Search PubMed⌕ Search

Biomedical subjects

A Moosa

Publications and source records attributed to A Moosa.

At least 37 records · Page 2Linked to original sources
PubMed1990

Therapeutic drug monitoring in a paediatric epilepsy clinic.

In 1988 a therapeutic drug monitoring programme for anticonvulsants was introduced in the paediatric neurology clinic at King Edward VIII Hospital, Durban. Although before this serum drug levels were routinely measured, the new approach involved the application of clinical pharmacokinetics to the results so that an individualised drug profile was available for use in conjunction with clinical evaluation at the patient's next visit. Case reports are presented to illustrate the value of using serum levels in this way. Of the 58 patients entered into the study in the course of 1 year, 32 (55%) benefited from the monitoring programme in that the pharmacokinetic report contributed to a dosage adjustment that resulted in a reduction in either seizure frequency or side-effects. The greatest value of the programme proved to be in rationalizing the use of phenytoin. Because of wide inter-patient variation and non-linear kinetics, it is difficult to establish an optimum maintenance dose for this drug. The individualised dose achieved in the present study using Bayesian forecasting resulted in improved seizure control in 10 of the 11 patients (91%) receiving phenytoin.

Anticonvulsants↗
PubMed1990

Spinal muscular atrophy in African children.

Forty-five African children with SMA were seen over a period of five years. Fifteen had severe infantile form (Group 1), 19 intermediate (Group 2), 9 juvenile (Group 3) and 2 cervical type. A positive family history was obtained in only 9% of patients. The female/male ratio was 1:1.7. The age of onset was under four months in Group 1, between 5-24 months in Group 2. In 77% of Group 3 onset was between 5-24 months, 22% between 25-48 months. The lower limbs were more severely affected than upper limbs in all except the two patients with cervical SMA, proximal muscles more than distal in 82% and proximal and distal muscle were equally affected in 18%. Bulbar weakness was present in 73% and facial weakness in 80% of Group 1 patients only. Fasciculation of tongue occurred in 50% of Group 1, 42% of Group 2 and 44% of Group 3 patients. Tremor of hands was seen in none of the patients in Group 1, 58% in Group 2 and 66% in Group 3. Tendon reflexes were absent or depressed in all except one patient in Group 2 and were normal in the legs of the two patients with cervical SMA. The blood CK was elevated in 26% of patients. An ECG "tremor" was present in 26% of patients in Group 1, 68% in Group 2 and 66% in Group 3. Four patients (all in Group 1) died of pneumonia; the outcome in the others is not known.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMed1990

Chondrodystrophic myotonia (Schwartz-Jampel syndrome) in South African children.

Three children with the clinical features of the Schwartz-Jampel syndrome are presented, two with classical features and the third with physical and radiological features resembling those found in the Schwartz-Jampel syndrome but myotonia could not be elicited either clinically or electrophysiologically. Various arguments are put forward for the absence of myotonic phenomena in the latter child.

Black People↗
PubMed1990

Circulating and breast-milk anti-rotaviral antibodies and neonatal rotavirus infections: a maternal-neonatal study.

In view of the high prevalence of rotavirus (RV) diarrhoea in Indian (Asian) infants in South Africa, a hospital-based study of 124 mothers and their neonates was carried out to establish the prevalence of maternal and neonatal circulating anti-RV antibodies, RV antibodies in breast-milk, and neonatal RV infections in this population. Thirty-four per cent of the mothers and 38% of the neonates had complement-fixing (CF) serum antibodies. There was a significant correlation between maternal and cord blood antibody levels (p less than 0.001; chi-square test). Fifteen per cent of hospital-born newborns showed asymptomatic RV excretion while still in hospital, mostly at 2-6 days of age, but some even earlier, with two shedding the virus before the age of 24 h. This excretion occurred in both seronegative and seropositive babies. The breast-milk of only 3.2% of the mothers was positive for CF-anti-RV antibodies, implying that either these were not present in the breast-milk or that the CF-test employed was not sufficiently sensitive for detecting these antibodies in milk specimens. Eighteen (18.2%) of 99 infants followed up showed evidence of RV infection 1-7 months after birth; none was symptomatic; 12 excreted RV in the stools while 6 others seroconverted. Asymptomatic reinfection was documented in 4 of 14 babies who had been infected initially as neonates.

