Asian Pacific Journal of Tropical Medicine

1-7

Authors: Adenike Okunlola, Oluwatoyin A. Odeku

Objective:The quantitative effects of formulation and processing variables affecting the binding properties of Chinese yam starch (Dioscorea oppositifolia) in chloroquine phosphate tablet formulations have been investigated in comparison with corn starch using a 23 factorial experimental design.Methods:Chinese yam starch, representing the "low" level, and corn starch, representing the "high" level were used as binders at concentrations of 2.5 ％w/w and 10 ％ w/w in chloroquine phosphate tablet formulations. The mechanical properties of the tablets, measured by the tensile strength (T) and brittle fracture index (BFI) as well as the release properties measured by the disintegration time (DT) and dissolution time (t80 time for 80 ％ drug release), were used as assessment parameters.Results:The ranking of the individual coefficient values for the formulations on T was D ＞N -C, on BFI was N ＞D -C, on DT was D ＞N ＞C and on t80 was C＞N＞D while the ranking of the interaction coefficient on T was N-D＞ C-D – N-C, on BFI was N-D ＞ N-C = C-D, on DT and t80 was N-C＞ N-D＞ C-D. Changing the binding agent from Chinese to corn starch, led to a decrease in T, DT and t80 but increase in BFI of the tablets. There were significant (P<0.001) interactions between the nature of binder, N and the other two variables, C and D.Conclusion:The result showed that Chinese yam possessed stronger binding capacity than corn starch and could be useful as an alternative binder when tablets with high mechanical strength with minimal problems of lamination, and slow release are required.

11-15

Authors: Obianime AW , Uche FI

Objective:To investigation the comparative effects of the aqueous extracts of the seeds of Tetracarpidium conophorum (T. conophorum) and Proviron on the sperm parameters of male guinea pigs, and screen phytochemical constituents of the seeds of T. conophorum. Methods: The sperm count, motility and morphology of the male guinea pigs were done using Neubauer chamber (Haemocytometer), light microscope and dilute carbol Fuchsin (1∶20) method, respectively. Phytochemical screening was done by standard procedures. Results: The aqueous extract of the T. conophorum seeds (100-400 mg/kg) caused statistically significant increase (P< 0.05, ANOVA) in the sperm count and motility, from 67.7± 2.10 and 56.5 ± 2.40 to 78.0± 3.5 and 75.0± 2.8, respectively. The highest effect was obtained at 300 mg/kg of T. conophoru. At this dose, the sperm count and motility of the male guinea pigs administered with T. conophorum were the same with the group administered 12.5 mg/kg Proviron. The values were 78.0 ± 3.50 and 75.0 ± 2.80, respectively for sperm count and motility (P <0.001, ANOVA). At 400 mg/kg, T. conophorum caused a slight decline in sperm count and motility. These effects were dosedependent and comparable to the observed effects of Proviron (12.5 mg/kg) on sperm parameters of male guinea pigs. In timedependent study, the observed effect of T. conophorum (300 mg/kg) and Proviron on the values of sperm count and motility at 14th day were almost the same. These values are 58.0± 1.80 and 70.0 ± 2.60, respectively for sperm motility and count. However, on the 7th day of treatment, T. conophorum exhibited highest effect which was higher than that of Proviron. These effects decreased progressively from the 14th to the 28th day. But Proviron showed the highest effect on the 28th day. These effects were all timedependent and statistically significant at P < 0.05 (ANOVA). Finally, the phytochemical screening of the seeds of T. conophorum revealed the presence of flavonoids, tannins, alkaloids, terpenoids, carbohydrates, volatile oils, steroids, saponins and cardiac glycosides. Conclusion:This study shows that the seeds of T. conophorum possess some active principles that can contribute positively on male fertility. This therefore, supports the claims on the use of the seeds of this plant by traditional medicine practitioners to increase/improve libido in men. However, further studies need to be done to investigate the mechanism of this action and also to isolate and characterize the active principles responsible for this effect in the extracts of this plant.

18-21

Authors: Siddiqui R, Siti Asma' H,Tang L, Jie CC, Rosliza AR, Roziawati Y

Objective: To analyze the effect of selected plant product against several bacterial which commonly causes oral infection. It was hope that in future, this product will become the remedy for treatment of oral infection and with the hope that it can substitute antibiotics. Methods: A total of 5 species of oral bacteria from American Type Culture Collection (ATCC) were employed in this study(S.mutans, S.aureus, P.aeruginosa, S.sobrinus and L.salivarius). Three types of natural plants crude extracts were used(garlic, curry leaves and cloves). Bactericidal and bacteriostatic effects of these herbs were tested.Results: It was shown garlic had antibacterial effects on all bacteria. The Minimal Inhibitory Concentration (MIC in g/mL) of garlic towards S.aureus, P.aeruginosa, S.mutans, S.sobrinus and L.salivarius were 0.3,1.8,1.2,0.5 and 1.8, respectively. There was significant difference among the MIC of garlic on tested bacteria. It was more potent toward S. aureus. The curry leaf solution on the other hand, did not show any zone of inhibition in all bacteria plates but adversely showed enhanced growth of those bacteria. Clove had shown its antibacterial effects on S. aureus and P. aeruginosa. The clove was more potent toward S. aureus with the MIC of 0.45 g/mL. P. aeruginosa was more sensitive to clove compared to garlic. For S.aureus, it was more sensitive to garlic compared to clove.Conclusion:The antibacterial activity of garlic and clove crude extracts shown in our study further confirm these natural plants' potential usage in therapeutic use for oral diseases or infections. This could be the platform for the interested party to do research and development on it and to produce oral health products which are more affordable for lower economic income groups and with fewer side effects as seen in synthetic drug.

28-32

Authors: Saraswathy TS , Az-Ulhusna A, Nor Zahrin H, Nurhasmimi Hassan , Zainah S, Rohani J

Objective:To analyse the laboratory surveillance data from 2004 till 2008 to examine the changing trend of rubella cases in Malaysia.Methods:Samples for this study were either received through the measles case based surveillance program or were hospital cases received for serodiagnosis of congenital rubella syndrome (CRS). Specific rubella IgM antibody test was carried out on all samples that were negative for measles IgM antibody and for serodiagnosis of CRS.Results:Through the surveillance program for measles, the samples received for rubella had increased five fold from 365 in 2004 to 1 522 in 2007. Positive rubella cases detected had also increased from 4.1 % in 2004 to 33.2 % in 2007. The age group 11 to 20 years accounted for 73.6 % of rubella cases confirmed in 2008, with a higher incidence among males than females. Positive rubella IgM was detected in 25 CRS cases during the 6 year period between January 2003 and December 2008.Conclusion:The measles elimination program had contributed to significant progress in the control of rubella, with the majority of rubella cases detected through this strategy. Since rubella is not notifiable in Malaysia, this integrated measles and rubella surveillance should be continued. However, to enhance the progress, specific targets should also be established in the national program to eliminate rubella and CRS.

37-39

Authors: Malison Marilyn T, Sia Su Glenn L

Objective:This study aims to determine the prevalence of intestinal parasites infesting the vegetable foodstuffs and determine the parasitological profile of the vegetable foodstuffs examined. Methods:About 200 randomly sampled vegetable foodstuffs obtained from the vendors of the Balintawak and Divisoria public markets were examined for the occurrence of intestinal parasites. Results:A total of 119 (59.5 %) vegetable foodstuffs examined were tested positive. The most common parasite found was the Ascaris lumbricoides. No significant differences between the prevalence of intestinal parasites at the two public markets were found (P > 0.05).Conclusion:The vegetables can be a potential source of parasitic infection.

43-47

Authors: Lawrence O

Objective: To investigate the incidence of human cytomegalo virus (HCMV) in pregnant women. Methods: One hundred and twenty two (122) blood samples and 80 umbilical cord fluids were tested for IgG and IgM respectively using the enzyme linked immunosorbent assay (ELISA). Results: Of the 122 samples screened for IgG and IgM only 56 (47.1 %) tested positive for IgG while 63 (52.9 %) were positive for IgM with 3 samples nonspecific. Pregnant women with signs of normal pregnancy made up 60% of the positive results while 20 % had a history of ectopic pregnancy and 20 % with a history of miscarriages. Of the total of 80 umbilical cord fluids tested, only 59 (73.8) tested positive. Eleven of the selected 40 umblical cord fluid was positive to IgG to human cytomegalovirus along with mother and child. Antibody titration result gave diagnostic titre for both IgG and IgM from the 40 umbilical cord fluids. There was a significant relationship between mother, child and umbilical cord fluids ( χ2=1.360, CI=99 %, P=0.568). Conclusion: There could be a possible neonatal infection, and the infection is common among toddlers and children of preschool age.

