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Biomedical subjects

J Moodley

Publications and source records attributed to J Moodley.

At least 127 records · Page 7Linked to original sources
PubMed2000

Pre-eclampsia - a problem of primipaternity not primigravidity?

Recent reports suggest that the incidence of pre-eclampsia may be associated with a change in paternity and the duration of cohabitation. In this study, we undertook to confirm the association between the duration of cohabitation and pre-eclampsia by performing a case-control study. There was no significant difference between women with pre-eclampsia and their controls in respect to the duration of cohabitation.

Journal Article↗
PubMed2000

Apolipoprotein E polymorphism in South African Zulu women with preeclampsia.

OBJECTIVES: Apolipoprotein E may contribute to the hypertiglyceridemia and consequent endothelial dysfunction of preeclampsia. We carried out a study to determine whether the apolipoprotein E genotype plays any role as a risk factor for preeclampsia in a black South African population with a high incidence of preeclampsia. DESIGN: A descriptive, prospective study design was used. SETTING: King Edward VIII Hospital, a tertiary care, referral academic hospital in Durban, South Africa. PATIENTS AND PARTICIPANTS: One hundred three South African Zulu women with preeclampsia and 110 healthy normotensive women attending the antenatal clinic were recruited. MAIN OUTCOME MEASURES: The relationship between the apolipoprotein E allele and genotype frequencies to preeclampsia as well as adverse perinatal outcome. RESULTS: The frequencies of varepsilon2 and varepsilon4 alleles (0. 19 and 0.25, respectively) were much higher than those reported in other population groups. However, there was no significant difference in the apolipoprotein E genotype and allele frequencies between the study and the control groups. The varepsilon2/2 genotype was associated with increased risk of perinatal death (p = 0.047). CONCLUSION: The study suggests that, despite the high incidence of both preeclampsia and the varepsilon2 and varepsilon4 alleles in South African Zulu women, apolipoprotein E genotype does not appear to be a risk factor for preeclampsia in this population.

Adolescent↗
PubMed2000

Intensive care unit morbidity and mortality from eclampsia: an evaluation of the Acute Physiology and Chronic Health Evaluation II score and the Glasgow Coma Scale score.

OBJECTIVE: To determine the maternal morbidity and mortality in patients with eclampsia admitted to an intensive care unit (ICU), and to establish the efficacy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the organ system failure score as defined by Knaus, and the Glasgow Coma Scale (GCS) score in predicting outcome. DESIGN: Retrospective analysis of a 3.5-yr period. SETTING: Surgical ICU in a university hospital. PATIENTS: A total of 105 patients who were admitted with a diagnosis of eclampsia were studied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The data captured included the reason for admission, maternal age, gestational age, parity, number of seizures, duration of ICU stay, anticonvulsant therapy, drug therapy, GCS score, APACHE II score, and the occurrence of organ failure. Of the 126 patients with eclampsia who were admitted to the ICU, records of 105 patients (83%) were found. The overall mortality was 10.5% (n = 11). The mean age, gestation, parity, number of preadmission seizures, and duration of stay were similar in survivors and nonsurvivors. Although the APACHE II score was significantly higher in nonsurvivors, multiple logistic regression analysis suggested that the goodness-of-fit scores for GCS and APACHE II were similar (38.29 vs. 38.01). The GCS scores of survivors were significantly higher than those of nonsurvivors (10.61 vs. 5.0; p<.001). Respiratory failure was the most common organ failure in both groups. The mean number of organ failures was higher in nonsurvivors compared with survivors (2.9 vs. 1.3; p<.001). An occurrence of more than two organ failures that persisted for >48 hrs was invariably associated with a fatal outcome. Anticonvulsant therapy consisted of magnesium sulfate or phenytoin and a midazolam infusion. Only one patient (0.9%) had a seizure, and this occurred en route to the ICU. No seizures occurred after admission to the ICU. CONCLUSIONS: The organ system failure score and the GCS score are good predictors of outcome in eclampsia. Apart from the GCS score, other variables in the APACHE II score are not valuable for outcome prediction. The low GCS score in nonsurvivors suggests that closer attention to the neurologic management may be beneficial. A prospective study is indicated to validate these findings.