Adolescent↗
PubMed1990

Rotavirus studies in Indian (Asian) South African infants with acute gastro-enteritis: I. Microbiological and epidemiological aspects.

This study, which is the first one documenting rotavirus (RV) diarrhoea in Asian infants in South Africa, describes the virological and epidemiological aspects of this disease in this population. Fifty-five per cent of 1142 hospitalized cases investigated over a 31-month period showed a positive stool ELISA for RV. Most of these children stopped shedding RV by days 4-6 of hospital admission, though prolonged excretion was recorded in some acute cases for up to 13 days. Mixed RV-bacterial infections occurred in 7% of the total gastro-enteritis (GE) patients, while 8.6% had pure bacterial gastro-enteritis. Sixteen per cent of 188 GE patients had serum anti-RV complement-fixing (CF) antibodies on admission. Rotavirus diarrhoea occurred in half of the seropositive infants. Seroconversion occurred in only two-thirds of the initially seronegative children who had RV diarrhoea. In 5.6% of the RV diarrhoea patients the infection was acquired nosocomially whilst in the hospital for other illnesses. The age-groups mainly affected were between 3 and 14 months, with a peak at 9-11 months; 3% of the RVGE patients were neonates. Both the RVGE and the total GE admissions showed well-marked winter peaks, with an inverse relationship between RV prevalence and both temperature and humidity. It is concluded that RV is the most important cause of infantile GE in this population, whereas pure bacterial infections play a relatively minor role. Circulating anti-RV antibodies do not necessarily afford protection against RV diarrhoea, probably owing to serotypic differences.

Age Factors↗
PubMed1990

Rotavirus serology and excretion in hospitalized non-diarrhoeal patients.

Despite the well-recognized association between rotavirus (RV) and infantile diarrhoeal disease, a few studies have shown that the isolation rate of RV from the faeces of non-diarrhoeal patients can be high, suggesting that the finding of RV in the stools of individual gastro-enteritis (GE) patients need not necessarily denote an aetiological relationship. A prospective study of rotavirus serology and stool excretion was carried out in a group of non-diarrhoeal paediatric patients. A positive ELISA for RV antigen was found in 13.3% children, which compared favourably with an asymptomatic RV-excretion rate of 16.2% found in normal subjects in the community, but differed significantly from the 54.6% RV-excretion rate found in hospitalized GE patients. This confirms that RV is an important enteropathogen. Furthermore, approximately half of the non-diarrhoeal infants acquired nosocomial RV infections in hospital, most of these being asymptomatic. One-sixth of asymptomatic RV excretors showed evidence of prior exposure to rotavirus.

Antibodies, Viral↗
PubMed1990

Rotavirus studies in Indian (Asian) South African infants with acute gastro-enteritis: II. Clinical aspects and outcome.

In a prospective study of rotavirus (RV) diarrhoea in Indian (Asian) infants in South Africa, it was found that in common with findings elsewhere in the world, vomiting and dehydration are prominent features of this disease. The dehydration was usually isotonic, though both hypo- and hypernatraemia did occur. Hypokalaemia was found to be much less common in RV than in non-RV diarrhoea. Unlike findings elsewhere, no definite 'rotavirus syndrome' associated with pyrexia and respiratory symptoms could be identified in RV diarrhoea as these occurred with equal frequency in non-RV patients. The mean total duration of RV diarrhoea (i.e. before admission plus during the hospital stay) was 5 days. The RV patients took significantly longer to recover from their diarrhoea than the non-RV ones, and mixed RV-bacterial infections prolonged the illness even more. Breast-feeding was associated with milder disease. Less than 2% of both RV and non-RV cases developed persistent diarrhoea of longer than 14 days' duration and this was most frequent in patients under 6 months of age with poor nutritional status.

Child↗
PubMed1990

A double-blind placebo-controlled trial of prednisone in active rheumatic carditis.

In view of the controversy surrounding the use of corticosteroids in the management of active rheumatic carditis, a prospective double-blind controlled clinical trial comparing prednisone (2 mg/kg/24 h in three divided doses) versus placebo was carried out in 35 children with this disease, using strict clinical criteria to define carditis and excluding cases where the diagnosis was doubtful. The duration of the study, which included long-term follow-up, was 7 years. The results failed to show that prednisone at this dosage and frequency was of any benefit either in the short-term clinical response or in the long-term follow-up with regard to later requirement of valvular surgery (using the 5% level of significance). Other findings were that one-third of cases improved with time, irrespective of treatment, most of them having mild to moderate carditis initially.

