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Goren K, Cen Y, Montemurri V, Moodley D, Sutton A, Ahmed A, Alphonsus L, Denezis P, Fleming C, Guertin H, Hyland K, Kalim A, Kim HH, Krause S, Liang A, Maclean E, Neocleous P, Patel A, Pritchard S, Purcell V, Qaqish M, Ryall S, Shum K, Suwary K, Vucetic A, Skinner J, Woolsey A, Marcotte E. The impact of music, play, and pet therapies in managing pain and anxiety in paediatric patients in hospital: a rapid systematic review. Paediatr Child Health 2023; 28:218-224. [PMID: 37287483 PMCID: PMC10243982 DOI: 10.1093/pch/pxad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/29/2023] [Indexed: 06/09/2023] Open
Abstract
Background Hospitalized children face pain and anxiety associated with the environment and procedures. Objective This review aimed to assess the impact of music, play, pet and art therapies on pain and anxiety in hospitalized paediatric patients. RCTs assessing the impact of music, play, pet, and/or art therapies on pain and/or anxiety in hospitalized paediatric patients were eligible. Methods Database searching and citation screening was completed to identify studies. A narrative synthesis was used to summarize study findings and certainty of evidence was assessed using GRADE. Of the 761 documents identified, 29 were included spanning music (n = 15), play (n = 12), and pet (n = 3) therapies. Results A high certainty of evidence supported play in reducing pain and moderate certainty for music and pet. A moderate certainty of evidence supported music and play in reducing anxiety. Conclusion Complementary therapies utilized alongside conventional medical treatment may mitigate pain and anxiety in hospitalized paediatric patients.
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Affiliation(s)
- Katherine Goren
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Yuchen Cen
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Vanessa Montemurri
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Dirusha Moodley
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Arielle Sutton
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Alveena Ahmed
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Lotus Alphonsus
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Peter Denezis
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Courtney Fleming
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Hailey Guertin
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Kiley Hyland
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Ayesha Kalim
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Harry Hyunteh Kim
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Sarah Krause
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Aileen Liang
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Eleanor Maclean
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Penelope Neocleous
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Arjun Patel
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Sharon Pritchard
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Victoria Purcell
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Michael Qaqish
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Stephanie Ryall
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Kathryn Shum
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Kylie Suwary
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Andrea Vucetic
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Jamila Skinner
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Amadene Woolsey
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Emily Marcotte
- Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
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Lalla U, Allwood BW, Louw EH, Nortje A, Parker A, Taljaard JJ, Moodley D, Koegelenberg CFN. The utility of high-flow nasal cannula oxygen therapy in the management of respiratory failure secondary to COVID-19 pneumonia. S Afr Med J 2020; 110:12941. [PMID: 32880537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023] Open
Affiliation(s)
- U Lalla
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
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Moodley D, Geerts S, Richardson DM, Wilson JRU. The importance of pollinators and autonomous self-fertilisation in the early stages of plant invasions: Banksia and Hakea (Proteaceae) as case studies. Plant Biol (Stuttg) 2016; 18:124-131. [PMID: 25865269 DOI: 10.1111/plb.12334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/04/2015] [Indexed: 06/04/2023]
Abstract
Reproduction is a crucial stage in the naturalisation of introduced plant species. Here, using breeding system experiments and observations of floral visitors, we investigate whether a lack of pollinators or an inability to autonomously self-fertilise limits naturalisation in five Australian Banksia species and the co-familial Hakea salicifolia in South Africa. Banksia species were heavily utilised by native insects and nectar-feeding birds. Although Banksia produced fruit when pollinators were excluded, pollinators significantly increased seed set in four of the five species. H. salicifolia flowers were visited by 11 insect species; honeybees (Apis mellifera) were the main visitors. Flowers in naturalised H. salicifolia populations received almost four times the number of visits as flowers in non-naturalised populations; the latter showed both pollen limitation (PLI 0.40) and partial self-incompatibility. This should not prevent invasion, since H. salicifolia produces fruits via autonomous selfing in the absence of pollinators. The results suggest a limited role of breeding systems in mediating naturalisation of introduced Proteaceae species. Other factors, such as features of the recipient environments, appear to be more important. Spatial variation in rates of reproduction might, however, explain variation in the extent and rate of naturalisation of different populations.
