Browsing by Author "Moodley, Jagidesa."

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Adherence to iron prophylactic therapy during pregnancy in an urban regional hospital in Durban, South Africa.
(2017) Mkhize, Princess Zinhle.; Moodley, Jagidesa.; Naicker, Thajasvarie.
Iron and folic acid supplementation plays a major role in prevention and control of iron deficiency anaemia in antenatal care. In South Africa, although all pregnant women receive iron, folate and calcium supplementation throughout pregnancy, anaemia is still common. Low adherence may be a key contributor to the ineffectiveness of supplementation programs.Therefore, this study was conducted to examine adherence to prophylactic iron supplementation during the antenatal period. An observational clinical study was conducted in a regional hospital from January- December 2016. Women (n=100 HIV uninfected and n=100 HIV infected) were recruited and subdivided into three groups: (a) 1st attendees ≤ 34 weeks (n=33), (b) 34-36 weeks (n =34) and (c) ≥ 37 weeks /birth (n=33) respectively. A structured questionnaire was used for data collection. Data were coded and computed onto an excel sheet for statistical analysis using SPSS software. Data from women (n = 24) from 1st visit attendees ≤ 34 weeks and 34-36 weeks subgroups indicated that pill count and self-reported data reflected 50% adherence and 46% non-adherence, being higher in the HIV infected women (75%). Nausea was the commonest side effect in all trimesters (79, 2%). Adherence (27.8%) and non-adherence (72.1%) to iron, folic acid and calcium supplementation were observed in 176 (88%) women. Promoting essential strategies on the importance of consumption and effectiveness of iron prophylactic therapy is essential to maintain and improve anaemia in antenatal attendees during pregnancy.
An aetiological study of white vulval skin lesions amongst patients attending the gynaecological clinic at R.K. Khan Hospital, Durban.
(1998) Moodley, Manivasan.; Moodley, Jagidesa.
BACKGROUND White vulva! skin lesions may be due to various conditions, including benign and non-benign causes. The dilemma faced by the clinician with such a patient is the aetiology of the lesion, as well as the approach to management. AIM To establish the aetiology of white vulva! skin lesions in patients attending the gynaecology clinic and to evaluate the role of Collin's test and vulvoscopy. SETTING R. K. Khan Hospital, which is a secondary level hospital in Durban, KwaZulu Natal. METHOD Sixty-two patients with white vulva! skin lesions whom consented to the study were recruited. The investigations consisted of Pap smear, colposcopy of the vulva [Vulvoscopy], perineum and where appropriate, vaginoscopy and colposcopy; Collin's test and biopsy of all abnormal areas detected by these tests. RESULTS Pruritus vulvae was the commonest presenting symptom [70%1. No vulvoscopic abnormalities were detected in 97% of patients, whilst 3% had acetowhite areas indicative of Human papilloma virus infection. Collin's test was positive in 40% of patients, although, histologically these areas were benign. All patients in the study had benign lesions on histology. CONCLUSION All patients in this study had benign causes of white vulval skin lesions. However, this cannot lead us to conclude that there is no role for doing Vulvoscopy and Collin's test, as premalignant and malignant lesions should be detected by these tests had they been present.
Apoptosis - a comparative study of its role on the trophoblast cell in normotensive and hypertensive placental bed.
(2006) Dorsamy, Enbavani.; Moodley, Jagidesa.; Naicker, Thajasvarie.
Abstract available in PDF.
An audit of peripartum hysterectomy at the Pietermaritzburg complex of hospitals.
(2012) Uzoho, Nathan N.; Moodley, Jagidesa.
RATIONALE OF THE STUDY. To carry out a retrospective chart review of all patients who had a peripartum hysterectomy in hospitals at different levels of health care in the Pietermaritzburg Hospital Complex to examine the incidence and indications for peripartum hysterectomy. METHODS. The charts of 120 cases of peripartum hysterectomy operations performed between January 2003 and January 2008 in the Pietermaritzburg hospital complex of University of KZN were analysed retrospectively. The total number of deliveries were 48 964. The traditional indications, risk factors and associated complications were revisited to determine if there have been changes in current obstetric practice. RESULTS. The overall incidence of peripartum hysterectomy at the Pietermaritzburg complex of hospital was 0.25/1000 deliveries (95% C1 0.2 – 2.9). Uterine atony, bleeding abruption placentae, placentae praevia, uterine rupture following induction and extension of uterine incision into the uterine arteries comprised 87.9% of the indications for peripartum hysterectomy. By far, the most common complications were wound infection and haemorrhage due to difficult haemostasis. Both comprised 61% of complications, others were bladder injury and renal failure. Coagulopathy occurred in 16.7% of cases of whom 2 died due to massive uncontrollable haemorrhage and 26.7% cases had relaparatomy. There were 13.3% of haemorrhagic shock and 5% developed septic shock. All the patients had blood transfusion, 13.3% of patients received platelets in addition to blood. The results showed that 55.8% had previous caesarean sections while 12.5% had VBAC. There were 75.8% live babies. CONCLUSION. The review noted that there has not been a significant change in the incidence and indications for peripartum hysterectomy. The incidence of peripartum hysterectomy in the study 0.25/1000 compared favourably with the findings from similar studies in different parts of the world. Worldwide the incidence of PH ranges from 0.2 to 5.09/1000 deliveries, in our study the incidence was 0.25/1000.
Cardiovascular evaluation of hypertensive disorders of pregnancy by echocardiography.
