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Image 7:
This gentleman has had increasing dysfunction and recurring bouts of pain in both of his feet over the past 35 years. He is a Malay aboriginee who has lived all his life in the jungle and has always walked barefoot.
Diagnosis:
He has chronic tophaceous gout, a very common clinical entity in this population. The population has a genetically linked level of serum uric acid that is a good mg% higher than the rest of the world and also a high prevalence of Hemoglobin E, beta-thalassemia, G6PD and combinations thereof. The hemoglobinopathies are all associated with chronic or acute hemolysis and associated increased purine metabolism.
