perinatal Death
  19. Alias AM, Shahruniza AS, Sulaiman H
    Med J Malaysia, 2019 Oct;74(5):456-458.
    PMID: 31649232
    Fosfomycin (FMT) was first isolated in 1969 and has gained popularity in the past few decades, specifically in the treatment of uncomplicated urinary tract infection (UTI). A retrospective study was undertaken to study the pattern of FMT use in our outpatient clinics. Subjects were divided into guideline compliant (GC) and non-guideline compliant (NGC) groups, based on available guidelines. More than half of the subjects (51, 51%) fall in the NGC group. Diabetes was an independent risk factor for inappropriate FMT prescription. This represented an opportunity for antimicrobial stewardship in treating diabetic patients with uncomplicated UTI when this agent is chosen.
    MeSH terms: Ambulatory Care Facilities; Diabetes Mellitus; Fosfomycin; Humans; Patient Compliance; Retrospective Studies; Risk Factors; Urinary Tract Infections; Inappropriate Prescribing
  20. Teh CL, Cheong YK, Wan SA, Ling GR
    Reumatismo, 2019 Oct 24;71(3):154-159.
    PMID: 31649384 DOI: 10.4081/reumatismo.2019.1225
    Treat-to-target (T2T) for gout has been established recently to improve its management, which has been reported to be sub-optimal with significant gaps between the goals of treatment and day-to-day clinical practice. T2T recommended a goal of serum urate (SUA) target of <360 μmoI/L in all patients with gout and <300 μmoI/L in patients with tophaceous or severe gout. T2T strategy was applied in the management of gout patients in two Rheumatology clinics from 1 January 2016 onwards. We performed a clinical audit to assess T2T of SUA in gout patients and to identify causes for failure to achieve target SUA among them. There were a total of 304 patients for our analysis. They were of multi-ethnic origin with male predominance (88.8%). They had a mean age of 57.7+13.7 years and mean disease duration of 10.1+8.7 years. The most common comorbidities were hypertension (76.2%), dyslipidemia (52.5%) and diabetes mellitus (DM) (27.4%). Our patients' body mass indexes showed that 47.7% were obese while 34.2% were overweight. Up to 62.4% of our patients had tophi and 42.6% had joint deformities. Only 34.9% of patients achieved target SUA. Nonadherence (52.3%) was the main reason identified for failure to achieve target SUA. The independent predictors for failure to achieve target SUA were nonadherence (HR=7.84, p=0.000) and presence of tophi (HR=1.95, p=0.001).
    MeSH terms: Adult; Aged; Borneo; Diabetes Mellitus; Gout; Hospitals, General; Humans; Hypertension; Malaysia; Male; Middle Aged; Obesity; Retrospective Studies; Uric Acid; Comorbidity; Body Mass Index; Dyslipidemias; Overweight; Clinical Audit
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