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Biomedical subjects

J Moodley

Publications and source records attributed to J Moodley.

At least 217 records · Page 12Linked to original sources
PubMed1993

Re-screening for syphilis at the time of delivery in areas of high prevalence.

Two hundred women who were screened for syphilis at their initial antenatal visit were rescreened at the time of delivery. Umbilical cord blood specimens as well as maternal sera were tested. Twenty-two (11%) women were rapid plasma reagin (RPR)-positive at booking, while a total of 23 (12%) were RPR-positive at the time of delivery, including an additional 5 (3%) who seroconverted. Four women who were RPR-positive at initial testing had become negative by the time of delivery following treatment. Of all neonates born to seropositive women, only 1 demonstrated clinical evidence of congenital syphilis. In view of the high seroconversion rate, we recommend screening for syphilis at the initial antenatal visit and rescreening at the time of delivery in areas such as ours.

Female↗
PubMed1993

Expectant management of early onset of severe pre-eclampsia in Durban.

Fifty patients with severe pre-eclampsia who presented before 32 weeks' gestation were managed conservatively (sedation, bed rest, antihypertensive therapy and intensive fetal and maternal monitoring) until intervention was indicated. Twelve patients presented before 26 weeks of pregnancy and there were no fetal survivors in this group; 23 presented between 26 and 29 weeks and 8(34,8%) of the babies in this group survived. The rate of perinatal loss in those presenting between 30 and 32 weeks was 26,6% (N = 4). Patients who had a history of a hypertensive disorder in their previous pregnancy(ies) had a higher perinatal mortality rate; 23 such mothers experienced 16 perinatal losses compared with 27 mothers who had no such history and who had only 8 perinatal losses. There was 1 maternal death, there were 2 cases of eclampsia, 3 of pulmonary oedema, 4 of abruptio placentae and 1 case of renal failure; 2 patients had disseminated intravascular coagulation. The local indigent and underprivileged black population have a more aggressive form of early onset of severe pre-eclampsia than that reported for other population groups. The high maternal complication rate of 30,8% and the low fetal survival rate before 26 weeks indicate that there is no place in our setting for expectant management of severe pre-eclampsia in patients presenting before 26 weeks. This applies particularly to those with a previous history of hypertension in pregnancy.

Adolescent↗
PubMed1992

Vaginal absorption of low-dose tranexamic acid from impregnated tampons.

Tranexamic acid (TA), an antifibrinolytic drug, is usually administered orally to women with menorrhagia. This route of administration is associated with adverse side-effects, therefore tampons impregnated with TA were used to assess the absorption of the drug across the vaginal epithelium. Blood levels of TA in group A (9 patients), who had one tampon inserted, and group B (10 patients), who had a tampon inserted at 2-hourly intervals so that a total of 3 tampons were administered over a 6-hour period, demonstrated absorption of the drug into the blood stream in low concentrations.

Absorption↗
PubMed1992

Thrombelastography after aspirin ingestion in pregnant and non-pregnant subjects.

The thrombelastograph (TEG) and bleeding time were performed before and 6 h after a single oral dose of aspirin 600 mg in a group of eight healthy volunteers and 12 pregnant patients. Measured TEG variables (r, k, r+k times and maximum amplitude) were unaltered after aspirin although there was a significant prolongation of the bleeding time in both groups. Although the TEG appeared not to detect aspirin-induced changes in platelet function, the TEG measures all phases of coagulation and the unaltered TEG after aspirin suggested a functioning coagulation system.

Aspirin↗
PubMed1992

A comparative study of the use of epoprostenol and dihydralazine in severe hypertension in pregnancy.