(2004) Desai, Dushyant K.; Moodley, Jagidesa.; Naidoo, Datshana Prakesh.
Background: Preliminary observations suggest that aberrations in maternal central hemodynamics and uterine artery Doppler velocimetry reflect the severity of hypertensive disorders of pregnancy. In addition, the precise changes of cardiac output in normal pregnancy, particularly in the third trimester, have remained controversial. Aims and Objective: To measure concomitantly Doppler echocardiographic maternal central hemodynamics and uterine artery Doppler velocimetry and evaluate their association with adverse feto-neonatal outcome in hypertensive pregnant women. To evaluate cardiac output longitudinally in the latter half of pregnancy in normal healthy women. Design and Setting: Prospective study conducted at the Obstetric Unit, King Edward VIII Hospital, Durban, South Africa. Study sample: forty (40) pregnant hypertensives without any prior therapy and a further group of pre-eclamptic women (n=22) treated with stat dose sodium gardinal and alpha-methyldopa were studied. Results: i) A trend to a higher cardiac output was seen in the hypertensives compared to the normotensives. Hypertensive women were of larger stature; there was no difference in cardiac index. Fetal birthweight correlated poorly with cardiac index in pre-eclamptic women (r =0.21). A better correlation was seen with uterine artery resistance index (r = - 0.65) and systemic vascular resistance index (r = -0.49). Critical values for cardiac index and systemic vascular resistance index to predict poor adverse feto-neonatal outcome with good predictive values were not identified. ii) Pre-eclamptics treated with stat dose of sodium gardinal and/or methyldopa prior to echocardiography had a significantly lower systemic vascular resistance index and uterine artery resistance index compared to the untreated group. The lower systemic vascular resistance index in this treated cohort occurred from a combination of non-significant lower blood pressure and higher cardiac index. iii) Compared to normotensive women, untreated pre-eclamptics had a significantly lower heart rate (p< 0.001), a higher stroke index (p=0.018) and no difference in resultant cardiac index (p=0.452). iv) In gestational apoteinuric hypertensives presenting after 34 weeks gestation, maternal hemodynamics and uterine artery resistance index did not help define a higher risk group. v) In chronic hypertensives pregnancies, left ventricular hypertrophy correlated with severity of blood pressure. Higher risk chronic hypertensives were better selected by proteinuria than maternal central hemodynamics or uterine artery resistance index. vi) In normal pregnancy, maternal cardiac output peaked in early to mid third trimester and was maintained till term. Significant correlations were observed among maternal cardiac output, maternal body surface area and fetal birth weight. Discussion: i) This study shows that cardiac index and systemic vascular resistance index measured in the latter part of the second and third trimesters in hypertensive pregnant women were not associated with adverse fetal outcome. Large variations in cardiac index values were observed that restricted detection of satisfactory critical values for cardiac index and systemic vascular resistance index to predict adverse outcome. ii) An improved correlation of uterine artery resistance index with maternal hemodynamics and fetal birthweight in pre-eclampsia supports the hypothesis that poor placentation does not allow for a normal increase in uterine blood flow. iii) The poor correlation between uterine artery resistance index and maternal central hemodynamics, does not support the hypothesis that elevated cardiac output in hypertensive pregnancies (hyperdynamic disease model) occurs as a compensatory response to maintain adequate perfusion in a utero-placental bed with high resistance that did not decrease.
A comparison of depressive scores amongst newly diagnosed HIV-infected and uninfected pregnant women using the Edinburgh Depression Scale.
(2016) Nydoo, Puvashnee.; Moodley, Jagidesa.
Objective Prevalence rates of HIV infection in KwaZulu-Natal are high, with a significant amount of those infected being women of reproductive age. A diagnosis of HIV infection has been associated with an increased risk for the development of depression. Antenatal depression is a serious health concern, as it has the potential to cause wide-reaching adverse consequences for both mother and unborn child. Thus the objective of this study is to compare depressive scores between newly diagnosed HIV-infected and uninfected pregnant women in KwaZulu-Natal to elucidate any association between a new diagnosis of HIV infection and the development of antenatal depression. Methods 102 newly HIV tested Black African pregnant women were recruited from antenatal clinics at two regional hospitals; further stratified into two cohorts based on HIV status (HIV-infected: n=40; HIV-uninfected: n=62). Women’s sociodemographic and clinical data were recorded, before being assessed for depression using an IsiZulu version of the Edinburgh Depression Scale. Results Of the sample, 9.8% suffered from depression. Prevalence rates of antenatal depression did not differ significantly between the HIV-infected and uninfected cohorts (p=0.79). A diagnosis of HIV infection (p<0.0001) and maternal age (p=0.03) are risk factors for antenatal depression. Unemployment (p=0.09) is a borderline risk factor for the development of antenatal depression. Conclusion Prevalence rates of depression are low in our sample. A new diagnosis of HIV infection in pregnancy places women at an increased risk for the development of antenatal depression. Younger age and unemployed status may also influence depression.
Contraception and pregnancy in microbicide trials.
(Elsevier., 2012) Sibeko, Sengeziwe.; Cohen, Gabriel M.; Moodley, Jagidesa.