52-58

Authors: Mahmoud M Al-Bendary, Mahmoud Abdel-Aziz, Waleed A Al-Sherbeeny, Raghda El-Sayed Farag, Abdel-Hady El-Gilany, Mohammad Hosam Eldeen Zaghloul

Objective:To determine the prevalent pathogens responsible for spontaneous bacterial peritonitis (SBP) and their sensitivity pattern, to test the efficiency of different culture techniques in microbial isolation, and to study the diagnostic predictors of such cases.Methods:One hundred eight SBP episodes from 92 adult patients were compared to 88 cirrhotic ascites patients cross-matched with age and sex without SBP. Ascitic fluid was subjected to cytological, biochemical examination and culture on both conventional and blood culture bottles at the bedside for bacterial identification and antimicrobial susceptibility testing.Results:The prevalence of SBP was 25.02 %. Logistic regression analysis revealed that; previous SBP episode, low ascitic fluid protein levels, high serum creatinine and low serum albumin levels were the independent significant predictors of SBP. About forty-five per cent of SBP episodes were detected by conventional culture compared to 73.15 % by modified technique with a significant difference. Gram-negative bacteria were the cause of SBP in 46 (58.23 %) culture positive episodes. Escherichia coli and Staphylococcus aureus were the most commonly detected organisms. Resistance to different antibiotics was high.Conclusion:Culture of ascitic fluid in blood culture bottles at bedside increases the sensitivity of SBP detection. There is a recent increase in Gram-positive pathogen with emergence of multidrug resistance. These recent changes may have an impact on guidelines for management and treatment of SBP in our locality.

63-70

Authors: Sayasone S, Erlanger TE, Kaul S, Sananikhom P, Tanner M, Utzinger J, Odermatt P

Objective:To compare perceived illhealth and health seeking behavior between two communities affected by the large Nam Theun 2 hydroelectric project in central Lao People's Democratic Republic (PDR). Methods:Two different affected areas: Nakai plateaubeing remote, sparcely populated and mountainous, and Xe Bang Fai lowland plains, more densely populated and comparatively affluent were included. Data were obtained from two crosssectional householdbased health and socioeconomic surveys. Results:We found pronounced differences in the frequency of selfreported fever, cough, headache and myalgia according to location. On the Nakai plateau, 45.1 % of the individuals with illhealth report (recall period: 2 weeks) went to a local health volunteer compared to only 7.2 % in the Xe Bang Fai area (P<0.001). In Nakai, there were disproportionately more illiterates seeking help from local health volunteers when compared to those who attended at least primary schooling (49.2 % versus 17.5 %, P<0.01). Selfmedication with antimalarials was more common in Xe Bang Fai than on Nakai (32.3 % versus 7.0 %, P<0.001). The mean amount of money spent per health consultation was US$ 1.7 in Nakai and US$ 7.2 in Xe Bang Fai. Conclusion:The observed differences in selfreported illhealth and health seeking behavior among these two Lao communities need to be considered when implementing settingspecific mitigation measures as part of the public health action plan of the Nam Theun 2 hydroelectric project.

78-80

Authors: Col Prasan Kumar Hota

Splenic abscess is an uncommon clinical presentation in surgical practice, associated with high morbidity and mortality. Mortality may be 100 % if left untreated. Splenic abscess is also rarely encountered as a complication of typhoid fever. We present here a case of multiple splenic abscesses with neuropsychiatric complications due to typhoid fever, which was managed successfully with splenectomy and other supportive therapies. Another case of single splenic abscess due to enteric fever was treated successfully with CTguided aspiration and appropriate antibiotics.Being a rare entity in clinical practice, splenic abscess has been poorly studied. Haematogenous seeding of the spleen due to typhoid is a common cause of splenic abscess in the tropical countries. In multiple or multiloculated abscesses aspiration usually does not succeed, which happened in our case. Splenectomy remains the definitive choice of treatment. However, Ultra sonography (USG) or CTguided aspiration may be tried in selective cases.

1-7

Authors: Mariana A, Ho TM, Lau TY, Heah SK, Wong AL

Objective:To determine distribution of arthropods in rice grains obtained from different sources. Methods:Rice samples were randomly collected from public in urban areas, farmers in rice field areas, aborigines in undeveloped areas and retailers in commercial premises. Random samples of rice were taken out from each sample for isolation of arthropods using a modified Berlese Tullgren Funnel Method. Mites were mounted prior to identification; weevils were directly identified.Results:Samples of rice from retailers in commercial premises had the highest infestation by arthropods followed by samples from urbanites, aborigines and rice farmers. Two species of weevils, Sitophilus oryzae( S. oryzae)and Sitophilus granarius(S. granarius), were found. Samples from commercial premises had the least percentage of weevils compared to those collected from domestic premises. Depending on the source of samples, densities of S. granarius and S. oryzae ranges from 11-103 weevils/kg and 7- 80 weevils/kg, respectively. Important species of mites in stored rice identified were mainly members of the families Cheyletidae, Echimyopodidae, Pyroglyphidae, Saproglyphidae and Tenuipalpidae. Among the species of mites identified were Austroglycyphagus malaysiensis, Cheyletus fortis, Cheyletus malaccensis, Dermatophagoides pteronyssinus, Grammolichus malukuensis and Suidasia pontifica. Average density of most of the mites was less than 40 mites/kg of rice grains. In this study, the highest number of mites in rice samples was recovered from commercial premises, followed by samples from urbanites. Samples from farmers and aborigines contained lesser mites.Conclusion: This study demonstrated the presence of 3 allergenic mite species in rice, i.e A. malaysiensis, D. pteronyssinus and S. pontifica. Weevils, S. oryzae and S. granarius that are known to be allergenic, were also found.

14-19

Authors: Apichart Nontprasert, Cheeraratana Cheeramakara, Sasithon Pukrittayakamee, David AB Dance, Ty L Pitt, Michael D Smith, Sirivan Vanijanonta, Nicholas J White

Objective: To investigate the banding patterns of whole cell protein (WCP) and outer membrane protein (OMP) of Burkholderia pseudomallei (B. pseudomallei) in clinical isolates from patients with melioidosis. Methods: WCP and OMP of of B.pseudomallei in 50 clinical isolates, from 47 patients with melioidosis were prepared and separated by polyacrylamide gel electrophoresis (SDS PAGE) using 10% gels and stained with Coomassie brilliant blue. The banding patterns were compared by using a laser densitometer and dendrogram.Results: There were 6 different banding patterns of WCP and 2 types of OMP. Type 15 WCP had 8 common protein bands at 19.0 - 45.0 kDa with identical OMP pattern. The banding patterns of WCP in type 6 were distinct from the others and also its OMP profile. The majority of clinical isolates (37/50, 74%) were in type 1 WCP. Of the remaining isolates, 8 were in type 2, 2 in type 3, and one each was in type 4 to 6. There was no significant association between the WCP typing and the demographic or clinical features of the investigated patients.Conclusion: Despite the wide variation of clinical features of melioidosis, the results of this study show that B. pseudomallei had a few differences in the WCP and OMP profiles. Therefore typing of WCP and OMP, using SDSPAGE analysis, could be an alternative method for phenotypic differentiation in clinical isolates of B. pseudomallei.

