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Biomedical subjects

J Moodley

Publications and source records attributed to J Moodley.

At least 163 records · Page 9Linked to original sources
PubMed1998

Amoebic liver abscess in pregnancy: report of two cases.

Amoebic liver abscess is a rare complication of pregnancy. It however, carries significant morbidity and because the diagnosis is often delayed, physicians in developing countries need to be reminded of its possibility when patients present with right lower chest and abdominal pain. This study presents the clinical reports of two cases in which the diagnosis was delayed and review the literature on amoebic liver abscess in pregnancy.

Abdominal Pain↗
PubMed1998

Resympathectomy for sympathetic regeneration.

Explanations for recurrent sympathetic activity after an apparently successful sympathectomy are varied and often tenuous. Among the theories given for recurrent sympathetic activity are the development of alternate neuroanatomic pathways, the possibility of an incomplete operation (failure to appreciate an alternative anatomic pathway at the time of surgery, i.e., nerve of Kuntz), and sympathetic regeneration. The latter, although long suspected, has never been conclusively demonstrated in humans. In this report, a case of recurrent sympathetic activity with conclusive evidence of sympathetic regeneration is described.

Adult↗
PubMed1998

Perinatal outcome of babies born to black South African women with hypertension.

BACKGROUND: Perinatal mortality rates (PMR) associated with hypertension are known to be high but there have been isolated reports that primigravidae who develop hypertension late in pregnancy have a better PMR than normotensive gravid women. OBJECTIVE: To verify this report and compare the perinatal outcome in differing categories of hypertensive disorders of pregnancy. DESIGN: Maternal and neonatal data were recorded for all hypertensive patients admitted to King Edward VIII Hospital over a six month period from January to June 1995. In addition, similar data from normotensive women matched for age, parity and gestational age were also recorded. The latter formed the control group. RESULTS: Three hundred and thirty seven women were entered into the study. Group A consisted of 189 patients with hypertension, while group B consisted of 148 normotensive pregnant women. There were no significant differences between the groups in relation to maternal age and parity. More women in the hypertensive group had Caesarean sections than in the control group (study group 115 versus control 35: p = 0.001). The perinatal outcome (SBs + NNDs) was significantly greater in the control group than in the hypertensive group (p = 0.031). More importantly, the number of perinatal deaths in the aproteinuric group was significantly different from the control group (aproteinuric group = 2; control group = 26, p = 0.007). Furthermore, the hypertensive group had greater foetal weights than the control groups (controls 1.65 kg versus 2.3 kg hypertensives: p = 0.0001). CONCLUSION: This study shows that babies born to hypertensive mothers have a significantly greater birthweight than a control group of normotensive women. Further, although there are no statistically significant differences in perinatal outcome between moderate and severe categories of hypertension and control patients, there were significantly fewer perinatal deaths in women with aproteinuric hypertension.

Adult↗
PubMed1997

Presence of intrinsic B lymphocyte tolerance in mixed but not in complete semiallogeneic bone marrow chimeras.

The existence of intrinsic B lymphocyte transplantation tolerance was investigated in murine semiallogeneic complete and mixed bone marrow chimeras. Complete chimeras (CC), which were obtained by infusing 20x10(6) C57BL/10 (P1) bone marrow (BM) cells into irradiated (10.5 Gy) (C57BL/10xBALB/c) F1 recipients, were repopulated for 100% with P1 lymphohematopoietic cells. In mixed chimeras (MC), which were obtained by injection of 15 x 10(6) P1 together with 5 x 10(6) F1 BM cells, between 15% and 40% of F1 lymphohematopoietic cells persisted after BM transplantation. Neither MC nor CC were able to develop significant T cell immunity (mixed lymphocyte reaction) or B cell immunity (IgG alloantibodies) against the mismatched host antigens (BALB/c), despite repetitive immunizations. However, after immunization with third-party cells (C3H), the IgG alloantibodies raised cross-reacted with the host-type (BALB/c) antigens in the CC but not in the MC. This suggested that intrinsic B lymphocyte tolerance for host antigens had occurred in MC but not in CC. This was further evidenced in transfer experiments using lethally irradiated C57BL/10 mice reconstituted with purified control C57BL/10 T lymphocytes together with purified C57BL/10 B lymphocytes isolated from CC or MC. Only the recipients reconstituted with B lymphocytes from CC, and not those from MC, produced anti-BALB/c IgG alloantibodies after immunization. These results show that intrinsic B lymphocyte tolerance can be achieved after transplantation and that this depends on the presence of lymphohemopoietic cells expressing the tolerogens.