The distinctive feature of the human immunodeficiency virus (HIV) epidemic in Sub-Saharan Africa is the burden on women, in particular young women of reproductive age. Consequently, most late-phase effectiveness microbicide clinical trials are conducted in sub-Saharan Africa where fertility rates are high. Because late-phase clinical trials are conducted over prolonged periods of time, women participating in these trials may fall pregnant during the trial. Their unborn babies may be exposed to a drug whose teratogenic potential is unknown if the investigational drug is not withdrawn. High pregnancy rates in such trials may compromise statistical integrity, as women will be withdrawn from the study drug for the duration of the pregnancy. It is therefore imperative for microbicide trials to implement effective contraceptive and pregnancy management programmes that maintain low pregnancy rates and the safety of unborn babies while not compromising the conduct and statistical integrity of the trial.
Critically ill obstetric and gynaecology patients : the development and validation of an outcome prediction model.
(2006) Paruk, Fathima.; Moodley, Jagidesa.
Introduction: Outcome prediction tools have the potential to provide significant adjunctive information for intensivists. Critically ill obstetric and gynaecology patients constitute a unique subset of the general ICU (intensive care unit) population yet, there exists no outcome prediction model developed specifically for these patients. Objectives: To evaluate the APACHE II score, prospectively develop and validate an outcome prediction model, evaluate organ failure (Organ Failure score and SOFA score) and review the SIRS (Systemic Inflammatory Response Syndrome) response in a cohort of critically ill obstetric and gynaecology patients. Design: A prospective study conducted over a 2 year period in the Surgical ICU at King Edward VIII Hospital, Durban. Institutional ethics approval was obtained. Patients were allocated to one of the following categories: Obstetric hypertensive group (Group I), Obstetric non-hypertensive group (Group II) and Gynaecology group (Group III). Group III was further subdivided into a pregnant (Group IIIa) and a non-pregnant group (Group IIIb). Data captured included demographic details, clinical assessment, investigations, treatment, variables required for calculating the APACHE II score, organ failure (OF) assessment, SIRS criteria and patient outcome. The APACHE II system, organ failure assessment and SIRS was evaluated in the entire patient subset. For the purpose of the outcome prediction model, the subset was divided into 2 groups: a development group and a validation group. STATA 7 software was utilised for data analysis. Results: The dataset comprised 260 inpatients. Obstetrics and gynaecology cases represented 18.5 % of the total ICU population (n=1408). The majority of the patients were young (mean age 27 ± 10.5 years). The mean ICU stay was 5.5 ± 7.9 days. The observed mortality for Groups I, II, III, IIIa and IIIb was 23.4%, 43.2%, 42.9%, 33.3% and 55.5% respectively. The mean APACHE II score was significantly higher in nonsurvivors compared to survivors for all patient subgroups (p< 0.0001). However the APACHE II system performed variably in each of the 3 groups. The area under the curve for the ROC curves in each of the 3 main subgroups varied from 0.81 to 0.94 for APACHE II. Groups IIIa and IIIb were too small to permit ROC curve analysis. Age, mean arterial pressure, respiratory rate, temperature, the Glasgow Coma Scale score and pH were identified as significant outcome predictors. Using these parameters an obstetric and gynaecology outcome prediction (OGOP) model was developed for Groups I, II and III. The area under the curve for the ROC curves in each of the subgroups was >0.9 for the OGOP Model. A predictive equation could not be developed for Groups IIIa and IIIb (due to a small number of admissions in these two groups.) Duration and the number of organ failures, correlated with outcome. The duration and number of organ failures associated with mortality differed for each group. Three OF exceeding 72 hours, 3 OF exceeding 48 hours and 3 OF equal to 48 hours were invariably fatal in Groups I, II and III/IIIa/IIIb respectively. SOFA scores were significantly higher in nonsurvivors compared to survivors (p<0.0001). A day one SOFA score equal to 18 (Group I), 15 (Group ll) and 13 (Group III, IIIa, IIIb) was also invariably fatal. A SIRS response was noted in 94.2% of the patient cohort (245/260). The SIRS response varied in the subgroups. Sterile shock and septic shock were associated with a high mortality rate. Groups IIIa and IIIb differed with respect to the mean age, duration of hospital and ICU stay and mortality rate. Although these subsets were numerically restricted (24 and 18 admissions respectively), the results suggest that the two subsets are distinctly different in nature. Comment: The OGOP model is easier to calculate and it is superior to the APACHE II System. It needs to be validated in other local and international units. Organ failure assessment as well as the SIRS response provides useful supplementary outcome information. Although current outcome prediction tools are not designed for individual application, continued research and refinement of the available tools, as well as the exploration of novel methods, may one day result in "near-perfect" prediction estimates and further broaden the scope of their utility.
The effect of adipokines in HIV associated pre-eclampsia : (C-peptide, ghrelin, gastric inhibitory polypeptide, glucagon like peptide-1, glucagon, insulin plasminogen activator inhibitor-1 and visfatin).
(2016) Mathonsi, Colisile N.; Moodley, Jagidesa.; Naicker, Thajasvarie.; Ajith, Anushka.