26-29

Authors: Uche FI, Okunna BU

Objective: To investigate the analgesic and antiinflammatory effects of the methanolic extract of the leaves of Triumfetta rhomboidea on mice and rats respectively. And to screen the phytochemical constituent of the extract.Methods: The analgesic effect was determined by acetic acidinduced writhing test in mice. While the antiinflammatory activity was determined by egg albumininduced oedema of the rat paw. Phytochemical screening was done by standard procedures. Results: Triumfetta rhomboidea leaf extract (50-400 mg/kg) caused a statistically significant inhibition on the egg albumininduced eodema or inflammation in Wister albino rats with P < 0.001 (ANOVA). This effect was higher than the observed effect with Piroxicam (0.5 mg/kg) which was used as a standard. The effect was also dosedependent. Furthermore, Triumfetta rhomboidea extract caused a statistically significant reduction in the number of acetic acidinduced writhing in mice, with P < 0.001 (ANOVA). These effects were also doesdependent and greater than the analgesic effects by paracetamol which was used as a reference drug. Phytochemical screening revealed the presence of flavonoids, steroids, triterpenoids alkaloids, tannins and saponins in Truimfetta rhomboidea leaf extract. Conclusion:Triumfetta rhomboidea can be recommended for acute inflammatory disorders and diseases associated with pains. This also supports its traditional use as an antisnake bite and anticancer or antitumor agent. Further study is on the way to find out the mechanism of its action and also to isolate, identify and characterize the active principle responsible for these effects in this plant.

34-37

Authors: Idogun E. S, Airauhi L. U

Objective:To assess the plasma electrolyte status of patients with diagnosis of malaria but without the symptoms of diarrhea, vomiting or altered sensorium and correlation of the plasma electrolyte changes and the degree of parasitaemia.Methods: All the participants were adults, who met the clinical case definition of malaria but without the symptoms of diarrhea, vomiting or other medical illness. Blood slides were screened microscopically for malaria parasite and the parasite positive patients were grouped into A (mild), B (moderate) and C (heavy) malaria parasiteamia, depending on the malaria parasite count per high power microscopic field. Plasma sodium, potassium and chloride were estimated using the ion selective electrode method, while bicarbonate ions were determined by simple titration method.Results: A total of 200 subjects were studied which comprised of 150 patients and 50 controls. The mean plasma sodium was significantly lower in patients with heavy parasitaemia［group C, (128.8±1.2) mmol/L］compared to those with mild and moderate parasitemia［(133.5± 2.8) mmol/L and (133.5± 3.5) mmol/L, P<0.0001］. The mean plasma chloride was lowest in those patients with heavy parasitaemia (group C) than those patients of group A and B (P<0.0001). Patients in group C also had significant hypokalaemia［(3.2± 0.5) mmol/L］ when compared to those in groups A and B［(3.6±0.3) mmol/L and (4.1±0.6) mmol/L respectively, P<0.0001］. Conclusion: A disorder of plasma electrolytes in malaria patients that had no symptoms of diarrhea and vomiting was reported. And the severity of hyponatraemia and hypokalaemia correlate with the severity of the patients′ malaria parasitaemia. This data should alert clinicians on the need to assess electrolytes status of patients with malaria even without the symptoms of fluid loss, especially when malaria parasitaemia is heavy.

44-48

Authors: Ghaleb Adwan, Bassam Abu Shanab, Marwan Odeh

Objective:This study was conducted to update the prevalence of methicillinresistant Staphylococcus aureus (MRSA) isolates among human clinical S. aureus isolates recovered from Northern Palestine, to evaluate the possible presence of vancomycinResistant S. aureus (VRSA) and vancomycin intermediate resistant S. aureus strains (VISA) and to determine the antimicrobial susceptibilities of these clinical isolates.Methods:The in vitro activities of 11 antibiotics against 204 nonduplicate S. aureus isolates from clinical samples in North of Palestine were determined by the diskdiffusion method. These samples were isolated between June 2006 and December 2007. The minimum inhibitory concentration (MIC) of vancomycin for 115 methicillin resistant Staphylococcus aureus (MRSA) strains was carried out using the agar dilution method.Results:One hundred and fifteen (56.4 %) of these isolates were MRSA and according to their antibiotic profile these are multidrug resistant (resistant to three or more nonβlactam antibiotics). Ninety nine (43.6 %) isolates were methicillin sensitive S. aureus (MSSA), forty four of MSSA isolates (44.4 %) were multidrug resistant, while forty five (45.6 %) were non multidrug resistant. Our results showed that the most common resistance (95.6 %) was to penicillin. Two strains of MRSA have shown to be vancomycin intermediate resistant, had MIC of 4 μg/mL and 8 μg/mL and these vancomycin intermediate resistant S. aureus strains (VISA) are resistant to all antibiotics tested.Conclusion:According to our information this is the first study report about VISA in Palestine.

54-57

Authors: Azikiwe CCA, Amuzu LU, Unekwe PC, Nwosu PJC, Ezeani MC, Siminialayi MI, Obidiya SO, Arute JE

Objective:Aim of present study is to scientifically, verify the antidiabetic activity/potency of Vernonia amygdalina in human diabetes.Methods:A search was made at Nnewi, South-East Nigeria for known diabetes who use Vernonia amygdalina either as their sole or supplementary antidiabetic. A total of ten volunteers comprising, eight females and two males were recruited. They were all of age range of 3650 and average weight of 78 kg and suffering from non-insulin form of diabetes. The purpose of the study was explained to them and their consent obtained. They were asked not to take any other antidiabetic outside Vernonia amygdalina throughout the four weeks study period. There was however, no form of restrictions to their choice of diet or life style. They were requested to abstain from any drugs a week prior to commencement of study. Their prescriber′s dosage range was followed and minimum daily dose of 210 mL (approximately 220 mg of dry extract) was administered in Week1, followed by daily dose of 420 mL (440 mg) in Week2. In Week3 they received 630 mL (660 mg) daily dose and in Week4, they received daily dose of 840 mL (880 mg). Their fasting blood sugar were estimated precrude drug administration and on weekly basis for the four week study period. Their weekly weights were measured to check for possible weight gain or loss. Results were subjected to statistical analysis and Students TTest was used to calculate Pvalue. Pvalue ≤0.05 were considered significant. Results: It was observed that all the volunteers in the study group were taking Vernonia amygdalina only as supplementary. Two volunteers dropped out of the study at the end of Week3 leaving us with 8 in Week4. There was no significant bodyweight change within the four week study. The starting mean fasting blood sugar which was 133.3 mg/dL(7.41 mmol/L) rose to 136.6 mg/dL(7.59 mmol/L) in Week1, to 149.5 mg/dL(8.31 mmol/L) in Week2 and to 166.5 mg/dL(9.30 mmol/L) in Week3. Week4 had us left with 8 volunteers with a mean of 190.6 mg/dL(10.59 mmol/L). There was significant differences in increase in sugar levels between the precrude extract administration and treatment period with Vernonia amygdalina (P≤0.05 for Week1, P≤0.02 for Week2, P≤0.01 for Week3 and P≤0.001 for Week4). Conclusion:Claims of antidiabetic efficacy of Vernonia amygdalina in human diabetes are scientifically non verifiable based on our work hence these claims are false. We also feel bold to state that we could not demonstrate any antidiabetic activity of Vernonia amygdalina in human subjects. We recommend that NAFDAC and all relevant agencies must sit up and control all forms advertorial on Medicinal plants until such are well studied and proven.

66-70

Authors: Yap Felix Boon Bin

Objective: To assess the efficacy of ADA isoenzyme estimation over that of total ADA level in pleural fluid and serum as a more efficient diagnostic indicator in tuberculous pleural effusions in high prevalence country like India.Methods:The efficacy was analysed in total thirty four patients of pleural effusions. Total ADA was estimated by Guitsi and Galanti Calorimetric method and ADA isoenzymes with and without EHNA［Erythro-9(2-hydroxy 3-nonyl) adenine］ a potent ADA1 inhibitor using the same method. Results:The results demonstrated a statistically significant values of ADA2 in serum (P< 0.001), pleural fluid (P=0.000) and significant value for the ratio of pleural fluid ADA2／serum ADA2 (P<0.001) and pleural fluid ADA1／ADA2 (P<0.005). The sensitivity and specificity values of pleural fluid ADA2 is 81.8 % and 91.6 % (cut off value 60 IU／L for Tuberculous effusions), serum ADA2 95.4 % and 66 % (cut off value 70 IU／L for tuberculous effusions). ADA2 is an isoenzyme, which is significantly raised in tuberculous pleural effusions both in the serum and pleural fluid. Conclusion: Estimation of ADA isoenzymes is redundant as a diagnostic aid over total ADA estimation in view of the limited improvements both in specificity and sensitivity patterns and also in term of costbenefit ratio.