APACHE↗
PubMed2000

Mitral stenosis in pregnancy: a four-year experience at King Edward VIII Hospital, Durban, South Africa.

OBJECTIVE: To evaluate prospectively mitral stenosis in pregnancy with emphasis on women with persistent symptoms. SETTING: King Edward VIII Hospital, a tertiary referral obstetric unit. PARTICIPANTS: One hundred and twenty-eight consecutive women with mitral stenosis. DEMOGRAPHICS: The mean age was 27 years and 38 women (30%) were primigravidae. Seventy-eight (61%) women had their first cardiac evaluation in the third trimester. Fifty-four women (42%) of these women had mitral stenosis diagnosed for the first time in the index pregnancy. Twenty-nine (23%) had a previous mitral valvulotomy. Nineteen women (15%) developed hypertension during pregnancy, 10 of whom had pre-eclampsia. Sixty-three women (49%) had a mitral valve area of < or = 1.2 cm2 with 11 having critical mitral stenosis (mitral valve area < or = 0.8 cm2). Atrial fibrillation was present in 12 women. Most women (87%) required medical therapy to control the heart rate. OUTCOME IN PERSISTENT SYMPTOMATIC WOMEN: Intervention was considered in 37 women (29%) who remained symptomatic, 11 (9%) of whom had a calcified mitral valve. The remaining 26 women were scheduled for balloon mitral valvulotomy during pregnancy, 20 of whom had balloon mitral valvulotomy with good effect (16 antepartum; 4 postpartum). In seven women, scheduled balloon mitral valvulotomy was not performed because of advanced preterm labour (n = 5), fetal distress (n = 1) and preterm labour with fetal distress (n = 1). These seven, together with the 11 with calcific mitral stenosis, were managed conservatively with good outcome. MATERNAL COMPLICATIONS: Fifty-one percent had maternal complications, the majority occurring at their initial admission to hospital. Pulmonary oedema was the most frequent. Multiple logistic regression analysis showed that the severity of stenosis assessed by measurement of the mitral valve area by echo-Doppler was the most powerful predictor of maternal pulmonary oedema. The other factors were late antenatal presentation, presence of symptoms prior to the index pregnancy and diagnosis of cardiac disease for the first time in the index pregnancy. CONCLUSION: Despite serious disease, women with persistent symptoms treated either by balloon mitral valvulotomy where feasible, or conservatively with close noninvasive monitoring, had a satisfactory fetal and maternal outcome.

Adolescent↗
PubMed2000

The p53 codon 72 polymorphism in black South African women and the risk of cervical cancer.

The p53 codon 72 genotype was examined in blood samples taken from 121 Zulu-speaking black South African women with histologically proven squamous carcinoma of the cervix. Freshly biopsied tumour tissue was also available for human papillomavirus subtyping from 100 of these women. A control group consisted of 251 healthy race-matched women attending a contraceptive service facility. The results show that there were no statistically significant differences in the frequency of the homozygous arginine genotype between patients with cancer of cervix, irrespective of human papillomavirus status, and healthy controls. This finding suggests that the arginine allele does not predispose towards viral tumour genesis in this population, and supports the findings of research done in other ethnic groups.

Alleles↗
PubMed2000

Tissue kallikrein activity in pregnancy.

