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E Gouws

Publications and source records attributed to E Gouws.

At least 73 records · Page 4Linked to original sources
PubMed1995

Marked hyperinsulinaemia in postmenopausal, healthy Indian (Asian) women.

The effect of the menopause on insulin metabolism has not received specific attention in populations prone to non-insulin-dependent (Type 2) diabetes mellitus (NIDDM). Insignificant or slight alterations in insulin levels have been reported in postmenopausal women of mainly European ancestry. We thus report on the results of a cross-sectional study on the correlates of fasting insulin levels in 177 healthy, Indian nurses aged between 25 and 55 years. Fasting insulin concentration was markedly higher in the 75 postmenopausal subjects (23.9 mU I-1) than in the 102 premenopausal women (11.7 mU I-1 (p < 0.0001). Forty-three (57%) of the postmenopausal subjects had insulin values more than 20 mU I-1 (the upper normal limit). Stepwise regression analysis on the entire group revealed menopause (p < 0.0001), waist:hip ratio (p = 0.0001), apolipoprotein E genotype (p = 0.002), and the testosterone: sex hormone binding globulin ratio (p = 0.0002) as statistically significant, independent predictors of log insulin levels. Age did not account for the difference between premenopausal and postmenopausal subjects. The apolipoprotein E genotype emerged as a significant correlate of insulin levels, only in postmenopausal women: epsilon 3/3, 26.3 mU I-1; epsilon 3/4, 51.8 mU I-1 (p = 0.0007). Hyperinsulinaemic postmenopausal subjects had higher fasting glucose levels than normoinsulinemic nurses (p = 0.03), but glycosylated haemoglobin and fructosamine values were all within the normal range. Thus fasting hyperinsulinaemia was marked and common among a group of healthy, postmenopausal Indian nurses below the age of 55 years, suggesting that the menopausal transition may permit or provoke insulin resistance in this susceptible population.

Adult↗
PubMed1995

Meconium aspiration in South Africa.

This retrospective study of 569 cases of meconium aspiration from 11 institutions in South Africa reveals a high incidence varying from 4 to 11/1,000 and a mortality rate of 12%. Mortality was significantly related to the degree of asphyxia at birth. Twenty-five per cent of the babies (136/569) required intensive care and 36% died. Of the mothers 18-25% were unbooked and most of the babies were inborn (87%). Babies born to primiparous mothers and to mothers over 35 years of age were at greater risk of death. In order to reduce mortality and the numbers admitted to the intensive care unit simple measures for the reduction in the incidence of this disease need to be emphasised in all teaching and training programmes.

Delivery, Obstetric↗
PubMed1994

Intravenous administration of the proton pump inhibitor omeprazole reduces the risk of acid aspiration at emergency cesarean section.

This study documented gastric pH and volume, and the number of patients at risk for acid aspiration of gastric contents, in a group of mothers undergoing emergency cesarean section under general anesthesia. Patients were randomized in a double-blind fashion to receive omeprazole 40 mg intravenously or placebo at the time of decision to proceed to cesarean section. In addition, all patients received 10 mg intravenous metoclopramide and 30 mL of 0.3 M sodium citrate. Aspiration of gastric contents was undertaken immediately after endotracheal intubation (PI) and before tracheal extubation (PE). Patients with both pH < 3.5 and volume > 25 mL were deemed to be at risk of acid aspiration should regurgitation occur. Only cases where the study-drug-to-PI-aspiration interval was > 30 min were evaluated. There were 282 patients in the study group and 259 in the control group. PI, 11 patients (4.25%; 95% confidence interval [CI] 1.79-6.71) were at risk in the control group compared with 4 (1.42%; 95% CI 0.04-2.8) in the study group (P = 0.045). The omeprazole-to-PI-aspiration interval in these four cases was < or = 40 min. PE, 19 (7.3%; 95% CI 4.17-10.51) patients were at risk in the control group compared with 2 (0.7%; 95% CI 0-1.69) in the study group (P < 0.0001). Mean pH in patients receiving omeprazole was significantly higher (P < 0.001) than in the control group. Gastric volumes were significantly lower in the omeprazole group compared with the control group at both PI (P = 0.006) and PE (P = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Operative sepsis in neurosurgery: a method of classifying surgical cases.

