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Biomedical subjects

J Moodley

Publications and source records attributed to J Moodley.

At least 37 records · Page 2Linked to original sources
PubMed2005

Medical vs. surgical evacuation of first-trimester spontaneous abortion.

OBJECTIVE: To determine whether management of incomplete first-trimester abortion with vaginal misoprostol in an under-resourced setting is a viable treatment option. METHODS: A total of 94 women were randomized to 600 microg of misoprostol intravaginally or to surgical curettage. The women receiving misoprostol were administered a second dose if the abortion was incomplete; and if still not complete after a week, evacuation of retained products of conception was performed. All women had a follow-up visit 2 weeks following complete abortion. RESULTS: The overall success rate of medical management was 91.5%, with 15 of 47 successful cases after 1 dose of misoprostol; 8.5% of the 47 women required evacuation of retained products of conception after 1 week because of treatment failure. The success rate in the surgical arm was 100%. Patients in the medical arm had a longer duration of bleeding and a greater need for analgesia. There were no differences in hemoglobin levels, white blood cell count, adverse effects, pain score, and satisfaction with treatment at the follow-up visit. However, more women who received the medical treatment would recommend it or choose it in the future. CONCLUSION: Medical management using 600 microg of misoprostol in 2 doses is effective to treat incomplete first-trimester abortions in an under-resourced setting when there is no evidence of uterine sepsis.

Abortifacient Agents, Nonsteroidal↗
PubMed2005

Intersex conditions in children and adolescents: surgical, ethical, and legal considerations.

INTRODUCTION: Approximately one in 2000 children globally is born with an intersex condition. There is unfortunately a relative paucity of data on the choices and the surgical and psychosocial outcomes in patients who undergo genital surgery for intersex conditions and ambiguous genitalia, especially in developing countries. Specialists in these and other countries, where patient follow-up is generally poor, are faced with the daunting task of offering the appropriate medical and surgical management, in the absence of guidelines or recommendations. SURGICAL CONSIDERATIONS: A surgical procedure in these patients sometimes involves clitoral recession, reduction, vaginoplasty, and gonadectomy. The best surgical outcome is likely to be achieved with a multidisciplinary surgical team; however, the choice of surgery and appropriate timing remains controversial. Some authors have suggested delaying surgery until the child becomes competent to make his/her own decisions. LEGAL/ETHICAL CONSIDERATIONS: All procedures should conform to an ethical code of practice and be in the interest of the child. Exhaustive counseling of all parties and informed consent is of paramount importance, as is adherence to laws that protect the rights of the child as outlined in respective constitutions. RECOMMENDATIONS: Recommendations in this article, which have been put together from the combined input of three departments, are broad-based. They emphasize the need for extensive counseling, informed consent, adherence to ethical and legal norms, a multidisciplinary input and a shift away from a paternalistic approach.

Adolescent↗
PubMed2005

Adverse events in gynaecology at King Edward VIII Hospital, Durban, South Africa.

Audit of the quality of gynaecological care is essential so that errors due to medical interventions can be reduced to the bare minimum. The aim of this study was to determine the incidence and nature of adverse gynaecological events. The clinical records of all women admitted with gynaecological conditions over 9 months were assessed for adverse events, defined as an injury caused by medical management rather than the underlying disease. Adverse events occurred in 11.7% of admissions and 52% were avoidable. The majority of adverse events were minor (disability lasting less than 6 months). Mortality accounted for 17.7% of adverse events and 2.1% of all admissions. The death rate was higher in the elective admissions. The frequency of adverse events increased with age, the presence of co-existing illnesses, and severity of the illness on admission. Therapeutic mishaps (n = 67; 8%) were the most common type of adverse event. Lessons learnt from audit should reduce adverse events considerably.

Developing Countries↗
PubMed2005

The accuracy of urine dipsticks as a screening test for proteinuria in hypertensive disorders of pregnancy.