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Affiliation(s)
- D Moodley
- Department of Botany and Zoology, Centre for Invasion Biology, Stellenbosch University, Matieland, South Africa
- Invasive Species Programme, South African National Biodiversity Institute, Kirstenbosch National Botanical Gardens, Claremont, South Africa
- School of Agriculture, Earth and Environmental Science, University of KwaZulu-Natal, Durban, South Africa
| | - S Geerts
- Department of Botany and Zoology, Centre for Invasion Biology, Stellenbosch University, Matieland, South Africa
- Invasive Species Programme, South African National Biodiversity Institute, Kirstenbosch National Botanical Gardens, Claremont, South Africa
- Department of Conservation and Marine Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - D M Richardson
- Department of Botany and Zoology, Centre for Invasion Biology, Stellenbosch University, Matieland, South Africa
| | - J R U Wilson
- Department of Botany and Zoology, Centre for Invasion Biology, Stellenbosch University, Matieland, South Africa
- Invasive Species Programme, South African National Biodiversity Institute, Kirstenbosch National Botanical Gardens, Claremont, South Africa
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Nagiah S, Phulukdaree A, Naidoo D, Ramcharan K, Naidoo RN, Moodley D, Chuturgoon A. Oxidative stress and air pollution exposure during pregnancy: A molecular assessment. Hum Exp Toxicol 2014; 34:838-47. [PMID: 25403174 DOI: 10.1177/0960327114559992] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic air pollution exposure during pregnancy can cause oxidative stress leading to adverse birth outcomes. The aim of this study was to assess and compare oxidative stress response in peripheral lymphocytes isolated from pregnant women from a highly industrialized locale (south Durban (SD); n = 50) and a control with lower air pollutant levels (north Durban (ND); n = 50). Oxidative stress response was measured by quantifying malondialdehyde (MDA) levels and a SuperArray gene panel. Mitochondrial function (adenosine triphosphate (ATP) levels and mitochondrial depolarization), DNA integrity (comet assay and mitochondrial DNA (mtDNA) viability) and DNA repair (OGG1) were assessed. Antioxidant response was assessed by quantification of glutathione (GSH) and SOD2, nuclear factor erythroid 2-related factor 2 (Nrf2) and uncoupling protein 2 (UCP2) protein and messenger RNA (mRNA) expression. Levels of MDA (p = 0.9), mitochondrial depolarization (p = 0.88), ATP (1.89-fold), SOD2 (1.23-fold) and UCP2 (1.58-fold) gene expression were elevated in the SD group with significantly higher UCP2 protein levels (p = 0.05) and longer comet tail length (p = 0.0004). The expression of Nrf2 protein (p = 0.03) and mRNA levels (-1.37-fold), GSH concentration (p < 0.0001), mtDNA amplification (-2.04-fold) and OGG1 mRNA (-2.78-fold) activity were decreased in the SD group. Of the 84 oxidative stress-related genes evaluated, 26 were differentially regulated. Pregnant women exposed to higher air pollutant levels showed increased markers for oxidative stress and compromised DNA integrity and repair.
