Background & Objective: Tetanus remains an important health problem in Kano, Northwestern Nigeria. It is associated with a high mortality rate, it is therefore necessary to identify predictors of mortality with the view to reducing the mortality rate. Methods: Demographic and clinical data of all adult tetanus patients managed at Aminu Kano Teaching Hospital and Murtala Muhammad Specialist Hospital between Jan 2004 to Dec 2009 were collected and analyzed. Results: A total of 146 patients were identifi ed during the study period, out of which complete information was obtained in 126 patients. All the patients had generalized tetanus. There were 93 (73.8%) males and 33 (26.2%) females. Their age ranged between 17 and 62 with mean age of 35.2. Two fi fth (39%) of the patients were in the age group of 21 – 30 years. The risk factors of high mortality were: age >40 years, incubation period <48 hours, onset <48 hours, absence of previous tetanus immunization, evidence of autonomic dysfunction, and severity. Mortality was not related to fever and gender. Binary logistic model revealed that severity of tetanus at presentation was the most signifi cant (p= 0.029) prognostic factor to mortality. Conclusion: The mortality rate of adult tetanus in Northwestern Nigeria is high. Several risk factors for high mortality have been identifi ed.

Neuromyelitis optica (NMO) was first described as a severe monophasic syndrome of acute bilateral optic neuritis and transverse myelitis. Whether it is a form of multiple sclerosis (MS) or a separate disease entity has been continually debated since the beginning of last century. The redefinition of NMO as a relapsing disease, the wider use of magnetic resonance imaging showing longer spinal cord lesion, and the recently discovered anti-aquaporin-4 (AQP4) water channel antibody, or NMO-IgG, has rekindled this controversy. The many recent publications including the abstracts published in this issue of Neurology Asia have shown that anti-AQP4 antibody is of variable sensitivity in different populations. It appears to be associated mainly with longitudinal extensive spinal cord lesions and frequent relapses. The site of pathology of NMO also do not co-localize with the widespread expression of AQP4 in the body, throwing doubts on the suggestion that the anti-AQP4 antibody plays primary role in the pathogenesis of NMO. In the day-to-day clinical practice in Asia, anti-AQP4 antibody remains a research investigatory test. As for optic-spinal MS, which is closely similar to NMO based on recently revised criteria, interferon should remain the treatment of first choice.

The objective of this study was to determine the effect of smoking ban in eateries on smoking behaviors and intention to quit smoking among adult smokers in Klang Valley. A validated questionnaire was utilized for this study whereby three variables of the study (socio-demographic characteristics, smokers attitude, and intention to quit smoking) were measured. The structured questionnaire contained closed ended questions where present of dichotomous(yes/no), multiple choice questions and 7-point likert scale questions. 600 questionnaires were distributed to target respondents in eateries of Klang Valley. The inclusion criteria were local citizen of Malaysia, those who gave consent to take part in the study, literate in English, smokers aged 18 years old and above. The data were analyzed utilizing SPSS software version 21.0. There were 504 completed and usable responses received, which represented an 84% response rate. Majority of smokers in Klang Valley were male which constituted around 78.2% of the respondents. Manufactured cigarette, 75.2% was the most preferred type of nicotine among smokers. Smokers attitude and social support with a smoking ban in restaurants and eateries was significantly associated with intention to quit smoking. 73.8% of smokers agree that the smoking ban in eateries and restaurants have reduced their daily smoking frequency and 58.3% of smokers agreed that the nationwide smoking ban at eateries and public places aspire them to quit smoking.Smoking ban is beneficial to help reduce prevalence of smoking among smokers that in turn helps to reduce secondary smoking and burden of non-communicable diseases in the long run. Though only a little over half of the respondents claimed that the ban inspires them to quit smoking, this is a positive start as the ban was just introduced. When effectively implemented, they are seen as an important element of policy to support behavior change in favor of a healthy lifestyle. The Ministry of Health should push forward with the ban on public smoking as soon as possible. The ban should be in tandem with efforts to help smokers quit. Implementing this scheme nationwide would be a remunerative move to help strive for a better health and cleaner environment for this country.