77-79

Authors: Siti Suraiya Md Noor, Zaidah Abdul Rahman, Sarimah Abdullah ,Zakuan Zainy Deris，Che Wan Aminuddin

Objective: To investigate the prevalence, clinical and bacteriological features and outcome of extrapulmonary tuberculosis in patients attending a tertiary care hospital at Kota Bharu, Kelantan. Methods: All culture positive tuberculosis cases recorded in Hospital Universiti Sains Malaysia at Kota Bharu during five years period from 20032007 were included in the study. Mycobacterium detected in samples originating from sites other than lungs was considered as a case of extrapulmonary tuberculosis. Age, site of infection, bacteriological findings and outcomes were analyzed. Results: Out of 437 tuberculosis cases recorded from 20022006, 59 cases had culture positive extrapulmonary tuberculosis. Their mean age was 37 years and 44% were between the ages of 2040 years. About 63% were negative for acidfast bacilli by ZN stain. Of the 59, 97% was Mycobacterium tuberculosisc (M. tuberculosis) while two (3%) were atypical Mycobacterium Runyon GroupIV. Only 3 (5%) were isoniazid resistant. Extrapulmonary sites involved were lymph nodes 19 (31%), central nervous system 12 (20%), pleural 11(19%) spine 8 (14%), renal 3 (5.1%) and others 6 (10.2%). In this series, 11(18%) were positive for HIV. There was no significant association between extrapulmonary tuberculosis and HIV status. The outcome of CNS tuberculosis was the poorest with a mortality rate of 25%.Conclusion: M. tuberculosis is the predominant organism in extrapulmonary tuberculosis and culture is the most effective method for its diagnosis.

1-5

Authors: Diganta Pan, Ashok Kumar Bhatia, K.N. Bhilegaonkar

Objective: The leaves extract of Carica Papaya (C. Papaya)papaya has been shown to possess antimalarial activity, thus this work aims at finding out if the plants antimalarial activity is present in or extended to the seeds. Methods: The seeds of C. papaya were collected from its fruit, air dried for 5 days and ground into fine powder. 80.65 g of the powder was then soaked for 48hours in 300 mL of methanol. Filtration was carried out using Whatman No.1 filter paper. The filtrate was evaporated to dryness by a three-day continuous heating on a hot plate of 30℃. The dry extract yield was scraped out of the Petri dish weighed and refrigerated until required. The percentage extract yield was calculated out from the initial powder weight. A preliminary phytochemical study was done by re-dissolving the appropriate amount of the dry extract in distilled water and appropriate test reagent added. The LD50 of the seeds of C. papaya was carried out using arithmetic method. Swiss albino Mice of both sexes and of average weight of 18-25 g were used as animals for antimalarial activity. They were housed in standard animal house, fed on Rats/Mice pellets and had non restricted excess to both feed and water throughout the 60day study period. While the non pregnant female Mice were used as test animals, the male animals were used as malaria parasite donors. Precautions were taken to ensure that all animals in the study groups were free from infection with Eperythrozoon coocoides. The female animals were then divided into three main groups (A-C) of 25 animals per group. Group A was used for malaria suppressive study (early infection day 0-3) and was further subdivided to 5subgroups (a-e) of 5animals per group. Group B was used for malaria curative study (established malaria infection day 3-7) and was further subdivided to 5subgroups (a-e) of 5animals per group. Group C was used for malaria prophylactic study (repository4days treatment prior to malaria parasite infection) and was also further subdivided into 5subgroups (a-e) of 5animals per group. At the appropriate time, 50 mg/kg/day, 100 mg/kg/day and 200 mg/kg/day of crude extract of C. papaya were administered orally to the different subgroups(b-d) within the three main groups. One subgroup(a) in each main group also received orally, 5 mg/kg/day of chloroquine phosphate as positive control while one subgroup (e) in each main group also received orally, 0.2 mL/kg/day of distilled water as negative control. Malaria parasites infected red blood cells numbering 1×107 and suspended in 0.2 mL of physiological saline was inoculated intraperitoneally, to each animal of the subgroups (a-d) in each of the three main groups at the appropriate time. Blood smears were made from animals' tail, stained with Lieshman and examined microscopically at 100× for the presence of malaria parasite. Percentage malaria parastaemia was calculated as well as average percentage malaria parasitaemia suppression. %100,0,100,0 Results: Extraction yield of 25.29% was obtained while the LD50 was 620 mg/kg. The phytochemistry showed the richly presence of alkaloids, as well as glycosides, carbohydrates, resins, fats and fixed oils. The suppressive study at doses of 200,100 and 50mg/kg/day showed 53.02%, 43.43% and 19.83 % suppressive activity against Plasmodium berghei respectively. This activity compared to that of chloroquine, a standard antimalaria drug that gave 95.95% suppressive anti-parasitaemia. The prophylactic study at doses of 200, 100 and 50 mg/kg/day showed 63.85%, 61.12% and 48.08% prevention to malaria parasitaemia respectively as against 94.78% showed by chloroquine. The curative study however, at doses of 200, 100 and 50 mg/kg/day failed to suppress malaria parasitaemia with a mean survival range of 6-8 days as against 27.2 days showed by chloroquine. The seeds extract of C. papaya showed a significant malaria parasitaemia suppressive activity (P≤0.05). These activities are dose dependent and comparable to those of Chloroquine phosphate. Conclusion: The results above suggest that the seeds extracts of C. papaya possess antimalarial activity like the leaf extracts. The antimalarial activity may be attributable to the richly presence of alkaloids and or the presence of its proteolytic enzyme (Papain). The present finding justifies the inclusion of the seeds of C. papaya in the treatment of malaria by local herbalists. The seeds extracts therefore, if well purified and characterized may be used in treatment of very early plasmodiasis as well as a good prophylactic drug in human. This work at the moment is limited to animals, thus clinical trials in humans is be recommended particularly, when C. papaya seeds are non harmful/non toxic.

11-18

Authors: P.O. Osadebe, E.O. Omeje

Objective: In our continued efforts to isolate the active immunomodulatory and antiviral constituents of Loranthus micranthus Linn parasitic on Kola acuminata, we set out to fractionate the crude aqueous methanol extract of the plant. The establishment of the most potent fraction(s) as well as the isolation of the pure active secondary metabolite responsible for the immune stimulatory and antiviral activities in Eastern Nigeria mistletoe has become very needful. This will enable us prove our assumption that this particular specie is different from the European version, Viscum album.Methods: Five solvents of varying polarity namely nhexane, chloroform, ethylacetate, acetone and methanol were successively employed in the complete fractionation of the crude aqueousmethanol extract of Eastern Nigerian mistletoe, Loranthus micranthus Linn., harvested from Kola acuminata in that order. The fractions were dried invacuo using a rotary evaporator maintained at a temperature of (40±5)℃. The different fractions were screened for immunomodulatory activity using a universal model; the cellular mediated delayed type hypersensivity test in experimental mice. This was performed by administering two different dose levels: 250 mg/kg and 500 mg/kg of each fraction against standard positive and negative control. Results: Results of the study established dosedependent immunostimulatory (upregulatory) effects of the five fractions of the extract as the model used in the study with different percentage stimulations compared to controls. At the dose levels of 500 mg/kg and 250 mg/kg body weight, the percentage stimulation observed were as following: chloroform fraction 311.11% and 122.22 %, ethyl acetate fraction 193.38 % and 95.56%, nhexane 155.56 % and 3.50 %, acetone fraction 95.56 % and 51.11 % and methanol fraction 68.89% and 24.44 % respectively. Levamisole, a known potent immunostimulant, afforded a stimulation of 68.89% at a dose of 2.5 mg/kg.Conclusion: The study showed that the order of immunomodulatory potency is chloroform fraction>ethylacetate fraction>hexane fraction>acetone fraction>methanol fraction. Bioassayguided fractionation and purification of the active extracts led to the isolation of pure compounds phytochemically characterized as sterols and flavonoids. This work indicates that the main constituents of our local mistletoe responsible for immunostimulation are the flavonoids, terpenoids and or steroids. Glycosides, carbohydrates, tannins and alkaoids appear to augment the measured activities.