To determine tissue kallikrein (TK) activity in black African women with hypertensive disorders of pregnancy; 140 women were recruited and divided into the following groups: group A--35 preeclamptic women, group B--35 mild to moderate hypertensive pregnant women and group C--35 normotensive pregnant women, and group D--35 normotensive non-pregnant healthy women. The activity of tissue kallikrein was determined from a random untimed urine sample using a selective, synthetic chromogenic tripeptide substrate having the sequence H-D-Val-Leu-Arg-pNA (S-2266). Urinary sodium and potassium levels was determined by flame photometry. Tissue kallikrein activity was decreased in women with preeclampsia (1.54 +/- 0.95 vs 3.05 +/- 0.83 ngTK/microg protein; p < 0.0001) and mild to moderate hypertensive group (2.03 +/- 0.76 vs 3.05 +/- 0.83 ngTK/microg protein; p < 0.0001) compared with normotensive pregnant women. There was also a significant difference in tissue kallikrein activity between the pregnancy groups (1.54 +/- 0.95 vs 2.03 +/- 0.76 ngTK/microg protein; p < 0.001). No difference in tissue kallikrein activity was observed between normotensive pregnant and normotensive non-pregnant healthy women (3.05 +/- 0.83 vs 3.14 +/- 0.88 ngTK/microg protein; p = 0.51). There was no difference in the excretion of urinary sodium and potassium in pregnancy groups compared to normotensive pregnant group. Tissue kallikrein activity is decreased in hypertensive disorders of pregnancy.

Adult↗
PubMed2000

How do South African obstetricians manage hypertensive disorders of pregnancy--a survey.

OBJECTIVE: To determine the current management of hypertensive disorders of pregnancy in South Africa. METHOD: A postal questionnaire was sent to 600 South African obstetricians. RESULTS: The response rate was 72% (432/600), with 425 questionnaires suitable for analysis. South African obstetricians disagree on the definitions of various hypertensive disorders of pregnancy. Methyldopa was the antihypertensive used most frequently for the treatment of mild to moderate hypertension (diastolic blood pressure between 90 and 109 mmHg), while intravenous dihydralazine was preferred in severe hypertension (diastolic blood pressure > or = 110 mmHg and proteinuria > or = +2). To stop convulsions in eclampsia, 256 respondents (60%) said they would use diazepam, 28 (11%) said they would continue with a diazepam infusion, and the remaining 228 (89%) preferred magnesium sulphate (MgSO4) to prevent further convulsions. The intramuscular route was the preferred method of administration for MgSO4. In cases of eclampsia, 273 respondents (64%) said they would use intravenous dihydralazine to lower high blood pressure (> or = 160/110 mmHg) and proteinuria; 98 respondents (23%) said they would use methyldopa, 38 (9%) nifedipine, and 8 (2%) apresoline. Eight (2%) said they would not use antihypertensives. In patients with severe pre-eclampsia and impending eclampsia, 330 respondents (78%) said they would use MgSO4 as prophylaxis, 46 (11%) diazepam, and 6 (1.4%) phenobarbitone. Forty-three of the respondents did not prescribe prophylactic anticonvulsant therapy. To prevent pre-eclampsia, 247 of the respondents (58%) said they would prescribe low-dose aspirin. CONCLUSION: This study demonstrates that South African obstetricians show great uniformity in terms of the treatment of hypertensive disorders of pregnancy.

Anticonvulsants↗
PubMed2000

Relationship between histopathological changes in post partum renal biopsies and renal function tests of African women with early onset pre-eclampsia.

BACKGROUND: To improve the diagnostic accuracy of concurrent renal disease in hypertension of pregnancy, biopsy evaluation is essential. In addition, establishing underlying renal disease is important for prognosis on future pregnancies. We therefore designed a study to determine the diagnostic yield of postpartum renal biopsy and the nature and frequency of complications associated with this procedure. Also, to determine relationships, if any, between renal function tests and ultrastructural and histopathological findings. METHODS: Fifty renal biopsies were performed in the immediate postpartum period in black African women with early onset pre-eclampsia. Each biopsy specimen was placed in a separate container and coded so that sampling was unknown to the electron microscopist. Each biopsy specimen was divided into three parts, and processed and stained for light, fluorescent and transmission electron microscopy using conventional techniques. RESULTS: Renal tissue biopsies were adequate for diagnostic purposes in all cases. There were no complications in any of the 50 patients studied. Ultrastructural examination confirmed the light microscopy findings. In addition the ultrastructural findings showed intramembranous deposits, foot process fusion and mesangial deposits. In 16 patients with normal renal function tests; the biopsies evaluation from these patients showed ultrastructural changes. In the remaining 34 patients with abnormal renal function tests of varying severity; biopsy evaluation from these patients showed both ultrastructural and histopathological changes. CONCLUSION: Renal biopsy procedure is safe, and ultrastructural and histological findings obtained from postpartum renal biopsies are more informative than the routine renal function tests.

