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Biomedical subjects

K Mahomed

Publications and source records attributed to K Mahomed.

At least 37 records · Page 2Linked to original sources
PubMed2000

Leukocyte selenium, zinc, and copper concentrations in preeclamptic and normotensive pregnant women.

Preeclampsia is an important cause of maternal and perinatal mortality worldwide. The etiology of this relatively common medical complication of pregnancy, however, remains unknown. We studied the relationship between maternal leukocyte selenium, zinc, and copper concentrations and the risk of preeclampsia in a large hospital-based case-control study. One hundred seventy-one women with proteinuric pregnancy-induced hypertension (with or without seizures) comprised the case group. Controls were 184 normotensive pregnant women. Leukocytes were separated from blood samples collected during the patients' postpartum labor and delivery admission. Leukocyte concentrations for the three cations were measured by inductively coupled plasma-mass spectrometry (ICP-MS). Concentrations for each cation were reported as micrograms per gram of total protein. Women with preeclampsia had significantly higher median leukocyte selenium concentrations than normotensive controls (3.23 vs 2.80 microg/g total protein, p < 0.0001). Median leukocyte zinc concentrations were 31% higher in preeclamptics as compared with controls (179.15 vs 136.44 microg/g total protein, p < 0.0001). Although median leukocyte copper concentrations were slightly higher for cases than controls, this difference did not reach statistical significance (17.72 vs 17.00 microg/g total protein, p = 0.468). There was evidence of a linear increase in risk of preeclampsia with increasing concentrations of selenium and zinc. The relative risk for preeclampsia was 3.38 (adjusted odds ratio [OR] = 3.38, 95% confidence interval [CI] = 1.53-7.54) among women in the highest quartile of the control selenium distribution compared with women in the lowest quartile. The corresponding relative risk and 95% CI for preeclampsia was 5.30 (2.45-11.44) for women in the highest quartile of the control zinc distribution compared with women in the lowest quartile. There was no clear pattern of a linear trend in risk with increasing concentration of leukocyte copper concentrations (adjusted for linear trend in risk = 0.299). Our results are consistent with some previous reports. Prospective studies are needed to determine whether observed alterations in selenium and zinc concentrations precede preeclampsia or whether the differences may be attributed to preeclampsia-related alterations in maternal and fetal-placental trace metal metabolism.

Adult↗
PubMed1999

Plasma homocyst(e)ine concentrations in eclamptic and preeclamptic African women postpartum.

OBJECTIVE: To examine the relationship between plasma homocyst(e)ine and risk of eclampsia and preeclampsia among sub-Saharan African women who delivered at Harare Maternity Hospital in Zimbabwe. METHODS: We ran a hospital-based, case-control study at Harare Maternity Hospital, University of Zimbabwe, Harare, Zimbabwe comprising 33 pregnant women with eclampsia and 138 with preeclampsia. Controls were 185 normotensive pregnant women. Plasma was collected postpartum and homocyst(e)ine levels were measured by high-performance liquid chromatography and electrochemical detection. RESULTS: Women with eclampsia or preeclampsia had significantly higher mean homocyst(e)ine levels than normotensive controls (12.54 or 12.77 micromol/L versus 9.93 micromol/L, respectively, P<.001). The odds ratio (OR) for eclampsia was 6.03 among women in the highest quartile of the control homocyst(e)ine distribution (median 13.9 micromol/L) compared with women in the lowest quartile (median 6.2 micromol/L). The corresponding OR for preeclampsia was 4.57. Nulliparas with elevated homocyst(e)ine had a 12.90 times higher risk of preeclampsia compared with multiparas without elevated homocyst(e)ine. CONCLUSION: Postpartum plasma homocyst(e)ine concentrations are higher among Zimbabwean women with eclampsia and preeclampsia compared with normotensive women.

Adolescent↗
PubMed1999

Insulin secretion, clearance and sensitivity in black pregnant and non-pregnant women in Harare, Zimbabwe.

