Gout - Damn this rich man/woman’s disease or old folk’s disease

Signs and symptoms

Gout presenting in the metatarsal-phalangeal joint of the big toe: Note the slight redness of the skin overlying the joint.

Gout can present in multiple ways, although the most usual is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint). The metatarsal-phalangeal joint at the base of the big toe is affected most often, accounting for half of cases. Other joints, such as the heels, knees, wrists and fingers, may also be affected.Joint pain usually begins over 2–4 hours and during the night. This is mainly due to lower body temperature. Other symptoms may rarely occur along with the joint pain, including fatigue and a high fever.

Long-standing elevated

Gout uric acid levels (hyperuricemia) may result in other symptoms, including hard, painless deposits of uric acid crystals known as tophi. Extensive tophi may lead to chronic arthritis due to bone erosion.^[11] Elevated levels of uric acid may also lead to crystals precipitating in the kidneys, resulting in stone formation and subsequent urate nephropathy

 

Cause

The crystallization of uric acid, often related to relatively high levels in the blood, is the underlying cause of gout. This can occur because of diet, genetic predisposition, or underexcretion of urate, the salts of uric acid. Underexcretion of uric acid by the kidney is the primary cause of hyperuricemia in about 90% of cases, while overproduction is the cause in less than 10% About 10% of people with hyperuricemia develop gout at some point in their lifetimes. The risk, however, varies depending on the degree of hyperuricemia. When levels are between 415 and 530 μmol/l (7 and 8.9 mg/dl), the risk is 0.5% per year, while in those with a level greater than 535 μmol/l (9 mg/dL), the risk is 4.5% per year

 

Lifestyle

Dietary causes account for about 12% of gout^] and include a strong association with the consumption of alcohol, fructose-sweetened drinks, meat, and seafood. Other triggers include physical trauma and surgery

Studies in the early 2000s found that other dietary factors are not relevant. Specifically, moderate consumption of purine-rich vegetables (e.g., beans, peas, lentils and spinach) are not associated with gout. Neither is total consumption of protein Alcohol consumption is strongly associated with an increased risk, with wine presenting somewhat less of a risk than beer and spirits.

The consumption of coffee, vitamin C and dairy products, as well as physical fitness, appear to decrease the risk This is believed to be partly due to their effect in reducing insulin resistance.^[20]

Genetics

Gout is partly genetic, contributing to about 60% of variability in uric acid level. The SLC2A9, SLC22A12 and ABCG2 genes have been found to be commonly associated with gout and variations in them can approximately double the risk.^[22][23] Loss-of-function mutations in SLC2A9 and SLC22A12 cause hereditary hypouricaemia by reducing urate absorption and unopposed urate secretion. The rare genetic disorders familial juvenile hyperuricemic nephropathy, medullary cystic kidney disease, phosphoribosylpyrophosphate synthetase superactivity and hypoxanthine-guanine phosphoribosyltransferase deficiency as seen in Lesch-Nyhan syndrome, are complicated by gout.^[5]

Medical conditions

Gout frequently occurs in combination with other medical problems. Metabolic syndrome, a combination of abdominal obesity, hypertension, insulin resistance and abnormal lipid levels, occurs in nearly 75% of cases.^[6] Other conditions commonly complicated by gout include lead poisoning, kidney failure, hemolytic anemia, psoriasis, solid organ transplants and myeloproliferative disorders such as polycythemia.^[5][24] A body mass index greater than or equal to 35 increases male risk of gout threefold^] Chronic lead exposure and lead-contaminated alcohol are risk factors for gout due to the harmful effect of lead on kidney function. Lesch-Nyhan syndrome is often associated with gouty arthritis.

Medication

Diuretics have been associated with attacks of gout. However, a low dose of hydrochlorothiazide does not seem to increase risk Other medications that increase the risk include niacin, aspirin (acetylsalicylic acid), ACE inhibitors, angiotensin receptor blockers (except losartan), beta blockers, ritonavir, and pyrazinamide.^[11][27] The immunosuppressive drugs ciclosporin and tacrolimus are also associated with gout,^[5] the former more so when used in combination with hydrochlorothiazide.^[

Diagnosis

 

Gout on X-rays of a left foot. The typical location is the big toe joint. Note also the soft tissue swelling at the lateral border of the foot.

 

Spiked rods of uric acid crystals from a synovial fluid sample photographed under a microscope with polarized light. Formation of uric acid crystals in the joints is associated with gout.

