Biomedical subjects
S Moodley
Publications and source records attributed to S Moodley.
Wound healing assessment using 20 MHz ultrasound and photography.
BACKGROUND/AIMS: To compare two non-invasive techniques of assessing wound healing, photography and high resolution ultrasound (HRUS) scanning, in experimentally induced full-thickness human skin wounds. METHODS: Punch biopsy wounds, 4 mm in diameter, were made aseptically through locally anaesthetised skin on the anterior (volar) surface of the non-dominant forearm, 3 cm below the base of the cubital fossa, of 20 human participants. The wounds were treated with a topical antibiotic and covered for 3 days with Mepore sterile dressings. Wound healing was assessed on post-operative days 3, 7, 14 and 21 from photographs and HRUS B-scans. All photographs were taken of the wound site and adjacent intact skin under standardised conditions. The prints obtained were examined visually and digitised. Digital HRUS B-scans were taken through the centre of the wound bed and the adjacent intact skin parallel to the epidermis. Using the scanner's calibrated linear measurement capability, the wound width was measured adjacent to the deep surface of the scab, at the base of the wound, and midway between these two levels. RESULTS: The wound margins were more clearly defined in the HRUS scans than in the photographs of the wounds; in some of the latter the scab masked the wound margins. Changes in the surface width of the wound were affected by the time of scab dehiscence, which varied between volunteers. There was less individual variation in the width of the base of the wound, as measured from the HRUS scans. CONCLUSIONS: In contrast to photography, which allows recording of changes in the superficial aspect of the wound only, HRUS scanning permits the quantitative assessment of structural changes deep within the wound. Temporal changes in the width of the base of the wound can be used as an indication of the progress of repair.
Use of the CID W22 as a South African English speech discrimination test.
South Africa currently lacks a pre-recorded South African English (SAE) specific speech discrimination test. In the absence of such a test, the SAE speaker recording (Tygerberg recording) of the American (USA) English (AE) CID W22 wordlists--in combination with the original American CID W22 normative data--is the most widely used alternative. The reliability and validity of this method, however, has never been formally assessed. This study assessed the performance of 15 normal hearing, female, first language SAE speakers on the first two full-lists of Tygerberg CID W22 recording at 20, 30, 40, 50, 60 and 70 dBSPL, and compared their scores to the American CID W22 wordlist normative data. Overall, the South African subjects performed worse than the original American normative data at the lower presentation intensities (< 50 dBSPL). Use of the Tygerberg CID W22 recording--with the original American CID W22 normative data--for near threshold assessment of SAE speaking subjects was therefore concluded to be problematic. Use at suprathreshold intensities (> 40 dBSPL), however, was considered a viable option. These results reiterate the need for large scale, South African specific normative studies for the CID W22 wordlists if they are to continue their role as the dominant speech discrimination wordlists in South Africa.
The effect of tonsillectomy on eustachian tube function.
A two-part study was designed to investigate the effect of tonsillectomy on eustachian tube function and to identify if any change is related to postoperative pain. Middle ear pressure was measured by tympanometry and results were classified as type A (+50 daPa to -99 daPa), type B (flat) or type C (-100 daPa to -350 daPa). Thirty-one patients with type A tympanograms, undergoing tonsillectomy enrolled in study A. Patients had tympanometry the next day and filled in a questionnaire incorporating visual analogue pain scores. In study B, 30 patients underwent a similar protocol and were followed up at 1 week tympanometry and a questionnaire. A control group of 26 patients undergoing appendicectomy was recruited. Follow-up was available on 23 patients from study B. Combining A and B, on the first postoperative day 39% of patients developed type C tympanograms. No member of the control group developed any change in middle ear pressure. There was no significant relationship between pain scores for throat pain or otalgia and the development of negative middle ear pressure. By day 7 all patients had type A tympanograms. Otalgia was a delayed symptom significantly associated with increased throat pain. Transient negative middle ear pressure commonly occurs following tonsillectomy.
Urogenital tract infections in pregnancy at King Edward VIII Hospital, Durban, South Africa.
OBJECTIVES: To evaluate the role of detecting asymptomatic bacteriuria and endocervical infections in the black prenatal patients attending King Edward VIII Hospital (KEH), Durban, with the view of justifying a screening programme. Screening for syphilis and human immunodeficiency virus (HIV) infection were also evaluated. SUBJECTS: 181 asymptomatic black prenatal patients attending the antenatal clinic for their first antenatal visit volunteered for the study and gave their written consent. DESIGN: Examination of each prenatal patient included obtaining of endocervical swabs to detect endocervical infections (C trachomatis, N gonorrhoeae), serum for syphilitic and HIV testing, and a midstream specimen of urine for microscopy and culture. RESULTS: Asymptomatic bacteriuria was found in 5.6% of patients in this study. Cervical infections were diagnosed microbiologically in 8.2% of women. These were N gonorrhoeae in 4.1% and C trachomatis in 4.7%. Serological tests for sexually transmitted diseases showed the presence of syphilis in 7.6% and antibody to the HIV in 1.9%. Overall, one or more sexually transmitted diseases were found in 16.5% of the women studied. CONCLUSIONS: This study suggests that all women presenting for routine antenatal care in a setting such as Durban should be screened for lower genital tract infections. Ideally this should include a midstream urine specimen for culture, serum for syphilitic and HIV antibody testing and endocervical swabs for sexually transmitted pathogens. In developing communities, however, more reliable and cheaper methods of endocervical screening need to be available before antenatal screening for cervico-vaginal infections can be justified.