27-32

Authors: Uche FI, Ezugwu CO

Objective: The methanol extracts of the leaves of Kolancheo (K.) pinnata, Aspilia (A.)africana, Mucuna (M.) pruriens, Emilia (E.) coccinea, Triumfetta (T.) rhomboidea, Laportea (L.) ovalifolis, Celosia (C.)trigynea, Cucurbita (C.)moschata and Asystesia (A.)gangestica were evaluated for antioxidant activities, the reducing potentials of these plants were also determined and phytochemical screening of some of these plants were carried out. Methods: The antioxidant activities of these plants were evaluated by the use of 2, 2diphenyl1picrylhydrazyl (DPPH) free radical assay and spectrophotomer. The reducing potentials of these plants were determined using Ferric chloride, Potassium Ferricyanide and Trichloroacetic acid proceedures. The phytochemical screenings of the medicinal plants were equally done using standard procedures.Results: The percentage of antioxidant activities values for the plants were: (31.00 ± 1.80) %, (58.40 ± 1.26) %, (59.10 ± 1.60)%, (60.00 ± 1.05) %, (60.80 ± 1.28) %, (62.40 ± 1.26) %, (64.80 ± 2.10) % , (75.70± 2.60) % and (82.70 ± 2.80)% for A. gangestica, C. moschata, C. trigynea, L .ovalifolia, E. coccinea, M. pruriens, A. africana,K. pinnata and T .rhomboidea ,respectively. These values were dosedependent and statistically significant at P < 0.05 (ANOVA). The results showed that T. rhomboidea had the highest antioxidant activity value (82.70 ± 2.80 %) while A. gangestica had the least value (31.00 ± 1.80 %). The percentage of antioxidant activities of these plants were comparable to the standard used, Tocopherol which was found to be (97.20 ± 1.06) %. The reducing potentials of the plants were found to be positively correlated to the antioxidant activities of the plants. Phytochemical screenings revealed the presence of alkaloids, flavonoids, terpenoids, saponins and tannins in the medicinal plants.Conclusion: The findings from this study have revealed the potentials of these plants as antioxidants. This could be exploited in drug development in search of powerful antioxidants which are urgently needed to challenge free radicals in biological systems. It will consequently help to prevent the body from free radicals originated ailments. However, further study needs to be done to isolate and characterize the active principles in these plants.

41-45

Authors: O.G. Oyero, A.O. B. Oyefolu

Objective: The acceptability of herbal remedies for alleviating discomforts and illhealth has become very popular, on the account of the increasing cost of allopathic medicine for personal health maintenance. The observable nonadherence of herbalists to the established World Health Organization (WHO) / National Agency for Food and Drug Administration Control (NAFDAC) regulations for the quality control of herbal medicines is an issue for concern. In view of this, 34 popular and widely consumed crude herbal remedies in southwestern, Nigeria were screened for compliance with standard limits for bacterial contamination, bacteria flora and their antibiotic susceptibility pattern.Methods: Isolates recovered from samples were identified using the cultural, morphological and biochemical characteristics. They were also tested for drug sensitivity using standard procedures. Results: A heavy bacteria load ranging from 3.00 × 103-9.58 × 105 CFU/ML and 1.20 × 105- 5.41 ×105 CFU/ML was observed for water and spirit extracted preparations respectively. The bacteria flora cum contaminants were: Staphylococcus aureus, Bacillus cereus, Bacillus subtilis, Pseudomonas aeruginosa, Micrococcus luteus, Lactobacillus plantarum, Klebsiella pneumoniae, Escherichia coli, streptococcus, Shigella, Neisseria, Arthrobacter, Kurthia and Clostridium species. All the isolates were multidrug resistant (MDR) strains. Conclusion: The crude herbal preparations consumed in Nigeria failed to comply with the internationally recognized standards regarding bacteria load and flora. The presence of MDR pathogens is of greatest concern. It poses a great risk to consumer's health and could be a source of introducing MDR organisms into the human population. There is the need for the enforcement of established guidelines to ensure the safety of these preparations.

50-57

Authors: Charuai Suwanbamrung, Ratana Somrongthong, Phechnoy Singchagchai, Luechai Srigernyaung

Objective: To explore the meanings and domains for giving communities the capacity to be successful in dengue prevention and control.Methods: One hundred and twenty participants were purposely selected from 4 subdistricts of 4 provinces in Southern Thailand with a high dengue incidence. Sixty community leaders and sixty noncommunity leaders participated in this study. Indepth interviews (IDIs), as well as focus group discussions (FGDs) with taperecorders and notetaking, were used to collect data. All records were transcribed verbatim and analyzed by using the Colaizzi method for content analysis.Results: The findings showed that people view the creation of a sustainable dengue community program as possible only with the support of each community in its entirety: "everyone, every sector, all participating, and with continuing activities." Community capacity for dengue prevention and control was dependent on ten domains: 1) stakeholder participation, 2) community leadership, 3) a coreactivities group, 4) a problemsolving needs assessment, 5) dengue information transfer, 6) resource mobilization, 7) a sense of community for the dengue problem, 8) a dengue network partnership, 9) critical dengue situation management, and 10) continuing dengue prevention and control activities.Conclusion: These community capacity domains can be developed into an assessment tool for the community capacity building process. Community capacity domains require community leaders and noncommunity leaders to clarify dengue prevention and control assistance required.

64-66

Authors: Kalantar E, Solatni J, Khosravi B, Salehi A

Objective: Diarrhea is a leading cause of morbidity and mortality among children in developing countries. The bacterial pathogen most commonly associated with childhood diarrhea is Escherichia coli. A one year prospective study was carried out in Sanandaj to determine the prevalence and roles of the different E. coli pathotypes in children less than five years of age with acute diarrhea. Methods: Rectal swab were collected prospectively from children with acute diarrhea and transported to the Department of Microbiology, School of Medicine, KUMS, Sanandaj during 2008. The study was approved by the institutional ethics committee. Results: During this study period, rectal swabs were investigated from a total of 466 children 1 to 144 months of age (mean, 29.97 months ±S.D) with diarrhea. Among the children, 191 (41%, 191/466) were girls, and 275 (59%,275/466) were boys. The age specific incidence rates of acute diarrhea among children 13-24 and 1-12 months of age were 37.37% (37/99) and 26.26 % (26/99), respectively, during the study period.A total of 99 strains of E. coli were detected. EPEC 59 (59.59%) and EIEC 22 (22.22%), were the most commonly found Escherichia coli strains detected in stools from children. Disk diffusion testing showed E. coli strains resistance to tetracycline (89.89 %), chloramphenicol (88.88%), Ampicillin (79.79%), Amoxicillin (75.75%) and Ceficime (75.75%).Among risk factors like age, sex, haemoglubin, father's and mother's education, food and weight of children only mother's education was significant (P=0.018). Conclusion: In most of the clinical laboratories in Iran, E. coli does not considered as an etiologic agent responsible for diarrhea. Results in this study revealed that E. coli should be considered as an etiologic agent causing acute diarrhea among children. We therefore, recommend the routine isolation and identification of E. coli strains in all the clinical laboratories in Sanandaj. Guidelines for appropriate use of antibiotics in Sanandaj need updating.

75-76

Authors: Amit Agrawal

Spontaneous, non-surgical haematogenous Staphylococcus aureus meningitis is rare and associated with high mortality. Mixed infection causing meningitis (pyogenic and tubercular) is further rarer, poses a difficult diagnostic and management challenge, which warrants early diagnosis and aggressive therapy. We present a case of concurrent pyogenic and tubercular meningitis in a child managed successfully. It seems that in present case initial pyogenic infection resulted in the immunocompromised state for the child that would had lead to the activation of tubercular foci resulting in tubercular meningitis.