Gout may be diagnosed and treated without further investigations in someone with hyperuricemia and the classic acute arthritis of the base of the great toe (known as podagra). Synovial fluid analysis should be done, however, if the diagnosis is in doubt. X-rays, while useful for identifying chronic gout, have little utility in acute attacks.

'WHY I CHOSE THE DEMOCRATIC ACTION PARTY' - Zaid Ibrahim

By Zaid Ibrahim –

[A little lengthy, but more than worth a read]

I am pleased to announce that I have joined the Democratic Action Party as an ordinary member. In politics, I laboured hard on various platform to express my political ideals which can contribute towards building a better Malaysia. My principles never wavered. I believe that leaders must have the capacity to be fair and just towards the people they govern.

Malaysia today is far cry from the country we once knew. Today the world look at us as a failed state. Our riches are gone, our sovereignty tarnished, and our leaders have brought us shame. Life is more difficult for many of us now than before. The Emperor in Putrajaya continues to rule with no regard to what is right and wrong. Only a new government can save this country.

Government need good leaders to solve people’s problem. I see DAP as an effective government that can contribute towards solving our nation’s problems. In Penang, we have a state government that offers good administration, provides better housing and cleaner streets, and creates jobs for the people. That’s what good politics does - it solves people’s problems.

As a Malay, I am proud of its heritage, Malays can only recover their inner strength and self-belief only when they are true to themselves. It’s our values that define us all. For Malays to be competitive and relevant in the modern world, it’s not enough for them to be preoccupied with things the preachers tell them, whether about halal and haram, or the wonders of polygamy. They must want to be part of the new world. I believe DAP, together with Pakatan Harapan, can stem the tide of Talibanisation, that has changed Malay identity beyond recognition.

I know that the mere mention of DAP is taboo to some Malays. Our Prime Minister is working overtime to instil hatred and fear of the party amongst Malay voters. With Pas helping him, Datuk Seri Najib Razak has been unrelenting in their attacks on DAP and Tun Dr Mahathir Mohamad. They are labelling DAP as anti-Malay and anti-Islam. But we will not let them succeed.

I can only conclude from the ferocity of their attacks that they know full well that this BN Government will fall if Malay voters are not afraid of DAP. They know that when DAP can win the heart of the Malays, the support to Pakatan Harapan will be unstoppable. Here I will work hard to tell the Malays that DAP are not what Najib and Hadi tell them. It’s a political party that has consistently fought against corruption and abuse of power in the last 50 years. It’s the party the Malays need to support for they have long lost faith in their own Malay leaders. They remember too well the saying 'Harapkan pegar, pegar makan padi' after their experience with 1MDB, Felda and Mara.

To Malays I can only repeat the words of national laureate Datuk Usman Awang, “Jangan takut melanggar pantang, jika pantang melanggar kemajuan. Jangan segan menentang larangan jika percaya kepada keadilan.”

Melayu itu orang yang bijaksana. We will know after GE14 if Usman Awang is right or wrong.

Najib and UMNO no longer deserve the support of the people. They have abused the people’s trust and have governed by using fear. Najib is not interested in building a nation, only in being its master franchiser. To him, money rules over everything else.

Then there is another Malay party - PAS - that likes to sell religious products. Their outdated ideas represent their own interpretations, which they are forcing on Malays. They are stripping Malays of their culture, of basic rights, of choice and of their dignity. PAS has done nothing to solve the real problems of the people. It doesn’t have anything resembling an economic plan. It does not have a plan for education. It doesn’t even try to do simple things like clear blocked drains, stop flash flooding or collect rubbish regularly in the state that they govern.

Now Najib and PAS President Abdul Hadi Awang have a new plan for GE14. Although they deny it, their proposed law, the RUU355, is actually 'hudud by the back door'. This single act will divide the country and its legal system but they don’t care. They say their project, 'Act 355' is needed to 'defend Islam' but in reality, these two failed politicians have nothing else to offer. They are fishing for votes. Islam can be honoured by arresting leaders who steal people’s money. Islam can be honoured only when ulamaks start defending the truth.

Malaysia has to be overhauled. Development is currently lopsided, with the rich and the unscrupulous hogging all the cream. In the 1980’s it was non-Malays who left for Australia and England. Now Malays with skills and money are also leaving in large numbers. It’s time we reverse the clock and stop the emigration of Malaysians overseas. We must do everything to prevent Malaysia from becoming another Syria.

It’s time that Felda and the Felda settlers be relieved of their debt problems, which is very difficult to overcome because of the system’s chronic corruption. It’s time urban poverty received our attention, and for something meaningful to be done for unemployed youths and impoverished families who have been displaced from their estates. It’s time to remove artificial restrictions for students from entering public universities.