OBJECTIVE: To compare the antihypertensive effects of epoprostenol sodium (prostacyclin) with that of dihydralazine in acute hypertensive crises of pregnancy. DESIGN: A prospective randomized study. A minimum of 20 patients per group was considered statistically acceptable (alpha = 0.05, power = 0.9). SETTING: A large urban tertiary hospital. SUBJECTS: Forty-seven pregnant patients with diastolic blood pressures of > 100 mmHg were studied. INTERVENTION: Lowering of high blood pressure with either dihydralazine (n = 25), the standard drug for this purpose, or epoprostenol (n = 22). MAIN OUTCOME MEASURE: A significant drop in high blood pressure was regarded as a fall of 15 mmHg diastolic and 30 mmHg systolic blood pressure. RESULTS: There were no statistically significant differences in the antihypertensive effects between the two treatment groups. Epoprostenol infusion caused less tachycardia; the mean pulse rate changed from 81.77 beats/min, before treatment to 88.36 at stabilization, compared with a change from 80.96 beats/min to 102.68 in the group treated with dihydralazine (P = 0.0024). CONCLUSION: The place of epoprostenol in pregnancy might be in patients with severe hypertension and tachycardia and in those requiring acute control of severe hypertension on the operating table before general anaesthesia.

Adult↗
PubMed1992

The efficacy of phenytoin in relation to serum levels in severe pre-eclampsia and eclampsia.

OBJECTIVES: To investigate the efficacy of phenytoin in relation to total and free serum levels in patients with severe pre-eclampsia and eclampsia. DESIGN: Prospective descriptive study. SETTING: Labour Ward, King Edward VIII Hospital, Durban, South Africa. Tertiary referral centre serving an underprivileged community. SUBJECTS: Eleven patients admitted with a hypertensive crisis. Four patients had eclampsia and 7 had impending eclampsia. MAIN OUTCOME MEASURES: Free and total phenytoin levels; efficacy of phenytoin as an anticonvulsant and side-effects of therapy. RESULTS: Although total phenytoin levels were within the therapeutic range, free phenytoin levels were abnormally high in all patients. Three patients (2 with eclampsia and 1 with imminent eclampsia) each had a seizure after phenytoin treatment had been initiated. CONCLUSION: Neither total nor free phenytoin levels were good predictors of seizure control. It is postulated that the poor performance of phenytoin as an anticonvulsant in severe eclampsia may relate to inadequate distribution of the drug to the brain as a result of cerebral oedema and poor cerebral perfusion rather than paradoxical seizure activity associated with high free phenytoin levels.

Adolescent↗
PubMed1992

Urogenital tract infections in pregnancy at King Edward VIII Hospital, Durban, South Africa.

OBJECTIVES: To evaluate the role of detecting asymptomatic bacteriuria and endocervical infections in the black prenatal patients attending King Edward VIII Hospital (KEH), Durban, with the view of justifying a screening programme. Screening for syphilis and human immunodeficiency virus (HIV) infection were also evaluated. SUBJECTS: 181 asymptomatic black prenatal patients attending the antenatal clinic for their first antenatal visit volunteered for the study and gave their written consent. DESIGN: Examination of each prenatal patient included obtaining of endocervical swabs to detect endocervical infections (C trachomatis, N gonorrhoeae), serum for syphilitic and HIV testing, and a midstream specimen of urine for microscopy and culture. RESULTS: Asymptomatic bacteriuria was found in 5.6% of patients in this study. Cervical infections were diagnosed microbiologically in 8.2% of women. These were N gonorrhoeae in 4.1% and C trachomatis in 4.7%. Serological tests for sexually transmitted diseases showed the presence of syphilis in 7.6% and antibody to the HIV in 1.9%. Overall, one or more sexually transmitted diseases were found in 16.5% of the women studied. CONCLUSIONS: This study suggests that all women presenting for routine antenatal care in a setting such as Durban should be screened for lower genital tract infections. Ideally this should include a midstream urine specimen for culture, serum for syphilitic and HIV antibody testing and endocervical swabs for sexually transmitted pathogens. In developing communities, however, more reliable and cheaper methods of endocervical screening need to be available before antenatal screening for cervico-vaginal infections can be justified.

Adolescent↗
PubMed1992

Syphilis in the 'unbooked' pregnant woman.