No abstract available.
Diabetic Nephropathies

We report a 21-year old female patient who presented with an 18-month history of a swelling in the distal phalanx of her right little finger. Although the history, clinical features and MRI were suggestive of a benign tumour or a tuberculous lesion, the histo-pathological examination of the swelling was reported as a conventional osteosarcoma. Osteosarcoma of the hand is very rare. This article highlights the possibility of a seemingly benign lesion seen in a routine clinic could well turn out to be malignant, and the need to maintain a high index of suspicion
Osteosarcoma

Many of our chronic kidney disease (CKD) patients venture into complementary and alternative medicine (CAM) to seek a cure for the disease beyond conventional management. The objective of this study was to determine the prevalence and pattern of CAM usage; and its association with the progression of CKD in our population. This was a cross-sectional survey recruited CKD patients from Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Data was collected via interview using questionnaires which explore the demographics, type and pattern of CAM use. Patients’ comorbidities and serum creatinine were extracted from the medical notes to assess the association between progression of CKD and usage of CAM. Chi-square, Independent Samples t-test, Mann-Whitney U test and logistic regression were used to evaluate for an association. Three hundred and seventy two eligible patients were recruited. The prevalence of CAM use was 29% in the past year. Younger age, higher education and higher income level were associated with significantly more usage of CAM. Natural products were the commonest type of CAM used (86.1%). The belief in the effectiveness of CAM was the main reason for its uptake and about 57.8% revealed their practice to their physician. We found that the use of CAM in Malaysian CKD patients did not influence the progression of the disease.

Quassia borneensis has been traditionally used as antihypertensive agent without any scientific literature on its mechanism of action. The objective of this study was to evaluate the antiinflammatory, antioxidant and antiproliferation properties of Q. borneensis extracts. The hexane, chloroform and aqueous extracts of root and bark of Q. borneensis were subjected to nitric oxide (NO) inhibition assay in LPS-stimulated RAW 264.7 cells. Expression of inducible NO synthase (iNOS) protein level was analyzed by Western blot. The antioxidant and antiproliferative activities of the extracts on HL-60 cells were determined using Ferric Reducing Antioxidant Power (FRAP) and MTT assays, respectively. The chloroform extract of Q. borneensis root obtained by soxhlet method (CSR) significantly inhibited 97.64 ± 0.96% of NO production (p < 0.001) and suppressed iNOS expression (p < 0.05) at the highest concentration of 1.0 μg/ml. The chloroform extract of bark obtained by maceration (CMB) exhibited the highest antioxidant capacity in the absence and presence of HL-60 cells, where the FRAP value were 125.45 ± 9.10 μM FeSO4.7H2O and 181.55 ± 3.45 μM FeSO4.7H2O, respectively. The greatest inhibition of HL-60 cell proliferation was exhibited by the chloroform extract of bark obtained by soxhlet method (CSB) with the IC50 of 5.0 μg/ml. The findings suggested that the chloroform extracts of Q. borneensis possess antiinflammatory, antioxidant and antiproliferative activities.

Acanthamoeba is a free-living protozoa which causes serious ocular problem. Acanthamoeba keratitis is becoming more prevalent amongst contact lens wearers and it can cause loss of vision and blindness if not treated properly. The objective of this research is to determine the effectiveness of gentamicin against six Acanthamoeba spp. isolates, of which three were clinical isolates (HS 6, HKL 95, HTH 73) and three environmental isolates (SMAL 7, SMAL 8, TTT 9). Cyst suspension from the chosen isolates were exposed to gentamicin. After 48 hours of incubation at temperature of 30°C and 37ºC, each mixture was filtered and filtration membrane was put onto non-nutrient agar laid with Escherichia coli. The agar plates were incubated for three days at 30oC and 37oC and the plates were examined daily until day 14 to look for the presence of Acanthamoeba trophozoites under inverted microscope. The presence of trophozoites indicated the ineffectiveness of gentamicin. Gentamicin was found to be effective against Acanthamoeba cysts from all the test strains at both incubation temperatures. The minimum cysticidal concentration (MCC) mean value of gentamicin was 0.193 mg/mL at 30oC and 0.229 mg/mL at 37oC. So, we concluded that gentamicin has cysticidal potential towards Acanthamoeba.