OBJECTIVE: To assess whether reported gestational differences in glucose tolerance in Caucasian and Black women could be due to alterations in insulin secretion, clearance or sensitivity. DESIGN: Cross sectional survey. SETTING: Antenatal Clinic, Harare; Department of Medical Laboratory Sciences, University of Zimbabwe. SUBJECTS: 90 healthy women in all the trimesters of pregnancy and 30 healthy non-pregnant women of reproductive age. MAIN OUTCOME MEASURES: Fasting (basal) plasma insulin, C-peptide and glucose concentration. Fasting plasma C-peptide, C-peptide to insulin ratio and glucose to insulin ratio were used as indices of insulin secretion, hepatic insulin clearance and insulin sensitivity respectively. RESULTS: Not all means of the fasting plasma glucose levels amongst the four groups of women were equal (p < 0.001), with all possible comparisons being significant except for the first and second trimester groups. Among the comparisons of the means of the glucose:insulin ratio in the four groups of women, only the means of the first and second trimester women differed (mean difference = 0.23, honestly significance difference = 0.20). All groups were comparable in the means of plasma insulin, C-peptide levels and the C-peptide:insulin ratio. CONCLUSION: Since fasting plasma insulin, C-peptide and C-peptide:insulin ratio were not significantly altered in all trimesters of pregnancy, these data suggest normal basal insulin secretion and clearance during gestation in these sub-Saharan African women.

Analysis of Variance↗
PubMed1999

Hepatitis B virus infection among pregnant women delivering at Harare Maternity Hospital, Harare Zimbabwe, 1996 to 1997.

OBJECTIVE: To determine the prevalence of hepatitis B virus (HBV) carrier and infectivity status among pregnant women delivering at Harare Maternity Hospital. DESIGN: A serological survey study of pregnant women admitted for labour and delivery. SETTING: Harare Maternity Hospital, Harare, Zimbabwe between June 1996 and June 1997. SUBJECTS: A random sample of 1,000 women, delivering at the hospital during the study period agreed to participate in the study. Serum samples were available for 984 women. MAIN OUTCOME MEASURES: HBV carriage status was determined by the presence of hepatitis B surface antigen (HBsAg) by enzyme immunoassay (EIA). Maternal HBV infectivity status was determined by testing all HBsAg positive women for the presence of hepatitis e surface antigen (HBeAg) using EIA. RESULTS: Overall 246 (25%) women were identified as carriers of HBV (95% confidence interval 22 to 28%). The frequency of HBV carriers did not vary with maternal age, parity or marital status. Only a positive prior history of spontaneous abortion was associated with an increased prevalence of HBV carriage status. Eight of the 246 (3.3%) women identified as HBV carriers tested positive for HBeAg. Hence, 0.8% of the entire study population was found to be at high risk of transmitting HBV to their newborns. CONCLUSIONS: Our results demonstrate a high prevalence of HBV carriage among women giving birth at Harare Maternity Hospital. None of the demographic variables studied were important predictors of HBV carriage status. The high carriage rate and low infectivity rates suggest that HBV infection is likely to be acquired by horizontal, rather than by vertical means of transmission. Given the scarcity of financial resources, routine testing of mothers for HBsAg may not be feasible. Our results suggest, however, that mass vaccination of all infants, irrespective of maternal HBV carriage status, may be the most effective approach to HBV prevention and control in Zimbabwe.

Adult↗
PubMed1999

Hypertension in pregnancy--1.

This review is aimed at clinicians working in a country like Zimbabwe, with limited health care resources. The management of the condition includes early detection, control of blood pressure, monitoring for maternal and foetal complications with timely delivery by the most appropriate route.

Causality↗
PubMed1999

Hypertension in pregnancy--2--eclampsia.

Eclampsia is a grand mal convulsion associated with pregnancy-induced hypertension. It is caused by cerebral hypoxia from intense vasospasm combined with cerebral oedema. CT scans show cerebral ischaemia from thrombosis and oedema.

Anticonvulsants↗
PubMed1998

Plasma tumor necrosis factor-alpha soluble receptor p55 (sTNFp55) concentrations in eclamptic, preeclamptic and normotensive pregnant Zimbabwean women.

We sought to examine the relationship between excessive tumor necrosis factor-alpha (TNF-alpha) release (as measured by sTNFp55 plasma concentrations) and risk of eclampsia and preeclampsia, respectively, among sub-Saharan African women delivering at Harare Maternity Hospital, Zimbabwe. In total, 33 pregnant women with eclampsia, 138 women with preeclampsia and 185 normotensive women were included in a case-control study conducted during the period, June 1995 through April 1996. Postpartum plasma sTNFp55 was measured by enzyme linked immunosorbent assay. Women with eclampsia had significantly higher sTNFp55 than normotensive controls (1.87 vs 1.35 ng/ml, P<0.001). Similarly, women with preeclampsia had sTNFp55 concentrations higher than normotensive controls (1.69 vs 1.35 ng/ml, P < 0.001). The odds ratio for eclampsia was 5.00 (adjusted odds ratio (OR) 5.00, 95% confidence interval (CI) 1.20-20.92) among women in the highest quartile of the control sTNFp55 distribution compared with women in the lowest quartile. The corresponding odds ratio and 95% CI for preeclampsia was 2.37 (1.11-5.06). Postpartum plasma sTNFp55 concentrations are increased among Zimbabwean women with eclampsia and preeclampsia as compared with their normotensive counterparts. These findings are consistent with the hypothesized role of cytokines in mediating endothelial dysfunction and the pathogenesis of preeclampsia/eclampsia. Additional work is needed to identify modifiable risk factors for the excessive synthesis and release of TNF-alpha in pregnancy; and to assess whether measurements of sTNFp55 early in pregnancy may be used to identify women likely to benefit from anti-inflammatory therapy.