Animals↗
PubMed1997

Changes in urinary tissue kallikrein excretion in black African women with hypertensive disorders of pregnancy.

The aim of this study was firstly to establish whether tissue kallikrein (TK) was involved in the aetiology of hypertensive disorders of pregnancy. Secondly, to assess whether tissue kallikrein:creatinine ratios may differentiate normotensive pregnant women from those with hypertensive disorders of pregnancy and have a predictive value. Random untimed urine samples were collected from all women (n = 264) recruited to this study. Urine specimens were analyzed for urinary tissue kallikrein using a selective, synthetic chromogenic tripeptide substrate (H-D-Val-Leu-Arg-pNA). Urinary creatinine levels were measured using standard methods. There was a significant difference in the excretion of urinary tissue kallikrein between normotensive pregnant women (2.91 ng TK/microgram protein) and women with mild (2.52 ng TK/microgram protein; p < 0.0001) and severe (1.53 ng TK/microgram protein; p < 0.0001) hypertension in pregnancy. No statistical difference was observed with regard to urinary tissue kallikrein excretion between normotensive pregnant and normotensive non-pregnant women (2.87 ng TK/microgram protein; p = 0.16). A positive correlation was observed between the diastolic blood pressure and urinary tissue kallikrein excretion in women with hypertensive disorders of pregnancy. When compared to the normotensive pregnant group, the urinary kallikrein:creatinine ratios were significantly lower in the mild (0.6 versus 0.3; p < 0.0001) and severe (0.6 versus 0.12; p < 0.0001) hypertensive groups. The urinary creatinine excretion was significantly higher in the mild (9.55 +/- 2.6 mmol/l; p < 0.0001) and in severe (15.62 +/- 5.48 mmol/l; p < 0.0001) hypertensives when compared to normotensive pregnant values (5.65 +/- 2.6 mmol/l). The reduced urinary tissue kallikrein excretion in hypertensive disorders of pregnancy may be a significant factor in the development of the hypertension in pregnancy. Measurement of urinary tissue kallikrein: creatinine ratios may represent a simple and practical predictive test to differentiate women with hypertensive disorders of pregnancy from normotensive pregnant women.

Adult↗
PubMed1997

Localisation of tissue kallikrein in the kidney of black African women with early onset pre-eclampsia: a pilot study.

Increased renal production of vasodilator mediators like kinins would counteract the vasospasm of pre-eclampsia. This study examines the cellular localisation of tissue kallikrein (TK), the potent kinin forming enzyme within the nephron of patients with early onset pre-eclampsia. Using the peroxidase-antiperoxidase immunoenzyme complex, TK was immunolocalised in the principal cells of the distal connecting tubule and the cortical collecting duct cells of the distal nephron of control tissue. Moderate reactivity was observed in the epithelial cells lining the Bowmans capsule. In early onset pre-eclampsia, TK was additionally localised in the proximal tubule cells, however, the intensity of reactivity was reduced when compared to that of the distal tubule cells. In patients with hypertension of pregnancy, the occurrence of TK in the proximal tubule suggests either gene induction or emiocytosis of TK.

Adolescent↗
PubMed1997

Drug management of hypertensive disorders of pregnancy.

Drugs used in the acute and long-term management of hypertension in pregnancy and the preeclampsia-eclampsia syndrome have been reviewed and their therapeutic effects and maternal and fetal adverse effects have been considered. The review also focuses on recent developments in the areas of prevention and management of pre-eclampsia-eclampsia syndrome. Although a number of new drugs have emerged, as potentially useful in the management of hypertension in pregnancy and pre-eclampsia-eclampsia syndrome, some remain at the cornerstone of therapy; for example, methyldopa for long-term treatment of chronic hypertension, hydralazine or nifedipine for rapid reduction of severely elevated blood pressure, and magnesium sulphate for eclampsia. Some of these agents, especially the calcium antagonists, show promise in that their use is associated with fewer side effects. Safety for the fetus, however, has not been adequately evaluated yet. Neither aspirin nor calcium supplements appear to improve the outcome in pregnancy. Currently, the dilemma whether to treat hypertension in pregnancy and pre-eclampsia-eclampsia syndrome with old, established, cost-effective drugs or the promising newer drugs provides an interesting academic challenge.

