Maternal Filicide among Women Admitted to Forensic Psychiatric Institutions in Malaysia: Case Series.

OBJECTIVES: To examine the characteristics of maternal filicide and describe the adverse life events experienced by women who have committed filicide and been hospitalised in forensic psychiatric institutions in Malaysia. METHODS: Registration records from 2000 through 2012 of female patients from 2 main forensic psychiatric institutions in Malaysia were reviewed. The medical records of patients who had committed maternal filicide were selected and descriptively evaluated. RESULTS: A total of 18 cases of maternal filicide were identified. Family dysfunction that presented with marital discord, domestic violence, or husband with substance abuse was the main stress experienced by the women. Three social circumstances, including an adolescent who became a victim of date rape; immigrants who experienced sexual abuse; and filicide-suicide precipitated by financial difficulties were highlighted. CONCLUSION: Women who committed filicide had experienced various difficulties in their life. The presence of such life events might alert mental health professionals to investigate the possibility of filicide among their patients.

Antimicrobial compounds from leaf extracts of Jatropha curcas, Psidium guajava, and Andrographis paniculata.

The present research was conducted to discover antimicrobial compounds in methanolic leaf extracts of Jatropha curcas and Andrographis paniculata and ethanolic leaf extract of Psidium guajava and the effectiveness against microbes on flower preservative solution of cut Mokara Red orchid flowers was evaluated. The leaves were analyzed using gas chromatography-mass spectrometry. A total of nine, 66, and 29 compounds were identified in J. curcas, P. guajava, and A. paniculata leaf extracts, with five (88.18%), four (34.66%), and three (50.47%) having unique antimicrobial compounds, respectively. The experimental design on vase life was conducted using a completely randomized design with 10 replications. The flower vase life was about 6 days in the solution containing the P. guajava and A. paniculata leaf extracts at 15 mg/L. Moreover, solution with leaf extracts of A. paniculata had the lowest bacterial count compared to P. guajava and J. curcas. Thus, these leaf extracts revealed the presence of relevant antimicrobial compounds. The leaf extracts have the potential as a cut flower solution to minimize microbial populations and extend flower vase life. However, the activities of specific antimicrobial compounds and double or triple combination leaf extracts to enhance the effectiveness to extend the vase life need to be tested.

Psidium guajava and Piper betle leaf extracts prolong vase life of cut carnation (Dianthus caryophyllus) flowers.

The effect of leaf extracts of Psidium guajava and Piper betle on prolonging vase life of cut carnation flowers was studied. "Carola" and "Pallas Orange" carnation flowers, at bud stage, were pulsed 24 hours with a floral preservative. Then, flowers were placed in a vase solution containing sprite and a "germicide" (leaf extracts of P. guajava and P. betle, 8-HQC, or a copper coin). Flowers treated with 8-HQC, copper coin, and leaf extracts had longer vase life, larger flower diameter, and higher rate of water uptake compared to control (tap water). The leaf extracts of P. guajava and P. betle showed highest antibacterial and antifungal activities compared to the other treatments. Both showed similar effects on flower quality as the synthetic germicide, 8-HQC. Therefore, these extracts are likely natural germicides to prolong vase life of cut flowers.

Distribution of radium in oil and gas industry wastes from Malaysia.

Radium concentrations in 470 samples of the various types of waste from oil and gas industries were analysed using gamma spectrometers. The results showed that the radium concentration varied within a wide range. The highest mean 226Ra and 228Ra concentrations of 114,300 and 130,120 Bq/kg, respectively, were measured in scales. Overall, 75% of the waste, mostly sludge and extraction residue lies within the normal range of radium concentration in soils of Malaysia. However, some platform sludge can have radium concentration up to 560 Bq/kg.

Management of female genital warts with an analog of imiquimod 2% in cream: a randomized, double-blind, placebo-controlled study.