Antigens, CD↗
PubMed1998

Risk factors for pre-eclampsia among Zimbabwean women: maternal arm circumference and other anthropometric measures of obesity.

Maternal pre-pregnancy obesity is a risk factor for pre-eclampsia (proteinuric hypertension in pregnancy) among North American and European women. We studied the relationship between maternal obesity and risk of pre-eclampsia among Zimbabwean women. A case-control study was conducted at Harare Maternity Hospital, Harare, Zimbabwe, between June 1995 and April 1996. Study participants were 144 women with pre-eclampsia and 194 normotensive women serving as controls. Maternal weight, height and mid-arm circumference were measured and recorded during study participants' postpartum hospital admission. Maternal mid-arm circumference, considered to be relatively stable during pregnancy among women of developing countries, was used as the primary indicator of maternal pre-pregnancy obesity. Logistic regression procedures were used to estimate odds ratios and 95% confidence intervals. There were linear trends in risk of pre-eclampsia with increasing mid-arm circumference, increasing weight and increasing body mass index. After adjusting for potential confounding factors, women in the highest quintile for mid-arm circumference (28-39 cm) were 4.4 times more likely to have had their pregnancy complicated by pre-eclampsia than women in the lowest quintile (21-23 cm). Odds ratios of similar magnitude were observed for the other anthropometric measures. To our knowledge, this is the first study to demonstrate a positive association between maternal obesity and pre-eclampsia risk in a black African population. Biological mechanisms thought to explain this relatively consistent epidemiological finding include endothelial cell injury, possibly resulting from hyperlipidaemia.

Adult↗
PubMed1998

Risk factors for preeclampsia-eclampsia among Zimbabwean women: recurrence risk and familial tendency towards hypertension.

We sought to estimate the risk of recurrence of preeclampsia-eclampsia among Zimbabwean women. Additionally, we sought to assess the extent to which family history of pregnancy-induced or chronic hypertension was predicative of the risk of developing preeclampsia-eclampsia. This hospital based case-control study was conducted at Harare Maternity Hospital, Harare Zimbabwe during the period June 1995 to April 1996. Study participants were 200 women with preeclampsia or eclampsia and 200 normotensive pregnant women serving as controls. Logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Among multiparous women, a history of any pregnancy-induced hypertension was associated with a 10.5-fold increase in risk of preeclampsia-eclampsia in a subsequent pregnancy (95% CI 4.7-23.5). Women who reported that their mother or sisters experienced pregnancy-induced hypertension were found to be at an increased risk of preeclampsia-eclampsia (OR = 2.3 and 2.6, respectively). A 2.3-fold excess risk of preeclampsia-eclampsia was associated with paturients' maternal history of chronic hypertension (95% CI 1.3-3.6). The corresponding relative risk of preeclampsia-eclampsia for women reporting to have a sister with chronic hypertension was 2.6 (95% CI 1.2-5.3). Zimbabwean women, like North American and European women, are at increased risk for the recurrence of preeclampsia-eclampsia. Findings from our study and those of others suggest a possible genetic component involved in the multifactorial aetiology of preeclampsia-eclampsia. The information provided here should be useful to clinicians involved in the management of patients with a prior history or family history of hypertension.

Journal Article↗
PubMed1998

Mortality in the first 2 years among infants born to human immunodeficiency virus-infected women in Harare, Zimbabwe.

Transmission of human immunodeficiency virus (HIV) and mortality was studied among infants of infected women in Zimbabwe. Of 367 infants born to HIV-infected women, 72 (19.6%) died compared with 20 (5.4%) of 372 infants of uninfected women (P < .01). Infection by HIV DNA polymerase chain reaction among infants who survived >7 days and died within 2 years could be assessed in 87% (58/67) of infants of infected women and 83% (5/6) of infants of uninfected women; transmission occurred in 40 of 58 infants. Among 27 infected infants tested at birth, 19 (70%), 5 (19%), and 3 (11%) were apparently infected via in utero, intrapartum or early postpartum, and late postpartum transmission, respectively. The majority of HIV-infected infants who died in the first 2 years of life were likely to have acquired in utero infection.