Adrenergic Antagonists↗
PubMed1997

Thromboelastography in abruptio placentae.

The purpose of this study was to document thromboelastographic (TEG) changes in abruptio placentae and to compare these results with that of conventional tests used to monitor coagulation. This was a prospective study of 30 patients with abruptio placentae. All coagulation investigations including the TEG were performed on admission, immediately following delivery, and after periods of 4 hours and 24 hours. Results showed that standard coagulation tests detected coagulation abnormalities except the platelet count returned to normal limits within 24 hours of delivery. There was strong correlation between fibrinogen levels and the TEG parameters, ma and k time (r=0.8). There was moderate correlation between platelet count and ma (r=0.6). In conclusion, minor abnormalities in the clotting profile are clinically unimportant. The TEG does not detect such minor abnormalities because of its inherent ability to test the coagulation cascade as a whole. Major abnormalities are clinically relevant and the TEG detect 75% of them. Further, the TEG establishes the diagnosis of hypercoagulability an early sign of disseminated intravascular coagulation. Although standard laboratory tests are still necessary to detect coagulation abnormalities on admission, the TEG is a useful test in large obstetric units where laboratory results are not immediately available for the purposes of monitoring and treating ongoing coagulation defects.

Journal Article↗
PubMed1997

Bacterial vaginosis and lower genital tract infections in women attending out-patient clinics at a tertiary institution serving a developing community.

The prevalence of bacterial vaginosis and other lower genital tract infections were determined in women from a developing community. Patients were recruited from four out-patient clinics of a large urban tertiary referral hospital serving the indigent Black population of KwaZulu/Natal, South Africa. A total of 208 women attending the sexually transmitted diseases (STD) (n = 51), colposcopy (n =50), family planning (n = 52) and antenatal (n = 55) clinics were investigated. Endocervical and vaginal specimens were collected for microbiological investigation of recognised sexually transmitted pathogens. Estimation of vaginal pH, amine test and wet smear microscopy were performed at the bedside. Peripheral venous blood was obtained for serological tests for syphilis, hepatitis B surface antigen and antibody to the human immunodeficiency virus (HIV). Vaginal infections were detected in a total of 50% (104) of women, endocervical infections alone in 9% (18) and concurrent vagino-endocervical infections in 20% (41). Bacterial vaginosis (BV) was diagnosed in 35% (73) and its prevalence amongst different clinic populations ranged from 25% to 41% with no significant differences between any groups. Trichomoniasis was detected significantly more often in women attending the STD and antenatal clinics. Endocervical infections were found mainly in women attending the STD clinic, though the prevalence of Chlamydia trachomatis amongst the other clinic attenders ranged from 13% to 20%. Micro-organisms such as Gardnerella vaginalis, Mycoplasma hominis, anaerobes and curved Gram-negative rods were found in significantly higher number of women with BV. This study confirms the high prevalence of vaginal, endocervical and mixed vagino-endocervical infections in women from developing communities. The high prevalence of bacterial vaginosis as a single infection and its association with other recognised sexually transmitted pathogens in a large proportion of women, is of significance since such infections not only predispose to ascending upper genital tract infections but are also associated with complications in pregnancy such as premature rupture of membranes, preterm labour and endometritis.

Journal Article↗
PubMed1997

The efficacy of phenytoin in eclampsia.

Although the Eclampsia Trial Collaborative Group reported that magnesium sulphate was more effective in preventing recurrent convulsions in eclampsia than phenytoin, confirmatory evidence that phenytoin is not useful as a prophylactic anticonvulsant agent in eclampsia is necessary. This prospective descriptive study enrolled 68 women with eclampsia. Recurrence of seizures occurred in 18 (26.5%) patients following phenytoin therapy. In 16 patients, the seizure recurrence occurred between the loading dose and first maintenance dose at 6 hours. There was no statistical difference in the clinical characteristics of those who had seizure recurrence compared with those that did not. Seizure recurrence following phenytoin therapy in eclampsia is unacceptably high. These results suggest that phenytoin is not effective as a prophylactic anticonvulsant in eclampsia. No conclusions about its effectiveness compared with alternative prophylactic anticonvulsants can be made from this descriptive study.