Neurosurgical operations have traditionally been classified along the lines of general surgical procedures. A prospective study, during an 18-month period, was undertaken in 2249 patients undergoing neurosurgical procedures to establish and evaluate a method of classifying surgical cases by the use of specific neurosurgical criteria. Patients were placed in one of five categories according to the level and type of contamination at the time of surgery. Infection included all abnormal wounds and was documented as deep when infection occurred beneath the galea (subgaleal pus, osteitis, abscess/empyema, ventriculomeningitis) and as superficial if only the scalp (including wound erythema) was involved. A statistically significant difference in the sepsis rate was found in the different categories (P < 0.0001). Of the 342 "dirty cases," 9.1% of patients developed further wound sepsis. Concomitant cerebrospinal fluid fistulae (44%), second operations (11.8%), and patients with penetrating injuries (9.2%) were the major factors implicated in sepsis in the "contaminated" category (9.7%). In the "clean contaminated" category, a sepsis rate of 6.8% was found. Prolonged surgery (longer than 4 hours) was also implicated in higher infection rates (13.4%). This study strongly supports the separation of patients who have foreign materials implanted (sepsis rate = 6.0%) from "clean" patients, essentially cases categorized as having no known risk factors that may affect sepsis, in whom a sepsis rate of 0.8% was found (P < 0.001). Importantly, surgery for the repair of so-called "clean" neural tube defects in neonates requires separate consideration. An infection rate of 14.8% existed in this subgroup. A uniform system of reporting wound abnormalities is also proposed.

Bacteriological Techniques↗
PubMed1994

Hyponatremic natriuretic syndrome in tuberculous meningitis: the probable role of atrial natriuretic peptide.

Hyponatremia has been reported in up to one third of patients with intracranial disease and has frequently been associated with tuberculous meningitis, often complicated by hydrocephalus. The lowered plasma sodium levels were previously attributed to the syndrome of inappropriate secretion of antidiuretic hormone. A controlled prospective study of 24 patients with tuberculous meningitis and hydrocephalus was carried out. Analyses of serum electrolytes and cerebrospinal fluid were performed. Plasma and cerebrospinal fluid levels of atrial natriuretic peptide (ANP) and antidiuretic hormone (ADH) were measured by radioimmunoassay. Fifteen patients were found to be hyponatremic (plasma sodium < 130 mmol/L) and ANP levels of 12 to 1,488 pg/ml were present (median, 26 pg/ml). The remaining 9 patients had normal plasma sodium values between 130 and 145 mmol/L, and in these, plasma ANP values varied between 12 and 21.7 pg/ml (median, 12 pg/ml). The difference between these two groups was not statistically significant. (Control values from patients undergoing myelography were established to range between 12 and 40 pg/ml; median, 14.4 pg/ml.) ANP levels were undetectable in the cerebrospinal fluid in all. Plasma ADH levels in the hyponatremic group were between 7 and 159 pg/ml (median, 40 pg/ml). In the normonatremic group, plasma ADH levels of 25 to 250 pg/ml (median, 29 pg/ml) were obtained. (The controls ranged between 3.6 and 35 pg/ml; median, 10.4 pg/ml). In the hyponatremic group, there was a moderate negative correlation (r = -0.683) between plasma ANP and plasma sodium (P = 0.02). No correlation between plasma ADH and plasma sodium was found (r = -0.168; P = 0.62).(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Natriuretic Factor↗
PubMed1994

The use of transcranial Doppler ultrasonography as a method of assessing intracranial pressure in hydrocephalic children.

Previous studies in children have shown a strong correlation between raised intracranial pressure (RICP) and the Gosling pulsatility index (PI) as determined by transcranial Doppler ultrasonography (TCD). This diagnostic modality can, therefore, be used as a non-invasive method for the indirect evaluation of shunt function in children with hydrocephalus. Transcranial Doppler waveform analyses were done in 15 children with hydrocephalus, before and after insertion of a ventriculo-peritoneal shunt. All had clinical evidence of raised intracranial pressure (ICP) prior to surgery. CT had demonstrated dilated ventricles and, in some, additional features of RICP. Fifteen children without clinical and CT evidence of hydrocephalus were examined in an identical manner to act as a control group. The results clearly demonstrated that TCD may be a useful, non-invasive means of assessing the need for a cerebrospinal fluid (CSF) diversionary procedure and also for follow-up and monitoring.