Our country must be on par with other modern and progressive nations. This country needs Pakatan leaders, who can craft fairer economic policies that give the people opportunities to make a decent living, and who can establish a progressive education system that will equip Malaysians with skills that will make them competitive.

Malaysians must make the right decision this time. It is not our destiny to support a kleptocratic government just for the sake of stability or to maintain segregation between Muslims and non-Muslims in order to defend the purity of Islam. To realise the full potential of its people, Malaysia must have leaders who have the courage to change these things. It’s not too late. I believe Pakatan Harapan, with leaders like Anwar Ibrahim and Tun Dr Mahathir, will spearhead these far-reaching reforms successfully.

To Tun Dr Mahathir, I say thank you for being here. It is important for the people that you are leading this charge to fight for the country’s future. Your Vision 2020 for an economically advanced country that is liberal, modern and progressive - a country in which Malaysians of all races live in peace and harmony - is in tatters. Although you once lamented that Malaysians are unwilling to change, I believe they will this time. You have inspired them to do so.

Finally, I want to thank the DAP leadership, in particular Mr Lim Kit Siang, for accepting my membership application. I seek no position in the party, and only wish to help our joint effort in rebuilding this country. I hope to be able to tell my grandchildren that I was part of the team helping Pakatan Harapan and Tun Dr Mahathir regain the country from the clutches of the unscrupulous and the hypocritical. To my friends who have accepted this invitation, a big thank you.

Together, we can save Malaysia.

Comments

Hope he is not going to hop again as need strong character and resilience to remain and perjuang for a better Malaysia. Hope when PH wins he gets the Law Portfolio  and start repealing laws which are aginst the Malaysian Constitution alsorestore the rights of Sabah and Sarawak

Sad Sad when a foreign worker in Malaysia have to teach our youth to multi task including work

Sad Sad when a foreign worker in Malaysia have to teach our youth to multi task including work.Maybe this video was video taped as a joke but the joke is real here among our youth

 

 

 

 

Wives , wives and wives - Sunday day of Laughter

Night cycling by teenagers: Past efforts failed to curb the activity

Parents and guardians must do more to supervise their children’s activities, says deputy home minister

JOHOR BAHR: Night cycling activity involving children and teenagers in the city has been raised on numerous occasions since 10 years ago, but with no solution reached, said Deputy Home Minister Nur Jazlan Mohamed.
He said efforts were made by the authorities, including the police, to curb the activity, like giving advice, but it went unheeded.
“Therefore, I urge parents and guardians to supervise their children’s activities. We do not want what happened today to recur,” he said in a statement which was conveyed to the media by his special officer, Rashid Kasman, at the Forensic Department of the Sultanah Aminah Hospital here today.
The statement was issued in response to an incident in which eight teen cyclists were killed after they were mowed down by a car driven by a 22-year-old woman at 3am here today.
Another eight were injured, including two critically, in the accident which occurred along Jalan Lingkaran Dalam near the Mahmoodiah Muslim cemetery.
“An incident like this has been expected and it happened today.
“Prior to this, there have been cases involving child and teenaged cyclists, but it involved one or two persons only, unlike today, ” he added.
Nur Jazlan also expressed his condolences to the families of the victims involved.

Comments - Why so sombong just because you drive a car maybe an expensive car with a driver. The solutions have always been there but the people in power do not care not the people who build the roads. Bicycle lanes are practically non-existent in this count and if there are like in USJ Subang Jaya , cars and lorries are parked there ( MPSJ does not enforce the law that no obstruction or parking on bicycle lanes and school kids are forced to ride on the main roads. A tragedy waiting to happen by MSPJ have been warned and also no zebra crossing in Subang Jaya. There was a tragedy last year when a school kid crossed the traffic light from US11 to USJ 12 at night when the sign was green for him to cross and a fast food delivery man riding a motorcycle beat the red light, ram into the boy and killed him on the spot. I was passing the road and saw the aftermath of the accident. Was the motorcyclist punished yes or no but do not know)

Learn from your neighboring country Singapore where bicycle lanes have been build all over and Malaysia and start now because it is never too late to start doing things right if your heart is in to it.