Journal Article↗
PubMed1997

Screening for proteinuria in hypertensive disorders of pregnancy.

One hundred and fifty patients were recruited to assess the reliability of a random urinary dipstick for protein compared with 24 hour urine analysis and to determine if a shorter interval of collection is reliable in screening for proteinuria in hypertensive disorders of pregnancy. These patients were instructed in the collection technique of a 24 hour urine sample. Aliquots were taken to represent 6 and 12 hour collections. The mean gestational age was 30 weeks and the mean diastolic blood pressure 95 mmHg. Of the patients, 84 had proteinuria and 66 had no proteinuria on random urinary dipstick analysis. The random urinary dipstick showed a sensitivity of 84%, and a specificity of 61%. The urinary dipstick of the hour 6 sample showed a sensitivity of 84.5%, and a specificity of 90.1%. Urine analysis of the 6 hour sample showed a sensitivity of 87.9% and a specificity of 80.4%. Analysis of the 12 hour sample yielded an accuracy of approximately 83%. The random urinary dipstick is unreliable in screening for proteinuria in hypertensive disorders of pregnancy. A 6 hour collection is much more accurate.

Journal Article↗
PubMed1997

Single photon emission and cerebral computerised tomographic scan and transcranial Doppler sonographic findings in eclampsia.

OBJECTIVE: To define more clearly the neuropathophysiology of eclampsia utilising single-photon emission computed tomography (SPECT), cerebral computerised tomography (CT) and transcranial Doppler (TCD) ultrasonography. DESIGN: A prospective study SETTING: The obstetric unit in King Edward VIII Hospital, a large tertiary referral centre in Kwa-Zulu Natal, South Africa. PARTICIPANTS: Sixty-five women with eclampsia. INTERVENTIONS: Imaging and ultrasonographic investigations were performed within 48 hours postpartum. Unenhanced cerebral CT scans were performed in all the women and SPECT scans were performed on 63 women using Technetium-99m-hexamethylpropyleneamineoxime (99mTc-HMPAO) as a tracer of regional cerebral blood flow. Middle cerebral artery blood flow velocity waveforms were measured using 2 MHz pulsed Doppler ultrasound via the transtemporal approach. MAIN OUTCOME MEASURES: Abnormalities in SPECT scan, CT scan and TCD ultrasound findings. RESULTS: SPECT scanning revealed perfusion deficits in the watershed areas in all women, 75% of whom had concomitant deficits in the parieto-occipital areas of the brain. Hypodensities (cerebral oedema) were reported in 38 CT scans (58.5%), with parieto-occipital involvement in 97.4% of cases. Increased flow velocity measurements in the middle and posterior cerebral arteries were recorded in 36 (85.7%) women in whom TCD ultrasound was performed. CONCLUSION: The pathophysiological mechanism of eclamptic seizures is primary cerebral vasospasm with resultant ischaemia and cerebral oedema involving mainly the watershed areas and parieto-occipital lobes of the brain. SPECT scanning has been shown to be superior to CT scanning and TCD ultrasonography in detecting neuropathophysiologic alterations in eclampsia. However, each of the three investigative tools provide its own unique information and all three are necessary research techniques to improve our understanding of the neuropathophysiological mechanism of eclamptic seizures.

Adolescent↗
PubMed1997

Correlation between histological changes and loss of anionic charge of the glomerular basement membrane in early-onset pre-eclampsia.

This study morphometrically evaluates the glomerular anionic charge and examines the renal pathology in African women with early-onset pre-eclampsia. Polyethyleneimine-labelled anionic sites were decreased within the glomerular basement membrane in the early-onset pre-eclampsia group as compared with the control group (p < or = 0.02). A strong correlation (r = -0.76) was obtained between the number of anionic sites and the severity of proteinuria. Renal biopsy specimens revealed the coexistence of decreased glomerular charge with pathology of glomerular basement membrane, endothelial cells, foot processes, and mesangial cell proliferation. The loss of glomerular charge induces structural alterations of the glomerular filtration barrier and may be the mechanism responsible for proteinuria in early-onset pre-eclampsia.

Anions↗