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Biomedical subjects

M Moodley

Publications and source records attributed to M Moodley.

At least 19 recordsLinked to original sources
PubMed2004

Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection.

Postmenopausal bleeding (PMB) accounts for about 5% of all office gynaecology visits. The causes of PMB are varied. Many women with endometrial cancer present with this symptom. Although many investigations are described, the most appropriate approach is often unclear. In a patient with no obvious local cause, the emphasis should be on uterine and adnexal evaluation. Based on a literature review, the evidence favours a conservative approach if the endometrial thickness (ET) is < 4mm, unless there are risk factors. All patients with ET 4 mm should have outpatient endometrial sampling. If this is unsuccessful, then outpatient hysteroscopy with directed biopsy or inpatient hysteroscopy is favoured. The role of ancillary investigations are described.

Biopsy↗
PubMed2004

Evaluation of chest X-ray findings to determine metastatic gestational trophoblastic disease according to the proposed new staging system: a case series.

Recently, a new staging system has been proposed for gestational trophoblastic disease (GTD) to ensure uniformity in staging as well as to facilitate comparison of treatment outcomes. However, the use of a chest X-ray was considered adequate for the detection of lung metastases. We describe a case-series of patients with malignant GTD and pulmonary metastases undetected by conventional chest X-ray. The scoring and therefore treatment according to high-risk or low-risk depends on various risk factors, including the number of metastases. In all three patients described, a computerised axial scan (CT) of the chest confirmed the presence of lung metastases. With the increasing availability of CT scanning in most parts of the world, particularly in tertiary hospitals in which trophoblastic tumours are likely to be managed, we propose that CT scan of the chest be performed if the chest X-ray is negative, especially if the clinical findings point to a diagnosis of malignant GTD.

Adult↗
PubMed2004

Use of the nested reverse transcription-polymerase chain reaction for the detection of human papillomavirus 16 E6 transcriptional activity in cervical cancer: a technical perspective.

AIM: The aim of this study was to evaluate HPV 16 E6 expression using nested RT-PCR in cervical tumour tissue and compare this technique with standard RT-PCR in a group of patients using injectable contraceptive steroids. PATIENTS AND METHODS: Tumour DNA was analysed for the presence and type of HPV by polymerase chain reaction (PCR) from 120 cervical cancer samples. Ribonucleic acid (RNA) was extracted from cervical tissue samples and cell-lines. Reverse transcription was carried out on all samples using reverse transcriptase enzyme to form single-stranded cDNA. The GAPDH (glyceraldehyde-3-phosphate dehydrogenase) housekeeping gene was used. RESULTS: The majority of patients had squamous cell carcinoma. Of 120 cervical tissue samples, there were 111 samples with confirmed HPV 16 infection. RNA was extracted in only 86 samples. Of these, 23 samples contained genomic DNA. Of the remaining 63 patients, there were 53 patients who had expression of HPV-type 16. E6 full-length gene expression. In total there were 25 patients (40%) with expression of the HPV 16 E6*I gene and 30 patients with expression of the E6*II gene. The nested PCR method using S1/S2 primers detected 54 patients with the E6*I & E6*II transcripts in comparison to classical PCR which detected only 31 such transcripts. CONCLUSION: Nested RT-PCR is the method of choice to determine the role of different E6/E7 splice products in HPV-associated carcinogenesis.

Carcinoma, Squamous Cell↗
PubMed2003

Microsatellite analysis of early stage (Ia-IIb) uterine cervical squamous carcinoma.