Doppler velocimetry in concordant and discordant twin gestations.
Doppler blood flow studies in 63 pairs of concordant and 17 pairs of discordant twins were compared with those of 277 appropriate for gestational age singleton fetuses. Discordancy was defined as a more than 20% intra-pair actual birth weight difference. The data were divided into five groups: singletons and large and small concordant and discordant twins. Statistical comparisons of the regression lines for the large concordant and discordant twins and the singletons showed no significant differences among the three lines, either in slopes (P = .1) or intercepts (P = .08). Comparisons of the regression lines for small concordant and discordant twins and the singletons indicated a significant interaction among the three lines (P = .01). Additional analysis leads us to conclude that the systolic-diastolic ratio (S/D) decreases with advancing gestational age for all groups except small discordant twins. The S/D of small discordant twins differed significantly from that of singletons and tended to differ from that of small concordant twins.
Comparison of maternal and neonatal morbidity in midforceps delivery and midpelvis vacuum extraction.
The present study examines the incidence of maternal and neonatal morbidity associated with delivery from the midpelvis using the vacuum extractor when compared with obstetric forceps. Previous studies have failed to minimize the influence of confounding variables such as maternal and neonatal disease and indication for delivery on outcome when comparing determinants of maternal and neonatal morbidity in the two groups. Results indicate that there was significantly more maternal morbidity in forceps deliveries across most variables. There were no statistically significant differences in neonatal morbidity between the two groups except for a higher incidence of inconsequential cephalhematoma in the vacuum group. It is concluded that the vacuum extractor may be a valuable instrument in delivery from the midpelvis and that it should be more widely used in appropriate clinical situations.
Application of Doppler echocardiography in the assessment of fetal cardiac disease.
Pulsed Doppler echocardiography was used in conjunction with real-time two-dimensional and M-mode ultrasound techniques in 19 fetuses between 28 and 40 weeks of gestation. Of these, nine also had echocardiographic examination performed neonatally. In one fetus with complete heart block, pulsed Doppler echocardiography showed tricuspid regurgitation. The ventricular and atrial rates were accurately determined by M-mode ultrasound; pericardial effusion was noted in the two-dimensional examination. The left ventricular stroke volume, as measured by the Doppler technique, was 13.5 ml, and the minute output was 486 ml/min. In another fetus, Doppler studies assisted two-dimensional echocardiography in detecting pulmonary aneurysm. Neonatal echocardiography confirmed this and also showed the presence of tetralogy of Fallot. In three fetuses with ventricular ectopy, 30% to 50% reduction in the right ventricular stroke volume was recorded by the Doppler technique. This study demonstrates the clinical potential of pulsed Doppler echocardiography in assessing fetal cardiac disorders and justifies further investigation to define its clinical utility.
Fetal pulmonary maturity: relationship between optical density (650 nm) to the lecithin/sphingomyelin ratio and phosphatidylglycerol in amniotic fluid.
An optical density value greater than or equal to 0.15 at A650 n m of amniotic fluid obtained through transabdominal amniocentesis from a high risk obstetrical population, which excluded diabetes mellitus, isoimmunization, and amniotic fluid infection, correlated 98.6% with a mature lecithin to sphingomyelin ratio (L/S) greater than or equal to 2.0% and 41.6% with the presence of phosphatidylglycerol (PG). The corresponding false positive rates were 1.4% and 16.8%, respectively. In 30 infants delivered within 48 h of testing, A650 n m greater than or equal to 0.15 correlated 100% with absence of respiratory distress syndrome. A650 n m is not recommended for Rhesus immunized gestations, diabetic pregnancies and amniotic fluid infection due to a high false positive rate with A650 nm compared to L/S and PG.
Report of a case with aplasia cutis congenita, elevated amniotic fluid alpha-fetoprotein, and positive acetylcholinesterase band.
A case report of a pregnant mother with elevated midtrimester maternal serum alpha-fetoprotein, an elevated amniotic fluid alpha-fetoprotein with a positive acetylcholinesterase band, and grossly normal fetal anatomy is presented. A premature female infant was delivered with bilateral symmetrical flank skin lesions consistent with the diagnosis of aplasia cutis congenita.