Adult↗
PubMed1998

The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 1. South Africa.

OBJECTIVE: To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labout. DESIGN: Multicentre randomised controlled trial. SETTING: Four urban academic hospitals in South Africa. Obstetric surveillance included the use of electronic fetal heart rate monitoring in most cases. PARTICIPANTS: Women in labour at term with moderate or thick meconium staining of the amniotic fluid. INTERVENTIONS: Transcervical amnioinfusion of 800 mL saline at 15 mL per minute, followed by a maintenance infusion at 3 mL per minute. The control group received routine care. Blinding of the intervention was not possible. MAIN OUTCOME MEASURES: Caesarean section, meconium aspiration syndrome and perinatal mortality. RESULTS: Caesarean section rates were similar (amnioinfusion group 70/167 vs control group 68/159; RR 0.98, 95% CI 0.76-1.26). The incidence of meconium aspiration syndrome was lower than expected on the basis of previous studies (4/162 vs 6/163; RR 0.67, 95% CI 0.19-2.33). There were no perinatal deaths. There were no significant differences between any of the subsidiary outcomes. CONCLUSIONS: This study concurred with three previous trials which found no effect of amnioinfusion for meconium-stained amniotic fluid on caesarean section rate, though the pooled data from all identified trials to date show a significant reduction. The findings with respect to meconium aspiration syndrome were inconclusive in this study alone because of the small number of babies affected, but the point estimate of the relative risk was consistent with the finding of a significant reduction in previous studies and with the Zimbabwe arm (CRAMP 2) of this study. Pooled data clearly support the use of amnioinfusion for meconium stained amniotic fluid to reduce the incidence of meconium aspiration syndrome.

Amnion↗
PubMed1998

The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 2. Zimbabwe.

OBJECTIVE: To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour. DESIGN: Multicentre randomised controlled trial. SETTING: A large urban academic hospital. Electronic fetal heart rate monitoring was not used. PARTICIPANTS: Women in labour at term with moderate or thick meconium staining of the amniotic fluid. INTERVENTIONS: Transcervical amnioinfusion of 500 mL saline over 30 minutes, then 500 mL at 30 drops per minute. The control group received routine care. Blinding of the intervention was not possible. MAIN OUTCOME MEASURES: Caesarean section, meconium aspiration syndrome and perinatal mortality. RESULTS: There was no difference in risk for caesarean section in the two groups (amnioinfusion 9.5% vs control 12.3%; RR 0.84, 95% CI 0.53-1.32). Meconium aspiration syndrome was significantly less frequent in the amnioinfusion group (3.1% vs 12.8%; RR 0.24, 95% CI 0.12-0.48), and there was a trend towards fewer perinatal deaths (1.2% vs 3.6%; RR 0.34, 95% CI 0.11-1.06). CONCLUSIONS: Amnioinfusion is technically feasible in a developing country situation with limited intrapartum facilities. In this study amnioinfusion for meconium stained amniotic fluid was associated with striking improvements in perinatal outcome.

Abnormalities, Multiple↗
PubMed1998

PVC bags considerably reduce availability of diazepam.

OBJECTIVE: To examine the role of Polyvinyl Chloride (PVC) bags and different infusing solutions commonly used, on the availability of diazepam. DESIGN: A descriptive study--diazepam was mixed into PVC bags and glass containers containing normal saline or Ringers lactate and the concentration of diazepam was measured at zero, one, two, three and eight hours after the initial preparation. SETTING: Laboratory study. RESULTS: There was no difference in the concentrations of diazepam between the two solutions. However, concentration fell to around 80% in glass and to 50% in the PVC container after four hours and to an even lower level in the PVC container after eight hours. CONCLUSION: The present study is reported so as to alert clinicians of this effect and to promote efforts to utilize non-PVC bags and the shortest possible infusion sets.

Anticonvulsants↗
PubMed1998

Dietary risk factors for pre-eclampsia among women attending Harare Maternity Hospital, Zimbabwe.