Introduction: Acanthamoeba is an ubiquitous free-living protozoa which causes serious ocular problems. Acanthamoeba keratitis is becoming more prevalent amongst contact lens wearers. The disease can cause loss of vision and blindness if not treated properly. The objective of this research is to study the sensitivity of six Acanthamoeba spp. isolates, of which three were from the clinical isolates (HKL 95, HTH 40 and HS 6) and the remaining three from environmental isolates (TTT 9, TL 3 and SMAL 8) to antimicrobial agents. Methods: The antimicrobial agents chosen for this purpose were polyhexamethylene biguanide and chlorhexidine. Cyst suspensions from the chosen isolates were exposed to PHMB and chlorhexidine respectively. After 48 hours incubation time at 30°c,each mixture was filtered and filtration membrane was put onto non-nutrient agar laid with Escherichia coli. The agar plates were incubated for three days at 30°c and examined daily until day 14 to detect the presence of Acanthamoeba trophozoites under the inverted microscope. The presence of thropozoites indicated the ineffectiveness of the antimicrobial agents. Results: Both of the antimicrobial agents tested were found to be effective against Acanthamoeba cysts from all the test starins. Polyhexamethylene biguanide gave minimum cysticidal concentration (MCC) mean value of 2.848mg/mL while chlorhexidine showed MCC mean value at a concentration of 3.988mg/mL. Conclusion: It can be concluded that the Acanthamoeba were sensitive to polyhexamethylene biguanide and chlorhexidine.

Objectives: There is a lack of current published information on health and nutritional status of Orang Asli children. A study was conducted to assess breastfeeding practices, dietary intake and growth status of Orang Asli children in Sepang and Carey Island, Selangor.Methods: A total of 173 children(88 Temuan and 85 Mah Meri) from 137 households were measured for body weight and height. Information on breastfeeding practices and dietary intake was obtained from their mothers. Results:Most of the mothers (98.9%) breastfed their infants with a high proportion (86.8%) initiating breastfeeding within one hour after delivery.About 53% of the mothers reported discarding colostrum due to various reasons including the perception that colostrum in undesirable and can produce ill-health. Although many of these mothers (58.3%) discarded colostrum on their own initiative, about 25% of them reported that they were advised by health professionals. Among mothers who had stopped breastfeeding at the time of the study (n=48), the mean duration of breastfeeding was 12.1 ± 8.9 months. About 33% of the mothers stopped breastfeeding before their infants were 6 months old and only 31% breastfed their children for more than 1 year. The percentages of significantly underweight, stunted and wasted were 48.9%, 5.2.2% and 4.3% respectively for children aged 1-3 years, whereas among children aged 4-6 years old, 35.8%, 50.6% and 1.3% were underweight, stunted and wasted, respectively. A higher proportion of Mah Meri than Temuan children in both age groups were significantly underweight, stunted and wasted. Despite the adequate intake of energy and most nutrients,the Orang Asli children had insufficient mean number of servings for all food groups-grain and cereals, fruits, vegetables, meat and fish, and milk and dairy products. Conclusion: In this study, undernutrition is a major health and nutrition problem among the Orang Asli children. The problem could be due to many factors that include poor infant and child feeding practices. Concerted efforts by various government and non government agencies are essential to improve the health and nutrition of Orang Asli.