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Biomedical subjects

J Moodley

Publications and source records attributed to J Moodley.

At least 73 records · Page 4Linked to original sources
PubMed2003

Absence of Factor V Leiden, thrombomodulin and prothrombin gene variants in Black South African women with pre-eclampsia and eclampsia.

It has been suggested that gene aberrations may contribute to vascular endothelial dysfunction of pre-eclampsia in Caucasian and Japanese women. This study was undertaken to examine the association between pre-eclampsia in Black Zulu speaking South African women and the Factor 5 Leiden mutation. 100 patients with pre-eclampsia comprised the study group. The control group comprised 110 normotensive pregnant women of the same population group. Genotyping was performed to detect the G or A allele at residue 506 of the Factor V gene, and the C or T allele at residue 455 of the thrombomodulin gene. Our findings demonstrate that these particularly genetic loci are of little use in disease association studies for pre-eclampsia in homogenous Zulu speaking Africans.

Adolescent↗
PubMed2003

Saving mothers: 1999-2001.

The 'big five' causes of maternal death in South Africa in the 3 years 1999-2001 were non-pregnancy-related infection (mainly AIDS), complications of hypertension in pregnancy, obstetric haemorrhage, pregnancy-related sepsis and pre-existing medical conditions. Women 35 years and older were at greater risk of dying than younger women, and women in their first pregnancy or who had had 5 or more pregnancies were also at greater risk. Recommendations have been made by the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) that address the problems of avoidable factors. If implemented, these should result in a reduction of maternal deaths.

Adult↗
PubMed2003

Misoprostol for cervical ripening at and near term--a comparative study.

OBJECTIVE: To compare the safety and efficacy of misoprostol with that of dinoprostone for the induction of labour at term, or near term. DESIGN: Three hundred and ninety-six women with term pregnancies were randomised to receive either oral or vaginal misoprostol, or dinoprostone. Women who had had a previous caesarean section (CS) or those with a malpresentation or who were parity > or = 5, were excluded. The control group received dinoprostone 1 mg inserted in the posterior fornix and repeated 6-hourly to a maximum of three doses. The study group received either oral misoprostol 20 micrograms 2-hourly to a maximum of four doses (80 micrograms), or vaginal misoprostol 25 micrograms in the posterior fornix with a switch to the oral misoprostol regimen if there was no change in the Bishop's score or no palpable uterine contractions. RESULTS: There was no significant difference in vaginal delivery rate within 24 hours between the groups (58.1% v. 58%, p = 0.633). There were no significant differences in CS rates between the groups; however, more CSs were performed for fetal distress in the misoprostol group than in the dinoprostone group (28% v. 25%). There was a significantly higher incidence of hyperstimulation in the vaginal misoprostol group (21.4%) than in the other two groups (oral misoprostol 16.5%, dinoprostone 8.9%) (p = 0.004). The incidence of meconium staining of liquor was comparable between the groups. CONCLUSIONS: In selected women, the efficacy of misoprostol for the induction of labour at term is similar to that of dinoprostone but misoprostol is associated with a higher incidence of hyperstimulation.

Adult↗
PubMed2003

Domestic abuse--an antenatal survey at King Edward VIII Hospital, Durban.

OBJECTIVES: To determine exposure to domestic violence by a partner or spouse among pregnant women attending a public sector hospital in Durban, South Africa. DESIGN: Six hundred and four randomly chosen women from a low-income community were interviewed over a 6-month period using a standardised questionnaire. RESULTS: Thirty-eight per cent had experienced domestic violence at some point in their lives. Physical abuse (52%) was the most common, and 35% had been abused during the current pregnancy. CONCLUSION: Domestic violence is common in pregnancy among women attending a public sector hospital.

Domestic Violence↗
PubMed2003

Choriocarcinoma presenting with upper gastrointestinal bleeding and intussusception.

Choriocarcinomas are rare genital tract tumours, which can present with extragenital symptoms and signs. We report on an 18-year-old nulliparous woman presenting with jejunal choriocarcinoma. An outline of the diagnostic difficulties and different manifestations of extragenital choriocarcinoma is given. A high index of suspicion should be maintained and a multi-disciplinary approach is mandatory.

Adolescent↗
PubMed2003

Unsafe abortions in a developing country: has liberalisation of laws on abortions made a difference?