1-6

Authors: Amazu LU, Ebong OO, Azikiwe CCA, Unekwe PC, Siminialayi MI, Nwosu PJC, Ezeani MC, Obidiya OS, Ajugwo AO

Objective: The leaves extract of Carica Papaya (C. Papaya)papaya has been shown to possess antimalarial activity, thus this work aims at finding out if the plants antimalarial activity is present in or extended to the seeds. %100,0,100,0〗Methods: The seeds of C. papaya were collected from its fruit, air dried for 5 days and ground into fine powder. 80.65 g of the powder was then soaked for 48hours in 300 mL of methanol. Filtration was carried out using Whatman No.1 filter paper. The filtrate was evaporated to dryness by a three-day continuous heating on a hot plate of 30℃. The dry extract yield was scraped out of the Petri dish weighed and refrigerated until required. The percentage extract yield was calculated out from the initial powder weight. A preliminary phytochemical study was done by re-dissolving the appropriate amount of the dry extract in distilled water and appropriate test reagent added. The LD50 of the seeds of C. papaya was carried out using arithmetic method. Swiss albino Mice of both sexes and of average weight of 18-25 g were used as animals for antimalarial activity. They were housed in standard animal house, fed on Rats/Mice pellets and had non restricted excess to both feed and water throughout the 60day study period. While the non pregnant female Mice were used as test animals, the male animals were used as malaria parasite donors. Precautions were taken to ensure that all animals in the study groups were free from infection with Eperythrozoon coocoides. The female animals were then divided into three main groups (A-C) of 25 animals per group. Group A was used for malaria suppressive study (early infection day 0-3) and was further subdivided to 5subgroups (a-e) of 5animals per group. Group B was used for malaria curative study (established malaria infection day 3-7) and was further subdivided to 5subgroups (a-e) of 5animals per group. Group C was used for malaria prophylactic study (repository4days treatment prior to malaria parasite infection) and was also further subdivided into 5subgroups (a-e) of 5animals per group. At the appropriate time, 50 mg/kg/day, 100 mg/kg/day and 200 mg/kg/day of crude extract of C. papaya were administered orally to the different subgroups(b-d) within the three main groups. One subgroup(a) in each main group also received orally, 5 mg/kg/day of chloroquine phosphate as positive control while one subgroup (e) in each main group also received orally, 0.2 mL/kg/day of distilled water as negative control. Malaria parasites infected red blood cells numbering 1×107 and suspended in 0.2 mL of physiological saline was inoculated intraperitoneally, to each animal of the subgroups (a-d) in each of the three main groups at the appropriate time. Blood smears were made from animals' tail, stained with Lieshman and examined microscopically at 100× for the presence of malaria parasite. Percentage malaria parastaemia was calculated as well as average percentage malaria parasitaemia suppression. %100,0,100,0 Results: Extraction yield of 25.29% was obtained while the LD50 was 620 mg/kg. The phytochemistry showed the richly presence of alkaloids, as well as glycosides, carbohydrates, resins, fats and fixed oils. The suppressive study at doses of 200,100 and 50mg/kg/day showed 53.02%, 43.43% and 19.83 % suppressive activity against Plasmodium berghei respectively. This activity compared to that of chloroquine, a standard antimalaria drug that gave 95.95% suppressive anti-parasitaemia. The prophylactic study at doses of 200, 100 and 50 mg/kg/day showed 63.85%, 61.12% and 48.08% prevention to malaria parasitaemia respectively as against 94.78% showed by chloroquine. The curative study however, at doses of 200, 100 and 50 mg/kg/day failed to suppress malaria parasitaemia with a mean survival range of 6-8 days as against 27.2 days showed by chloroquine. The seeds extract of C. papaya showed a significant malaria parasitaemia suppressive activity (P≤0.05). These activities are dose dependent and comparable to those of Chloroquine phosphate. 100,0,100,0〗Conclusion: The results above suggest that the seeds extracts of C. papaya possess antimalarial activity like the leaf extracts. The antimalarial activity may be attributable to the richly presence of alkaloids and or the presence of its proteolytic enzyme (Papain). The present finding justifies the inclusion of the seeds of C. papaya in the treatment of malaria by local herbalists. The seeds extracts therefore, if well purified and characterized may be used in treatment of very early plasmodiasis as well as a good prophylactic drug in human. This work at the moment is limited to animals, thus clinical trials in humans is be recommended particularly, when C. papaya seeds are non harmful/non toxic.

15-22

Authors: Ravichandran Veerasamy, Vishnu Kanth Mourya, Ram Kishore Agrawa

Objective: Inhibition of HIV-1 integrase is an important strategy for the treatment of HIV and AIDS. Therefore, HIV-1 integrase inhibitory activity of 3aroyl-1,1-dioxo-1,4,2-benzodithiazines has been analyzed with different physicochemical parameters.Methods: In the present work, quantitative structure activity relationship studies were performed on a series of benzodithiazines as HIV1 integrase inhibitors using the modeling software Win CAChe version 6.1. Multiple linear regression analysis was performed to derive quantitative structure activity relationship models which were further evaluated for statistical significance and predictive power by internal and external validation. Results: The best QSAR models were having good correlation coefficient (r) with low standard error of estimation (SEE) and cross validated square of correlation coefficient (q2). The robustness of the models was checked by Y-randomization test and they were identified as good predictive models. The model for HIV integrase (wt) inhibitory activity of benzodithiazines suggest that the increase of dipole moment (Z) of molecules leads to reduce 3' processing and strand transfer inhibitory activity, substitution with high electro positive groups is conducive for the 3' processing inhibitory activity, and the increase in heat of formation is favorable for 3'processing and strand transfer inhibitory activity. Conclusion: The model for HIV integrase (C65s) inhibitory activity of benzodithiazines suggest that the increase of dipole moment (X) of molecules leads to reduce 3' processing and strand transfer inhibitory activity, and the substitution with high hydrophobic groups is conducive for the 3' processing and strand transfer inhibitory.

29-34

Authors: Mihir Kumar Pramanik, Gautam Aditya

Objective: Rice fields are dynamic mosquito larval habitats with assemblage of different predator taxa, including the larva of the mosquitoes Lutzia. Entomological surveillance in the ricefields is essential to evaluate the potential of these predators as biological resource to regulate vector mosquito population. In view of this, a survey of ricefields for immatures of different mosquito species including Lutzia was conducted. Methods: Survey of selected ricefields was carried out to evaluate the species composition of mosquitoes. Laboratory evaluation of the immatures of Lutzia mosquitoes was carried out to assess its predation potential using mosquitoes and chironomid as preys.Results: The survey revealed the presence of five mosquito species belonging to the genera Anopheles and Culex and the predatory immatures of the mosquito Lutzia fuscana (Wiedemann, 1820). The ratio of prey and predatory larva ranged between 1.46 and 4.78 during the study period, with a significant correlation on the relative abundance of the larval stages of Lt. fuscanus and Anopheles and Culex larvae. Under laboratory conditions, a single IV instar larvae of Lt. fuscanus was found to consume on an average 5 to 15 equivalent instars of Anopheles sp. and Culex sp. larvae per day depending on its age. The prey consumption reduced with the larval stage approaching pupation. When provided with equal numbers of chironomid and Anopheles or Culex larvae, larva of Lt. fuscanus consumed mosquito larvae significantly more compared to chironomids.Conclusion:The survey results and the preliminary study on predation are suggestive of the role of Lt. fuscanus in the regulation of vector mosquito populations naturally in the ricefields. Since Lt. fuscanus is common in many Asian countries, further studies on bioecology will be helpful to justify their use in mosquito control programme.

41-45

Authors: Hanan Ahmed Habib Babay, Ali Mohammed Somily

Objective: To determine the clinical implication of and intestinal carriage with methicillin resistant Staphylococcus aureus (MRSA) and extended spectrum βlactamase (ESBL)producing Enterobacteriacae. Methods: A total of 180 stool specimens were screened for MRSA and ESBL producing enterobacteria. Identification of ESBL producing Enterobacteriacae was done by MicroScan Walk Away 96 system ( Dade Behring Inc., West Sacramento, CA 95691, USA ) and confirmation by doubledisc synergy test. MRSA was identified by disc diffusion using 30 μg cefoxitin disc and the MicroScan. Results: The rate of fecal MRSA carriage was 7.8% (14/180), 35.7% (5/14) were recovered from surgical wards. Three patients (21.4%) had MRSA recovered from other body sites, and 2 (14.2%) had in addition ESBL producing Escherichia coli (E.coli) and Klebsiella pneumoniae (K.pneumoniae) respectively. Four (28.5%) patients with MRSA fecal carriage died. MRSA fecal carriage was recovered from both inpatients and outpatients. Four (2.2%) cases carried ESBL producing Enterobacteriacae in feces .Three (75%) were from intensive care unit (ICU).One patient had both ESBLproducing E.coli and K.pneumoniae from stool as well as E.coli from tracheal aspirate .Two ICU patients with fecal ESBL died. Conclusion: Fecal screening for MRSA and ESBL of all patients at high risk admitted to different hospital wards and ICUs and implementing infection control measures were recommended.