The purpose of this randomized, double-blind, placebo-controlled study was to determine the clinical efficacy and tolerability of an analog of imiquimod (2%)in cream to cure genital warts in women. Sixty preselected women, ranging between 18 and 45 years of age (mean 24.3) and having 411 lesions (mean 6.8) with clinical, histopathological and polymerase chain reaction (PCR) confirmed diagnosis of human papilloma virus (HPV) infection were randomized to two parallel groups. Each patient received a precoded 40-g tube and instructions on how to apply the trial medication to their lesions at home two times daily for five consecutive days per week. The active treatment period was six weeks. Patients were evaluated on a weekly basis. A clinically and PCR established total clearance of target warts was recorded as a cure. By the end of the treatment, 43.3% of patients and 42.8% of warts were cured. Code disclosure revealed that imiquimod cream had cured 83.3% of the treated patients and 84.3% of the tested warts, while the placebo healed one subject and four warts (p < 0.0001). Eight patients (13.3%) in the imiquimod group experienced mild to moderate, non-objective, drug-induced symptoms with no dropouts. Among the 26 cured patients, five had a relapse after 11 months. In conclusion, the data presented demonstrate that 2% imiquimod in cream with mild to moderate subjective side effects is significantly more effective than placebo in eliminating genital warts in women.

Human leukocyte interferon-alpha in a hydrophilic cream versus in a gel for the treatment of genital herpes in males: a placebo-controlled, double-blind, comparative study.

The aim of this double-blind, placebo-controlled, comparative study was to differentiate the clinical efficacy and tolerability of human leukocyte interferon-alpha incorporated (2 x 10(6) IU/g) in a hydrophilic cream and in a gel to heal males afflicted with first episodes of genital herpes. Patients (n = 60), aged 18-40 years (mean 23.2) with culture-confirmed diagnosis of herpes genitalis were randomized to three parallel groups. Each patient was allocated a precoded 40-g tube, containing either preparation or placebo. Cream or gel was applied three times daily for 5 consecutive days. The duration of the active treatment was two weeks. Patients were examined after 48 hours in initial treatment, and thereafter two times a week. A reepithelialized lesion with some residual erythema was recorded as healed. The study demonstrated that patients treated with leukocyte interferon-alpha cream had both significantly shorter mean duration of lesions than gel and placebo recipients (5.3 days vs. 8 days, 13 days respectively; p < 0.001) and a higher number of healed patients (80% vs. 55%, 20% respectively; p < 0.001). Of the 60 patients, 49 (82%) complained of no drug-related side effects. Eleven patients predominantly in the cream/gel groups reported non-objective transitory increase in their body temperature (> 38 degrees C) with moderate headache, malaise and myalgia. The study was followed-up for 24 months after the first day of the treatment, and out of 31/60 cured patients, 4 had a relapse after 18 months. In conclusion the study affirmed that human leukocyte interferon-alpha (2 x 10(6) IU/g) in a hydrophilic cream is more efficacious than its incorporation in gel or placebo, thus suggesting that leukocyte interferon-alpha in a hydrophilic cream, with a profile of non-objective mild to moderate drug-induced indications, may be considered an alternative and effective treatment modality to cure male patients afflicted with first episodes of genital herpes.

Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study.

The purpose of this double-blind, placebo-controlled study was to evaluate the clinical efficacy and tolerability of topical Aloe vera extract 0.5% in a hydrophilic cream to cure patients with psoriasis vulgaris. Sixty patients (36M/24F) aged 18-50 years (mean 25.6) with slight to moderate chronic plaque-type psoriasis and PASI (Psoriasis Area and Severity Index) scores between 4.8 and 16.7 (mean 9.3) were enrolled and randomized to two parallel groups. The mean duration of the disease prior to enrollment was 8.5 years (range 1-21). Patients were provided with a precoded 100g tube, placebo or active (with 0.5% Aloe vera extract), and they self-administered trial medication topically (without occlusion) at home 3 times daily for 5 consecutive days per week (maximum 4 weeks active treatment). Patients were examined on a weekly basis and those showing a progressive reduction of lesions, desquamation followed by decreased erythema, infiltration and lowered PASI score were considered healed. The study was scheduled for 16 weeks with 12 months of follow-up on a monthly basis. The treatment was well tolerated by all the patients, with no adverse drug-related symptoms and no dropouts. By the end of the study, the Aloe vera extract cream had cured 25/30 patients (83.3%) compared to the placebo cure rate of 2/30 (6.6%) (P < 0.001) resulting in significant clearing of the psoriatic plaques (328/396 (82.8%) vs placebo 28/366 (7.7%), P < 0.001) and a decreased PASI score to a mean of 2.2. The findings of this study suggest that topically applied Aloe vera extract 0.5% in a hydrophilic cream is more effective than placebo, and has not shown toxic or any other objective side-effects. Therefore, the regimen can be considered a safe and alternative treatment to cure patients suffering from psoriasis.

