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Biomedical subjects

J Moodley

Publications and source records attributed to J Moodley.

At least 235 records · Page 13Linked to original sources
PubMed1991

Evaluation of a new hydrocolloid occlusive dressing for central catheters used in total parenteral nutrition.

Catheter-related sepsis still remains one of the most frequent and serious complication of total parenteral nutrition. Strategies for preventing contamination of central venous lines have focused on decreasing the number of micro-organisms around the exit site and inhibiting their entry into the catheter wound. This prospective study compares a new occlusive hydrocolloid dressing (Visiband; Convatec Squibb) with that of a polyurethane film dressing for nutritional catheters. Dressings were changed either on day 3 or day 5 after application. Swab smears of the catheter exit site at each dressing change were stained by Gram's method before inoculation onto a blood agar plate, a chocolate agar plate and a MacConkey agar plate. Significantly less colonisation occurred under the former dressing at day 3 and day 5 dressing changes. In addition, the polyurethane film dressing was associated with a significant increase in skin colonisation (P = 0.04) and the number of positive Gram-stain microbes if left unchanged for 5 days (P = 0.0018). Staphylococcus aureus catheter-related sepsis occurred in 1 patient on day 18 in the polyurethane film dressing group. In addition, Candida albicans colonisation was confined to patients with the polyurethane film dressing. While the type of dressing applied to the catheter exit site may influence the incidence of catheter colonisation and infection, it must be emphasised that strict adherence to aseptic technique during catheter insertion and manipulation of the dressing is vital in the prevention of catheter-related sepsis during total parenteral nutrition.

Adult↗
PubMed1990

Synthetic laminaria tent for cervical ripening.

The efficacy and safety of a synthetic laminaria tent (Lamicel; Cabot) in ripening the cervix before induction of labour was compared with prostaglandin E2 (PGE2) oral tablets used intravaginally. Eighty patients were randomly assigned to use of the laminaria tent (N = 40) or PGE2 (N = 40). There were an equal number of primigravidas and multigravidas in each group. The only significant difference between the groups was the higher frequency of uterine hypertonicity (29 v. 5 : PGE2 v. tent) and consequent fetal distress (5 v. 1 : PGE2 v. tent) in the PGE2 group. However, the duration of labour was shorter in the PGE2 group than in the tent group (10, 14 h v. 11,61 h). These findings indicate that the synthetic laminaria tent is the preferred agent for cervical ripening in high-risk pregnancies and in developing countries.

Administration, Intravaginal↗
PubMed1990

Sexually transmitted pathogens and colposcopic findings in asymptomatic HIV-1 antibody-positive blood donors.

Sixteen asymptomatic human immunodeficiency virus (HIV-1) antibody-positive female blood donors were examined for sexually transmitted diseases by lower genital tract microbiological tests and colposcopy. Two donors had generalised lymphadenopathy, and in 13 (81.2%) human papillomavirus was detected on histological examination. In 5 (31.2%) Neisseria gonorrhoeae was cultured. Sexually transmitted pathogens were found in all but 3 subjects and multiple agents were detected in 9. The high prevalence of sexually transmitted diseases coupled with the generally poor response to counselling has a frightening potential for spread of HIV locally.

Adolescent↗
PubMed1990

Kaposi's sarcoma associated with acquired immunodeficiency syndrome presenting as a vulval papilloma. A case report.

A patient with acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma presenting with a vulval neoplasm is reported. Although more common in black than white people, Kaposi's sarcoma infrequently presents with gynaecological symptoms or lesions. In this case report the management of Kaposi's sarcoma presenting as a vulval neoplasm in a young woman with a positive antibody test to HIV is discussed and the need to screen young women with vulval neoplasms for this infection is highlighted.

Adult↗
PubMed1990

Induction of labor with mifepristone (RU 486) in intrauterine fetal death.

