Antiplasmodial properties of some Malaysian medicinal plants

Seven Malaysian medicinal plants were screened for their antiplasmodial activities in vitro. These plants were selected based on their traditional claims for treatment or to relieve fever. The plant extracts were obtained from Forest Research Institute Malaysia (FRIM). The antiplasmodial activities were carried out using the pLDH assay to Plasmodium falciparum D10 strain (sensitive strain) while the cytotoxic activities were carried out towards Madin- Darby bovine kidney (MDBK) cells using MTT assay. The concentration of extracts used for both screening assays were from the highest concentration 64 microg/ml, two fold dilution to the lowest concentration 0.03 microg/ml. Goniothalamus macrophyllus (stem extract) showed more than 60% growth inhibition while Goniothalamus scortechinii root and stem extract showed a 90% and more than 80% growth inhibition at the last concentration tested, 0.03 microg/ml. The G. scortechini (leaves extract) showed an IC50 (50% growth inhibition) at 8.53 microg/ml, Ardisia crispa (leaves extract) demonstrated an IC50 at 5.90 +/- 0.14 microg/ml while Croton argyratus (leaves extract) showed a percentage inhibition of more than 60% at the tested concentration. Blumea balsamifera root and stem showed an IC50 at 26.25 +/- 2.47 microg/ml and 7.75 +/- 0.35 microg/ ml respectively. Agathis borneensis (leaves extract) demonstrated a 50% growth inhibition at 11.00 +/- 1.41 microg/ml. The study gives preliminary scientific evidence of these plant extracts in line with their traditional claims.

Listeria meningoencephalitis: two cases and a review of the literature

INTRODUCTION

Although presently uncommon locally, Listeria is increasing an important cause of central nervous system (CNS) infection worldwide. It differs from the common meningitis pathogens in its clinical features and treatment.

CLINICAL PICTURE

We present 2 recently encountered cases of Listeria meningoencephalitis. In case 1, a previously healthy 42-year-old man presented with clinical features of meningoencephalitis. In case 2, a 64-year-old woman had clinical features of pneumonia and meningoencephalitis. Both had a predominantly lymphocytic picture in their cerebrospinal fluid (CSF) samples. Listeria grew in blood cultures of both patients and the CSF culture of the first.

TREATMENT

In both cases, Listeria was resistant to the empirical antibiotics used. Intravenous ampicillin was eventually used in both patients, with gentamicin, added for synergistic action in the first.

OUTCOME

The first patient developed complications of hydrocephalus, subdural collection and extensive cerebritis and ventriculitis. The second patient had focal seizures and a pontine infarct. Both did not survive.

CONCLUSION

These 2 recent cases with different presentations of intracranial listerosis highlight the increasing importance of listerial infections in Singapore. Clinicians need to be familiar with the features of this lethal disease in order to recognize and manage it successfully.

Headache characteristics and race in Singapore: results of a randomized national survey

This study presents the first account of the racial differences in headache prevalence and characteristics in the Singapore population. A questionnaire was administered to 2096 individuals from a randomized sample of 1400 households to test the hypothesis that race was independently correlated with headache diagnosis and morbidity. The overall lifetime prevalence of headaches in the study population was 82.7%; this did not vary between racial groups. The modal age of headache onset in all races was in the second decade and was similar in all races. Multivariate analysis showed that headache morbidity was independent of age, sex, income level, marital status, shift duties, and educational level, and correlated only with race and a positive family history of severe headache. Non-Chinese were more likely to suffer from severe headaches than Chinese, were more likely to seek medical attention, and were more likely to require medical leave for their symptoms. Non-Chinese had more migrainous headaches than Chinese, although characteristics of headache both groups experienced that were unrelated to severity differed only in a few aspects. We conclude that racial factors account for differences in headache classification, perception of headache severity and health-seeking behavior.

Thoracoscopic thymectomy for myasthenia gravis: a case report

Total thymectomy combined with medical therapy is currently the most effective therapeutic strategy for patients with myasthenia gravis. The standard approach for total thymectomy is that of a median sternotomy. Other approaches include the cervical approach and partial sternotomy. We report a patient who underwent video-assisted thoracoscopic thymectomy at our institution. There was no postoperative complications and the patient was discharged on the fifth postoperative day. Video-assisted thoracoscopic thymectomy has proved to be an effective surgical therapy for the treatment of myasthenia gravis. The long-term outcome awaits close follow-up of the patients operated using this technique.

Neurologic deficit and recovery in the donor limb following cross-C7 transfer in brachial-plexus injury

Two adult patients with post-traumatic complete brachial plexus injury were treated with cross-C7 nerve-root transfer from the contralateral side. A detailed documentation of the motor and sensory functional status of the donor upper limb was carried out before and after division of the C7 nerve root. Gross motor deficits were observed immediately after surgery in shoulder extension and adduction, elbow extension, forearm pronation, wrist flexion, and hand movement. Sensory deficit involving the hand was maximal immediately after division of the C7 root. Functional recovery was rapid starting within 10 days following the root division. In both patients, the motor and sensory deficits were temporary. Full functional recovery was documented at 6 months. However, objective qualitative and quantitative differences in the motor and sensory deficits in the donor limbs were still present by 1.5 to 2 years, although these did not affect the functional status of the donor limbs. The presence of multiple segmental root innervation of the muscles and skin, other than the C7 root in the upper limb, provides for a compensatory mechanism that allows for this rapid and full functional recovery following the single nerve-root loss. The absence of any long-term functional deficit makes cross C7 transfer a viable option in the surgical management of complete unilateral brachial-plexus injury.