Child↗
PubMed1994

Community-based survey versus sentinel site sampling in determining the nutritional status of rural children. Implications for nutritional surveillance and the development of nutritional programmes.

A study of the anthropometric status of under-5-year-olds was conducted in the Nqutu district of KwaZulu by means of a representative community-based sample and concurrent samples from primary health care clinics, preschools and primary schools. The first objective of this exercise was to determine the extent of acute nutritional stress in the district as an indication of the appropriateness of food relief efforts in the region. The absence of wasting and the high prevalence of stunting (37.5%) in the community-based sample suggested that the main problem is chronic socio-economic underdevelopment, rather than a severe or immediate lack of food. The fact that fewer than 20% of households are in any way reliant on domestic production for their maize requirements explains why the recent drought has not had a greater impact on the nutritional status of this vulnerable group. This study confirms that the more recent emphasis of the National Nutrition and Social Development Programme on social development is appropriate. An equally important objective of this study was to evaluate the usefulness of clinics, preschools and schools as sites for the collection of anthropometric data and the development of nutritional programmes. This preliminary attempt to develop the methodology for district-based nutrition surveillance suggested that all these sites have limitations both in respect of data collection and community access. The implications of using these sites and the developments needed to improve their usefulness in a future nutrition surveillance system are discussed.

Anthropometry↗
PubMed1994

Risk factors for coronary heart disease in the white community of Durban.

Coronary heart disease (CHD) is the leading cause of death among the white and Indian populations of Durban. This was a community-based study of the white population of Durban, which is predominantly English-speaking. There were 396 subjects (194 men, 202 women) aged 15-69 years. A history of CHD was present in 9.3% of the subjects. The important risk factors were hypercholesterolaemia, hypertension and smoking. The minor risk factors were obesity, hypertriglyceridaemia, hyperuricaemia, a sedentary occupation and a history of CHD in the immediate family. Electrocardiograph abnormalities denoting CHD were present in 17% of subjects. A study of the major risk factors showed that 35.1% (age and sex adjusted) had at least one major risk factor at the higher level (level A) and 33.8% (age and sex adjusted) at the lower risk levels (level B). When the combination of risk factors was taken into account, 15.2% and 28% had two major risk factors, one each at levels A and B respectively. On average the percentage of men and women with one risk factor or more increased with age. A protective high-density lipoprotein/total cholesterol ratio > or = 20% was present in 53.5% of the respondents. Because of the severe nature of CHD, an intensive programme for the primary prevention of CHD risk factors should be instituted.

Adolescent↗
PubMed1993

In vitro sensitivity of southern African isolates of Plasmodium falciparum to halofantrine.

Twenty southern African isolates of Plasmodium falciparum and a 'control' Gambian strain were tested in vitro for their sensitivity to halofantrine. The concentration required to inhibit 50% of parasite growth, the IC50, ranged from 0.039 to 15.000 nmol/litre, with a mean of 4.619 nmol/litre. These IC50 values were comparable with those obtained in studies carried out in West Africa but were higher than the IC50 of South-East Asian isolates. All 21 isolates examined in the present study had minimum inhibitory concentrations (MIC) of 32 nmol/litre or less, with a median MIC value of 8 nmol/litre. Halofantrine was equally active against chloroquine-sensitive and chloroquine-resistant isolates and was also active against pyrimethamine-resistant strains. Indications are that this drug would be suitable for the treatment of P. falciparum malaria in the southern African region.

Africa, Southern↗
PubMed1993

A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective cesarean section.

