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Biomedical subjects

A I Bhigjee

Publications and source records attributed to A I Bhigjee.

At least 19 recordsLinked to original sources
PubMed2006

Optimizing therapy of seizures in patients with HIV and cysticercosis.

Worldwide, about 40 million people are living with HIV and 50 million people have neurocysticercosis (NCC). About 5% of patients with HIV and the majority of patients with NCC develop recurrent seizures. Mechanisms of seizure production in HIV include mass lesions, meningitis, encephalitis, and ischemia. Seizures in NCC may occur at all stages of cyst development, from the vesicular and colloidal to the calcified stages. Seizures in HIV present special problems with regard to choice of antiepileptic drug (AED) and the potential for drug-drug interactions with antiretroviral (ARV) treatments. Newer AEDs with simpler pharmacokinetic profiles may be the preferred agents, particularly when protease inhibitors form part of ARV regimens. Seizures in NCC are easily controlled with the older AEDs. Although there has been some debate about the value of antiparasitic drugs in NCC, accumulating data suggest that the use of these agents in active disease decreases the risk for development of chronic epilepsy.

Anticonvulsants↗
PubMed2005

Ischemic stroke in young HIV-positive patients in Kwazulu-Natal, South Africa.

Cerebrovascular disease occurs in HIV-positive individuals, but no relationship between the two has been established. The authors reviewed a cohort of patients aged 15 to 44 years to evaluate stroke in HIV-positive and negative subjects. Patients who were HIV-positive with no other identifiable etiology were compared to age- and race-matched HIV-negative patients. HIV-positive and HIV-negative groups did not differ in angiographic, cardiac, or serologic tests. A positive HIV test does not provide causal information or diagnosis.

Adolescent↗
PubMed2005

Seizures in HIV/AIDS: a southern African perspective.

South Africa, with a population of 44.8 million, has over 5 million human immunodeficiency virus (HIV)-infected individuals. Over 70% of HIV-infected patients will present with clinically relevant neurologic disease at some stage during the course of their disease. New onset seizures occur in 3-11% of these patients. The mechanism of seizure production in HIV-positive patients includes incidental association, HIV itself, opportunistic infections (OIs), neoplasia, cerebrovascular disease, drug toxicity, and metabolic derangements. In developing countries, OIs constitute the largest group presenting with seizures. Seizure management in HIV-positive patients presents special problems, especially with respect to drug-disease and drug-drug interactions. The older antiepileptic drugs (AEDs) are protein-bound and largely depend on the cytochrome p450 system for their metabolism. The newer AEDs may be safer in patients on antiretroviral drugs. However, they are expensive, an important consideration in developing countries.

AIDS-Related Opportunistic Infections↗
PubMed2004

Multidrug-resistant tuberculous meningitis in KwaZulu-Natal, South Africa.

Multidrug-resistant (MDR) pulmonary tuberculosis (TB) is well described in the literature. Reports of MDR TB meningitis (MDR-TBM), however, are limited to case reports and a single case series. During the period of 1999-2002, 350 patients with TBM were identified by cerebrospinal fluid culture for TB. Thirty patients (8.6%) had TB that was resistant to at least isoniazid and rifampicin. All 30 patients were included in this study. We reviewed hospital charts of the patients with MDR-TBM and describe our experience. Seventeen patients with MDR-TBM died, and, of those who were known to be alive, many experienced significant morbidity. Eighteen patients were HIV positive. Twenty-two patients had been treated for TB in the past, 3 patients had received no previous treatment for TB, and the history of TB treatment was unknown for 5 patients. The study highlights the prevalence of MDR-TBM and identifies new challenges in the management of affected patients.

Adolescent↗
PubMed2004

Oral trimethoprim-sulfamethoxazole in the treatment of cerebral toxoplasmosis in AIDS patients--a prospective study.

Toxoplasma encephalitis is the commonest cause of intracranial mass lesions in AIDS patients. Effective therapy includes pyrimethamine plus sulfadiazine, clindamycin with pyrimethamine, and co-trimoxazole. This study examines the efficacy of oral co-trimoxazole in 20 AIDS patients with toxoplasmosis and seeks to confirm the experience of Torre et al.

AIDS-Related Opportunistic Infections↗
PubMed2002

Paradoxes in medicine.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed2001

Spectrum of myelopathies in HIV seropositive South African patients.

The authors determined the cause of myelopathies in 33 HIV seropositive individuals in KwaZulu/Natal, South Africa. The main associations were with human T-cell lymphotrophic virus-I, tuberculosis, herpes zoster, and syphilis. A novel association with probable bilharziasis was noted. Only one case of vacuolar myelopathy was identified. Opportunistic infections will probably persist until routine antiretroviral therapy becomes widely available in South Africa.

Adult↗
PubMed2000

Role of cerebrospinal fluid shunting for human immunodeficiency virus-positive patients with tuberculous meningitis and hydrocephalus.