BACKGROUND: Proteinuria is used as a criterion in the classification system for hypertensive disorders of pregnancy including preeclampsia. The aim of the study was to evaluate the accuracy of dipstick urinalysis in a single voided urine sample and in an aliquot of a 24-hour urine collection in the assessment of proteinuria in hypertensive pregnant women, using the 24-hour urine protein excretion as the gold standard. METHODS: One hundred ninety-eight women who presented with hypertension in pregnancy were recruited at the antenatal clinic at King Edward VIII Hospital in Durban, South Africa, a tertiary referral center. Exclusion criteria included women with eclampsia, urinary tract infection, and chronic renal disease. Routine dipstick urinalysis (Bayer) was performed by midwives for proteinuria, and a 24-hour urine specimen was collected for quantitative protein assessment. A laboratory technician performed urine dipstick test for protein on a mixed aliquot of the 24-hour urine specimen. This result, together with that of the screening dipstick urinalysis, was compared to the 24-hour urine protein excretion. RESULTS: The results of the 198 patients were analyzed, of the total, 72 had preeclampsia. Using a value of = 0.3 g protein excretion per 24 hours (1 + to 4 + on urine dipsticks) as positive, sensitivity, specificity, and predictive values for dipstick urinalysis were calculated. The positive predictive value for dipstick urinalysis ranged from 64.9% (single voided urine sample) to 94.2% (24-hour urine aliquot). The negative predictive value ranged from 75.2% (single voided urine sample) to 84.2% (24-hour urine aliquot). CONCLUSION: Dipstick urinalysis is not very accurate: therefore, all women presenting with hypertension during pregnancy should have a 24-hour urine protein measurement.

Adult↗
PubMed2005

Isolated splenic tuberculosis.

Tuberculosis isolated to the spleen is a rare clinical entity particularly in the non-HIV-positive patient population. In the four patients described, two presented with thrombocytopenia; in two patients the condition was diagnosed serendipitously at laparotomy undertaken for abdominal trauma.

Adult↗
PubMed2005

A randomized trial of pain relief in termination of pregnancy in South Africa.

The aim of this prospective trial was to evaluate and compare paracervical block with diclofenac for pain relief during manual vacuum aspiration (MVA) for surgical termination of pregnancy. Participants were randomized into three groups, viz. group (i) diclofenac 75 mg intramuscularly (i.m.) 30 min before the procedure; (ii) diclofenac 75 mg i.m. 30 min before the procedure, together with local infiltration of the cervix with lignocaine 1% (10 mL); (iii) diclofenac 75 mg i.m. 30 min before the procedure together with local infiltration of the cervix with lignocaine 1% (10 mL) and paracervical block with lignocaine 1% (5 mL). There was a significant difference in pain scores during the procedure between groups (i) and (ii) (P < 0.001), and between groups (i) and (iii) (P < 0.001) in pain scores during the procedure. There was no difference in pain score between groups (ii) and (iii) (P = 0.144). Post procedure analysis of pain score also showed significant difference between group (i) on one hand, and groups (ii) and (iii) (P < 0.001), but no significant difference between groups (ii) and (iii)(P = 0.029). The local anaesthetic infiltration of the cervix in combination with diclofenac or together with diclofenac and paracervical block provides better pain relief during and after the MVA.

Abortion, Induced↗
PubMed2004

Management of human immunodeficiency virus infection in pregnancy.

The HIV global epidemic is having a devastating effect on women of reproductive age; women aged 15-24 years are 2.5 times more likely to be infected than young men in the same age group. Further, mother-to-child transmission (MTCT) accounts for almost two-thirds of the new infections that occur in children world-wide, annually. MTCT of HIV-1 varies widely and is dependent on obstetric practices, mode of delivery, breastfeeding, and the level of the viral load in the mother. Antiretroviral therapy (ARV) in pregnancy is prescribed for two main reasons: (i) women who need ARV medication for their own health; (ii) women who do not need treatment, or do not have access to treatment are offered prophylaxis to prevent MTCT, using one of a number of ARV regimens known to be effective. HIV infection is also associated with significant maternal morbidity and mortality. Clinicians caring for HIV-infected women need to update their knowledge continuously to provide optimal care.

Adolescent↗
PubMed2004

Corticosteroids for HELLP syndrome in pregnancy.