 

Look and the motorcyclist dying on the roads like flies yes flies because when motorcyclist meets with an accident he or she gets squash like a fly on the road. Again no motorcycle lanes or signs say that motorcyclist only allowed on the slow lane if no motorcycle lane available. Need political will and it will save lives. Kids from poor families who cannot afford public transport or cars, use bicycle as a cheap mode of transport and no petrol needs only free air from petrol stations to keep the tires inflated

 

I bet another Panel will be setup and some high profile personalities will be appointed, given an office, allowances and perks. Budget will be a few million ringgits and 6 to 12 months to conclude the investigation and when done final report will be stamped OSA and filed in file 13. When not use that money to start building bicycle lanes, proper signage’s and have local council enforce the law

 

In Malaysia we only can hope and hope because nothing good comes out of the investigations but only good comes in for the big fat cats pockets. Appoint the layman in these panels and you will have preventative suggestions as common folks ride motorcycles and bicycles where else the so call experts drive cars

 

Blame the victims is easy but if there were bicycle lanes this would not have happen at all and all bicycles must have head lights and also back lights with reflector lights. Cyclist must wear vest with reflective tapes as at night will be visible

I have do and analysis later on and give my input for cyclist to cycle safety day and night

 

News of accident below

 

Eight teenagers on bicycles killed, mowed down by car

By Bernama

 

Six others are injured, two critically in the 3am incident in JB

JOHOR BAHRU: Eight male teenagers on bicycles were killed after they were mowed down by a car in Jalan Lingkaran Dalam, besides the Mahmoodiah cemetery, near here, early this morning.

Johor Bahru Selatan District Police chief, ACP Sulaiman Salleh said eight others were injured, two critically in the 3am incident.

“The injured are being treated at the Sultanah Aminah Hospital,” he told reporters at the hospital mortuary here today.

He said a group of 20 to 30 teenagers, aged 13 to 17 years, on bicycles were believed to have obstructed Jalan Lingkaran Dalam and other nearby roads before before being mowed down by the car.

“A 22-year-old woman driving a car from Taman Pelangi ploughed into a group of the youths when she was believed to have failed to brake in time,” said Sulaiman.

“The driver also sustained minor injuries and sent to the hospital as she was traumatised,” said Sulaiman.

He said the woman was currently detained to help in investigation.

He said, of the 16 victims, six were still schooling.

“The case is being investigated under Section 41 (1) of the Road Transport Act 1987,” he said.

Sulaiman said preliminary investigation found the woman was not drunk and was not speeding during the incident.

Modified bicycles

Sulaiman said police found the bicycles used by all the victims had been modified and were not following the permitted specifications.

“The offence is under Part Three of the Highway Code whereby a cyclist must abide by the method in paragraph five until Article 68 and summonses could be imposed under the Malaysia Highway Authority 165/69 for modifying a bicycle.

“Action too can be imposed on the guardian who is negligent under Section 33 of the Child Act 2001 for not supervising their children,” he said.

As such, he reminded parents to always monitor the activities and movements of their children.

Throughout last year, he said 28 modified bicycles had been seized during 28 operations.

For this year alone, Sulaiman said 17 bicycles were seized in five operations conducted.

 

 

 

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EPF declares 5.7% dividend for 2016

Below news release from Beritadaily.com

My comments in Blue – The KWSP statement for the 2016 dividends was release on the day of the PAS RUU 355 was planned to take away the heat from KWSP and the government for the lowest dividends in years . Well done BN and PAS for another good job for betraying the common folks and the retires who depend on their KWSP dividends to survive. This year the KWSP members will eat less, spend less, buy cheaper and smaller houses if all they can afford it while the big fat cats get richer and richer. Please think about the poor alley cats which are the common folks. A few days ago I predicted 5.5% and just off my mark by 0.2% only not bad not bad

 

 

In 2015, the EPF declared a 6.4% dividend

KUALA LUMPUR: The Employees Provident Fund (EPF) has declared a 5.7% dividend for 2016, with the total payout amounting to RM37.08 billion, a commendable achievement in view of the much tougher market environment.

Chairman Samsudin Osman said the EPF is pleased it has been able to consistently exceed its two strategic investment targets of at least 2.5% nominal dividend on a yearly basis and at least 2% real dividend on a rolling three-year basis.

In 2015, the EPF declared a 6.4% dividend.

“As a retirement savings fund, the EPF always emphasises on sustainability of returns over the long term horizon as opposed to short term gains.

“This is a commendable achievement in view of the much tougher market environment. For 2016, the rolling three-year real dividend was 3.83%, 183 basis points above the target,” he added, in a statement here today.

During the year, the EPF faced a challenging investment climate due to unsettling events such as Brexit and the US presidential elections.

In retrospect, the EPF was operating on the back of slower global growth while navigating between changes in the monetary policies in major economies, the slump in crude oil prices, weaker domestic currency, and large-scale outflow of capital from emerging market economies to developed economies and safe haven currencies, said Samsudin.