Introduction: South Africa has a maternal ratio of 300 deaths/100,000 live births. Non-pregnancy related infections (mainly deaths in HIV infected pregnant women complicated by tuberculosis and pneumonia) accounts for 34.7% of maternal deaths followed by obstetric haemorrhage and hypertension accounts (15.8% and 14.8% respectively). Moreover, 61% of women South Africa is overweight or obese (almost double the global rate of 30%). In pregnancy, endocrine and metabolic maternal adaptations include increase in body weight, however, the impact of adipokines in HIV associated pre-eclampsia remains unknown. The aim of the study was to examine the levels of adipokines viz., C-peptide, ghrelin, gastric inhibitory polypeptide (GIP), glucagon like peptide 1 (GLP), plasminogen activator inhibitory (PAI) 1, visfatin, glucagon and insulin in HIV associated pre-eclampsia. Materials and Methods: Following institutional and regulatory approval, participants (n=301) were recruited from RK Khan Hospital and divided into groups non-pregnant (n=90), normotensive (n=121), early (n=32; EOPE) and late onset (n=58; LOPE) pre-eclampsia. The pregnant cohort was stratified according to their HIV status. Maternal clinical demographics, indications and mode of delivery were recorded. Serum was used to quantify the adipokines levels using the multiplex ELISA technique. Absorbance was read spectrophotometrically at 450 nm. Graph Pad Prism (version 6) was used to analyse all data. Result: C-peptide did not differ according to HIV status. With regards pregnancy type, there was a significant difference in c-peptide between the non-pregnant versus normotensive pregnant (p<0.01) and the normotensive versus LOPE groups (p<0.01) being elevated both the pre-eclamptic groups (EOPE +LOPE). Ghrelin did not differ across study groups (p>0.05), by HIV status (p>0.05). When considering HIV status, GIP varied between positive and negative groups (p<0.001). Additionally, there was a significant difference in GIP between the non-pregnant versus normotensive pregnant (p<0.01); normotensive pregnant versus EOPE (p<0.05) and the normotensive pregnant versus the LOPE group (p<0.01). GIP was elevated in the HIV positive EOPE group. Moreover, a significant difference in GLP-1 was noted across the study groups (p<0.05) and between non-pregnant versus normotensive groups (p<0.01). When considering HIV status, HIV positive groups differed from negative study groups (p<0.05). Additionally, the Mann Whitney U test showed a significant difference between the non-pregnant and the normotensive group (p<0.01). Glucagon-like peptide-1 was significant different across the study groups, with its levels elevated in the pre-eclamptic groups compared to the normotensive pregnant group (p<0.05), additionally, there was a difference between non-pregnant versus normotensive pregnant groups (p<0.01). Glucagon did not differ across the study groups (p>0.05), however, was significantly different between the non-pregnant and normotensive group (p<0.05). HIV status did not affect glucagon levels (p>0.05). A significant difference between HIV positive non-pregnant and HIV negative non-pregnant was noted (p<0.05). Insulin was not significantly different across the study groups (p>0.05) and by HIV status (p>0.05). However, a significant difference between the non-pregnant versus normotensive group (p<0.05) was noted. PAI-1 did not differ across the study groups (p>0.05) and between the groups (p>0.05). PAI-1 did not differ according to HIV status (p>0.05). A significant difference in visfatin across the study groups (p<0.05) and between the non-pregnant versus normotensive pregnant group (p<0.05) and the late onset pre-eclamptic versus the non-pregnant group (p<0.01) was observed. There was no effect of HIV status on the level of visfatin across the study groups (p<0.05). There was a significant difference between the HIV positive versus negative non-pregnant groups (p<0.05), furthermore, we have observed low levels of visfatin in the HIV positive pre-eclamptic groups. Discussion and conclusion: This study demonstrates elevated c-peptide, GIP, GLP-1, Insulin, PAI-1 and Visfatin in the pre-eclamptic groups compared to normotensive pregnant groups. These adipokines play a role in glucose homeostasis and have been reported to play a role in development of insulin resistance which is a high risk factor for developing pre-eclampsia. Several studies have reported that adipose tissue derived hormones, play a crucial role in the pathogenesis or as risk factors of pre-eclampsia development. Additionally, it is reported that adipokines are elevated in people with higher BMI (obese and overweight) which in turn predisposes one for developing pre-eclampsia. In terms of HIV status, we have observed that many of the adipokines were elevated in the HIV positive compared to the HIV negative group. This correlates with studies which reported that HIV plays a role in dysregulation of adipokines. In conclusion, our study is the first to examine adipokine dysregulation in the triad of HIV infection, pre-eclampsia and obesity. Furthermore, we have established that adipokines: C-peptide, GIP, GLP-1, PAI-1 and visfatin were significantly dysregulated hence they may have predictor test value in diagnosing pre-eclampsia development.
The effect of sildenafil citrate and kraussianone-2 on pre-eclampsia-like manifestations in Sprague-Dawley rats.
(2011) Ramesar, Shamal Vinesh.; Mackraj, Irene.; Moodley, Jagidesa.; Gathiram, Premjith.
Pre-eclampsia, often described as toxaemia of pregnancy, historically represents one of the most widely investigated conditions relating to human reproduction. To date no firm cure has been found and a clear, well defined mechanism has not been ascribed to the pathogenesis of the disease. Researchers seem to focus on single pathways in isolation of others. The disease rather represents a multitude of possible underlying pathologies nvolving genetics, immune dysregulation, vascular maladaptation, and sociobiological factors thus complicating the approach to treatment. However, a central theme is the presence of reduced placental perfusion resulting in a hypoxic and/or ischaemic placenta and the subsequent secretion of various factors that initiate the maternal syndrome. It is within this context that we examine how an intervention such as increasing placental perfusion may represent a promising treatment strategy for this disease. We sought to manipulate the vasodilatory mechanisms of the uterine vasculature using sildenafil citrate and a flavonoid extracted from Eriosema kraussianum (Kr2), in Sprague-Dawley rats that exhibited preeclampsia-like manifestations. Both treatment regimens improved fetal outcomes and reduced blood pressure amplification and proteinuria. They also reduced the plasma concentrations of the two anti-angiogenic factors; sFlt1 and sEng. Only sildenafil citrate improved nitric oxide levels which was expected, suggesting that Kr2 causes vasodilation by some other mechanism. Nevertheless, both compounds improved both pup and placental weights, suggesting that they also improve utero-placental perfusion. These findings that selective uterine vascular dilation improves placental perfusion may be promising in averting possible death to mothers and their babies from pre-eclampsia especially in low resource environments.