BACKGROUND: Hypotension after spinal anesthesia for cesarean section remains a common and serious complication despite the use of uterine displacement and volume preloading. The current study revaluated the role of crystalloid volume preloading in this context. METHODS: In a two-stage open sequential design, patients presenting for elective repeat cesarean section were allocated to receive either no preload or 20 ml/kg crystalloid administered over 15-20 min before spinal anesthesia. Hypotension was defined as a decrease in systolic pressure to less than 100 mmHg and to less than 80% of baseline value, and the study was designed to detect a 20% difference in the incidence of hypotension between the groups, with statistical significance at the 10% (alpha = 0.1) level, one-tailed. RESULTS: One hundred forty patients were studied. Hypotension occurred in 43 (55%, 95% CI 43.4-66.4) preloaded and 44 (71%, 95% CI 58-81.8) unpreloaded subjects, a difference in incidence of 16% (95% CI 0.04-31.6), which was statistically significant. There were no significant differences in the severity, timing, or duration of hypotension; the dose requirement for ephedrine; or the clinical and biochemical status of neonates between the groups. The only difference seen was a lower mean base excess (-3.4, SD 2.81 mM-1) in the neonates of hypotensive mothers compared to neonates of nonhypotensive mothers (-2.4, SD 1.99 mM-1). CONCLUSIONS: The study confirms that hypotension associated with spinal anesthesia for cesarean section cannot be eliminated by volume preloading in the supine wedged patient. The relatively small reduction in incidence of hypotension challenges our perception of the value of crystalloid preload. Though volume preload in the elective cesarean section is advocated, the requirement for a mandatory administration of a fixed volume before spinal anesthesia for urgent cases has been abandoned.

Adult↗
PubMed1993

Leg elevation and wrapping in the prevention of hypotension following spinal anaesthesia for elective caesarean section.

Ninety-seven parturients undergoing elective Caesarean section were allocated randomly to have their legs elevated to approximately 30 degrees on pillows or elevated and wrapped with elasticated Esmarch bandages or neither (controls) following spinal anaesthesia. All patients received intravenous crystalloid (20 ml.kg-1 over 20 min) prior to spinal injection and were placed in the left lateral tilt position. Significant hypotension was treated with intravenous ephedrine in 5 mg bolus doses. Leg wrapping resulted in a significant reduction in the incidence of postspinal hypotension in comparison to the control group (18% compared to 53%, p = 0.004). This represents a five-fold reduction in the likelihood of postspinal hypotension (odds ratio 5.3, 95% CI 1.7-16.3). Leg elevation alone did not significantly reduce the incidence of hypotension (39%). There was no significant difference in the time of onset of hypotension between the groups. For those patients requiring ephedrine, there was no significant difference in mean dose requirements between the groups. The use of leg compression immediately postspinal provides a simple means of reducing the accompanying hypotension and should be used more widely.

Adult↗
PubMed1993

The association between sexually transmitted pathogens and cervical intra-epithelial neoplasia in a developing community.

OBJECTIVE--To determine the association of sexually transmitted pathogens in women with cervical intra-epithelial neoplasia (CIN). SETTING--An urban tertiary referral hospital serving a large indigent developing community. PARTICIPANTS--48 women attending a colposcopy clinic and 49 women attending a family planning clinic. METHODS--Vaginal, endocervical, rectal swab specimens and sera were collected for the detection of sexually transmitted pathogens. Cervical cytology was performed on all patients. Women attending the colposcopy clinic had confirmation of abnormal cervical cytology by colposcopic directed biopsy. RESULTS--The mean age of women with CIN (33 years) was significantly greater than that of the women without CIN (28 years) and that of the family planning group (26 years). There was a high prevalence of sexually transmitted pathogens in all women. A significantly higher prevalence of bacterial vaginosis was found in women with CIN compared to those without (50% vs 20%; p = 0.034). The human papilloma virus (HPV) was detected in 46% of women with CIN and 65% of those without CIN. Chlamydia trachomatis (21%) and Trichomonas vaginalis (39%) were detected frequently in women with CIN. C. trachomatis (14%-21%) was detected more frequently than Neisseria gonorrhoeae (3-5%) in all asymptomatic women studied. CONCLUSION--This study demonstrates a high prevalence of sexually transmitted pathogens in women with and without CIN as well as family planning clinic attenders. Bacterial vaginosis was a significant finding in women with CIN. C. trachomatis was detected in a high proportion of all women studied and found more commonly than N. gonorrhoeae. We therefore recommend that all women attending gynaecological services in a developing community be investigated and treated for sexually transmitted diseases.