Unsafe abortion is still a major cause of maternal morbidity and mortality in Africa. To assess whether the introduction of legal abortions in South Africa has decreased admissions resulting from mid-trimester abortions, a prospective study of abortion cases admitted to the King Edward VIII Hospital, Durban, South Africa, over a four-month period was carried out. Two hundred and four women were admitted with incomplete abortion; 49% of which were spontaneous, 17% certainly induced, 10% probably induced, 18% possibly induced and 4.3% legally induced. A change in the laws on termination of pregnancy (TOP) has resulted in a decrease in cases of incomplete abortion being admitted to the gynaecological wards. However, illegal TOPs are still prevalent for a variety of reasons. There is need to place more emphasis on the delivery of efficient contraceptive services and reproductive health education for women.

Abortion, Legal↗
PubMed2002

Stage of the epidemic and viral phenotype should influence recommendations regarding mother-to-child transmission of HIV-1.

This article argues for a new approach to use of nevirapine in the prevention of vertical transmission of HIV-1. Existing antenatal surveillance should be strengthened to plan geographical allocation, and subsequent evaluation, of a "nevirapine plus" programme. As the epidemic evolves the programme should also and, ideally, care should be tailored to individual women. Underpinning this approach is evidence that a more virulent viral phenotype appears in many patients with advanced HIV-1 infection. This phenotype will become more common at the population level as the epidemic progresses. As efficacy of zidovudine correlates with viral phenotype, and use of the drug may alter phenotype, there is an urgent need for a replacement that is safe to use with nevirapine.

Anti-HIV Agents↗
PubMed2002

Appropriate neurological evaluation and multimodality magnetic resonance imaging in eclampsia.

HYPOTHESIS: Simultanagnosia is common in eclampsia and a visuospatial test may be the most appropriate method in assessing the degree and monitoring of neurological deficit. AIM: To determine a sensitive clinical test for the degree of neurological deficit in eclampsia and in monitoring neurological change. METHODS: Thirty women with eclampsia were evaluated by clinical neurological quantitative scales including the Canadian Neurological Scale, Glasgow Coma Scale, Mini-Mental State Examination, a validated Cookie Theft Picture Test (CTPT), magnetic resonance imaging (MRI) (T1/T2), diffusion weighted imaging (DWI) and magnetic resonance angiography (MRA). RESULTS: The CTPT, used to measure simultanagnosia, had a sensitivity of 100% (95% CI: 84.5-100), specificity of 33.3% (95% CI: 1.8-87.5) with positive predictive value of 93.1% (95% CI: 75.8-98.8) and negative predictive value of 100% (95% CI: 5.5-100). The degree of agreement between simultanagnosia as measured by CTPT and DWI was 93.3% (Kappa=0.474; P=0.001). Standard MRI compared with DWI had a sensitivity of 77.8% (95% CI: 57.3-90.6), specificity of 100% (95% CI: 31-100), positive predictive value of 100% (95% CI: 80.8-100) and negative predictive value of 33.3% (95% CI: 9-69.1). The degree of agreement between standard MRI and DWI was 90%, this was statistically significant (Kappa=0.412: P=0.001). CONCLUSIONS: The validated CTPT for simultanagnosia was abnormal in the majority (n=29; 96.7%) of eclamptic patients with other neurological scales normal. Standard MRI and DWI showed excellent correlation with this simple bedside clinimetric evaluation. The oedema in eclampsia is primarily of vasogenic origin.

Adolescent↗
PubMed2002

Leptin and pre-eclampsia in black African parturients.

OBJECTIVE: To measure serum concentrations of the hormone leptin during late pregnancy in Black African women with pre-eclampsia, healthy normotensive pregnant women as controls and healthy normotensive non-pregnant women; secondly, to explore the relationship between leptin and obesity. DESIGN: Observational, cross sectional study. SETTING: Antenatal clinics, antenatal wards, gynaecology out patient and family planning clinics of a tertiary hospital, Durban, South Africa. POPULATION: Pregnant and non-pregnant Black African women. METHOD: Serum leptin was measured by a homologous radio-immunoassay technique. Simple anthropometric parameters were used to explore the relationship between leptin and obesity. In each group, leptin levels were compared between obese (body mass index, BMI > or = 30 kg m(-2)) and lean women. MAIN OUTCOME MEASURES: Serum leptin concentrations, anthropometric parameters, mean blood pressures and proteinuria. RESULTS: There were 68 women with pre-eclampsia, 92 healthy normotensive pregnant women (controls) and 32 healthy normotensive non-pregnant women. Serum leptin levels were higher in pregnant compared with non-pregnant women [26.66 (1.96) and 25.89 (1.65) vs 17.97 (2.11) ng/mL, P = 0.02]. Weight and BMI showed the greatest correlation with leptin both in pregnant (r = 0.61 and r = 0.58, respectively) and non-pregnant women (r = 0.74 and 0.79, respectively). There was no significant difference in the mean concentrations of leptin between women with and those without pre-eclampsia [26.66 (1.96) vs 25.89 (1.65) ng/mL, respectively, P = 0.95]. CONCLUSION: Pregnancy is a hyperleptinaemic state. There is no difference in serum leptin levels between Black African women with pre-eclampsia and healthy normotensive pregnant women. Serum leptin concentration is largely determined by the degree of adiposity.