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Affiliation(s)
- S Nagiah
- Discipline of Medical Biochemistry, University of KwaZulu Natal, Durban, South Africa
| | - A Phulukdaree
- Discipline of Medical Biochemistry, University of KwaZulu Natal, Durban, South Africa
| | - D Naidoo
- Discipline of Medical Biochemistry, University of KwaZulu Natal, Durban, South Africa
| | - K Ramcharan
- Discipline of Occupational and Environmental Health, University of KwaZulu Natal, Durban, South Africa
| | - R N Naidoo
- Discipline of Occupational and Environmental Health, University of KwaZulu Natal, Durban, South Africa
| | - D Moodley
- Discipline of Medical Biochemistry, University of KwaZulu Natal, Durban, South Africa
| | - A Chuturgoon
- Discipline of Medical Biochemistry, University of KwaZulu Natal, Durban, South Africa
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Sardiwalla Z, Moodley D, Ndawonde T, Madikizela A, Ngobese N, Thobela N. A comparative study of central corneal thickness (CCT) and intraocular pressure (IOP) in University of KwaZulu-Natal students of Black and Indian ethnicity*. African Vision and Eye Health 2012. [DOI: 10.4102/aveh.v71i4.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Thisstudy compared central corneal thickness (CCT) and intraocular pressure (IOP) of Black and Indian students from the University of Kwa-Zulu-Natal. Two hundred (100 Black and 100 Indi-an) participants of both genders aged 18-25 years (mean and standard deviation; 20.1±1.6 years) participated in this study. CCT and IOP were measured for the right eye of each participant using a Tono-Pachymeter (NT530P) and a Goldmann applanation tonometer (GAT) respectively. Data was analyzed with descriptive, t-test and Pearson’s cor-relation statistics. In the total sample (N = 200), the mean CCT value was 519.5 ± 38.6 μm and CCT was higher in the Indians (526.5 ± 37.2 µm) than in the Blacks (512.4 ± 38.9 µm) (p = 0.01). Also, it was higher in the females (522.3 µm) than in males (516.7 µm), but the difference was insignificant (p = 0.07). The mean CCT was higher in the Indian males (520.1 µm) than in the Black males (513.2 µm), but the difference was insignificant (p=0.39). However, it was significantly higher in the Indian females (533 µm) than in the Black females (511.6 µm) (p = 0.003). In the total sample, the mean IOP was 14.6 mmHg and IOP was greater in Indiansthan Blacks (mean = 15.3 ± 2.9 mmHg and 13.8 ± 2.6 mmHg respectively) (p = 0.01). Also, the mean IOP (N = 200) value was slightly higher in the females (14.7 mmHg) than in males (14.5 mmHg) (p = 0.51). The mean IOP was higher in the Indian males (15.0 mmHg) than in the Black males (14.0 mmHg) (p = 0.07) and the mean IOP value was higher in the Indian females (15.7 mmHg) than in the Black females (13.6 mmHg) (p < 0.001). The higher mean IOP value in the Indian than Black participants was attributed to the higher mean CCT values. A positive, but inconsistent association between CCT and IOP was found in this study, the coefficient in the total sample (r = 0.382, p = 0.000), in the Blacks (r = 0.196, p = 0.05) and in Indians (r = 0.498, p = 0.000). A national population study comparing CCT and IOP in the various South African ethnic groups is recommended. Cognizance of these differences should be taken in the diagnoses of glaucoma in these ethnic groups. (S Afr Optom 2012 71(4) 171-177)
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Louw VJ, Dreosti L, Ruff P, Jogessar V, Moodley D, Novitzky N, Patel M, Schmidt A, Willem P. Recommendations for the management of adult chronic myeloid leukaemia in South Africa. S Afr Med J 2011; 101:840-846. [PMID: 22272968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 08/17/2011] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Chronic myeloid leukaemia (CML) is a chronic myeloproliferative disorder characterised by a chromosomal translocation between the long arms of chromosomes 9 and 22 [corrected] resulting in the formation of the BCR-ABL fusion gene. The management of CML has undergone major changes over the past decade. Novel treatment approaches have had a dramatic impact on patient outcomes and survival. Nevertheless, these outcomes can only be achieved in the context of expert management, careful monitoring of disease response, appropriate management of adverse events and timeous adjustments to therapy when responses are not achieved within stated time-frames. AIM With the advent of novel treatments providing molecular responses, both the monitoring and management of CML have become more complicated. The aim of these recommendations was to provide a pragmatic yet comprehensive roadmap to negotiate these complexities. METHODS Recommendations were developed based on local expert opinion from both the academic and private medical care arenas after careful review of the relevant literature and taking into account the most widely used international guidelines. About five meetings were held at which these recommendations were discussed and debated in detail. RESULTS A comprehensive set of recommendations was compiled with an emphasis on diagnosis, investigation, treatment and monitoring of disease. Careful attention was given to circumstances unique to South Africa, funding constraints, availability and access to laboratory resources, as well as the effects of concurrent HIV infection. CONCLUSION Most patients with CML can live a reasonably normal life if their disease is appropriately managed. These recommendations should be of value to all specialists involved in the treatment of haematological disorders.