Adolescent↗
PubMed2000

Passive ileal segment urinary diversion in advanced cervical carcinoma--a retrospective review.

OBJECTIVES: Urinary diversion is a clinical management option that gynaecological oncologists often use for urinary fistulas associated with cervical cancer. We retrospectively reviewed the indications and postoperative morbidity and mortality associated with this procedure. METHODOLOGY: The case records of all patients with cervical carcinoma undergoing a passive ileal segment urinary diversion at King Edward VIII Hospital in Durban between 1 January 1991 and 31 December 1995 were reviewed retrospectively. The patient profile, indication for the operation and postoperative morbidity and mortality were noted. RESULTS: Sixty-five patients were entered into the study. Thirty-two patients (49%) had untreated advanced cervical carcinoma, 12 (19%) had had prior palliative irradiation for cervical carcinoma and 21 (32%) had received prior radical radiotherapy for cervical carcinoma. Fifty per cent of patients experienced significant postoperative morbidity. This was especially high in those patients who had received prior radical radiotherapy (67%). Twelve patients (19%) died before discharge. Six (50%) of those who had received prior radical radiotherapy died following the procedure. Advanced age (more than 65 years), previous radical radiotherapy, extrapelvic metastatic carcinoma and re-laparotomy for complications of the procedure were significant risk factors for postoperative mortality in our study. CONCLUSION: Careful patient selection, the use of bowel free of radiation injury, supportive management of postoperative complications and the establishment of a specific unit of trained staff are essential in order to ensure a successful outcome in patients undergoing this procedure.

Adult↗
PubMed2000

Drainage at caesarean section--a randomised prospective study.

OBJECTIVE: To determine the efficacy of wound drainage at caesarean section with a view to reducing postoperative wound morbidity. SETTING: King Edward VIII Hospital, Durban, South Africa. METHOD: Four hundred and forty women undergoing emergency caesarean section using the transverse suprapubic incision were randomised to receive either drainage or non-drainage of the wound. Wound drains were removed 48 hours after surgery and patients were seen daily until the time of discharge from hospital. Wound inflammation, wound infection and duration of hospital stay were assessed in both groups. RESULTS: Seventy-two of the 440 patients (16.4%) developed wound morbidity ranging from induration, serous, sanguinous and purulent discharge to haematoma formation and wound dehiscence. Of the 217 patients who received drains, 37 showed evidence of wound morbidity (17.1%), as opposed to 35 of the 223 who were not drained (15.7%) (P = 0.701). CONCLUSIONS: No significant advantages could be demonstrated for routine drainage in terms of wound inflammation, wound infection, haematoma formation or duration of hospital stay.

Adult↗
PubMed1999

Congenital absence of the gall bladder.

Congenital absence of the gall bladder is an extremely rare embryological aberration with a reported incidence ranging between 0.013 and 0.075%. This report, the first from South Africa, discusses 2 cases of gall bladder agenesis, bringing to 413 the number of cases reported in the literature. In confirming the diagnosis of an agenesis of the gall bladder, it is necessary to exclude the abnormal locations which are intrahepatic, retrohepatic, on the left side, or within the lesser omentum or falciform ligament and retroperitoneal. Patients with gall bladder agenesis are classified into 3 categories: i) Multiple foetal anomaly (12.9%), ii) Asymptomatic (31.6%) and iii) Symptomatic (55.6%). Notwithstanding current diagnostic modalities, this rare condition may still present a dilemma to the abdominal surgeon. Agenesis of the gall bladder is a well-recognised but uncommon congenital abnormality. With the advent of minimal access surgery laparotomy may be avoided as the condition, when suspected, may be confirmed by ERCP and CT scan.

Adult↗