Adult↗
PubMed2002

Symphysiotomy and fetal destructive operations.

Symphysiotomy and fetal destructive operations - while rarely, if ever, performed in developed countries - are an option in developing nations of the world. Problems endemic to developing countries not infrequently predispose to patients arriving at health care facilities in a moribund state with neglected labour. The health care provider then has to decide on the options available to him to deliver the mother by the safest route without incurring morbidity and mortality. Under the circumstances, the outcome for the baby will depend on factors prevalent at the time. If the fetus is alive, then the choice is between a Caesarean section and symphysiotomy, and if the fetus has died, a destructive procedure is an option to abdominal-route delivery which carries considerable risk to the mother. The following review outlines the role of symphysiotomy and fetal destructive operations and their role in modern obstetrics.

Cesarean Section↗
PubMed2002

Antibodies to oxidised low-density lipoproteins and cardiolipin in pre-eclampsia and eclampsia.

The objective of this study was to test the hypothesis that autoantibodies to phospholipids and to oxidised low-density lipoprotein (ox-LDL) are increased in pre-eclamptic and eclamptic women compared with normal pregnancy. Serum concentrations of autoantibodies to ox-LDL and to cardiolipin were measured in 21 non-pregnant controls, 29 pregnant controls, 21 pre-eclamptic and six eclamptic women. Concentrations of IgG antibodies to ox-LDL and to cardiolipin were not significantly different in women with eclampsia as compared with the non-pregnant controls, pregnant controls and pre-eclampsia. Concentrations of IgM antibodies to cardiolipin were significantly lower in women with pre-eclampsia compared with non-pregnant controls and eclampsia. All three pregnant states differ markedly from the non-pregnant controls, of whom only 5% (1 of 21) had "high positive" IgG antibodies. These results suggest that ACAs rise as a result of the pregnant state rather than as a result of preeclampsia or eclampsia. According to these results, there is no evidence of increased production of serum autoantibodies against modified LDL in African women with pre-eclampsia, which may reflect reduced lipid peroxidation involving lipoproteins or no link at all. In addition, IgG and IgM anticardiolipin antibodies have no diagnostic value in preeclampsia and eclampsia.

Adolescent↗
PubMed2002

Induction or caesarean section for preterm pre-eclampsia?

Controversy continues over the mode of delivery in severe pre-eclampsia remote from term. The aim of this study was to assess prospectively the mode of delivery in severe pre-eclampsia remote from term. The clinical data of 108 women who presented consecutively with severe pre-eclampsia over a 1-year period was used for the study material. Sixty-eight (63%) patients were delivered by elective caesarean section and 40 (37%) underwent induction of labour. Twenty-six had a vaginal delivery following induction, the others (n = 14) had emergency caesarean section. No baby with a gestational age of < or = 27 weeks survived after delivery. Perinatal mortality was highest for the babies delivered following induction of labour (vaginal delivery vs. caesarean section after induction of labour, P = 0.0004; vaginal delivery vs. elective caesarean section, P = 0.002). Severe pre-eclampsia remote from term is associated with a high caesarean section rate. In this study, carried out in a developing country, elective caesarean section contributed to a better perinatal outcome than vaginal delivery or emergency caesarean section following induction of labour.

Adolescent↗
PubMed2002

Polymorphisms in various coagulation genes in black South African women with placental abruption.

This pilot study examined Factor V Leiden (R506Q), prothrombin (20210G-->A), thrombomodulin (A455V) and MTHFR (677C-->T) in 100 Zulu-speaking black South African women with placental abruption and 217 controls. The Factor V Leiden and prothrombin variant gene alleles were not detected in either patient or control groups. The thrombomodulin polymorphic variant was not seen in the patient group but three heterozygotes (1%) were found in the controls. No homozygotes for the MTHFR T677 variant were detected in the patients but two (1%) were noted in the controls; the normal and heterozygote genotype and allele frequencies for this polymorphism were similar in the two groups.

Abruptio Placentae↗