To determine the prevalence of syphilis in the 'unbooked' pregnant woman attending King Edward VIII Hospital, Durban, mothers who had no previous history or record of antenatal care were studied over a 3-month period. One hundred and fourteen mothers were recruited, 35 (30.7%) of whom had reactive syphilis serology. None had clinical evidence of primary or secondary syphilis. Clinical evidence of congenital syphilis was found in 4 of the 35 (11.5%) babies born to mothers with reactive syphilis serology. While the fluorescent treponemal antibody absorption (FTA-ABS) IgG test was positive in umbilical cord and neonatal venous blood of all 35 babies, the FTA-ABS IgM test was negative in all specimens, including the sera from the 4 babies with clinical signs of syphilis. The FTA-ABS IgM test is therefore of little value for the laboratory confirmation of congenital syphilis. It also has limitations when it comes to screening asymptomatic neonates born to mothers with reactive syphilis serology.

Adult↗
PubMed1991

Plasma noradrenaline and adrenaline levels in eclampsia. A preliminary study.

Plasma noradrenaline and adrenaline levels were measured in 18 women with eclampsia and 20 normotensive pregnant women matched for age and parity. While plasma noradrenaline concentrations were not statistically different in the two groups, plasma adrenaline values were higher in patients with eclampsia. The increases in adrenaline levels, although significantly elevated, were thought to be more related to stresses, such as muscular activity associated with convulsions. This study suggests that the aetiology of hypertension in pregnancy is not related to sympathetic overactivity.

Adolescent↗
PubMed1991

Maternal serum fructosamine values after delivery of macrosomic babies and unexplained stillbirths.

Measurement of serum fructosamine and haemoglobin A1 levels and glucose tolerance tests were performed in 75 women in the immediate postpartum period. None had predisposing factors to gestational diabetes. They were divided into three groups: group I consisted of 15 women who delivered an unexplained stillbirth; group II of 30 women who gave birth to babies weighing between 2,500 g and 3,900 g at term; and group III of 30 women who delivered babies weighing greater than or equal to 4,000 g. There was a significant difference in the mean level of serum fructosamine between the unexplained stillbirth and control groups (P less than 0.001). Although the HbA1 values varied in the three groups, there was a significant difference between the unexplained stillbirth group and the macrosomic infant group (P less than 0.05). All patients had normal glucose tolerance tests.

Adult↗
PubMed1991

Pituitary function tests in black patients with pseudocyesis.

Pituitary function was evaluated in a group of 10 patients with pseudocyesis. One patient was postmenopausal; the remainder demonstrated normal basal prolactin, luteinising hormone (LH) and follicle-stimulating hormone (FSH) levels and also normal pituitary-adrenal, pituitary-thyroid axes. Oestradiol deficiency was present in 6 patients, while 2 patients demonstrated elevated serum progesterone values, suggestive of a luteal phase. Gonadotrophin-releasing hormone administration resulted in exaggerated stimulation of LH and FSH in 4 and 2 patients, respectively. Impaired growth hormone (GH) secretion was present in 6 patients after insulin-induced hypoglycaemia and L-dopa administration. GH impairment is probably a consequence of the oestrogen deficiency that commonly occurs in this condition. It thus appears that there are aberrations in specific pituitary hormone responses after provocation in pseudocyesis.

Adult↗
PubMed1991

Continuous electrocardiographic monitoring in hypertensive crises in pregnancy.

Twenty-four patients first seen with hypertensive crises during pregnancy were studied by continuous electrocardiographic monitoring for a period of 24 hours to detect the presence of serious ventricular arrhythmias. Three patients were excluded from analysis because of low serum potassium levels. Thirteen of the remaining 21 patients had ventricular tachycardia on subsequent analysis of the electrocardiogram. These arrhythmias subsided after induction of anesthesia when blood pressure control was optimal. This finding may be implicated in the pathogenesis of pulmonary edema and sudden death in these patients.

Adult↗