The effects of fumonisin B¹ in preeclampsia.
(2012) Serumula, Metse Regina.; Chuturgoon, Anil Amichund.; Moodley, Jagidesa.
Preeclampsia is the leading cause of foetal and maternal mortality and morbidity in developing countries. In South Africa, maize is a dietary staple for most black African populations and is susceptible to contamination by mycotoxins such as fumonisin B1 (FB1).Fumonisin B1 is a ubiquitous secondary metabolite of Fusarium fungi produced predominantly by Fusarium verticillioides. This mycotoxin shares structural similarities with the backbone of sphingoid bases (sphinganine and sphingosine) which are substrates for the biosynthesis of complex sphingolipids. The mechanism of FB1 toxicity therefore is centred on the disruption of this process. The aim of the present study was to elucidate the possible causal link between FB1 and preeclampsia. Following ethical approval, 20 normotensive and 20 preeclamptic patients were recruited into the study. Blood and placental tissue were collected and processed for further analysis. The presence of FB1 was verified using standard immunohistochemical and electrophoretic techniques. The levels of FB1 and sphingolipids were quantified using high performance liquid chromatography (HPLC). Western blotting was conducted to confirm the presence of FB1 in the serum. Placental tissue apoptosis was evaluated using Hoechst staining and other markers. Lipid peroxidation was measured in serum and placental tissue of both groups. Fumonisin B1 was immunolocalised within the endothelial cells and mesenchymal cells of placentas from both groups, while FB1 was present in cytotrophoblastic cells of preeclamptic patients only. In addition, FB1 concentrations were significantly higher in preeclamptic compared to normotensive serum samples. Sphinganine was significantly elevated in preeclamptic serum samples whilst there was no statistical difference in the sphingosine levels between the groups. Chromatin condensation was higher in the preeclamptic patients. Caspase 3 and Fas were present with greater intensity in preeclamptic samples. The levels of lipid peroxidation were significantly higher in both serum and placental tissue of preeclamptic patients. This study has demonstrated not only the presence of FB1 in the serum and placental tissues of pregnant women but also the potential effects of this mycotoxin in the humans.
Evaluation of haematological parameters and immune markers in HIV-infected and non-infected pre-eclamptic Black women.
(2007) Naidoo, Kalendri.; Moodley, Jagidesa.
This study focuses on women with both pre-eclampsia and Human Immunodeficiency Virus (HIV). Pre-eclampsia is a pregnancy-specific syndrome that occurs after 20 weeks gestation. Thrombocytopenia is the most common haematological abnormality in pre-eclampsia. Further, studies suggest that the immunological mechanism plays some role in the aetiology of pre-eclampsia. The immunological hallmark of HIV infection is a progressive decline in the number of CD4 T lymphocytes and significant haematological abnormalities are also common in HIV-infected individuals i.e. anaemia, thrombocytopenia and leukopenia. The study population comprised of two groups i.e., pre-eclamptic HIV-positive African women and preeclamptic HIV-negative African women as the control group. Samples were analysed for haematological parameters (full blood count) and immunological markers (flow cytometry). There was no statistical significance in the following parameters: RBC, Hb, haematocrit, MCV, MCH, MCHC, platelets, MPV, WBC, lymphocytes, neutrophils, eosinophils, monocytes, basophils and CD8. There was a statistical difference in the CD3 and CD4 counts between both the groups. However, the CD3 and CD4 counts were within the normal range in the HIV-negative pre-eclamptic group and even though CD3 decreased, it was still within the normal range in the HIV-positive pre-eclamptic group, with CD4 decreasing below the normal range in the HIV-positive pre-eclamptic group. This suggests that immune mechanisms involving CD estimations do not play a role in pre-eclampsia since the decrease in the counts can be solely attributed to HIV infection. Results obtained in this study do not show any severe haematological or immunological abnormalities when women have both pre-eclampsia and HIV infection.
The function of Adipsin and C9 protein in the complement system in HIV-associated preeclampsia.
(2020) David, Mikyle.; Naicker, Thajasvarie.; Moodley, Jagidesa.
