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Biomedical subjects

M Moodley

Publications and source records attributed to M Moodley.

At least 55 records · Page 3Linked to original sources
PubMed1990

Subacute sclerosing panencephalitis in black children--a review of 18 cases.

Despite the fact that measles is severe and presents in very young Black children in Natal, South Africa, no case of subacute sclerosing panencephalitis was reported from this region prior to 1982. A retrospective study was therefore made over the six-year period 1982-1987 of 18 patients who presented to the King Edward VIII teaching hospital, Durban, with clinical and laboratory features of subacute sclerosing panencephalitis. The majority of patients (66 per cent) were between 8 and 12 years of age. The mean age of onset was 9.3 years, the youngest patient being four years nine months and the oldest 14 years. The male to female ratio was 1.25:1. A previous history of primary measles infection was obtained in 44.4 per cent of cases; 62.5 per cent occurred before the second birthday. The commonest mode of presentation was personality, intellectual and behaviour disorders (83 per cent) followed by myoclonic seizures (61 per cent) and choreiform movements (28 per cent). Measles antibody was present in the CSF in all cases. The EEG was abnormal in all recorded cases with pathognomonic periodic complexes being found in 56.2 per cent. Confirmation of the diagnosis was provided by brain biopsy in two cases and by necropsy in one case. The findings of this study suggest that subacute sclerosing panencephalitis may not be as uncommon in Black children as has hitherto been thought.

Adolescent↗
PubMed1985

Severe neurological sequelae of childhood bacterial meningitis.

Bacterial meningitis remains the most common type of central nervous system infection in both developing and developed countries. Despite modern antimicrobial chemotherapy, the incidence of severe neurological sequelae remains high. We review the pathogenesis of these sequelae and correlate them with computed tomography (CT) appearances. Early diagnosis and appropriate chemotherapy remain the cornerstones of management. Early and accurate diagnosis of complicating space-occupying lesions with the aid of CT and appropriate aggressive therapy are suggested if the prognosis is to be improved.

Atrophy↗
PubMedDate not supplied

Invasive cervical cancer and human immunodeficiency virus (HIV) infection: a South African perspective.

The aim of this study was to compare the prevalence and presentation of cervical cancer in HIV-positive and HIV-negative women in our local population. Six hundred and seventy-two patients with cervical cancer presented to the gynecology oncology unit of King Edward VIII Hospital, South Africa. The HIV seroprevalence among these patients was 21%. There was an increase in the background prevalence of HIV infection (1.6-32.5%) as well as a quadrupling in the prevalence of HIV infection among patients with invasive cervical cancer (5-21%) over a 10-year period. The mean ages of the HIV-negative patients and HIV-positive patients were 55.2 and 39.8 years, respectively. Most of the HIV-positive patients were in the 30- to 40-year-old age group (51%), whereas the majority of patients who were HIV negative were in the 50- to 60-year-old age group (36%). The majority of patients, irrespective of HIV status, were more likely to have late stage disease than early stage disease. There was an increase in HIV infection in patients with both types of background prevalence and among patients with invasive cervical cancer. The mean age of HIV-positive patients was 15 years younger than that of the HIV-negative patients. The majority of patients, irrespective of HIV status, presented with late stage disease.

Adult↗
PubMedDate not supplied

Choriocarcinoma and human immunodeficiency virus (HIV) infection: a case report.

The appropriate management of gynecological malignancies in human immunodeficiency virus (HIV)-infected patients is uncertain. Gestational trophoblastic disease is highly curable and occurs predominantly among young females. However, such patients are often immunocompromised and cytotoxic agents may further compromise immunity. This case report demonstrates the successful management of choriocarcinoma in a HIV-infected patient.

Adult↗
PubMedDate not supplied

Vulval myxoid liposarcoma.