Cervical cancer is the most common gynecologic malignancy of the developing world. The oncogenic role of human papilloma virus (HPV) is well known. Attention is now focusing on the complicit genetic changes, which allow progression of these tumors. Regarding these changes, deletion of tumor suppressor genes (loss of heterozygosity [LOH]) is the preferred pathway of progression with only a subset manifesting microsatellite instability (MSI). Implicated loci include 3p14.1-22. Several studies suggest that the mutator phenotype in cervical cancer may correlate with higher grade tumors, more advanced disease stage, and poor outcome. Unlike colorectal cancer, in which an inverse relationship has been demonstrated between microsatellite instability and loss of heterozygosity, cervical cancers expressing MSI have been found to coexpress LOH at other loci. In this study we analyzed 8-microsatellite loci including p53, DCC, APC, the MMR gene hMLH1 and 2 regions of interest on chromosome 3 in a high-risk population group in which HPV infection is endemic.

Carcinoma, Squamous Cell↗
PubMed2002

Physiotherapists and human immunodeficiency virus/acquired immune deficiency syndrome: knowledge and prevention: a study in Durban, South Africa.

This study determined what physiotherapists in Durban, South Africa know about human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), their attitudes towards patients and how they cope as individuals. Data were collected using a validated questionnaire. One-hundred-and-fourteen physiotherapists in Durban hospitals participated in the study. Seventy-two per cent of the questionnaires met the criteria for analysis. Ninety per cent of the participants believed that they knew about HIV/AIDS, but only 78% could identify all viral transmission modes. Of the 38 physiotherapists who believed that they knew the stages of an HIV infection, only 11% actually knew the stages, 28% could not explain them and 61% were vaguely aware. Fifty-six per cent of the respondents had treated patients who had died from HIV/AIDS. Only 38% of physiotherapists were completely at ease when treating HIV/AIDS patients despite the fact that 98% believed that physiotherapy was an integral component of the management of an AIDS patient. Fifty-one per cent of the respondents were unaware of support structures provided by their employers. The authors conclude that the perceptions of physiotherapists about their knowledge about HIV/AIDS do not stand up to scrutiny. Significantly more attention should be paid to the development, implementation and evaluation of the effectiveness of educational programmes on HIV/AIDS for physiotherapists in the workplace.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Dermatofibrosarcoma protuberans of the vulva: a case report and review of the literature.

OBJECTIVE: The purpose of this study is to describe the management of a patient with dermatofibrosarcoma protuberans (DFSP) of the vulva and to review the literature. METHODS: A 39-year-old was referred by a district hospital for incomplete excision of a vulval mass. The lesion involved the left labium major and measured 8 x 12 cm. The lesion was reexcised with a 3-cm margin of normal skin. RESULTS: The patient made an uneventful postoperative recovery. Histology confirmed a diagnosis of DFSP with clear margins. Immunohistochemistry was positive for CD34 glycoprotein. CONCLUSIONS: DFSP of the vulva is a rare fibrous tumor of intermediate grade malignancy, with a tendency for local recurrence. However, it rarely metastasizes. Management should be multidisciplinary and Mohs' micrographic surgery is generally advocated to ensure precise margin control. Survival rates range from 91 to 100%, and local recurrence rates of 20 to 49% have been reported. Therefore close follow-up is recommended.

Adult↗
PubMed1996

Dysphagia secondary to tuberculous lymphadenitis.

Oesophageal tuberculosis is a rare entity often pre-disposed to by caseating tuberculous mediastinal lymphadenopathy (TML). Although widely reported in children, TML is an under appreciated entity in adults; in this article dysphagia in an adult patient caused by TML is described.

Adult↗
PubMed1995

Rickets in black children beyond infancy in Natal.