In a double-blind controlled multicentric study involving 94 patients with an intrauterine fetal death, we investigated the efficacy and tolerance of mifepristone (RU 486), a steroid compound that antagonizes progesterone action at the receptor level. Success of treatment was defined as the occurrence of fetal expulsion within 72 hours after the first drug intake. Mifepristone treatment (600 mg per day for 2 days) was considered to be effective in 29 of 46 patients (63%). There were only eight successes in 48 patients (17.4%) in the placebo group (p = 0.001, chi 2 test). Tolerance was good in the mifepristone group. In the placebo group, disseminated intravascular coagulation occurred in one woman for whom the investigator waited several weeks for spontaneous expulsion. This large double-blind controlled study provides evidence that mifepristone is of interest in the management of intrauterine fetal death. It could provide a pharmacologic alternative to the use of prostaglandins in this indication.

Adult↗
PubMed1990

Detection of a small molecular species of human chorionic gonadotropin in the urine of patients with carcinoma of the cervix and cervical intraepithelial neoplasia: comparison with other assays for human chorionic gonadotropin and its fragments.

A low-molecular-weight glycoprotein containing sequences of the beta subunit of human chorionic gonadotropin (hCG) has been found in the urine of patients with carcinoma of the cervix using an immunoradiometric assay. This fragment has chromatographic and immunological identity with hCG beta core. This molecule was present in 52 to 77% of all patients with invasive disease, while between 11 and 27% of patients with cervical intraepithelial neoplasia (CIN) also exhibited significant hCG beta-core immunoactivity. Few patients had either a positive assay for intact hCG or a positive assay directed at an epitope on the beta subunit (beta-hCG radioimmunoassay) in serum. However, between 17 and 40% of patients with invasive disease were positive for free beta-subunit immunoactivity in the blood. The origin of the beta-core immunoactivity in the urine is uncertain; while tumor production cannot be excluded, it is possible that the molecule originates from renal metabolism of small quantities of the beta subunit of hCG. Regardless of the source of the molecule, hCG beta core is a far more sensitive marker of hCG production by tumors than is serum hCG.

Carcinoma↗
PubMed1990

Granuloma inguinale of the cervix: a carcinoma look-alike.

Granuloma inguinale of the cervix presents as a proliferative growth and may mimic carcinoma. Over a 3 year period 18 patients with cervical granuloma inguinale were detected. Nine (50%) had a clinical diagnosis of carcinoma of the cervix on admission, five of whom had extensive investigations to exclude a malignancy. In communities where these two conditions are commonly seen it is recommended that granuloma inguinale be considered in young women with granulomatous lesions of the cervix, so as to avoid extensive and financially costly investigations, and unnecessary psychological stress for patients.

Adult↗
PubMed1989

Sexually transmitted pathogens in acute pelvic inflammatory disease.

The prevalence of sexually transmitted pathogens in two groups of women was studied: 50 women with clinical diagnoses of acute pelvic inflammatory disease (PID) and 50 asymptomatic women attending a family planning clinic (FPC). Genital specimens, collected by non-invasive procedures, were examined. Endocervical Neisseria gonorrhoeae was present in 62% of the PID group and 10% of the FPC group (P less than 0.0001). One-third of N. gonorrhoeae isolates were penicillinase-producing strains. Chlamydia trachomatis was isolated from the endocervix in 30% of the PID group and 26% of the FPC group (P = 0.8240 NS). Mycoplasma hominis was more prevalent in the vaginas and endocervices of the PID group than the FPC group (84% and 72% v. 50% and 42%; P = 0.0006 and 0.0047 respectively). Trichomonas vaginalis was present in 56% of the PID group and 20% of the FPC group (P = 0.0004). Syphilis serology was positive in 34% of the PID group and 10% of the FPC group (P = 0.0026). In the PID group of patients, 8% were positive for HBsAg. Antibody to the human immunodeficiency virus was not detected in any of the 100 women. The high prevalence of recognised sexually transmitted pathogens underlines the need for appropriate antimicrobial agent(s) active against N. gonorrhoeae, C. trachomatis and M. hominis in patients with PID. In view of the high prevalence of penicillinase-producing strains of N. gonorrhoeae, routine use of an antibiotic active against such strains is desirable.

Acute Disease↗
PubMed1989

Nifedipine in acute hypertensive emergencies in pregnancy.

