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Biomedical subjects

I E Haffejee

Publications and source records attributed to I E Haffejee.

At least 19 recordsLinked to original sources
PubMed1995

Rheumatoid arthritis and connective tissue disorders: juvenile chronic arthritis.

That juvenile chronic arthritis (JCA) occurs in tropical countries there is no doubt. The spectrum of differential diagnoses is wider than in temperate regions. The disease tends to be more severe irrespective of the type of onset, and there is a high incidence of positive rheumatoid factor. Many cases present with advanced disease. There is a need for the establishment of clinics devoted specifically to the detection, documentation, and treatment of JCA.

Adolescent↗
PubMed1995

Rheumatic fever.

The incidence of RF and RHD in the tropics remains high, with a high proportion of children suffering from carditis with the first attack. Severe, incapacitating haemodynamic disturbances occur early. Many patients are seen with established RHD at their first visit, and the default rate is high. Poverty, overcrowding, poor transport facilities, understaffed and overburdened clinics, and poor follow-up add to the problem. A genetic predisposition to develop RHD appears to be important in certain countries like India, Egypt and Turkey, but no work to show this has been done in black Africa. Secondary prophylaxis remains the most practical means of controlling the disease in the tropics. Compliance with long-term prophylaxis depends on organized and concerted efforts of physicians, other health personnel, parents, teachers, and the community.

Child↗
PubMed1995

The epidemiology of rotavirus infections: a global perspective.

Rotavirus, which is the most common cause of infantile diarrhea worldwide, mainly affects infants between the ages of 6 and 24 months. Most infections in human newborns are mild or asymptomatic, due to the inherently attenuated nature of the "nursery" rotavirus strains. Adults are also sometimes affected, especially those in families with an infected child; the disease also occurs in closed adult communities. HIV-infected persons, travelers, or as a result of water-borne epidemics. Nosocomially acquired hospital infections add to morbidity and to the cost of hospitalization. A winter predominance of rotavirus diarrhea has been noted in temperate climates but not in tropical areas. Group A rotavirus infections are generally more common, but human infections with groups B and C have also been documented. The prevalence of serum antibodies is high during the neonatal period, but it declines sharply between the ages of 3 and 6 months, then rises steeply, peaking at approximately 2 years and remaining high into adulthood. Vaccines against rotavirus are currently under evaluation.

Adult↗
PubMed1995

Immunogenicity and safety of a live attenuated varicella vaccine in healthy Indian children aged 9-24 months.

OBJECTIVES: To investigate the safety of live attenuated varicella vaccine (Oka strain) and the optimal virus titre/dose required for immunogenicity in healthy South African children. DESIGN: Double-blind randomised clinical study using two different lots of varicella vaccine, each at two different titres. Subjects were randomly allocated to groups 1, 2, 3 and 4 to receive vaccine containing a mean virus titre of 10(4,5), 10(3,1), 10(3,9) and 10(2,7) PFUs per dose respectively. Clinical signs and symptoms were followed up for 42 days post-vaccination. Specific varicella antibodies were measured by an indirect immunofluorescence method in sera obtained on day 0 and day 42. SETTING: City Health Clinic, Chatsworth, Durban. PARTICIPANTS: A total of 200 healthy 9-24-month-old children were vaccinated, of whom 189 (44,5%) completed the study. MAIN OUTCOME MEASURES: Pre- and post-vaccination varicella antibody levels. Adverse events following varicella vaccination. RESULTS: The vaccine was safe and well tolerated. No local symptoms were reported. Skin reactions were specifically solicited in this study: 21 reactions were reported in 8.5% (17/200) of children. Vesicles were reported in 2 vaccines (< or = 10 vesicles in both cases). One serious adverse event was reported: hospitalisation for bronchopneumonia on day 16 post-vaccination which resolved without sequelae. Around day 42 post-vaccination (range 35-63 days) all the 176 initially seronegative subjects had seroconverted for varicella antibodies. Post-vaccination geometric mean titres (GMTs) were 104.1, 66.2, 69.5 and 77.0 for groups 1-4 respectively. Six subjects who were initially seropositive maintained or increased their titres post-vaccination; 3 of the 6 showed a booster response (a > or = 4-fold increase from the pre-vaccination titre). CONCLUSIONS: Varicella vaccine was found to be safe, immunogenic and well tolerated. No difference in seroconversion rates or GMTs, either between groups receiving the two vaccine lots or between groups receiving the different titres of each lot, was shown.

Antibodies, Viral↗
PubMed1991

The status of rotavirus vaccines in 1990.

The status of rotavirus (RV) vaccines in 1990 is reviewed with particular reference to the range of RV strains which infect human beings as well as the antibody response and immunity to naturally acquired RV infections. The requirements for an ideal vaccine are stated and the various approaches towards developing RV vaccines are described. Results of various field trials are given and finally important questions are posed which remain to be addressed if success in producing an ideal vaccine is to be achieved.