Adolescent↗
PubMed1990

Elevated platelet-free calcium in uraemia.

Bleeding complications in uraemia are not uncommon. The pathogenesis of haemorrhage in uraemia is still a matter of controversy and the pattern of bleeding suggests a defect of primary haemostasis. Platelet aggregation and biochemistry, including calcium levels, have been studied; however, the results are controversial. We have examined platelet aggregation, platelet-free calcium and calmodulin in platelet-rich plasma because of the significant role of calcium and calmodulin in regulating platelet and other cells' functions. Platelet aggregation in uraemic subjects was similar to that of controls. Platelet basal free cytosolic calcium and platelet calcium in response to 10 microM Ca++ ionophore A23187 in eight subjects with uraemia were 117 +/- 33 nM and 2025 +/- 398 nM (mean +/- SEM) respectively. By contrast in seven matched healthy controls basal calcium and ionophore-stimulated calcium values were 47 +/- 14 nM and 1354 +/- 414 nM, significantly less than in the patients with uraemia (P less than 0.05). The sensitivity of uraemic platelets to A23187 was similar to that of controls. Calmodulin activity in platelet-rich plasma of 12 subjects with uraemia showed no significant difference from that of controls [1.86 +/- 0.29 micrograms/ml (mean +/- SEM) and 2.0 +/- 0.37 micrograms/ml (mean +/- SEM) respectively]. We conclude that despite elevation of platelet calcium in uraemia, which may be due to a plasma factor such as parathyroid hormone, platelet aggregation is normal and bleeding in uraemia is more likely to be due to other factors, including the effect of reduced haematocrit on platelet endothelial interaction. Disturbances in platelet calcium cannot explain the bleeding manifestations in uraemia but warrant further investigation in order to identify the pathogenic mechanisms responsible.

Adolescent↗
PubMed1990

A review of typhoid fever in South African black children.

Typhoid fever continues to escape swift diagnosis, even in an endemic country, and its multi-system nature led to delayed diagnosis in 25% of the patients in this study. This may have been an avoidable factor, leading to death in some patients through delay in instituting appropriate antimicrobial therapy. Neurological features and diarrhoea were particularly common in this paediatric population. Relative bradycardia has been shown to be a highly statistically significant finding for our group as a whole. Amoxycillin remains an effective and useful alternative to chloramphenicol. The mortality rate of 2.5% remains unchanged over the last 10 years. The relative inaccessibility to good primary health care, acceptable water supplies and sanitation that the black South African child encounters cannot be ruled out as a co-factor.

Adolescent↗
PubMed1990

Subacute sclerosing panencephalitis in black children--a review of 18 cases.

Despite the fact that measles is severe and presents in very young Black children in Natal, South Africa, no case of subacute sclerosing panencephalitis was reported from this region prior to 1982. A retrospective study was therefore made over the six-year period 1982-1987 of 18 patients who presented to the King Edward VIII teaching hospital, Durban, with clinical and laboratory features of subacute sclerosing panencephalitis. The majority of patients (66 per cent) were between 8 and 12 years of age. The mean age of onset was 9.3 years, the youngest patient being four years nine months and the oldest 14 years. The male to female ratio was 1.25:1. A previous history of primary measles infection was obtained in 44.4 per cent of cases; 62.5 per cent occurred before the second birthday. The commonest mode of presentation was personality, intellectual and behaviour disorders (83 per cent) followed by myoclonic seizures (61 per cent) and choreiform movements (28 per cent). Measles antibody was present in the CSF in all cases. The EEG was abnormal in all recorded cases with pathognomonic periodic complexes being found in 56.2 per cent. Confirmation of the diagnosis was provided by brain biopsy in two cases and by necropsy in one case. The findings of this study suggest that subacute sclerosing panencephalitis may not be as uncommon in Black children as has hitherto been thought.

Adolescent↗
PubMed1990

Lactose maldigestion: increased age-related prevalence in institutionalized children.