OBJECTIVE: To identify specific foods that predispose Zimbabwean women to a higher or lower risk of pre-eclampsia and/or eclampsia. DESIGN: A case control study was implemented. Participants were asked by questionnaire to recall the specific amounts of meats, poultry, fruits, fish, vegetables and dairy products they had consumed in the month prior to giving birth. SETTING: Harare Maternity Hospital, Harare, Zimbabwe between June of 1995 and April of 1996. SUBJECTS: 180 women clinically diagnosed with pre-eclampsia (144) or eclampsia (36), and 194 normotensive women without these conditions. MAIN OUTCOME MEASURES: Pre-eclampsia/eclampsia. RESULTS: There were few associations between consumption of specific food items and the occurrence of pre-eclampsia/eclampsia. Meat and fruit were the only foods found to be significantly associated with pre-eclampsia. Women who consumed 12 or more servings of meat per month were more likely to have pre-eclampsia/eclampsia when compared to women eating 11 servings of meat or less per month. While intake of bananas and mangos was unrelated to risk, women who consumed other fruits (i.e. apples, oranges, grapes, peaches, apricots, paw paw, and plums), were 1.7 (95% CI = 1.0 to 3.1) times more likely to develop pre-eclampsia/eclampsia as women who ate none of these fruits. However, women who consumed relatively large quantities of these fruits were not at a particularly high risk. Increased consumption of kapenta was modestly associated with a decrease in disease risk, but this finding was well within the limits of chance and no association was present with intake of other types of fish. CONCLUSIONS: Our findings suggest that variation in consumption of specific foods do not have a strong effect on the incidence of pre-eclampsia in this population. However, further research involving the use of a more comprehensive dietary measure, biochemical measurements of nutrients, pre-pregnancy assessment and ascertainment of dietary intake prior to the development of pre-eclampsia are needed.

Adult↗
PubMed1997

Extra-amniotic saline infusion for induction of labour in antepartum fetal death: a cost effective method worthy of wider use.

OBJECTIVE: To compare the effectiveness of extra-amniotic saline with intra-amniotic prostaglandin F2 alpha in inducing labour in pregnancies with intrauterine fetal death. DESIGN: A randomised controlled trial. PARTICIPANTS: One hundred and twenty-one women in the extra-amniotic saline group and 123 women in the intra-amniotic prostaglandin group, performed at Harare Maternity Hospital, Zimbabwe during the period October 1994 to February 1996. RESULTS: The two methods were equally effective in achieving delivery. The number of women not delivering within 48 hours of recruitment was 6% for the extra-amniotic saline group compared with 11% for the intra-amniotic prostaglandin group (relative risk [RR] 0.51, 95% CI 0.21-1.22). The extra-amniotic saline group required augmentation with Syntocinon more frequently than the intra-amniotic prostaglandin group: 22% compared with 7% (RR 3.1, 95% CI 1.5-6.2). There were more complications associated with the intra-amniotic prostaglandin group: five women developed hypertonic contractions compared with none in the extra-amniotic saline group. In addition 23% of women in the intra-amniotic prostaglandin group developed acute vasovagal-like symptoms lasting for about 10 to 15 minutes which were distressing for the women. There was no evidence of any increase in febrile morbidity from extra-amniotic saline (RR 0.8, 95% CI 0.75-1.1). CONCLUSION: Extra-amniotic saline infusion in successful in inducing labour in antepartum fetal deaths after 20 weeks of gestation. This method has been shown to be safe and well tolerated by the women and should be considered in areas with limited resources. This method should be evaluated further for inductions of labour with a live fetus.

Abortifacient Agents, Nonsteroidal↗
PubMed1997

Hypertension in pregnancy--a major hospital cause for concern.

OBJECTIVE: To document the contribution made by hypertensive disease of pregnancy on maternal and foetal outcome in order to suggest possible changes in management. DESIGN: A descriptive study. SETTING: Harare Hospital-a tertiary referral hospital in Zimbabwe. SUBJECTS: Records of all women seen in the Unit were reviewed on a daily basis by one research fellow. MAIN OUTCOME MEASURES: Predefined events related to maternal and foetal outcome. RESULTS: A total of 354 women out of 4,846 cases reviewed were admitted for hypertensive related problems. Seven hundred and thirteen women were admitted to the antenatal ward, 39.8% because of hypertension; 55.6% were multiparous. Hypertensive women stayed in the antenatal ward for a mean of 7.9 days and gestation on admission was over 32 weeks in 64.4% of cases. Low birthweight, preterm labour, perinatal and maternal mortality and all measures of short term perinatal morbidity were significantly increased in the hypertensive group. CONCLUSION: The results clearly demonstrate the reproductive health issues associated with hypertension in pregnancy. The discussion focuses on methods to improve the management of these women.

Adolescent↗