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MESH Headings
- Adult
- Benzamides
- Comorbidity
- Dasatinib
- Disease Management
- HIV Infections/epidemiology
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Piperazines/administration & dosage
- Piperazines/therapeutic use
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Pyrimidines/administration & dosage
- Pyrimidines/therapeutic use
- South Africa
- Thiazoles/administration & dosage
- Thiazoles/therapeutic use
- Treatment Outcome
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Affiliation(s)
- V J Louw
- Division of Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein.
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Moodley D, Grobler SR, Olivler A. Cytotoxicity of a dentine bonding agent on four different cell-lines. SADJ 2005; 60:234-6. [PMID: 16119020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
UNLABELLED The aim of this study was to compare the cytotoxicity of a recently available dentine bonding agent on four different cell-lines (three human dental pulp fibroblast cell-lines and one mouse 3T3 fibroblast cell-line). METHODOLOGY Three human dental pulp cell-lines from 3 different donors and one established 3T3 mouse cell-line were grown and sub-cultured. Cell viability following exposure to Scothbond was then compared to a similar number of controls using the MTT assay. RESULTS Scotchbond 1 was cytotoxic to all four cell-lines. 3T3 cells showed a survival rate of about 60% as compared to two of the human dental pulp cells which showed a significantly lower survival rate (p<0.05, Kruskal-Wallis Multiple-Comparison Test). CONCLUSION These findings indicated that is cytotoxic to both human pulp and 3T3 cell-lines. In general, the human pulp cell-lines showed higher sensitivity than the 3T3 cell-lines. CLINICAL SIGNIFICANCE Scotchbond 1 cannot be recommended for direct pulp capping techniques and care should be taken when using this dentine bonding agent in cavities where the remaining dentine layer is minimal.
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Affiliation(s)
- D Moodley
- Oral and Dental Research Institute, University of the Western Cape, Faculty of Dentistry, Tygerberg, South Africa
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Abstract
The HIV global epidemic is having a devastating effect on women of reproductive age; women aged 15-24 years are 2.5 times more likely to be infected than young men in the same age group. Further, mother-to-child transmission (MTCT) accounts for almost two-thirds of the new infections that occur in children world-wide, annually. MTCT of HIV-1 varies widely and is dependent on obstetric practices, mode of delivery, breastfeeding, and the level of the viral load in the mother. Antiretroviral therapy (ARV) in pregnancy is prescribed for two main reasons: (i) women who need ARV medication for their own health; (ii) women who do not need treatment, or do not have access to treatment are offered prophylaxis to prevent MTCT, using one of a number of ARV regimens known to be effective. HIV infection is also associated with significant maternal morbidity and mortality. Clinicians caring for HIV-infected women need to update their knowledge continuously to provide optimal care.
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Affiliation(s)
- J Moodley
- MRC/UKZN Pregnancy Hypertension Research Unit, Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
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Grobler SR, Olivier A, Moodley D, van W Kotze TW. Cytotoxicity of two concentrations of a dentine bonding agent on mouse 3T3 and human pulp fibroblast cell-lines. SADJ 2004; 59:368-70, 372. [PMID: 15624873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The objective of this study was to investigate the cytotoxicity and effect of concentration of a recent dentine bonding agent on a mouse fibroblast cell-line (3T3) and four different human pulp fibroblast cell-lines. A mouse fibroblast 3T3 cell-line and 4 different human pulp fibroblast cell lines were used. The cells were grown and subcultured using standard conditions. For the testing of the cytotoxicity of the bonding agent (Prime & Bond NT) it was extracted with DMEM medium and the different cell-lines were exposed to the extraction. The MTT assay was used to establish the number of viable cells. For all 5 pairs (control vs test sample) of cell-lines for 4 microl bonding agent, the mouse and only two of the four human cell-lines showed a statistical significant difference (p < 0.05; Mann-Whitney) due to the cytotoxicity of the bonding agent. However, all 5 pairs showed significant differences (p < 0.05) at the 8 microl concentration level. To investigate the relative effect of concentration (4 microl compared to 8 microl) of a chemical agent (we used a bonding agent, Prime & Bond NT) on the cytotoxicity of these 5 cell-lines, the Kruskal-Wallis Multiple-Comparison test was used on the standardised medians. Statistically significant differences (p < 0.05) were found for various cell-lines between both concentration levels. In general, the tested bonding agent, at a higher concentration level, has an increased cytotoxic effect on all 5 cell-lines. About 69% (median) of 3T3 cells stayed viable with 4 microl (0.94cm2/ml) bonding agent and 61% when 8 microl was used. For the pulp cells the percentages were between 91% and 72% for 4 microl and between 77% and 24% for 8 microl. These findings indicated that the bonding agent Prime and Bond NT was cytotoxic and that different human pulp fibroblast cell-lines should be used in the cytotoxic testing of dental materials and secondly, if only one concentration is to be used it should be in the higher range of that suggested by the ANSI/ADA document (2000, Revision) for recommended standard practices for biological evaluation of dental materials.
