Naegleria fowleri is a free-living amoeba, known as a causative agent for a fatal disease of the central nervous system (CNS) in man such as Primary amoebic meningoencephalitis (PAM). Factors contributing to its pathogenicity and its distribution in the environment have been investigated by previous researchers. In case of its pathogenicity, several enzymes such as phospolipase A and sphingomyelinase, have been proposed to probably act as aggressors in promoting PAM but no study so far have been conducted to investigate the presence of proteinase enzyme in this amoeba although a 56kDa cystein proteinase enzyme has been identified in Entamoeba histolytica as an important contributing factor in the amoeba's virulence. In this preliminary study, a pathogenic amoeba, Naegleria fowleri (strain NF3) was examined for the presence of proteinases. Samples of enzymes in this amoeba were analysed by electrophoresis using SDS-PAGE-gelatin gels. The results showed that this amoeba possesses at least two high molecular weight proteinases on gelatin gels; their apparent molecular weights are approximately 128 kDa and approximately 170 kDa. Band of approximately 128 kDa enzyme is membrane-associated and its activity is higher at alkaline pH compared with lower pH; at lower pH, its activity is greatly stimulated by DTT. The approximately 170 kDa band enzyme appears to be inactivated at pH 8.0, at lower ph its activity is higher and DTT-dependance. The activity of this enzyme is partially inhibited by inhibitor E-64 but markedly inhibited to antipain suggesting it belongs to the cysteine proteinase group.
Enzymes ; Endopeptidases ; Hydrogen-Ion Concentration ; seconds ; pathogenicity

We report a case of a 21 year old girl who presented with sudden onset of abdominal, back and bilateral leg pain, paralysis with unexpected collapse at home. Physical examination was suggestive of acute aortic occlusion. CTangiogram revealed multi-system thrombo-embolic shower. She proceeded to urgent aortic thrombectomy and fasciotomy of the bilateral lower limb. Further investigation revealed atrial myxoma and we report the patient's postoperative progress and eventual transfer to rehabilitation facility.

Objective: This case report highlights arachnoid cyst, a rare benign space-occupying lesions (SOL) formed by an arachnoid membrane containing cerebrospinal fluid (CSF) which in most cases, are identified by accident. Conversion disorder is characterized as a deficit or distortion in neurological functioning, or symptoms suggesting a general medical condition that is not referable to an organic lesion. Methods: We report a case of a 24 year old woman who came to a psychiatrist with history of suicide attempt. She had a history of failed marriage but no history of substance abuse. She had a history of dizziness, light-headedness, blurred vision, seizure and headache for a while. Seizure was identified to be pseudo seizures in further assessments. Results: Diagnosis of Conversion Disorder with Adjustment Disorder was revealed. In Barin Computerized Tomography (CT) scan there was an extra axial cystic lesion with the height, frontooccipital and lateral size of approximately 6.4 cm by 4 cm by 2.5 cm respectively in the left anterior middle fossa and Sylvian fissure. Based on patient's history, the arachnoid cyst and its symptoms may have a synergistic effect on patient's symptoms of conversion disorder. Conclusion: This case reflects the importance of ruling out medical problems in patients with psychiatric symptoms.

Elderly are often associated with multiple social and health problems. Family members are important in helping them doing their daily activities. For elderly diabetics, family support has a role in diabetes management and glucose control. The aim of this study is to explore the perceptions of elderly diabetics regarding the role of family support on their glucose control. This qualitative technique was a part of the study on glucose control and its associated factors among elderly diabetics. It was conducted from February until May 2009 in Kulim. Ten respondents were purposively sampled based on their glucose control. HbA1c 6.5% or less was considered as good glucose control. In depth interview, using semi-structured interview guide was used in this study. The conversation had been taped, transcribed to verbatim and analyzed manually using thematic analysis. All ten respondents perceived that family support did not play a role on their glucose control. They believed that self-awareness and self-determination were important to control the glucose level. Those with good glucose control practiced healthy diet, and not affected by food prepared by their family members compared to those with poor glucose control. However, both groups claimed that, they did not receive much advice from their family members and no special food was prepared for them. Elderly diabetics should be motivated on self-determination and focusing on good glucose control. Health education should be given to patients and their family members to increase their diabetes knowledge especially on useful advice and proper food preparation. It could motivate the elderly diabetics to control their glucose level.
Diabetes Mellitus ; Diabetic Diet ; Aged ; Family ; Motivation

A case of a large dentigerous cyst associated with canine tooth in the maxillary antrum is presented. This case is of interest because of its extensiveness and the presence of an ectopic tooth in the roof of the maxillary sinus. Theoretical aspects of canine impaction and cyst formation are reviewed. The management of a jaw cyst, in particular, the still popular Caldwell-Luc procedure is discussed.