Animals↗
PubMed1991

Neonatal group B streptococcal infections in Indian (Asian) babies in South Africa.

In this, the first report of group B streptococcal (GBS) infections in Asian neonates in South Africa, the incidence was 2.65/1000 live births over a period of 3.5 years. Early onset disease (EOD), defined as arising less than or equal to 5 days after birth, was present in 79% cases; in most of these, the onset was before the age of 24 h. One baby presented with two episodes of late onset GBS infection. The incidence of culture-proven neonatal septicaemia during the same period was 12.3/1000 live births, GBS being commonest organism isolated. It was also the most frequent cause of bacterial meningitis in the newborn, accounting for 89% cases. Although neurological signs were present in 40% patients with EOD, only 13.3% had CSF-culture-positive meningitis. Radiographic features of hyaline membrane disease were found in half of the babies with EOD and for whom a chest radiograph was performed, while one had a pneumothorax. The overall mortality was 13.2% which is much lower than that reported in other series.

Female↗
PubMed1990

Typhoid fever in the adult and paediatric Indian population of Durban.

The features of typhoid fever in Indian South Africans are described. In children the illness was usually uncomplicated. However, anaemia, thrombocytopenia and hypo-albuminaemia were found in both adults and children. The initial symptoms on presentation of diarrhoea and vomiting frequently led to a misdiagnosis of gastro-enteritis. The previous administration of antibiotics also resulted in failure to isolate Salmonella typhi in 41% of patients studied. Typhoid acquired in the microbiology laboratory and that seen in visitors returning from India and the Far East is emphasised. The S. typhi isolates were uniformly sensitive to all antibiotics tested. The disproportionately high number of Indians of south Indian ancestry presenting to the R. K. Khan Hospital needs to be investigated.

Adolescent↗
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

Cow's milk-based formula, human milk, and soya feeds in acute infantile diarrhea: a therapeutic trial.

Acute infantile diarrhea is often managed by introducing lactose-free diets empirically from the time of diagnosis, in addition to conventional rehydration therapy. In order to assess the efficacy of this, a therapeutic trial was undertaken in which hospitalized gastroenteritis patients previously on milk-formula feeds were randomly fed, from the time of admission, either their original feed or a lactose-free soya preparation; patients previously on human milk with or without a supplement continued to receive this during their diarrheal illness. The results show that in nonrotaviral gastroenteritis, there is no difference in the duration of the illness irrespective of the type of feed given. In rotaviral gastroenteritis, continued breast-feeding significantly reduces the duration of acute diarrhea, while lactose-free soya feeds do not lead to a significant reduction in the duration of the illness when compared to cow's milk-formula feeds. Hence, it is concluded that (a) breast-feeding should be continued during an episode of infantile diarrhea, and that (b) empirical use of soya preparations from the time of hospital admission is not justified; however, the latter should be considered in infants whose purging rate goes up or diarrheal disease severity worsens 3 to 4 days after the onset of diarrhea or hospital stay and who are passing significant amounts of reducing sugars in their stool.

Acute Disease↗
PubMed1990

Persistent diarrhoea following gastroenteritis.

The persistent diarrhoea of greater than 14 days' duration in 17 infants, comprising 1% of 1672 patients who were admitted to a South African Hospital during January 1985-July 1987 for a study on acute gastroenteritis, is described. The age of the patients was between 20 days and 31 months (7.4 +/- 7.8 months), 11 of whom were of less than 6 months and the majority (13) were boys. Fifteen had the nutritional status below the 3rd weight-for-age centile. On admission, gastroenteritis was graded as mild in three patients, moderate in nine and severe in five. Seven, six and four patients had mild, moderate and severe dehydration respectively. Twelve patients required infusion of intravenous (i.v.) fluids for greater than or equal to 14 days to maintain hydration. Complications, such as bronchopneumonia and septicaemia, were present in five and three patients respectively. Nine of the 17 patients shed rotavirus in their stools, 7 of whom continued to do so for 10 to 18 days, and 3 of whom had associated infections either with Salmonella or with enteropathogenic Escherichia coli or both. Any causal agent was not detected in six patients. The mainstay of treatment was oral rehydration therapy with i.v. fluid when necessary and a normal diet of cow's milk-based formula to all except the two breast-fed infants. A failure to improve patients' condition led to the following graded additions to the treatment regimen: lactose-free soya diet, administration of oral gentamicin plus cholestyramine and feeding of semi-elemental formula ("Alfaré," R). The last one gave encouraging results, though the study was not a controlled therapeutic trial.

Acute Disease↗