A 26 year old woman presented with a 4-year history of a gradually enlarging fluctuant mass on the left labium majus. Histologic examination following excision revealed myxoid liposarcoma. Following the diagnosis, further surgery was performed to ensure complete resection. Routine excision of draining lymph nodes is not advocated. Although rare, myxoid liposarcoma should be considered in the differential diagnosis of a vulval soft tissue mass.

Adult↗
PubMedDate not supplied

P53 codon 72 polymorphism and human papillomavirus type in relation to cervical cancer in South African women.

The usefulness of the arginine (Arg) residue at codon 72 of the p53 tumor suppressor gene as a marker for the risk of cervical cancer remains unclear. Studies to date have focused mainly on Caucasian subjects despite marked ethnic variations in both the p53 polymorphism and the frequency of cervical carcinoma. Furthermore, not all studies have taken into account the type of human papillomavirus (HPV) infection present. In this study, undertaken at King Edward VIII Hospital, Durban, South Africa, we determined the p53 codon 72 status in 281 black South African women with cervical cancer and 340 ethnically matched healthy control subjects. In addition, HPV DNA was confirmed in 190 cervical tumors and the viral type determined. Results showed that overall more cancer patients than control subjects had an Arg allele at codon 72 with respect to both genotype and allelotype (P < 0.05). A significantly higher (P < 0.001) Arg allele frequency (55%) was also observed in patients whose tumors contained low or intermediate risk HPV DNA compared with control subjects (31%); the Arg homozygosity rate was 34% and 9% in patients and controls, respectively (P < 0.001). In contrast, patients harboring HPV 16/18 infections showed no differences in p53 status compared with controls. It would appear that, in the absence of HPV 16/18 infections, the Arg allele at codon 72 of the p53 tumor suppressor gene may constitute a risk factor for carcinogenesis of the cervix.

Black People↗
PubMedDate not supplied

Knowledge of cervical cancer screening and use of cervical screening facilities among women from various socioeconomic backgrounds in Durban, Kwazulu Natal, South Africa.

The value of screening for cervical cancer has been proven. Such screening in developed countries has achieved a decrease in incidence and mortality by about 80%. Although screening facilities are available in certain parts of developing countries, the incidence of cervical cancer remains very high and many patients present with late stage disease. The study was performed among women from different socioeconomic circumstances (low, middle, and upper social/financial backgrounds). The assessment was performed by means of a questionnaire. The majority of patients from lower socio-economic circumstances with multiple risk factors were not aware of cervical screening or facilities available for this purpose. However, in spite of knowledge of cervical screening and the availability of such services, the majority of women (87%) from higher social and educational backgrounds did not undergo cervical screening. Most patients resided within a 12-kilometer radius of a facility that either provided or could potentially provide screening. Although some patients (36.7%) had had a screening test performed at some time in the past, only 27.3% of patients reported having had a Pap test. This was due to failure on the part of the healthcare giver to disseminate information to the patient regarding the reason and value of cervical screening. Among women from higher socioeconomic groups, the level of education was better and knowledge of the Pap test was not age-dependent. We conclude that the mere provision of a cervical cancer screening service is not sufficient to ensure successful uptake since screening is a multifaceted entity. Improvement of socioeconomic and educational circumstances should improve the uptake of a screening program only if the healthcare giver provides appropriate information to the patient and the patient takes the initiative to avail themselves of such screening.

Adolescent↗
PubMedDate not supplied

Transcatheter angiographic embolization for the control of massive pelvic hemorrhage due to gestational trophoblastic disease: a case series and review of the literature.

Pelvic hemorrhage, either uterine or vaginal, secondary to gestational trophoblastic disease (GTD) can be catastrophic and sometimes fatal. Surgical intervention, however, such as resection of vaginal lesions or internal artery ligation are invasive and not without untoward events. Angiographic embolization is emerging as a practical, safe, effective, and less invasive technique with excellent results. This case series describes four patients with internal or external hemorrhage due to GTD. Angiography and embolization was performed using the modified Seldinger technique with gelfoam particles. The advantages of this method include outpatient procedure, conscious sedation, and minimal discomfort to the patient with excellent results. We conclude that angiographic embolization should be the method of choice in such circumstances and should form part of the therapeutic armamentarium of every interventional radiologist.