Human leukocyte interferon-alpha in cream for the management of genital herpes in Asian women: a placebo-controlled, double-blind study.

This double-blind, placebo-controlled study examined the clinical efficacy and tolerance of human leukocyte interferon-alpha (2 x 10(6) IU/g) in hydrophilic cream to cure patients afflicted with first episodes of genital herpes. Sixty patients aged 18-40 years (mean 24.5) with culture-confirmed herpes simplex genitalis, bearing 755 lesions (mean 12.6) were randomized to active and placebo groups. Patients joined the study within 7 days (mean 4.1) of the manifestation of lesions. Each patient was given a precoded 40-g tube containing placebo/active preparation with instructions on self-application of the trial medication to their lesions three times daily for 5 consecutive days (max. 15 topical applications per week). Patients were examined three times a week to evaluate clinical efficacy and other beneficial effects. A reepithelialized lesion with some residual erythema was recorded as healed. Patients resolved during the active treatment period (1-4 weeks) were spared further therapy and were requested to visit us as scheduled for posttreatment control after 16 weeks. From the remaining patients empty tubes were collected, and similarly coded replacement tubes were given to continue the treatment (in total 160 tubes were used). Patients treated with leukocyte interferon-alpha cream had significantly shorter mean duration of viral shedding/healing than placebo recipients, (6.2 days vs. 15 days; P < 0.01); thus the number of healed patients was 25/30 (83.3%) vs. 5/30 (17%; P < 0.001. Of the 60 patients 49 (81.6%) complained no drug-related side effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Human leukocyte interferon-alpha versus podophyllotoxin in cream for the treatment of genital warts in males. A placebo-controlled, double-blind, comparative study.

BACKGROUND: The incidence of overt genital warts, a common sexually transmitted disease of high prevalence, has been on the rise for the last few years. The infection is caused by several types of human papillomaviruses (HPVs), some of which have been accepted as a factor in the pathogenesis of genital squamous-cell carcinomas. OBJECTIVE: The aim of this double-blind, placebo-controlled study was to compare and evidence differences in clinical efficacy and tolerance between human leukocyte interferon-alpha (2 x 10(6) IU/g) and podophyllotoxin (0.5%), incorporated in a hydrophilic cream base to cure genital warts in Asian males. METHODS: Sixty patients, circumcised, who ranged in age from 18 to 40 years (mean 25.0), diagnosed with the evidence of penoscopy and HPV DNA (Southern dot blot) as harboring 396 lesions (mean 6.6), were randomized to three parallel groups. Each subject was allocated a precoded tube (40 g) containing one of two trial preparations or matching placebo for 3 days' (consecutive) usage, thrice daily. The study lasted 16 weeks with 4 weeks of active treatment. The patients were examined on a weekly basis, and a clinically and HPV-DNA-confirmed total regression of lesions was recorded as cured. Patients cured during the treatment were spared further therapy and were requested to visit us as scheduled for poststudy follow-up. RESULTS: Findings indicated that patients treated with leukocyte interferon-alpha cream had shown comparatively better results than the podophyllotoxin-treated group (90 vs. 55%, p < 0.0285) or the placebo group (15%). Mild and transient localized erythema (8.3%), burning sensation (6.6%) and transitory increase in body temperature (> 38 degrees C; 6.6%) were the most frequent adverse symptoms with no dropout. The study was followed up for 1 year, and out of 32/60 (53.3%) cured patients 3 had a relapse after 10 months. CONCLUSION: Leukocyte interferon-alpha (2 x 10(6) IU/g) has shown comparatively better results than 0.5% podophyllotoxin and placebo in a hydrophilic cream base, thus leukocyte interferon-alpha in cream may provide an alternative and effective regimen to treat genital warts in males.

Transcutaneous bilirubinometry in the management of bilirubinemia in term neonates.