BACKGROUND: Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a severe form of pre-eclampsia. Pre-eclampsia is a multi-system disease of pregnancy associated with an increase in blood pressure and increased perinatal and maternal morbidity and mortality. Eighty per cent of women with HELLP syndrome present before term. There are suggestions from observational studies that steroid treatment in HELLP syndrome may improve disordered maternal hematological and biochemical features and perhaps perinatal mortality and morbidity. OBJECTIVES: To summarise the evidence on the effects of corticosteroids on maternal and neonatal mortality and morbidity in women with HELLP syndrome. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (October 2003). We scanned lists of references from review articles and primary studies. SELECTION CRITERIA: Randomised and quasi-randomised trials evaluating the effects of adjunctive corticosteroids in patients diagnosed with HELLP syndrome were sought. DATA COLLECTION AND ANALYSIS: The two authors independently applied inclusion criteria, assessed trial quality and extracted relevant data. MAIN RESULTS: Of the five studies reviewed (n = 170), three were conducted antepartum and two postpartum. Four of the studies randomised participants to standard therapy or dexamethasone. One study compared dexamethasone with betamethasone. DEXAMETHASONE VERSUS CONTROL: There were no significant differences in the primary outcomes of maternal mortality and morbidity due to placental abruption, pulmonary oedema and liver hematoma or rupture. Of the secondary maternal outcomes, there was a tendency to a greater platelet count increase over 48 hours, statistically significantly less mean number of hospital stay days (weighted mean difference (WMD) -4.50, 95% confidence interval (CI) -7.13 to -1.87), mean interval (hours) to delivery (41 +/- 15) versus (15 +/- 4.5) (p = 0.0068) in favour of women allocated to dexamethasone. There were no significant differences in perinatal mortality or morbidity due to respiratory distress syndrome, need for ventilatory support, intracerebral hemorrhage, necrotizing enterocolitis and a five minute Apgar less than seven. The mean birthweight was significantly greater in the group allocated to dexamethasone (WMD 247.00, 95% CI 65.41 to 428.59). DEXAMETHASONE VERSUS BETAMETHASONE: There were no significant differences in all the maternal and perinatal mortality and in primary morbidity outcomes. Women randomised to dexamethasone fared significantly better for: oliguria, mean arterial pressure, mean increase in platelet count, mean increase in urinary output and liver enzyme elevations. REVIEWER'S CONCLUSIONS: There is insufficient evidence to determine whether adjunctive steroid use in HELLP syndrome decreases maternal and perinatal mortality, major maternal and perinatal morbidity.

Adrenal Cortex Hormones↗
PubMed2004

Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era.

In this clinico-anatomical study, factors potentially responsible for unsuccessful upper limb sympathectomy (ULS) by the thoracoscopic route were evaluated. This study comprised two subsets: 1) in the clinical subset, 25 patients (n = 50 sides) underwent bilateral second thoracic ganglionectomy for palmar hyperhidrosis, and factors predisposing to unsuccessful ULS were identified; and 2) in the anatomical subset, the neural connections of the first and second intercostal spaces were bilaterally dissected in 22 adult cadavers (22 right, 21 left; n = 43 sides). Alternate neural pathways (ANP) were noted in 9 of 50 sides in the 25 clinical cases (18%). In three asthenic patients (5 sides), fascia overlying the longus colli muscle mimicked the sympathetic chain. The right superior intercostal vein (SIV) was located anterior to the second thoracic ganglion in 6 of 50 sides (12%) and predisposed to troublesome bleeding in 2 of 50 cases; the SIV was posterior to the ganglion in 19 of 50 sides (38%), posing no technical problem. On the left, the SIV was noted outside the field of dissection in all but one case. A successful outcome to sympathectomy was noted in all 25 patients. A spectrum of sympathetic contributions to the first thoracic ventral ramus for the first intercostal space was noted in 37 of 43 anatomical cases (86%). These were categorized according to the arrangements of the intrathoracic ramus between the second intercostal nerve and the first thoracic ventral ramus. The cervicothoracic ganglion (37/43 cases; 86%) and an independent inferior cervical ganglion (6/43 cases; 14%) were always located above the second rib. The second thoracic ganglion was consistently located in the second intercostal space. This study demonstrates that ANPs have little clinical significance when a second thoracic ganglionectomy is undertaken. Technical failures may be avoided if the surgeon is mindful of anatomical variations at surgery.