Adult↗
PubMedDate not supplied

Gestational trophoblastic syndrome: an audit of 112 patients. A South African experience.

Gestational trophoblastic disease (GTD) represents a spectrum of histologically distinct entities including molar pregnancy and choriocarcinoma. The incidence of GTD varies in different parts of the world with high incidences in countries like Japan (2 / 1000 pregnancies). With the advent of sensitive assays for detection of serum beta human chorionic gonadotrophin (HCG) and ultrasound, GTD can now be detected earlier in pregnancy. To date no studies have been reported from South Africa regarding the epidemiology, management, and outcome of patients with GTD. This study was a retrospective audit based on 112 patients with GTD treated at King Edward VIII Hospital, Durban, South Africa. Clinical records of patients were reviewed with regards to presentation, investigation, management and outcome. Of 112 patients, there were 78 patients (70%) with hydatidiform mole and 34 patients (30%) with choriocarcinoma. The mean age of patients was 28.5 years (SD 8.1 years). The majority of patients were Black females (94.6%) while 4.4% were Asian and 1% Coloured females. The most common presenting symptom was vaginal bleeding (93.8%). There were 74 patients (66.7%) who had a previous normal term pregnancy and only two patients (1.8%) had previous molar pregnancies. Suction curettage was the main treatment modality for patients with molar pregnancy while choriocarcinoma was treated primarily with chemotherapy. A total of 72 percent of patients with molar pregnancy and 28 percent with choriocarcinoma had complete remission after initial treatment. Twelve patients died during the course of treatment mainly due to late presentation and advanced metastatic disease. Complete cure was achieved in 89% of patients. Age, parity, previous history, initial uterine size, presence of theca-lutein cysts, and initial betaHCG concentration was not found to be prognostic for persistent trophoblastic disease. In the present study, the incidence of molar pregnancy and choriocarcinoma was 1.2 / 1000 and 0.5 / 1000 deliveries, respectively. This is much lower than those quoted from countries such as Japan. However, the incidence quoted from our study may be overestimated as this was a hospital-based study and most of the uncomplicated deliveries occur in referring centers. Only 20% of patients in this study were above the age of 35 years with a mean age of 28.5 years. The majority of patients were of Black African ethnic origin mainly due to the fact that our hospital is a referral center for Black patients. Similar to other studies, the majority of patients with molar pregnancy were treated with suction curettage while the majority of patients with choriocarcinoma were treated with chemotherapy. Overall, spontaneous remission was achieved in 60% of patients with molar pregnancy and an overall complete cure was achieved in 89% of patients.

Adult↗
PubMedDate not supplied

The role of steroid contraceptive hormones in the pathogenesis of invasive cervical cancer: a review.