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Affiliation(s)
- S R Grobler
- Oral and Dental Research Institute, Faculty of Dentistry, University of the Western Cape, Private Bag X1, Tygerberg, 7505.
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Pillay T, Sturm AW, Khan M, Adhikari M, Moodley J, Connolly C, Moodley D, Padayatchi N, Ramjee A, Coovadia HM, Sullivan JL. Vertical transmission of Mycobacterium tuberculosis in KwaZulu Natal: impact of HIV-1 co-infection. Int J Tuberc Lung Dis 2004; 8:59-69. [PMID: 14974747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Increases in perinatal TB have paralleled the exacerbation of the TB epidemic in KwaZulu Natal. The exact risks for vertical transfer of Mycobacterium tuberculosis (VTRTB) to the baby are unknown, as is the impact of HIV-1 co-infection, which frequently accompanies maternal TB disease in the region. DESIGN Prospective case series study of 82 HIV-1-infected and 25 non-infected pregnant mothers, King Edward VIII Hospital, KwaZulu Natal, South Africa. RESULTS Perinatal mortality in HIV-1/TB diseased mothers was 85/1000 and associated with maternal anaemia (P = 0.02); 46% of newborns were premature, 66% low birth weight and 49% intrauterine growth restricted. These were significantly higher than overall hospital rates (P < 0.01, OR 4.8, 95%CI 3.2-7.0). Sites of detection of maternal TB, distribution of bacteriologically-proven TB, obstetric comorbidity and perinatal morbidity were similar in HIV-1-infected and non-infected mothers. VTRTB was detected in 16 newborns (16%), occurring similarly in bacteriologically-proven and suspected maternal TB disease, with no difference between HIV-1-infected and non-infected mothers. Eleven newborns with VTRTB were HIV-1 exposed; 64% acquired HIV-1 and died from rapidly progressive disease by 10 months of age. HIV-1-infected mothers and their exposed newborns had significantly lower CD4 counts. No association between perinatal maternal viral load, CD4 count or VTRTB was detected. CONCLUSION Mothers with TB disease in pregnancy are at risk for significant perinatal morbidity, mortality and VTRTB.
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Affiliation(s)
- T Pillay
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
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Moodley D, Grobler SR. Dentine bonding agents--a review of adhesion to dentine. SADJ 2002; 57:234-8. [PMID: 12229079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Although constant innovation has improved the performance of dentine adhesives, the true mechanism of resin adhesion to dentine is still not clear and the optimal dentinal surface pretreatment has yet to be determined for adhesive integrity of resin to dentine. The integrity of the collagen fibrils left exposed upon acid etching seem to play a major role in the mechanism of adhesion and intermingling of the adhesive monomers with the filigree of collagen fibers or hybrid layer should be considered the paramount dentine bonding mechanism. Definite trends are emerging but more research is necessary before general conclusions can be made about the functions of different bonding agents. The all-in-one self-etching/self-primer bottle systems are relatively new to the market and need more research before they can be advocated as the agent of choice.
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Affiliation(s)
- D Moodley
- Oral and Dental Research Institute, Faculty of Dentistry, University of Stellenbosch, Tygerberg
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Affiliation(s)
- J Moodley
- MRC/UN Pregnancy Hypertension Research Unit and Department of Obstetrics and Gynaecology, University of Natal Medical School, Durban, South Africa.