“As the majority of the world markets declined at the beginning of the year, the EPF’s performance was also affected. However, we ramped up our profit-taking activities in the second quarter (Q2 2016) onwards to ensure that we met our strategic targets,” he added.

The dividend payout for 2016 is higher than the payout amount in 2014 even though the dividend rate declared then was higher at 6.75%.

Samsudin said the payout amount required for one per cent dividend in 2016 was RM6.51 billion, higher compared with RM5.43 billion in 2014.

The payout amount required for every one per cent dividend rate has been growing at 9.5% annually since 2001 in tandem with the growth of members’ savings balance for the same period.

Members can check their EPF account statement for the crediting of the 2016 dividend starting Feb 19, 2017, through i-Akaun via the myEPF website at www.kwsp.gov.my.

Alternatively, members can also obtain their statement at EPF kiosks or visit any EPF branches nationwide

RUU 355 and the outcome to come and the Malaysian people as colletral damage - Do PAS and UMNO care at all

   Tan Sri Dato' Mohd. Sheriff Mohd. Kassim P.S.M., D.S.P.K., K.M.N., D.P.M.S. merupakan bekas Ketua Setiausaha Perbendaharaan Malaysia (1991-1993).

In addressing the issues surrounding RUU 355 , let me speak from the mind of an economist.
Those who are conversant with d dynamics of the Malaysian economy will understand how crucial the services sector has become as a stabiliser of growth in incomes and employment in times of low commodity and oil prices and slow private sector activities in investment and production . Thanks to tourism inflows and other foreign arrivals for education and expatriate employment in highly skilled jobs, we have built new sources of earnings called the" invisible incomes" of the country.
Tourism is now a major factor in creating the skilled and better paying jobs in hotels , entertainment industry , restraurants, holiday resorts , golf clubs . Private education is drawing in many foreign students who spend a lot on accommodation , food and entertainment, giving many small traders good business . Expatriates spend a lot on rentals and maids , putting money into the pockets of property owners.
Imagine one day , we suddenly have hudud laws. Travel agencies will caution their customers abt travelling to Malaysia. Familoes will send their children to other places for education. Foreign experts and professionals will think twice abt coming to work here. Many condos will hv empty apartments. Construction companies will lay off thousands of workers as no company will b interested to build hotels and high class condominiums . Restraunts and shopping centres will face hard times as locals dont spend as much as foreigners. Combine all the down turns , and we will see unemployment everywhere.
Thats why I keep on warning abt the risks and dangers of Islamising our laws and restricting our freedoms. The economic suffering does not make Islamisation a viable proposition for our multiracial country.

An ostrich for an MB, your rejection of hudud and GOD

      By Mariam Mokhtar      18 February, 2017

 

 

A picture is worth a thousand words.

 

See the photos taken by Malaysiakini’s journalists and read their report about the scale of destruction of the Orang Asli (OA) heartlands, and the seriousness of the problem.

Instead of looking into the issues, both the Kelantan state government and Putrajaya appear to lack the political will to help the OA.

The best answer about Kelantan’s worst flood in living memory, came from MP Nik Abduh Nik Aziz. In a way, he was blaming the Kelantan people for rejecting hudud.

With MPs like him, you wonder if everytime you do something bad, tell a lie, or have naughty thoughts, that God will strike you dead with a lightning bolt from the sky.

Nik Abduh said, “The flood is a reminder to all Muslims to return to Allah’s ways and stay away from His wrath. It necessitates the perseverance of the Kelantan government to implement hudud laws.”

In January 2015, Minister in the Prime Minister’s Department, Shahidan Kassim blamed uncontrolled logging for the flooding in Kelantan. He urged the state to replant trees in deforested areas, and warned, “In Kelantan, the way they’re cutting down the forest trees, it is as though the state has no law, while the department which should be looking after the forests, has not taken action.”

 

A defiant Kelantan Mentri Besar, Ahmad Yaakob and his Deputy, Mohd Amar Nik Abdullah denied claims that the floods had been caused by excessive logging. Mohd Amar defended his boss, and declared, “…the MB himself went on a helicopter ride, and a heavy amount of water came down from the National Park.”

Two reasons

When things go wrong, in Kelantan, it appears that there are only two possible reasons.

1) You are at fault for not praying hard enough.

2) God is punishing you, perhaps, for your infrequent praying and possibly for not adopting hudud law.

In Kelantan, it is NEVER the government’s fault, nor is it the fault of Putrajaya to deny the state its oil royalty.

 

 

My comments

Greed Greed and no respect for mature nature and God because when you destroy god's creation and given to all by God , no one have the right to destroy it