52-58

Authors: Idogun E.S, Airauhi L.U

Objective: The objective of the study was to evaluate mothers/care givers perception of malaria, their treatment practices and the effects on the outcome of malaria. Methods: Four hundred and sixty children were enrolled and their mothers/care givers interviewed. The children were screened for malaria parasitaemia and there after, blood specimens were obtained for biochemical and haematological evaluation from those children who met the criteria and tested positive to P. falciparum parasites. Packed cell volume, electrolytes, urea, creatinine, plasma glucose, and serum bilirubin were analyzed. Results: A total of 460 children were studied, 233 (50.7%) males and 227 (49.3%) females. Mild malaria cases were 112 (24.3%) and severe malaria 348 (75.7%). Those who presented early 106 (23.0%) and those who presented late 354 (77.0%). Perception and definition of malaria as well as the treatment seeking behaviors vary significantly with the level of education of the mothers and care givers. Those without formal education 68 (51.9%) wrongly perceived that the etiology of malaria can only be diagnosed by native doctors compared to those with primary six education 61 (26.5%) and junior secondary education 10 (10.1%). Only 43 (9.3%) gave the correct dose of chloroquine syrup to their sick children, while 32 (7.0%) gave at sub optimal doses. Conclusion: Wrong perception of malaria especially the complicated malaria and wrong treatment practices are major contributory factors to the high mortality and morbidity of malaria in Nigeria. There is therefore a need for health education to correct the wrong ideas about the cause and treatment practices of malaria as part of malaria control programme.

63-69

Authors: Maysaa El Sayed Zaki

Objective: To determine the etiology of acute diarrhea in children under 5 years of age and to improve knowledge of the etiology of gastrointestinal pathogens using traditional and molecular diagnostic techniques. Methods:Various common enteropathogens (viral, bacterial and parasites) associated with diarrhea were investigated by conventional and molecular techniques (PCR) for verotoxin present in Escherichia coli in 218 children less than 5 years of age admitted to Mansoura University Children hospital Egypt. Results: The occurrence of enteropathogens identified was as follows: E.coli O157∶H7 38.8% followed by Salmonella Spp 29.4%, Aeromonas 20% and Shigella Spp 11.8%. Rotavirus was found in of samples 17.1%. Rotavirus was statistically significant in age < 2 years old.The commonest parasites found were E.histolytica followed by Enterobius vermicularis, Giardia lambia, Hymenolepis nana and Ascaries. Shigella and Salmonella isolates were tested for their susceptibility to common antimicrobial agents and most of the isolates were resistant to ampicillin and trimethoprim/sulfamethoxazole. Conculsion: This study demonstrated that rotavirus, E. coli O157∶H7, Salmonella Spp, and Aeromonas were significant enteropathogens. Rotavirus was significantly associated with infantile gastroenteritis. The results highlight the value of using a combination of traditional and PCR techniques in the diagnosis of enteropathogens related to acute gastroenteritis in children.

74-76

Authors: Gyuse AN ,Udonwa NE, Okokon IB, Ibanga I, Ogbonna UK

Objective: This study aimed to determine the prevalence of Hepatitis B antigen among newly employed staff in a Tertiary Hospital in SouthSouth Nigeria. Method: The medical records of a total of 238 newly employed members of staff of the University of Calabar Teaching Hospital between 2000 and 2006 were reviewed. Their sociodemographic data and Hepatitis B Surface Antigen (HBSAg) results were analyzed. Results: The overall prevalence of Hepatitis B Surface Antiginaemia was found to be 5.04%. The prevalence was 7.30% in males and statistically significant compared to 3.50% in females. Conclusion: There is a reasonably high prevalence of HBSAg among adults prior to employment into Health Care Institutions. This poses a danger to clients seeking care in these health care facilities and other health care workers. Health Institutions must have clear policies on engagement of new staff relating to such communicable diseases based on existing Nigerian labour laws including the Workman Compensation Act. They must also implement policies on universal precautions to safeguard the health workers and clients in their care. Public enlightenment on the National Program on Immunization (NPI) must be intensified as a strategy to reduce the prevalence of HBSAg and its attendant consequences.

79-80

Authors: Bava Amadeo Javier, Rodríguez Rios Elizabeth, Troncoso Alcides

Chromoblastomycosis can also cause severe but usually superficial lesions on the legs. Like other deep mycosis, this chronic and disabling condition is seen in many tropical regions, including Argentina, where this man was infected. We describe the spatial epidemiology and identify risk factors for disease.

1-8

Authors: Deraz TE, El Sahriggy SA, Shaheen MA, Motawea AA, Gomaa HE, Fawzy SH, Mohamed AA

Objective: Diagnosis of atypical pathogens as an aetiology for community acquired pneumonia (CAP) in children is a challenge world wide. The aim of this study was to detect the frequency of atypical pathogens as a cause of communityacquired pneumonia (CAP) in Egyptian children. Methods: From 50 children (with age ranged from 2 months to 12 years) hospitalized for community acquired pneumonia; respiratory sputum samples were collected by induction or spontaneously. All samples were subjected to conventional cultures and Polymerase Chain Reaction(PCR) technique DNA extraction for identification of Mycoplasma, Chlamydia pneumoniae and Legionella pneumophila. Results: A definite pathogen was identified in 78% of the studied children; 30% typical bacteria, 8% candida albicans and atypical bacteria in 40% of the pneumonic children. Chlamydia pneumoniae was isolated from 26% of the children while Mycoplasma pneumoniae was isolated from 14%, whereas Legionella pneumophilla was not isolated at all. Conclusion: Atypical pathogens are evident as a potential aetiology for communityacquired pneumonia in (13.3%) of young and (80%) of older Egyptian children.

16-20

Authors: Nmorsi OPG, Isaac C, Ukwandu NCD, Ekundayo AO, Ekozien MI

Objective: Malaria remains the single leading killer of children in sub - Sahara Africa and Schistosomiasis is considered to be second to malaria in global importance. Co- infection of malaria and urinary schistosomiasis has been reported to exacerbate disease morbidity such as anaemia. In different part of the globe, the co-infection between malaria and schistosomiasis provides some protections on the infected persons. The protective effect of this co-infection elucidated immunologically using cytokines is lacking in our locality. Methods: Urine and blood samples obtained from the 160 volunteers were subjected to standard parasitological techniques for diagnosis of urinary schistosomiasis and malaria respectively. Blood samples collected from these volunteers comprising 80 children with schistosomiasis and malaria and the 80 children who had malaria only were subjected to cytokines concentration determination using commercial standard enzyme linked immunosorbent assay kits (Abcam, UK). Results: Eighty participants with co-infection had a mean malarial parasitaemia of 662 ± 201.1 μL while the 80 participants with only P. falciparum malaria had a mean malarial parasiteamia of 5943 ± 3270.7μL. Also the volunteers had mean haemoglobin of 11.2 g/dL for co-infected individuals and 5.7 g/dL for participants with single infection of malaria. The serum cytokine levels of the children with S. haematobium and P. falciparum and only P. falciparum infection are as follows; interleukin - 4 (16.6 pg/mL versus 5.2 pg/mL), IL - 5 (501.3 pg/mL versus 357.5 pg/mL); IL - 8 (2 550 pg/mL versus 309 pg/mL), IL-10 (273 pg/mL versus 290 pg/mL), TNF-α (25 pg/mL versus 290 pg/mL) and IFN-γ (21.9 pg/mL versus 2.5 pg/mL). The TNF-α /IL-10 ratio is 7 for the children with co-infection while those with only P. falciparum malaria infection had a TNF-α/IL - 10 ratio of 0.9. Conclusion: We conclude that the elevated IL-4, IL-5, IL-8 and IFN-γ concentration induced by schistosomiasis altered the Th1/Th 2 profile and protected the children against the morbidity and severity of malaria attack among the children with co-infection.