A study was performed to determine whether the age-related prevalence of lactose maldigestion is increased in healthy institutionalized children. Previous malnutrition did not exclude children from study. The control children had no prior history of malnutrition or hospital admissions for diarrhea. The anthropometric comparison showed the institutionalized children to be shorter and lighter than the controls, but they were of normal weight by stature, suggesting a normal recent nutritional state. Fasting breath hydrogen tests were performed following an oral dose of lactose 1 g/kg, given as a 10% solution. A rise of breath hydrogen of greater than or equal to 20 ppm was considered to indicate lactose maldigestion. Twenty-two of 44 controls and 39 of 49 study children were lactose maldigesters (p less than 0.01). The control children showed an age-related increase in the prevalence of lactose maldigestion, from 31.6% at age less than 5 years to 75% at age greater than 9 years. The institutionalized children, by comparison had an increased prevalence of 78.8% in the group under 5 years of age (p = 0.002). Equally high prevalence rates were found at all ages tested. At follow-up, lactose maldigestion was persistent in the majority of the study children. This had no nutritional impact despite a regular milk intake. The distinction between acquired and primary lactose maldigestion is of no practical significance in these children.

Adolescent↗
PubMed1989

Asymptomatic rotavirus infections among normal Indian children in Chatsworth, Durban.

During a 27-month survey in Chatsworth, Durban, serum from 1,041 normal Indian children, ranging in age from birth up to 13 years, was tested for the presence of anti-rotavirus antibodies by means of a complement fixation test. It was found that from an initial high positivity rate of 47.7% in the newborn, there was a sharp drop to 23.8% in the 1-2-month age group (P = 0.0009). This low positivity rate was maintained up to the age of 9-11 months, after which it rose to 46.4% in the 12-17-month age group (P = 0.0006). There was a further significant rise between the 2-3-year and 4-5-year age groups, probably reflecting rotavirus infections in nursery school and/or in the home, the latter being nosocomially acquired from younger siblings. Stool samples were obtained from 829 of the above subjects: overall, 16.2% were positive for rotavirus antigen by enzyme-linked immunosorbent assay; the highest rate (29.5%) of asymptomatic rotavirus infection was in the 12-14-month age group. The data indicate that asymptomatic infection with rotavirus is not uncommon in this community and that older children continue to be exposed to and become infected with rotavirus.

Age Factors↗
PubMed1989

Fatal neonatal meningitis and ventriculitis caused by multiresistant Achromobacter xylosoxidans. A case report.

Meningitis and ventriculitis in a 6-day-old neonate caused by a Gram-negative glucose-non-fermenting organism, Achromobacter xylosoxidans, was resistant to most antibiotics except ceftazidime and imipenem. The organism became resistant after 28 days treatment with ceftazidime. When the infant was 7 weeks old, imipenem became available but, in spite of 3 days of intravenous treatment, the organism was still recovered from ventricular cerebrospinal fluid and the child died. This would appear to be only the second report of neonatal meningitis caused by this organism.

Alcaligenes↗
PubMed1989

Once daily ceftriaxone vs. chloramphenicol for treatment of typhoid fever in children.

In a prospective, randomized, open study ceftriaxone was compared with chloramphenicol for treatment of 59 children who had bacteriologically confirmed acute typhoid fever. Ceftriaxone was administered intramuscularly in a once a day dose of approximately 80 mg/kg body weight for 5 days. Chloramphenicol was given orally for 3 weeks in a daily dosage of 50 to 100 mg/kg body weight divided into 4 doses. In the ceftriaxone group 23 of 29 patients were cured, 2 improved, 1 failed and 2 relapsed. For those who received chloramphenicol 22 of the 30 patients were cured, 5 improved, 1 failed and 2 relapsed. In none of the patients in either group were adverse effects recorded. The overall results of this comparative study suggest that short term treatment of typhoid fever with ceftriaxone is as effective and safe as conventional treatment with chloramphenicol.

Acute Disease↗
PubMed1989

X-linked spastic paraplegia: evidence for homogeneity with a variable phenotype.

Hereditary spastic paraplegia (HSP) is rarely inherited in an X-linked recessive mode in pure and complicated forms. Recently, molecular linkage studies have suggested that these variant X-linked HSP conditions result from locus heterogeneity. In this paper we report on the clinical and linkage analysis of a kindred with complicated X-linked HSP. The finding in this family of a map location of the putative HSP gene in the same region as the documented for the pure HSP gene provides evidence that allelic mutations might also be responsible for the variable phenotype encountered in these X-linked disorders.

Adolescent↗