One hundred full term babies of both sexes were randomly selected for transcutaneous bilirubin index (TcBI) estimation at the forehead at 12-24 h intervals from the time of appearance of clinical jaundice till the serum bilirubin levels fell within safe limits. TcBI was correlated with serum bilirubin estimated by conventional diazo method. Forty babies required phototherapy, in 20 an area of 2.5 cm2 over the forehead was covered during phototherapy to make an unexposed 'window' for TcBI estimation. The other 20 newborns received phototherapy as such and TcBI was estimated on the forehead. There was a linear relationship between serum bilirubin level and TcBI estimated at the forehead (r = 0.9090; P < 0.001). Further a significant linear correlation between prephototherapy and post-phototherapy (covered and uncovered groups) TcBI and serum bilirubin levels also existed (r = 0.7979; P < 0.001). There was no significant difference between post-phototherapy TcBI estimated at the covered and uncovered areas of forehead. However, post-phototherapy values of TcBI were significantly lower than corresponding prephototherapy values at higher serum bilirubin levels (> 16 mg/dl).

Omphalitis neonatorum.

Clinicobacteriological profile of omphalitis neonatorum was analysed in this prospective study which comprised 4776 neonates (4410 hospital-born, 366 deliveries at home). The incidence of omphalitis in the hospital-born babies was 2.3%. About 21.3% babies delivered at home were admitted for neonatal sepsis, meningitis, birth asphyxia, etc. They were found to be concomitantly suffering from omphalitis. Improper severing of the umbilical cord, application of oily substances on the umbilical stump and unhygienic rearing practices during neonatal period were some of the important predisposing factors. The fall of the umbilical stump and the diagnosis of omphalitis neonatorum was made significantly earlier (p < 0.001) in the hospital-born babies and none of them developed sepsis. The institution of therapy for umbilical sepsis was considerably delayed in the babies delivered at home and the omphalitis was the probable cause of sepsis in 46.6% cases. The Gram-negative organisms were responsible for omphalitis in 57.1% cases. Klebsiella was the commonest Gram-negative organism. Its incidence was more among the babies delivered at home signifying a potentially infective environment in the community. Gram's stain was a reliable and easy method for grossly identifying the organism in the umbilical smear.

Antibiotic associated colitis.

It is a prospective study based on 100 consecutive cases of diarrhea following antibiotic therapy admitted to the pediatric services of J.N. Medical College, A.M.U., Aligarh between January to December 1987. They had C. penicillin (50), chloramphenicol (34), ampicillin (34), gentamicin (34), cephalosporin (4) and cotrimoxazole (4) for 3 days to 3 weeks prior to the onset of diarrhea. Apart from routine and special investigations, naked eye and microscopic examination of stool, its culture for pathogens including Cl. difficile were carried out in all cases. Presence of Cl. difficile cytotoxin was demonstrated by observing the cytopathic. Effect on veru cell culture, 18 grew Cl. difficile (14 cyto toxin positive). Frequency of fever, vomiting, abdominal distension, dehydration and duration of diarrhea was not different (p > 0.05) in the two groups. Purge rate and presence of mucus and blood in Cl. difficile positive patients was significantly higher (p < 0.05). Eight Cl. difficile positive (7 cytotoxin+ve) were subjected to endoscopy. Three of them showed P.M. colitis and 2 non specific colitis. Chloromycetin, gentamicin and penicillin were the main culprits responsible for AAC. None of the patients given ampicillin alone suffered from AAC. The mortality was 5%.

Prognostic factors influencing mortality in meningococcal meningitis.

The clinical features and some laboratory parameters of 247 cases of meningococcal meningitis admitted between January 1983 and April 1990 to a paediatric ward in Jawahar Lal Nehru Medical College Hospital, India were analyzed retrospectively. A total of 189 (76.5%) were more than 5 years of age. The maximum number of cases occurred between October and April each year. Complications included bleeding tendencies, neurological deficits, gangrene of limbs, arthritis, uveitis and cataract. The overall mortality rate was 16%. A scoring system based on some clinical characteristics correctly predicted a fatal outcome in all but three children.

Comparison of temperatures at different sites in term and pre-term neonates.

Temperatures of 30 term and 20 preterm neonates were recorded by mercury-in-glass thermometer at 4 measurement sites; rectum (2 cm beyond anus), external auditory canal, axilla and between skin and mattress. Whereas, the mean rectal and aural temperatures in term infants were significantly higher than their preterm counterparts (p less than 0.01), axillary and skin mattress temperatures did not differ significantly in the two groups. The variation between stabilized temperature at four measurement sites was less marked in preterm as compared to term infants. The skin mattress temperature measurement is a simpler technique and it closely approximates the rectal temperature in preterm infants. Temperatures at all the measurement sites stabilized by 5 minutes both in term and preterm infants.