Background Hypertensive disorders of pregnancy (HDP) and non-pregnancy related diseases (HIV, TB) are the most common causes of maternal mortality in South Africa (SA). Preeclampsia (PE), a complex medical disorder, accounts for the majority of maternal deaths emanating from HDP. In SA, the prevalence of HIV infection in pregnancy is high. The complement system, a part of our innate response, may be altered in the synergy of HIV infection and PE development. Complement activation at the maternal-interface may exacerbate inflammation, tissue injury, apoptosis as well as vascular leakage, in the complicated state of PE. The complement proteins, adipsin and C9, activates the body’s natural defence against HIV infection. C9 functions as a pore-forming component of the membrane attack complex. Moreover, the high rollout in SA of antiretroviral therapy may affect the immune response in HIV infected women. This study investigates the concentration of the complement proteins, Adipsin and C9 in the duality of HIV-associated PE. Method Samples of 38 normotensive and 38 preeclamptic patients, stratified further by HIV status were collected from a regional hospital. Thereafter, analysis of analytes via the Bio-plex Multiplex immunoassay occurred. Results Maternal weight did not differ (p = 0.1196) across the study groups. The concentration of adipsin was statistically different between the PE vs normotensive pregnant groups, irrespective of HIV status (p = 0.0439). There was no significant difference in adipsin concentration between HIV-negative vs HIV-positive groups, irrespective of pregnancy type (p = 0.6290). Additionally, there was a significant difference in adipsin concentration between HIV negative normotensive vs HIV negative preeclampsia (p < 0.05), as well as a difference between HIV negative preeclampsia vs HIV positive preeclampsia (p < 0.05). C9 protein expression was not statistically different between the normotensive and PE groups, regardless of HIV status (p =0.5365). No statistical significance in C9 expression was found between HIV positive vs HIV negative groups, regardless of pregnancy type (p = 0.3166). Similarly, no statistical significance was noted across all study groups (p= 0.0774). Conclusion This study demonstrates a significant up-regulation of adipsin in PE compared to normotensive pregnancies; this finding correlates with the exaggerated inflammatory milieu of PE. Complement C9 protein was similar between pregnancy types. This similarity may emanate from properdin dysregulation or a genetic polymorphism. The concentration of adipsin and C9 proteins were not affected by HIV status due to the immune reconstitution effect of antiretroviral therapy. Furthermore, the up-regulation of adipsin in placental sites and urinary levels of PE in previous studies, in tandem with our findings, indicate the possibility of adipsin as a predictor value for PE development.
Gene polymorphisms of uric acid related proteins and the Angiotensin Receptor IV (AT4) in Pre-eclampsia.
(2019) Khaliq, Olive Pearl.; Naicker, Thajasvarie.; Moodley, Jagidesa.
Background: Hypertensive disorders of pregnancy remain one of the major contributions to maternal and fetal morbidity and mortality around the globe. Pre-eclampsia is a hypertensive disorder of pregnancy which complicates 3-10% of pregnancies worldwide. It is a multi-organ disorder affecting the maternal system, thereby creating a major setback in terms of targeting the aetiology. One of the main organs disrupted is the kidneys and a dysregulation of uric acid levels and the renin angiotensin system have been implicated in pre-eclampsia. Therefore, the aim of this study is to investigate the gene polymorphisms of uric acid, aminopeptidase-N, the angiotensin receptor IV, and plasma levels of the receptor in pre-eclampsia compared to normotensive pregnancies. Materials and Methods: This was a retrospective study consisting of 637 blood samples of which 280 were normotensives and 357 pre-eclamptic. Pre-eclampsia was subdivided into early (n=187) and late onset pre-eclampsia (n=170). DNA was isolated from blood samples using the Thermo Scientific GeneJet whole blood Genomic DNA purification mini Kit. Single nucleotide polymorphisms of uric acid (rs505802, rs1014290, rs12129861, rs2231142), the angiotensin receptor IV (rs18059) and aminopeptidase-N (rs6496603) were amplified using the TaqMan genotyping assay. Plasma levels of angiotensin receptor IV were also measured using the ELISA in pre-eclampsia and compared to normotensives. Results: We found that rs505802 was higher in late onset pre-eclampsia compared to early onset pre-eclampsia and the normotensive group. We also observed a significant elevation of rs1014290 in early onset pre-eclampsia compared to late onset pre-eclampsia and the normotensive group. Gene polymorphisms of the angiotensin IV receptor (rs18059) and aminopeptidase-N (rs6496603) showed no significant association with pre-eclampsia. However, plasma levels of angiotensin IV receptor were significantly lower in pre-eclampsia than in normotensives. Furthermore, we found that the levels decreased with the severity of pre-eclampsia. Conclusion: The single nucleotide polymorphisms of uric acid (rs505802, rs1014290) are associated with the pathogenesis of pre-eclampsia. Furthermore, plasma levels of angiotensin IV are decreased in pre-eclampsia, indicating a dysregulation of the renin angiotensin system in pre-eclampsia. ABSTRACT-ISIZULU Amathuluzi asetshenzisiwe: Lolucwaningo lubizwa nge-retrospective lusebenzise amagazi awu 637 aphuma kwabanomfutho osesimweni sempilo (normotensives) abangu 280 Kanye nabanomfutho ophakeme wegazi kubakhulelwe (pre-eclamptic) abangu 357. Abanomfutho ophakeme wegazi baphinde bahlukaniswa izigaba ezimbili, ezibizwa nge early (n=187) ne late onset (n=170). Ufuzo egazini lutholakale ngokusebenzisa I Thermo Scientific GeneJet whole blood Genomic DNA purification mini Kit. Ama Single nucleotide polymorphisms e uric acid (rs505802, rs1014290, rs12129861, rs2231142), angiotensin receptor IV (rs18059) nawe aminopeptidase-N (rs6496603) acubulungwe ngokusebenzisa i- TaqMan genotyping assay. Izinga le-angiotensin receptor IV egazini likalwe ngokusebenzisa i-ELISA kwabanomfutho wamandla ophakeme kwabakhulelwe (pre-eclamptics) makuqhathaniswa nabanomfutho osesimweni sempilo (normotensive). Imiphumela: Sithole ukuthi amazinga e rs505802 abephezulu ku late onset pre-eclampsia makuqhataniswa ne early onset pre-eclampsia ne normotensive. Siphinde sabona ukukhuphuka kwenani le rs1014290 ku-early onset pre-eclampsia makuqhathaniswa ne late onset pre-eclampsia Kanye ne normotensive group. Ama gene polymorphisms we angiotensin IV receptor (rs18059) Kanye ne aminopeptidase-N (rs6496603) awakhombisanga mahluko ekuhlobaneni ne pre-eclampsia. Kodwa, inani le angiotensin IV receptor egazini abehlile kulabo abanomfutho wamadla ophakeme egazini (pre-eclampsia) makuqhathaniswa nalabo abanomfutho osesimweni sempilo (normotensive). Siphinde sathola ukuthi lokwehla kuhambisana nokubhebhetheka kwesifo somfutho wamadla ophakeme egazini. Ukuvala: I single nucleotide polymorphisms ye uric acid (rs505802, rs1014290) ihlobene nokuqala kwesifo somfutho wamadla ophakeme egazini kwabakhulelwe (pre-eclampsia). Futhi, izinga le angiotensin IV egazini lehlile kulabo abanomfutho wamadla ophakeme egazini kwabakhululwe (pre-eclampsia), okukhombisa ukungalawuleki kwe renin angiotensin system kulabo abanomfutho wamadla ophakeme egazini (pre-eclampsia).
