The catalogue of ailments and illnesses that killed ten-month-old A'Maya Tamerry was mainly the result of protein calorie malnutrition, former Government Forensic Pathologist John Obafunwa told a Supreme Court jury yesterday.

And the Nigerian doctor estimated that on a scale of one to ten ? with ten being highest ? A'Maya's condition was an eight or nine in the level of malnutrition.

Using dozens of tissue sample slides projected on a large screen in the courtroom Dr. Obafunwa described the deteriorated state of the girl's internal organs before Chief Justice Richard Ground.

The trial of A'Maya's parents, Dr. Amenemhat Waset Amen-Ra Tamerry, 48, and his wife Maatkai Hatsheput Tamerry, 36, continued yesterday in Supreme Court after a brief hiatus due to the mother falling ill.

Dr. Obafunwa said he found no sign of malabsorption syndrome during the autopsy.

He also told the court that at birth A'Maya was a normal baby with no evidence of congenital conditions ? this was discovered during a routine new-born screening on May 4, 2000, three days after A'Maya was born. Dr. Obafunwa also said that the screening showed a normal protein profile.

However, in the post mortem exam Dr. Obafunwa told the court that A'Maya had an electrolyte imbalance, protein calorie deficiency, severe dehydration, acidosis, reduced vitamin level, severe anaemia, severe fatty liver, Keratomalacia (melting of cornea), yeast infection, gastric erosion, bilateral adrenal lipid depletion, aspiration of stomach contents (plant cells were found in the lungs, which could have occurred just before death when A'Maya was vomiting and gasping for air).

A'Maya's lungs had a rubber consistency but were supposed to have a spongy consistency. This was a sign of pneumonia, said Dr. Obafunwa, adding that a sample of A'Maya's lung sank in water meaning it was devoid of air.

Pneumonia would have arrived at the stage it did in a matter of days, he said.

Dr. Obafunwa said malnutrition would suppress the immune system and this would have allowed for the growth of fungus which lead to pneumonia in both lungs.

The air space in the lungs should be empty, he explained, but A'Maya's lungs were filled with red and white blood cells, fluid, plant cells, and yeast.

Under a microscope Dr. Obafunwa said he could confirm that the pneumonia was due to a yeast infection, which he added was "rare", and was due to immune deficiency, which was caused by protein calorie malnutrition.

The court heard that the stomach and small intestine contained blood stained fluid which was caused by infection and yeast.

Normally reddish brown, the girl's liver was yellowish, Dr. Obafunwa said, adding this too was due to a severe protein calorie malnutrition. A'Maya's liver was also riddled with fat cells, which had replaced the liver cells. Scar tissue was also present.

When Director of Public Prosecutions Kulandra Ratneser asked "can the liver function like this?", Dr. Obafunwa replied: "It is almost terminal."

He added the condition of A'Maya's liver would have taken weeks or months to develop.

Dr. Obafunwa said during liver failure people show signs of disorientation because toxins will enter the brain.

A'Maya's kidney's showed Keratin and quamous cells ? which are not normally present ? a condition due to Vitamin A deficiency.

The autopsy also revealed that A'Maya had both Kwashiorkor and Marasmus. Kwashiorkor is due to lack of protein and Marasmus is due to lack of total calories, said Dr. Obafunwa.

With Marasmus, A'Maya would have been lethargic, thin, and have wrinkly skin. Kwashiorkor would cause weight loss, silky hair, and liver problems, he said.

Mr. Ratneser asked: "If you are looking at a spectrum of one to ten what level of malnutrition would this child be?"

Dr. Obafunwa replied: "Eight or nine."

The court heard A'Maya had a shrunken thymus gland, which is one of the main organs used in fighting infection and is found in the neck.

According to Dr. Obafunwa, a ten month old child would have a thymus that weighed 15 to 20 grams. A'Maya's weighed two grams.

Such a condition would take "weeks to months, definitely not days" to develop Dr. Obafunwa said.

He added that her thymus contained fat cells and scar tissue. Fat cells were also found in A'Maya's pancreas.

Under a microscope, dark brown solids ? later identified as keratin ? was found in A'Maya's urethra, and yeast, keratin and quamous cells were found further up her urinary tract in her bladder.

Keratin is a manifestation of Vitamin A deficiency, while the presence of quamous cells would make the body more susceptible to infection, particularly of the urinary tract.

Dr. Obafunwa said that a urinary tract infection is painful and would cause a child to cry. He also told the court that the child's urine would be discoloured and noticeable in a diaper. He added that the discoloration would be present for weeks.

Swabs were taken and then tested from A'Maya's nose, throat, lungs, intestines, rectum, and eyes. No viruses were found. The court heard that this excluded any congenital condition.

A blood sample taken before death showed low Vitamin A, low Calcium, normal Vitamin D but in the low range, and low Iron levels.

A'Maya's stomach tested negative for drugs or alcohol, the court heard.

Dr. Obafunwa said A'Maya had fluid in the muscle fibres of her heart, which was due to protein calorie malnutrition. He also said fat cells were found in the heart muscle and small intestine, which should not be there.

The court has already heard A'Maya was fed sea moss regularly, and defence lawyer, Mark Pettingill asked Dr. Obafunwa: "Would you agree that there is no clinical evidence that sea moss caused the death of this child?"

Dr. Obafunwa replied: "The autopsy report did not specially identify sea moss. However, some of the findings could have been attributed to sea moss."

Dr. Obafunwa admitted he was not aware of the amount of sea moss the parents were giving A'Maya and that Carrageenan, an ingredient in sea moss, is also present in baby formula.

Mr. Pettingill's cross examination of Dr. Obafunwa will continue today.