Adult↗
PubMed1993

Intravenous ranitidine reduces the risk of acid aspiration of gastric contents at emergency cesarean section.

This study documented gastric pH and volume and the number of patients at risk of acid aspiration of gastric contents in a group of mothers undergoing emergency cesarean section under general anesthesia. Patients were randomized in a double-blind fashion to receive ranitidine, 50 mg intravenously, or placebo at the time of decision to proceed to cesarean section. In addition, all patients received 30 mL of 0.3 M sodium citrate on entry into the operating room. Aspiration of gastric contents was undertaken immediately after endotracheal intubation (PI) and before tracheal extubation. Patients with both pH < 3.5 and volume > 25 mL were deemed to be at risk of acid aspiration should regurgitation occur. Postintubation, 12 patients (4%) were at risk in the citrate-alone group and 7 patients (2.3%) were at risk in the ranitidine/citrate group (not significant). Preextubation, 17 patients (5.6%) were at risk in the citrate-alone group and 1 patient (0.3%) was at risk in the ranitidine/citrate group (P < 0.05). PI pH in patients receiving ranitidine/citrate (mean 5.2, SD 0.8) was significantly higher than in patients receiving citrate alone (mean 4.9, SD 1.1). None of the patients who received ranitidine more than 30 min before the PI sample were at risk compared to 6 (3.2%) in the citrate alone group (P = 0.05). We conclude that 50 mg of intravenous ranitidine given at the time of decision to proceed to cesarean section reduces the risk of acid aspiration provided that at least 30 min have elapsed from injection to induction of anesthesia.

Adult↗
PubMed1993

High risk of progression to NIDDM in South-African Indians with impaired glucose tolerance.

A four-yr prospective study was undertaken to examine the natural history of IGT in 128 South-African Indians classified as such at year 0 of the study, based on WHO criteria. Subjects were reexamined at year 1 and year 4. Of the 113 subjects who completed the study, 50.4% progressed to NIDDM (rate of progression 12.6%/yr), 24.8% persisted with IGT, and 24.8%, reverted to NGT. The majority (72%) who progressed to NIDDM did so in year 1. At year 1, 47 subjects were still classified as IGT; of the 40 subjects completing the study, 16 subjects (40%) progressed to NIDDM, 17 subjects (42.5%) persisted with IGT, and 7 subjects (17.5%) reverted to NGT. Examination of risk factors predictive of subsequent progression to NIDDM was undertaken by analysis of baseline variables in two ways: When year 0 was used as baseline (in 113 IGT0 subjects), significant predictive risk factors were the FPG and 2-h plasma glucose concentrations. All subjects who at year 0 had 2-h plasma glucose > or = 10.2 and < 11.1 mM or FPG > or = 7.3 but < 7.8 mM, subsequently progressed to NIDDM. When year 1 was used as baseline (40 IGT1 subjects), 90-min plasma glucose concentration (midtest level) was found to be a significant risk factor for development of NIDDM. In conclusion, this study has demonstrated that in South-African Indians with IGT, the majority (50.4%) progress to NIDDM within 4 yr; significant predictors of subsequent diabetes are the baseline fasting and 2-h plasma glucose concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1993

The role of contralateral ventricular dilatation following surgery for intracranial mass lesions.

Contralateral ventricular dilatation (CVD) has been described as an early indicator of tentorial herniation and has been associated with increased mortality and morbidity. Following surgery for supratentorial mass lesions, ipsilateral brain swelling often causes CVD. Drainage of CVD was performed in a series of 12 patients in whom no further lesion amenable to surgery was evident and after failure of other established methods of intracranial pressure (ICP) control. In 10 of the 12 patients the ICP was brought under control with a significant reduction in ICP (p < 0.05) when compared with predrainage ICP. Midline shift was reduced in seven patients. Therefore, following successful removal of intracranial mass lesions, patients who exhibit CVD should undergo drainage as an early measure.

Brain Edema↗