HIV and maternal mortality: turning the tide.
(Elsevier., 2010) Abdool Karim, Quarraisha.; AbouZahr, Carla.; Dehne, Karl.; Mangiaterra, Viviana.; Moodley, Jagidesa.; Rollins, Nigel C.; Say, Lale.; Schaffer, Nathan.; Rosen, James E.; De Zoysa, Isabelle.
No abstract available.
Immune evaluation of HIV-infected and noninfected pre-eclamptics.
(MedPharm, 2009) Naidoo, Kalendri.; Pupuma, Xanti Bongo S.; Moodley, Jagidesa.
No abstract available.
The impact of pneumonia in human immunodeficiency virus (HIV-1) infected pregnant women on perinatal and early infant mortality.
(2007) Khan, Munira.; Moodley, Jagidesa.
Background: Although the prevalence of pneumonia in pregnancy is reported to be less than 1%, the pregnant state and risk factors associated with the development of pneumonia adversely influence the outcome of pregnancy. KwaZulu-Natal is at the epicenter of the dual epidemics of tuberculosis and HIV-1 and the impact of these diseases occurring concurrently in pregnant women at King Edward VIII hospital (KEH), South Africa have been described previously. The impact of antenatal pneumonia in HIV-1 infected and uninfected women however has not been described in the study population and was investigated. Methods: Pregnant women with clinical and radiological evidence of pneumonia were recruited from the antenatal clinic and labour ward at KEH. The study was conducted prospectively between January and December 2000. The clinical profile of these women and the causative organisms were determined. In addition the impact of HIV-1 infection, maternal immunosuppression and maternal pneumonia on obstetric and perinatal outcomes were evaluated. Mothers diagnosed with tuberculosis and multi drug resistant tuberculosis were hospitalised at King George V hospital until delivery. Results: Twenty nine women were diagnosed with antenatal pneumonia (study arm) with Mycobacterium tuberculosis the only causative organism isolated. A control arm of 112 pregnant women was also studied. Maternal and perinatal mortality was restricted to the study arm with a maternal mortality ratio of 99 per 100 000 live births and a perinatal mortality rate of 240 per 1000 births. Pneumonia was significantly associated with a negative overall obstetric outcome in the presence of HIV- l infection, antenatal care, anaemia and second trimester booking status. In addition, the presence of pneumonia was significantly associated with maternal mortality. There was a highly significant association between exposure to pneumonia and poor neonatal outcome. Maternal pneumonia, maternal HIV infection and the presence of medical and obstetric conditions were significantly associated with low birth weight and neonatal pneumonia. Further, maternal pneumonia (p <0.001) and concurrent HIV infection (p=0.002) was significantly associated with neonatal death. Conclusion: The presence of pneumonia in the antenatal period impacts negatively on maternal and neonatal morbidity and mortality. Health care providers must maintain a high degree of suspicion when managing a pregnant woman with unresolving upper respiratory tract symptoms and refer timeously for further investigation. Pneumonia and in particular pulmonary tuberculosis associated with HIV co- infection in pregnancy is a threat to mother and baby. Therefore in areas endemic for TB and HIV infection, it may be prudent to screen HIV positive pregnant women for symptoms suggestive of pneumonia and thereby identify women requiring further investigations such as sputummicroscopy and cultures, and a screening chest radiograph.
An investigation into the clinical, biochemical, immunological and epigenetic factors in black South Africa women with preeclampsia and HIV.
(2015) Maharaj, Niren Ray.; Chuturgoon, Anil Amichund.; Moodley, Jagidesa.