Headache and self-assessed depression scores in Singapore University undergraduates

A self-administered questionnaire covering the diagnostic criteria of the International Headache Society was completed by 1208 undergraduates of the National University of Singapore to determine the prevalence and characteristics of headaches in this population. The relationship between headaches and depressive illness was investigated with the Zung Self-assessed Depression Scale. The mean age of respondents was 20.9 +/- 1.6 years; 50.3% were men and 46.4%, women. Ten point nine percent had migraine without aura, 29.8% had tension-type headaches, 1.1% had headaches consistent with migraines with aura, and in 56.3% the headaches could not be classified. The lifetime prevalence of headache in this population was 98.1%. Significantly higher mean Zung scores were found in subjects who had more intense and frequent headaches than in those without headaches and less severe symptoms, although the clinical relevance of this finding is uncertain. Zung scores did not differ significantly with diagnostic group, sex, or race.

Headache characteristics in university undergraduates presenting to medical attention

A 78-point self-administered questionnaire relating to headaches was completed by 1208 undergraduates of the National University of Singapore. The management and characteristics of the study population that had sought medical consultation for their headaches was studied. The lifetime prevalence of headaches in the study population was 98.1%. One hundred and six (8.8%) had visited a doctor for their headache. These had more severe symptoms and required more pharmacotherapy. They also tended to have migraines rather than tension headaches. Malays were more likely than non-Malays to seek medical attention. No significant gender predisposition was found. Eight of the 106 (7.5%) had been given prophylactic/interval therapy. A significant proportion of the study population responds well to non-prescription medication, suggesting that the purpose of many medical consultations may be to relieve anxieties regarding the diagnosis rather than to obtain symptomatic relief.

The bulbocavernosus reflex in the assessment of neurogenic impotence in diabetic and non-diabetic men

The results of a 6-year review of bulbocavernosus reflex (BCR) latencies in 300 men are presented. The relationship of BCR latency to potency, diabetic status and age was examined. The mean BCR latency in 32 normal men aged 22 to 78 years (x = 44.9 +/- 14.4) was 40.6 +/- 8.9 ms. A significant trend towards increasing BCR latency with age was evident. BCR latency was not found to be significantly associated with potency, the mean measurable BCR latency in impotent men being 43.0 +/- 11.6 ms. Diabetic men were more likely to have a prolonged measurable BCR latency (x = 46.2 +/- 11.2) and impotence, but even in this subset no significant correlation between BCR latency and impotence was detectable. Our results suggest that detectable pudendal neuropathy is unrelated to impotence in non-diabetic and diabetic men and does not usefully distinguish between neurologic and non-neurologic causes of impotence. With the advent of newer objective techniques to assess organic impotence, the value of BCR latency in the routine assessment of impotent subjects is questionable.

An index case of adrenomyeloneuropathy in a Chinese man

X-linked adrenomyeloneuropathy (AMN) is a phenotypic variant of adrenoleukodystrophy (ADL) presenting in early adult life with progressive ataxia and spasticity, and on occasion with adrenal insufficiency. We describe a 26-year-old Chinese man with a 2-year history of gait difficulty due to spasticity, absent pattern shift visual evoked (VER) responses and posterior white matter lesions on T2 weighted brain magnetic resonance images. His parents are clinically normal and his 24-year-old brother has hyperreflexia in the legs but normal VER latencies. The patient's ACTH levels were elevated and the serum cortisol did not rise with either Synacthen or corticotropin releasing hormone. Assay of his plasma confirmed elevation of very long chain fatty acids (VLCFA) consistent with a defect in peroxisomal VLCFA metabolism. This is the first local report of a patient with AMN.

Acetylcholine receptor antibody assay kit: establishment of controls in normals and non-myasthenics and evaluation of sera from patients with thyroid disease

Immunoprecipitation assays for antibodies to the nicotinic acetylcholine receptor are a specific test for the diagnosis of myasthenia gravis. However, testing has largely been confined to reference laboratories because the preparation of the reagents is laborious, making it less accessible to practising clinicians locally. We recently acquired a test kit produced by RSR Ltd (Avenue Park, Pentwyn, Cardiff) which makes testing of serum samples practicable in smaller centres. We describe our experience in establishing normal and control values in 30 separate samples. We also assayed the sera of ten patients with thyroid disease, some of whom had ophthalmopathy and/or weakness due to periodic paralysis, and none of these tested positive. Three additional patients with thyroid disease and concurrent myasthenia gravis were also inadvertently included in the latter assay and two had high titres and one had equivocal titres. The assay is now run regularly every quarter of the year.

Acute hemiparesis with hemichorea and crossed hemiparesis; unusual presentation for myasthenia gravis

Myasthenia gravis is an autoimmune disease mediated by antibodies directed against the acetylcholine receptor. Patients typically present with weakness and fatiguability involving predominantly ocular and bulbar muscles. We describe 2 patients with acute weakness, one with a left hemiparetic pattern and chorea, and the other with crossed left hemiparesis and right facial weakness. More typical features of generalised myasthenia developed with time and both had thymic follicular hyperplasia on thymic histopathology. Clinical improvement occurred in both following thymectomy and immunosuppression. These cases exemplify the fact that markedly asymmetric limb weakness can be an early feature of generalised myasthenia gravis.