Adult↗
PubMed2004

Perinatal tuberculosis and HIV-1: considerations for resource-limited settings.

Tuberculosis is the commonest HIV-1-related disease and the most frequent cause of mortality in young women in endemic regions. Tuberculosis and HIV-1 are independent risk factors for maternal mortality and adverse perinatal outcomes, and in combination have a greater impact on these parameters than their individual effects. In referral health centres in southern Africa around one-sixth of all maternal deaths are due to tuberculosis/HIV-1 coinfection. One-third (37%) of HIV-1-infected mothers with tuberculosis are severely immunocompromised, with CD4 counts of fewer than 200 cells/microL compared with 14-19% in mothers recruited into major mother-to-child intervention trials in Europe. Babies born to mothers with tuberculosis/HIV-1 also have higher rates of prematurity, low birthweight, and intrauterine growth restriction. Transmission rates of HIV-1 from mother to infant are around 25-45% in resource-limited settings, while that for mother-to-child-transmission of tuberculosis is 15% within 3 weeks of birth. We highlight this emergent problem, and discuss the dilemmas associated with diagnosis and management of pregnant HIV-1-infected mothers with tuberculosis, and their newborn babies.

Africa, Southern↗
PubMed2004

Imaging techniques to identify morbidly adherent placenta praevia: a prospective study.

The objective of this study was to assess the sensitivity and specificity of Gray scale ultrasonography, magnetic resonance (MRI) and colour flow Doppler imaging in the diagnosis of morbidly adherent placenta praevia. We collected prospectively 30 cases of placenta praevia diagnosed by Gray scale ultrasound, colour flow Doppler and MRI. Delivery by elective caesarean section was carried out at the 38th week, before the onset of labour, unless obstetric complications supervened. Data regarding maternal outcome and newborn status were collected. Three patients had a morbid adherence of the placenta at delivery, two of whom required caesarean hysterectomy, and the other an internal iliac artery ligation. One patient was delivered at 33 weeks' gestation due to uncontrollable bleeding and the remainder were delivered at 38 weeks. All mothers and infants were well at the time of discharge. Colour flow Doppler was shown to be more specific in the diagnosis of the morbidly adherent placenta praevia than MRI. Doppler had a negative predictive value of 95%.

Adult↗
PubMed2004

Medical management of uterine fibroids with medroxyprogesterone acetate (Depo Provera): a pilot study.

The aim of this study was to determine the effectiveness of medroxyprogesterone acetate (Depo Provera) in the treatment of menorrhagia attributed to uterine fibroids and to determine whether it reduces fibroid volume. Twenty premenopausal women with menorrhagia attributed to uterine fibroids received Depo Provera (150 mg/month) for 6 months. Control of bleeding was assessed by menstrual diary, haematologic parameters (Hb) and uterine and fibroid size measured sonargraphically. Following a period of 6 months after the initiation of Depo Provera, 30% became amenorrhoeic, 70% noticed improvement in their bleeding pattern and 15% had an increase in their haemoglobin levels. The mean uterine and fibroid volume was also reduced by 48% and 33%, respectively. Medical therapy with Depo Provera with symptomatic fibroids causes significant improvement in bleeding pattern as well as a reduction in fibroid volume.

Adult↗
PubMed2004

S-nitrosothiol and S-nitrosoalbumin levels in pre-eclampsia plasma.

The aetiology of pre-eclampsia still eludes researchers. Recently, the development of laboratory techniques to measure the levels of serum nitrosothiols, compounds that appear to play a role in signal transduction and stress responses, could be the driving force in the search for the exact cause of pre-eclampsia. We attempted to verify a new technique of estimating the levels of S-nitrosothiols and S-nitrosoalbumin in pre-eclampsia. The laboratory technique used as described previously could not identify these compounds. None the less, these nitrosothiols and nitrosoalbumin may be involved in the aetiology of pre-eclampsia.

Adolescent↗