Introduction: Preeclampsia (PE) and HIV/AIDS contribute significantly to adverse maternal and perinatal outcomes globally. The treatment of PE remains empiric, however in HIV infection, highly active antiretroviral therapy (HAART) is used routinely for maternal health and the prevention of vertical transmission in pregnancy. The relationship between PE and HIV /HAART remains controversial and despite extensive research, the pathophysiology of both conditions is not fully understood. Contemporary and new research strategies include immunological and genetic aspects of PE and HIV, and clinical and biochemical effects associated with HAART. Aims and Objectives: The aims of the study were to determine: (1) the association of HIV and HAART with clinical and biochemical indices in women with PE, (2) the effects of HAART in relation to inflammatory cytokines in PE and HIV, and (3) the role of gene polymorphisms in preeclamptic women with HIV on HAART. The specific objectives of the study were to identify significant differences (p>0.05) in the routine clinical and laboratory indices between the preeclamptic groups, (2) to identify significant changes in pro-inflammatory cytokines IL2, TNFα, IFNɣ and IL6 in relation to HIV / HAART and preeclampsia, and (3) to determine the association of single nucleotide polymorphisms (SNP) miRNA 27a (rs 895819T>C) and miRNA 146a ( rs 2910164G>C) with preeclampsia risk and susceptibility to associated factors. Materials and Methods: A prospective cohort study was conducted between July 2013 and September 2014 at Prince Mshiyeni Memorial Hospital in Durban, South Africa. To maintain ethnographic and anthropometric consistency, a standard cohort of one hundred and ninety three (193) Black women of Zulu ethnicity comprising 4 groups: i.e. uninfected normotensive (50; 26%), infected normotensive (45; 23%), uninfected preeclamptic (53; 28%) and infected preeclamptic women (45; 23%) was recruited during pregnancy after ethical approval and informed consent and followed until delivery. Women with gestational hypertension, renal disease, diabetes mellitus, chronic hypertension and collagen vascular disease were excluded. Specific patient characteristics, clinical features, laboratory indices, and complications were analysed descriptively. Serum levels of pro-inflammatory cytokines TNF-α, IFN- γ, IL2 and IL6 were determined, using commercially available kits and Cytometric Bead Array (CBA). Genotyping using PCR and the TaqMan® SNP genotyping assay for single nucleotide polymorphisms miRNA 27a rs895819T>C and miRNA 146a rs 2910164G>C was performed and analysed in relation to preeclampsia risk, susceptibility to related clinical features and pro-inflammatory cytokines. Comparative data was recorded and analysed descriptively. Results: Our results indicate that the clinical features, laboratory indices, and complications among HIV infected preeclamptic women on HAART is similar to uninfected preeclamptic women. However, gammaglutamyl transferase (GGT), a hepatic enzyme, was markedly elevated (p=0.001) in HIV infected preeclamptic women on HAART. There were significant decreases in pro-inflammatory cytokines IL2 (p=0.010), TNF-α (p=0.045), and IL6 (p=0.005), in normotensive women on HAART compared with uninfected women and significant decreases in IL2 (p=0.000) and TNFα (p=0.000) in preeclamptic women on HAART compared with uninfected preeclamptic women. In the genotype analyses, we found that the variant genotypes (GC/CC) in miRNA 146a were significantly associated with lower severe preeclampsia risk (OR: 0.34, 0.12-0.99; p=0.048), especially in the presence of HIV/HAART (OR: 0.11; 0.02-0.68, p= 0.018), and the variant genotype (TC/CC) in miRNA 27a was associated with an elevated BMI in preeclamptic women (32.57 vs 29.25; p= 0.06), especially in the presence of HIV/HAART (33.47 vs 27.87; p=0.005). Conclusion: The effects of HIV and HAART influence biochemical, immunological and genetic aspects in women with preeclampsia. Gammaglutamyl transferase, a hepatic enzyme, was markedly elevated and suggests a possible compounding effect on the liver, which is a target organ for preeclampsia and the side effects of HAART. Current management guidelines remain appropriate, however serial hepatic function tests are necessary in clinical practice. The prevention of obesity is also necessary to reduce long term cardiovascular complications associated with these conditions. The immune reconstitutive effects of HAART include a reduction in pro-inflammatory cytokines in normotensive women as well as in preeclamptic women, which may have a bearing on the clinical course of preeclampsia in women on HAART. MiRNA 27a and miRNA 146a are endogenous small RNAs that post transcriptionally regulate gene expression and are implicated in a plethora of pathophysiological processes related to preeclampsia and its related features. TC/CC and GC/CC genotype variants in the functional single nucleotide polymorphisms (SNP) microRNA27a (rs 895819 T>C) and microRNA 146a (rs 2910164G>C were associated with obesity and severe preeclampsia respectively. Obesity is a wellrecognised risk factor for preeclampsia, and severe preeclampsia is associated with increased morbidity and mortality. These findings demonstrate the importance of molecular genetics and inflammatory mediators in preeclampsia, the pathogenesis of which remains multifactorial in origin.
Knowledge and utilisation of contraception in Indian females attending an urban general practice.
(1995) Singh, Suriyabala Kissoon.; Naidoo, B. N.; Moodley, Jagidesa.
459 Indian female patients between the ages of 16 and 50. attending the practice of the researcher were asked to complete a confidential questionnaire on the knowledge and utilisation of contraception. The results of the study revealed that the majority of the participants were literate and possessed some knowledge of contraception. The contraceptive choice was the Pill with many participants also favouring the use of the intra uterine device. Condoms were used by only ten percent of the group while the use of the injection - Depot Provera - was negligible. Most peri menopausal women had completed their families and had undergone Tubal Ligation even though a fair number had the intra uterine device in place and also had continued using the Pill as their contraceptive.
Maternal complications in HIV infected women receiving combination antiretroviral treatment in a resource constraint setting.
(2017) Sebitloane, Hannah Motshedisi.; Moodley, Jagidesa.
Abstract in PDF file.