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Biomedical subjects

J Moodley

Publications and source records attributed to J Moodley.

At least 19 recordsLinked to original sources
PubMed1998

Intrapartum amnioinfusion for meconium-stained liquor in developing countries.

BACKGROUND: Intrapartum amnioinfusion (AI) has been reported to decrease perinatal mortality and morbidity in women with meconium-stained liquor. Such work has not previously been performed at King Edward VIII Hospital (KEH), in a developing country, where the incidence of meconium-stained liquor is said to be extremely high. OBJECTIVE: To establish whether AI during the intrapartum period for meconium-stained liquor decreases Caesarean section rates for fetal distress and decreases perinatal morbidity. METHOD: Informed consent was obtained from patients in labour who were 3-8 cm dilated, with meconium-staining of the liquor, grades I to III inclusive, and who had a normal cardiotocograph on presentation at term. Sixty patients were included in the trial; 30 had AI. The control group was managed by standard methods. The study group had an amnioinfusion of 0.9% normal saline at 15 ml/min under continuous cardiotocographic monitoring, until a volume of 11 was completed. This was repeated if delivery did not occur within 4 h. RESULTS: The mean pH of umbilical arterial blood was significantly higher in the AI group (7.30 versus 7.23; P = 0.0029). In addition fewer patients in this group developed hypoxic ischaemic encephalopathy (0 versus 2 controls) or meconium aspiration syndrome (1 versus 4 controls). This was not statistically significant. Caesarean section for fetal distress was performed on fewer patients in the AI group (3 versus 7 controls), although this was not statistically significant. CONCLUSION: These results demonstrate that amnioinfusion is an effective technique for improving the perinatal outcome of pregnancies complicated by meconium-stained liquor in labour. The decrease in Caesarean sections for fetal distress, though not statistically significant in this study, has clinical relevance. Furthermore, this study suggests that amnioinfusion is cost effective in a busy, high-risk labour ward unit and consequently should become standard practice in the management of meconium-stained liquor in labour.

Adult↗
PubMed1998

Infertility profile at King Edward VIII Hospital, Durban, South Africa.

A prospective observational study over a 6-month period on women presenting with infertility was conducted at King Edward VIII Hospital (KEH), South Africa. The aim of the study was to establish the patient profile and investigations performed on women presenting with infertility. One hundred women were recruited. The mean age of the women was 31 years and 60% had secondary infertility. The mean duration of infertility was 7.2 years; 61% had histories suggestive of pelvic inflammatory disease and approximately half (49%), had had previous infertility investigations; 16% of the women were HIV (human immunodeficiency virus) antibody positive and 16% had positive syphilis serology. Tubal factors were identifiable in 77%, ovulatory factors in 21% and uterine factors in 21%. Male factor infertility was present in 21%. The study confirms that in developing countries, tubal factors are the commonest cause of infertility.

Adult↗
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↗
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

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↗
PubMed1997

Obstetric and gynaecological patients in an intensive care unit: a 1 year review.

Management of the critically ill patient forms a significant proportion of obstetric and gynaecological (O & G) practice. There have however, been very few reports on the management of such patients in intensive care units (ICU). We review all O & G patients admitted to the surgical ICU at King Edward VIII Hospital, Durban, South Africa, and make recommendations regarding management of such patients. The medical records of all O & G patients admitted to the surgical ICU between the period January-December 1992 were analysed. Of all admissions to the ICU 13.6% (n = 122) were O & G patients. Eclampsia was the most common diagnosis accounting for 66% of all obstetric admissions. Of all eclamptics in the study period 24% were admitted to the ICU. The overall maternal mortality was 21%. O & G patients form a major workload of surgical ICUs and the majority of these patients are women with eclampsia. Management of such patients requires an understanding of the physiological changes of normal and abnormal pregnancies. Therefore, all large obstetrical units in developing countries should establish their own ICU in order that patient care, health personnel training and continuing health care education may be improved.

Adolescent↗