27-29

Authors: AKM Mamunur Rashid, Md. Asrafuzzaman, Abdullah Al Mamun, Abdullah Al Mahboob

Objective: Visceral leishmaniasis (Kala-azar) is endemic in many countries including Bangladesh. Clinical presentation of visceral leishmaniasis in children and adult may vary and at time may simulate many tropical and hepatobiliary diseases. Jaundice and ascites are not common in kala-azar patients. Methods: During the period of January 2005 to December 2006, all the records of the confirmed kala-azar patients presented with jaundice were included in this study. Kala-azar was confirmed by serology test ICT (Immuno Chromatography) and Bone Marrow study. Results: Total 12 kala-azar patients were encountered during this period. Among these twelve cases, presenting features were jaundice (7), splenomegaly (12), hepatomegaly (11) and ascites (4). Initial clinical diagnosis of chronic liver disease (CLD) was made in (5), Congenital hemolytic anaemia in (1) and kala-azar in rest of the patients (6). Common leucopenia and relative lymphocytosis was not observed in any patients. Conclusion: Kala-azar may present with various clinical manifestation in children and adult. Jaundice can be considered to be a common manifestation particularly in pediatric kala-azar patients. Otherwise, it may mislead to another diagnosis if it is taken as a rare feature in kala-azar.

35-38

Authors: Diganta Pan, Ashok Kumar Bhatia, Bhilegaonkar KN

Objective: The present study has characterized dialyzed toxin from non-O157 VTEC E. coli isolates by vero cell toxicity assay and pathogenecity in mice model. Methods: Toxins from non-O157 verocytotoxic Escherichia coli isolated from neonatal calves were characterized. Dialyzed toxin from E. coli O26, O111 and O103 serotypes were prepared and characterized by verocell toxicity assay and pathogenicity in mice model. E.coli O157:H7 considered as positive control for this study. Results: Cytopathic effects in vero cell line first rounding of vero cells, followed by clumping of cells and finally disintegrated, blackened, shriveled cell line within 16 to 72 hrs. Phenotypic markers such as hind limb paralysis and reddening of tail were prominent in all the toxicated mice. Extensive histopathological study was conducted for multiple organ involvement. Conclusion: Several methods for toxin assay were developed based on biological, immunological and detection of virulence genes related to toxin production but each test has draw back. Therefore, it is likely that future effort will be focused on the development of assay, which is fast, reliable, specific and sensitive methods based on mice model.

47-53

Authors: Zeehaida M, Siti Asma H, Siti Hawa H, Zaidah AR, Norbanee TH

Objective: Simple tests like direct smear of the acid fast bacilli (AFB) and Mycobacterium culture could assist the diagnosis of tuberculosis. This study is aimed at reviewing the outcome of smears, culture results and contamination rate among specimens requested for AFB smear and Mycobacterium culture. Methods: Retrospective laboratory data analysis requesting for Mycobacterium culture from January 2005 till December 2006 was done in a tertiary teaching hospital of Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Results: Four hundred and sixty seven (36.6%) isolates grew from 1 277 specimens. Of these isolates, 314 (67.2%) grew Mycobacterium tuberculosis, 23 (4.9%) grew Mycobacterium other than tuberculosis and 38 (8.1%) grew contaminants. Among the M.tuberculosis cultures, 165 (52.5%) had growth of more than 100 confluent colonies, whereas 39 cultures (12.4%) had growth of less than 19 colonies. Direct smear for AFB among smear positive cases showed presence of more than 50 bacilli/line in 231 (49.5%) cases and smear negative cases accounted for 63 (13.5%). Among smear positive cases, 291 (94.5%) cultures grew Mycobacterium species and another 17 (5.5%) cultures grew contaminants. In smear negative cases, 32 (62.7%) cultures grew Mycobacterium species and 19 (37.3%) cultures grew contaminants. Conclusion: The results from data analysis of the Mycobacterium cultures should be critically utilized in order to review the laboratory performance and to improve its services in the future. Some of the data is also useful to the administrators of the hospital in terms of estimating the risk of occupational hazard faced by the health care workers.

58-63

Authors: Abdulqadir Maghded Zangana, Tariq S. Al-Hadithi M.Sc, Sherzad Ali Ismail

Objective: Tuberculosis continues to be an important health problem in the world. Despite the widespread impression that abdominal tuberculosis is rare today, the disease is still endemic in developing world and is reemerging in the West. The aim is to review our local experience with tuberculous peritonitis. Methods: Between January 2000 and December 2006, the case records of histologically documented tuberculous peritonitis (TBP) diagnosed and treated at the tuberculosis coordinating center in Erbil city, Iraq were reviewed. Comparisons were made with pulmonary tuberculosis patients regarding socio-demographic, clinical and laboratory findings. Results: Forty one cases of TBP were diagnosed during the study period. Their age range was 26-72 years (46±17), with a male: female ratio of 1.5:1. The median duration of symptoms before diagnosis was 6 weeks (range:10 days to 18 months.). Eleven patients (26.8%) had comorbid conditions and 6 patients (14.6%) had a history of positive contact with Tuberculosis(TB) case. Presenting symptoms were abdominal distension (70%), abdominal pain (65%), fever (68%), anorexia (65%) and weight loss (44%). Four patients had pulmonary symptoms: cough and/dyspnoea (n=2) and cough (n=2). Chest X-ray changes consistent with pulmonary tuberulosis(PTB) were seen in 25%. Tuberculous peritonitis was diagnosed by laparoscopy (n=29) and laparotomy (n=12). Adverse effects of TB drugs occurred in nearly 40%, consisting of hepatitis (n=2), nausea/vomiting (n=11), rash (n=2) and encephalopathy (n=1). Hemoglobin and serum albumin levels were significantly lower in tuberculous peritonitis(TBP)TBP patients (P=0.027 and 0.003, respectively). There was a significantly greater occurrence of adverse effects (P<0.001) in TBP patients. No significant differences between TBP and PTB were demonstrated in regard to age and sex distribution, non-specific symptoms (fever, weight loss, and anorexia) and erythrocyte sedimentation rate. All were treated with standard regimens and responded to treatment. Conclusion: Tuberculous peritonitis is prevalent in our population. Therefore, TBP should be considered in patients presenting with abdominal symptoms and non-specific constitutional symptoms, particularly in young patients. Laparoscopy and laparotomy with tissue biopsy was the specific diagnostic procedure.

68-71

Authors: Olwookere SA, Fatiregun AA, Fayemi AF

Objective: To describe the pattern of admission defining ailments and outcomes of care among people living with human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS) (PLWHA) who presented for treatment at a tertiary health care institution in Nigeria. Methods: We reviewed the hospital records of all patients admitted for AIDS and AIDS-related illnesses at the University College Hospital, Ibadan, Nigeria, from January 2005 to January 2006. Results: Seventytwo PLWHA were admitted during the study period. There were 39 females (54.2%) and 33 (45.8%) males. Sixty-seven (95%) PLWHA presented with AIDS. Only 12 (17%) were already receiving highly active antiretroviral therapy before admission. Forty-three patients (60%) commenced antiretroviral(ARV) therapy on admission. Thirty-three patients (46%) had pulmonary tuberculosis, 10 (14%) had extrapulmonary tuberculosis, 21 (29.1%) had diarrhea-related illnesses, 20 (28%) had anaemia, and nine (12.5%) presented with coma. Twenty-nine patients (40.3%) were discharged home, and 43 (59.7%) died before discharge. Sixty-nine patients (95.6%) were judged to be indigent, and required financial support. The contributory causes of death included pulmonary tuberculosis in 21 (48.8%), diarrhoeal diseases in five (11.6%), anaemia in five (11.6%), coma in nine (20.9%), and pneumonia in three (7.1%). Conclusion: Tuberculosis was the major admission defining ailment among PLWHA.

74-75

Authors: P. C. Bhattacharyya, Jagdish Prasad Agarwal

Encephalitis is an uncommon manifestation of dengue fever. Here we present a 4 years old female child from Northeast Region of India who suffered from dengue encephalitis. To our knowledge, this is probably the first diagnosed case of dengue fever from this region.

81-82

Authors: Viroj Wiwanitkit

Erythrocyte sedimentation rate (ESR) determination is a classical hematological test. Although it is a non specific laboratory parameter it is still widely used in present medicine. The author hereby briefly reviews and discuses on clinical importance of ESR test for important tropical intraerythrocytic blood infection (malaria, leishmaniasis and babesiosis).