Giant-cell arteritis is an infl ammatory disease of blood vessels most commonly involving large and medium arteries of the head, predominately the branches of the external carotid artery. It is a form of vasculitis. Giant-cell arteritis of the temporal artery is referred to as “temporal arteritis”. Giant cell arteritis is rare among Asians. Diagnosis is based on American College of Rheumatology (ACR) classifi cation criteria for giant-cell arteritis with gold standard temporal artery biopsy.1 Blindness is a feared complication, mostly caused by anterior ischaemic optic neuropathy. High-resolution magnetic resonance imaging (MRI) has started to play a role in the diagnosis of giant cell arteritis. Evidence of arteritis involving the superfi cial temporal arteries with mural thickening and even the ophthalmic arteries can be seen on MRI, which further increase the diagnostic confi dence prior to biopsy.2,3 Optic perineuritis is a rare association with giant cell arteritis. MRI is required for diagnosis especially for differentiation from optic neuritis.4 We report a case of giant cell arteritis with optic perineuritis to demonstrate the role of MRI in the diagnosis.

Objective: To investigate the effect of drought stress and organic fertilizer on German chamomile (Matricaria chamomilla) nutrient uptake, leaf chlorophyll content and os-motic adjustment under field conditions.
Methods: This experiment was carried out through a randomized complete block design with a split factorial arrangement of treatments in three replications. The main plots were subjected to the following irrigation treatments: irrigation after 60, 90, 120, 150 and 180 mm evaporation from Class A pan. The sub-plots were treated with three vermi-compost doses (0, 5 and 10 t/ha).
Results: Although drought stress reduced the nutrient percentages in the shoots, appli-cation of vermicompost enhanced the nutrient percentages, particularly when the plants were subjected to moderate to severe drought stress conditions. Moreover, the results of this study showed that the interaction between irrigation treatments and vermicompost rates on leaf chlorophyll content was significant. Comparison between the combined treatments indicated that under normal irrigation and moderate drought stress conditions chamomile plants received 5 and 10 t/ha vermicompost showed significantly higher leaf chlorophyll content comparing to the control treatment.
Conclusions: Totally, organic fertilization by vermicompost could partly alleviate the effect of drought stress on chamomile by increasing N, P and K uptake and leaf soluble sugar, especially in stressed treatments.

Leisure involvement is an essential element in the daily life of the elderly people. Little is known, however, about the perceived leisure constraints among them, especially among the increasing elderly population in Malaysia. This study aims to explore constraints perceived by the elderly that prevent them from actively involved in leisure. In depth interviews were conducted, involving a total of 20 elderly aged 60 years and above with stratification by background characteristics. Each interview was conducted for an average of 15 to 30 minutes and discontinued when a saturation point was achieved. They were purposively selected from two health clinics located in two different districts in the state of Selangor, representing an urban and a rural area. Elderly participation in leisure activities was constrained by many factors. These factors can be divided into individual, family and community factors such as increasing age and related physical deterioration , education level, health status and the existence of chronic illness, absence of family member or friends to perform the activity together and non-conducive environment. The constraints should be endorsed and acknowledged by the relevant agencies and authorities in order to facilitate effective implementation of related policies, strategies and programmes to improve the health of the elderly people. These include the provision of appropriate services and facilities to cater senior citizens from various health and demographic perspectives.

Background: Headache disorders represent a major public health problem globally. It is more so in developing countries with rising trend in young adults affecting negatively their quality of life. There has been very little information on the epidemiology of headache disorder in Kashmir India which has witnessed prolonged and large scale militancy related disturbance. A prospective population based study was undertaken in Srinagar district of Kashmir to determine the prevalence of headache disorder. Methods: The study was a cross sectional survey using cluster sampling with a culturally adapted version of pretested questionnaire translated into local language, in Hazratbal Community Block of Srinagar. In the first phase households were screened. Individuals with headache were then examined by a senior neurologist for migraine and non migraine disorder. Results: The overall prevalence of headache was 66.2 % with female preponderance. Occurrence of headache was as high as 79.90 % in adults of 19-45 years. The prevalence rate declined after the age of 45 years in both the genders. Women had higher prevalence rate than men in all age groups and for all headache categories. Age distribution showed prevalence rate of migraine of 45.69% in young adults of 19-45 years; females 55.44% and males 32.79 %. Non migraine headache was more common than migraine type, and was more prevalent in young age group in both the genders, highest in adolescents (74.20 %). Conclusion: The high prevalence rate of headache both migrainous and non migrainous in Kashmir may be related to the stress the community has been subjected to from militancy related conflict since 1990.
Headaches

The College of General Practitioners of Malaysia and the Royal Australian College of General Practitioners held the first Conjoint Member of the College of General Practitioners (MCGP)/Fellow of Royal Australian College of General Practitioners (FRACGP) examination in 1982, later renamed the Conjoint MAFP/FRACGP examinations. The examination assesses competency for safe independent general practice and as family medicine specialists in Malaysia. Therefore, a defensible standard set pass mark is imperative to separate the competent from the incompetent.