OBJECTIVE: Tuberculous meningitis (TBM) and its complications continue to have devastating neurological consequences for patients. Budgetary constraints, especially in developing countries, have made it necessary to select patients for shunting who are likely to experience good recoveries. To date, the value of cerebrospinal fluid shunting for human immunodeficiency virus (HIV)-positive patients with TBM has not been clearly established. METHODS: Thirty patients with TBM and hydrocephalus were prospectively evaluated. Coincidentally, one-half of the patients were HIV-positive. All patients underwent uniform treatment, including ventriculoperitoneal shunt placement and antituberculosis treatment. CD4 counts were measured for all patients. Outcomes were assessed at 1 month. RESULTS: No complications related to shunt insertion were noted. The HIV-positive group fared poorly (death, 66.7%; poor outcome, 64.7%), compared with the HIV-negative group (death, 26.7%; poor outcome, 30.8%). Despite cerebrospinal fluid shunting, no patient in the HIV-positive group experienced a good recovery (Glasgow Outcome Scale score of 5). This is in contrast to the six patients (40%) in the HIV-negative group who, with the same treatment, experienced good recoveries (Glasgow Outcome Scale scores of 5) at discharge (P<0.14). No patient (either HIV-positive or HIV-negative) who presented in TBM Grade 4 survived, whereas no HIV-positive patient who presented in TBM Grade 3 survived. A significant relationship was noted between CD4 counts and patient outcomes (P<0.031). CONCLUSION: In the absence of obvious clinical benefit, HIV-positive patients with TBM should undergo a trial of ventricular or lumbar cerebrospinal fluid drainage, and only those who exhibit significant neurological improvement should proceed to shunt surgery.

AIDS-Related Opportunistic Infections↗
PubMed1999

Sequence of the env gene of some KwaZulu-Natal, South African strains of HTLV type I.

Phylogenetic analysis of HTLV-I suggests three main subtypes, namely, cosmopolitan, Central African, and Australo-Melanesian. HTLV-I is endemic in KwaZulu-Natal, South Africa. However, sequence data on the local strains are limited to the LTR region. The env gene of the local strain was amplified and sequenced from the peripheral blood of five seropositive individuals. Four had HTLV-I-associated myelopathy and one had infective eczema. The sequence analysis of the env gene showed a greater then 99% homology of the local strains. They were closely related to the North American strains (99.3%), followed by the Japanese strains (98.3-98.9%). Phylogenetic studies linked the local strains to the cosmopolitan subtype. This study provides new sequence data on the env gene of the local HTLV-I strain.

Amino Acid Sequence↗
PubMed1999

Intracranial mass lesions in HIV-positive patients--the KwaZulu/Natal experience. Neuroscience AIDS Research Group.

BACKGROUND: Neurological disease heralds the development of AIDS in 10-20% of HIV-seropositive individuals. In over half of these cases the presentation will be that of an intracranial mass lesion (IML). In developed countries toxoplasmosis is the most frequent cause of IML in a positive patient, followed by primary central nervous system lymphoma. Less common causes include tuberculomas, cryptococcomas, abscesses and gummas. As a result of these observations, the algorithm adopted in developed countries calls for initial empirical treatment for toxoplasmosis. Biopsy of the IML is only considered if there is no response to treatment after 10-14 days. Whether such an algorithm would be applicable to the local population is unknown. OBJECTIVE: We undertook a prospective study to determine the type and frequency of IML in local HIV-seropositive patients. A secondary objective, based on the findings, was to develop a local algorithm of management. PATIENTS AND METHODS: Over a 17-month period HIV-seropositive individuals with an IML were entered into the study. Biopsy or aspiration of the lesion was performed either stereotactically or free-hand. Tissue obtained was processed for routine and special histological studies. RESULTS: In the 38 cases where tissue was obtained, the most frequent cause of the IML was toxoplasmosis followed by encephalitis of obscure origin', brain abscess and tuberculoma/mycobacterial infection. CONCLUSION: This study demonstrated that the spectrum of IML seen locally was similar to that in developed countries. The management protocol used elsewhere was therefore adopted for local patients.

Adolescent↗
PubMed1999

Cytokine expression in patients with treated congenital hydrocephalus: a preliminary report of five patients.

BACKGROUND: Previous studies have described the elaboration of cytokines in experimental models of congenital hydrocephalus using rats or mice. However, there have been no reports of similar studies in humans. OBJECTIVE: To determine the cytokine expression pattern in the cerebrospinal fluid (CSF) of patients with treated congenital hydrocephalus. DESIGN: A prospective study. SETTING: Wentworth Hospital, Durban, South Africa. SUBJECTS: Five patients (three infants and two older patients) with congenital hydrocephalus treated by means of a ventriculoperitoneal shunt. INTERVENTIONS: Immunophenotyping of peripheral blood was performed on a flow cytometer. The isolation, in-vitro stimulation of peripheral blood and CSF mononuclear cells, and intracellular cytokine determination by flow cytometry were performed. MAIN OUTCOME MEASURES: Peripheral blood and CSF cytokine measurements. RESULTS: Although not statistically significant, all measured mean cytokine levels in the peripheral blood of the infant group were consistently higher than that of the adult group. CSF cytokine levels in both groups were similar and unremarkable. CONCLUSION: No clear pattern of CSF cytokine elaboration, either type-1 (T helper 1) (Th1) or Type-2 (T helper 2) (Th2), could be demonstrated in either of the groups. The significance of higher peripheral blood cytokine levels in the infants is unclear, but may be age-related, and is not apparent in the CSF.

Age Factors↗
PubMed1998

Multiple cerebellar haemangioblastomas symptomatic during pregnancy.

A patient with von Hippel-Lindau disease presented during her seventh week of pregnancy with obstructive hydrocephalus and brainstem compression caused by multiple cerebellar haemangioblastomas. Surgery was performed to relieve the hydrocephalus and remove the right cerebellar tumour. The patient's subsequent course supports the hypothesis of vascular engorgement of cerebellar haemangioblastomas during pregnancy.

Adult↗