OBJECTIVE: To determine the clinical spectrum of rickets among black children admitted to King Edward VIII Hospital, Durban. DESIGN: Prospective study of black children with rickets beyond infancy. SETTING: Hospital-based population; King Edward VIII Hospital, Durban. PARTICIPANTS: A total of 37 patients, aged 1-12 years, were recruited over a 3-year period. None had been on vitamin D or calcium supplementation prior to investigation. OUTCOME MEASURES: Rickets was diagnosed clinically, radiologically and biochemically (by a raised alkaline phosphatase value of > 350 IU). Gastro-intestinal, hepatic and renal glomerular causes were excluded in all patients using standard clinical and laboratory criteria. RESULTS: Twenty-three patients were diagnosed as having privational rickets. Nine had 25-hydroxyvitamin D (25-OHD) levels of < 10 ng/ml while 14 had levels within the normal range and were suspected of having dietary calcium deficiency. Ten had a phosphopenic variety of rickets; the remaining 4 had healing or healed rickets on the basis of radiological assessment and normal biochemical values. Pain together with difficulty in walking and bowing of the lower limbs were the main reasons for presentation. The main clinical findings were thickened wrists and ankles and rickety rosary (100%), stunting (85%), anterior bowing of lower limbs (70%) and genu valgum (65%). The calcium and vitamin D deficiency group showed a much better clinical, biochemical and radiological response to therapy than the phosphopenic group on follow-up (18 patients). CONCLUSION: This is the first substantial report on rickets in the older child in Natal, which extends the findings from Transvaal, thereby establishing a recognisable pattern of rickets beyond infancy in South Africa. It draws attention to the common clinical presentations which may alert health professionals to the presence of this problem. This report demonstrates that the two commonest types are privational rickets (due to calcium and/or vitamin D deficiency) and phosphopenic rickets.

Calcium, Dietary↗
PubMed1993

Cranial ultrasonography, CK-BB and neurological assessment as predictors of outcome in hypoxic ischaemic encephalopathy.

A comparison of cranial ultrasonography, CK-BB and neurological assessment was undertaken in 30 (16 severely, 14 moderately) asphyxiated newborns. In the 16 severely asphyxiated newborns, cranial ultrasonography proved to be of value when changes of 'cerebral oedema' persisted for longer than 48 hrs. Although the mean creatine-kinase (CK-BB) activity at 12-33 hrs after birth was higher compared with that in controls of the same age, the numbers were too small in the different age categories for statistical analysis. The 81.25% specificity of ultrasound as compared with 76.47% of CK-BB suggests that the former investigation is a better indicator of cerebral injury. Phenobarbitone administered as an anticonvulsant in eight patients did not influence the CK-BB levels and the outcome in these babies. The persistence of neurological signs for more than 2 weeks predicted a poor outcome. Sixty-two per cent of the severely asphyxiated babies were light-for-dates, indicating that a chronic condition may have contributed to the poor overall prognosis in these neonates. From a combination of persisting abnormal appearances on cranial ultrasonography, elevated CK-BB activity and neurological impairment, death or significant neurological damage in nearly 90% of the severely asphyxiated babies could be predicted.

Asphyxia Neonatorum↗
PubMed1992

Rett syndrome in South Africa.

Rett syndrome is a fairly recently recognized neurodevelopmental disorder of unknown aetiology that affects exclusively girls in whom early development is apparently normal but by the age of 6-18 months autistic behaviour and dementia, apraxia of gait, stereotypic repetitive hand movements, seizures and deceleration of head growth occur. Except for one Brazilian case, all previous reported cases have been from the northern hemisphere. We report three children (two Indian and one African) with the clinical features of Rett syndrome and believe these to be the first documented cases in Indian and African children in the southern hemisphere. More widespread knowledge of this syndrome is required, especially in developing countries, in order to prevent unnecessary and costly investigations, and to help families deal effectively with this important syndrome.

Black People↗
PubMed1992

Prediction of acute renal failure following soft-tissue injury using the venous bicarbonate concentration.

Sixty-four patients with soft-tissue injuries were studied prospectively to determine whether an initial venous bicarbonate concentration (VBC) of less than 17 mmol/L would predict the development of myoglobin-induced acute renal failure. The VBC was > 17 mmol/L in 59 patients, seven of whom had myoglobinuria. All recovered without renal complications. The remaining five patients all had VBC < 17 mmol/L and four had myoglobinuria. Acute renal failure developed in four patients (p < 0.001). The VBC on hospital arrival was the most accurate predictor of these patients' risk for the development of acute renal failure following soft-tissue injury.

Acute Kidney Injury↗