The effect of nifedipine (Adalat; Bayer-Miles)--a calcium channel blocker, which has a well-established place in nonobstetric hypertension--was compared with dihydralazine in 33 primigravidas with severe hypertension of pregnancy. Patients with a diastolic blood pressure greater than 110 mmHg before drug administration were randomly assigned to treatment with either nifedipine or dihydralazine. Both drugs were found to be equally efficacious. Nifedipine, however, showed an earlier onset of action in lowering systolic blood pressure and had the advantage of oral administration.

Acute Disease↗
PubMed1989

Termination of pregnancy with mifepristone after intra-uterine death. Clinical and hormonal effects.

Mifepristone was used in a dosage of 400 mg/d in a double-blind study to induce labour in patients with intra-uterine fetal death in late pregnancy. Eight of 12 patients who received the drug delivered within 72 hours while only 2 of 12 patients treated with placebo delivered during a similar period. No adverse effects, viz. excessive vaginal bleeding and abnormal biochemical or haematological parameters, were associated with the use of this drug.

Abortifacient Agents↗
PubMed1989

Placental bed morphology in black women with eclampsia.

Histopathological changes in the placental bed were studied in 7 primigravid patients with eclampsia and compared with those in 17 normotensive patients. Normal morphological changes, which included trophoblastic invasion of spiral arterioles of the decidual and myometrial segments, were noted in the biopsy specimens taken from normotensive patients but were not seen in the specimens obtained from patients with eclampsia.

Adolescent↗
PubMed1989

Attempts at dietary alteration of prostaglandin pathways in the management of pre-eclampsia.

It has been suggested that dietary supplementation with prostaglandin precursors may enhance the synthesis of PGE which lowers vascular sensitivity to increased levels of angiotensin II in pregnancy. Therefore the effect of dietary supplementation with evening primrose oil (linoleic acid and gamma-linoleic acid) in African primigravidae with established pre-eclampsia was studied. Patients were randomly allocated to one of two groups. Group A (23 patients) received 8 capsules/day of evening primrose oil and group B (24 patients) received 8 capsules of placebo. No significant differences were found between the groups in respect to perinatal outcome, blood pressure lowering effect and haematological indices.

Adolescent↗
PubMed1989

Influence of preoperative gastric aspiration on the volume and pH of gastric contents in obstetric patients undergoing caesarean section.

Aspiration of gastric contents, the most common anaesthetic cause of maternal mortality, is decreased by emptying of the stomach and the use of antacids and H2-receptor antagonists. One hundred and eighty-three mothers presenting for emergency Cesarean section were allocated to three groups. In group 1, the stomach was emptied before operation via an orogastric tube and thereafter 30 ml of sodium citrate 0.3 mol litre-1 was ingested 5-15 min before induction of general anaesthesia (our usual practice). Group 2 received only 30 ml of sodium citrate 0.3 mol litre-1. Group 3 received ranitidine 50 mg i.v. before operation, 5-15 min before induction of anaesthesia, in addition to sodium citrate. Our results show that preoperative gastric emptying with an orogastric tube followed by sodium citrate is preferred if anaesthesia should be induced 15-20 min later. However, the use of ranitidine and sodium citrate is preferred at subsequent times. Although our data show that preoperative gastric emptying decreased the mean intragastric volumes before Caesarean section, the number of patients at risk of acid aspiration was not reduced. In view of these findings and the unpleasantness of orogastric intubation, we suggest that routine preoperative gastric aspiration via an orogastric tube is not justified, although the manoeuvre should still be used following a recent meal.

Adolescent↗
PubMed1988

Guillain-Barré syndrome in pregnancy. A case report.

Severe Guillain-Barré syndrome in a patient 33 weeks pregnant, who went into premature labour 48 hours after requiring mechanical ventilation, is described. The labour required augmentation with oxytocin and a healthy 2,100 g baby was delivered using forceps. Obstetrically, the patient had an uncomplicated puerperium. She required ventilation for 20 days and after extensive physiotherapy was discharged with no disability. It is our opinion that the management of the gravid patient with Guillain-Barré syndrome does not differ much from that of non-pregnant patients with the disease. Supportive care in an intensive care unit remains the cornerstone of treatment and unnecessary obstetric intervention must be strongly resisted.

Adult↗