Invasive cervical cancer remains a leading cause of morbidity and mortality, especially among women in the developing world where screening is either deficient or absent. Of all agents linked to the causation of this disease, high-risk human papillomavirus (HPV) appears to be the strongest factor. However, not all women with HPV develop cervical cancer. Steroid contraception has been postulated to be one mechanism whereby HPV exerts its tumorigenic effect on cervical tissue. Steroids are thought to bind to specific DNA sequences within transcriptional regulatory regions on the HPV DNA to either increase or suppress transcription of various genes. Although some earlier studies were reassuring as no increased incidence of cervical cancer was observed, subsequent research has shown a causative association, especially among long-term users. The role of steroids was further enhanced by the discovery of hormone receptors in cervical tissue. Some earlier studies of oral contraceptive steroids found no increased risk, even after controlling for other risk factors, including smoking and number of partners. However, prospective studies have shown a greater progression of dysplasia to carcinoma-in-situ with more than 6 years of oral steroid contraceptive use. Similar findings were also evident from other work, including the Royal College of General Practitioners Oral Contraception Study. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives showed a relative risk of 1.2 for invasive cancer in users of the long-acting progestational contraceptive, depo-medroxyprogesterone acetate. However, in users of more than 5 years duration, an estimate of 2.4 was reported. The upstream regulatory region (URR) of the HPV type 16 viral genome, mediates transcriptional control of the HPV genome and is thought to contain enhancer elements that are activated by steroid hormones. It has been shown that steroid hormones bind to specific glucorticoid-response elements within HPV-DNA. Experimental evidence has revealed that high-risk type HPV 16 are able to stimulate the development of vaginal and cervical squamous cell carcinomas in transgenic mice exposed to slow-release pellets of 17 beta-estradiol in the presence of human keratin-14 promoter. Squamous cell carcinomas developed in a multi-stage pathway only in transgenic mice and not in nontransgenic mice. The E6 oncoprotein of HPV 16 has been shown to bind to the p53 tumor suppressor gene and stimulate its degradation by a ubiquitin-dependent protease system. Steroid hormones are thought to increase the expression of the E6 and E7 HPV 16 oncogenes, which in turn bind to and degrade the p53 gene product, leading to apoptotic failure and carcinogenesis. However, the molecular basis of this remains to be proven.

Contraceptives, Oral, Hormonal↗
PubMedDate not supplied

Successful use of anti-retroviral therapy in combination with cytotoxic chemotherapy for persistent molar pregnancy: a case report.

Due to the HIV pandemic, the chances of finding gynecological malignancies in HIV-infected women are increased. This poses management and ethical dilemmas as the treatment for such malignancies are likely to further decrease their immunity. Gestational trophoblastic disease occurs predominantly among young women and has excellent response to chemotherapy. However, such therapy is not possible if their immunity (CD4 counts) is markedly depressed. The patient described presented with persistent molar pregnancy and had low CD4 count. She was given antiretroviral therapy and once the CD4 count had risen to acceptable levels cytotoxic chemotherapy was administered. She received a total of 13 cycles of chemotherapy with no significant untoward effects. After a 6-month follow-up period the patient was well with a negative serum betaHCG level and CD4 count above 200. We conclude that HIV-infected women with gestational trophoblastic disease may be safely treated with cytotoxic chemotherapy provided anti-retroviral therapy is concurrently administered to boost immunity.

Adult↗
PubMedDate not supplied

Non-puerperal uterine inversion in association with uterine sarcoma: clinical management.

Non-puerperal uterine inversion due to uterine sarcoma is a rare entity often diagnosed at the time of surgery. Patients may present with pelvic pain, vaginal discharge, or hemodynamic shock. Clinically, the diagnosis may be suspected if there is a large vaginal mass and difficulty in palpating the cervix. Four surgical procedures have been described to manage non-puerperal uterine inversion, two by the abdominal route and two by the vaginal route. The Haultain procedure performed abdominally is preferred for uterine sarcomas as it facilitates reversion of the uterus vaginally or excision of the pedicle and removal of the prolapsed tumor vaginally. We describe a patient with this condition managed by the Haultain procedure.

Diagnosis, Differential↗
PubMedDate not supplied

Ovarian germ cell malignancy and human immunodeficiency virus (HIV) infection: a case report.

The occurrence of germ cell tumors in patients with human immunodeficiency virus (HIV) infection has not been previously reported. However, with the HIV pandemic in certain parts of the world, this association has become a reality. The approach to management as well as the role of adjuvant radiotherapy and chemotherapy is problematic as many of these therapies are toxic. The appropriate management of such tumors will remain elusive for sometime. The presentation, management, and outcome of ovarian endodermal sinus tumor in a HIV-infected patient is reported.

Adolescent↗