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Bobat R, Coovadia H, Moodley D, Coutsoudis A, Gouws E. Growth in early childhood in a cohort of children born to HIV-1-infected women from Durban, South Africa. Ann Trop Paediatr 2001; 21:203-10. [PMID: 11579858 DOI: 10.1080/02724930120077772] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study describes growth in a cohort of black South African children born to HIV-1-infected women in Durban. Children born to HIV-1-seropositive women were followed up from birth to early childhood. At birth and at each visit, growth parameters were measured. Mean Z-scores were calculated for weight-for-length, weight-for-age and length-for-age and, if they were low, the children were regarded as wasted, malnourished or stunted, respectively. At the end of the study, there were 48 infected and 93 uninfected children. There were no significant differences between the two groups at birth. Thereafter, the infected group was found to have early and sustained low mean Z-scores for length-for-age and weight-for-age but not for weight-for-length. The means reached significance at ages 3, 6 and 12 months for length and at 3, 6 and 9 months for weight. Infected children who died early had more severe stunting, wasting and malnutrition than infected children who survived. Infected children born to HIV-positive women have early and sustained stunting and are malnourished but not wasted. Children with rapidly progressive disease have both stunting and wasting and are more severely affected. Early nutritional intervention might help prevent early progression or death in HIV-infected children, particularly in developing countries without access to anti-retroviral therapy in state hospitals.
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Affiliation(s)
- R Bobat
- Department of Paediatrics, Nelson R. Mandela School of Medicine, University of Natal, Private Bag 7, Congella 4013, South Africa.
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Kuhn L, Coutsoudis A, Moodley D, Mngqundaniso N, Trabattoni D, Shearer GM, Clerici M, Coovadia HM. Interferon-gamma and interleukin-10 production among HIV-1-infected and uninfected infants of HIV-1-infected mothers. Pediatr Res 2001; 50:412-6. [PMID: 11518830 DOI: 10.1203/00006450-200109000-00018] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Immunologic consequences of exposure to HIV-1 in utero are still poorly understood. This study investigates relationships between type-1 [interferon-gamma (IFN-gamma)] and type-2 (IL-10) cytokine production and maternal-infant HIV-1 transmission. Cord blood leukocytes from deliveries of 71 HIV-1-infected and 11 uninfected mothers were tested for in vitro IFN-gamma and IL-10 production after phytohemagglutinin (PHA) stimulation. The infants of these HIV-1-infected mothers were followed prospectively after birth to determine HIV vertical transmission, and IFN-gamma and IL-10 production was measured again at 6 mo. Median PHA-stimulated IFN-gamma production was 210 pg/mL in cord blood cells from infected and 73 pg/mL from uninfected mothers (p = 0.12), and median PHA-stimulated IL-10 production was 491 pg/mL in cord blood cells from infected and 161 pg/mL from uninfected mothers (p = 0.004). PHA-stimulated IFN-gamma and IL-10 production alone were not significantly associated with transmission, but relationships between the two cytokines differed among infected and uninfected infants of HIV-1-infected mothers. PHA-stimulated IFN-gamma and IL-10 production was positively correlated among infected (r = 0.7, p = 0.12 in cord blood and r = 0.66, p = 0.03 at 6 mo) but not uninfected infants, and stronger relative production of IFN-gamma to IL-10 was observed among exposed uninfected than among infected infants (p = 0.04). Exposure in utero to HIV-1 may augment production of IL-10 detectable in fetal cord blood. Stronger relative production of IFN-gamma to IL-10 in cord blood cells from infants of HIV-1-infected mothers may be associated with protection against perinatal HIV infection.
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Affiliation(s)
- L Kuhn
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Division of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
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Moodley D, Pillay K, Naidoo K, Moodley J, Johnson MA, Moore KH, Mudd PN, Pakes GE. Pharmacokinetics of zidovudine and lamivudine in neonates following coadministration of oral doses every 12 hours. J Clin Pharmacol 2001; 41:732-41. [PMID: 11452705 DOI: 10.1177/00912700122010636] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A phase I, repeat-dose, open-label study was conducted to determine the pharmacokinetics and safety of zidovudine and lamivudine, coadministered orally every 12 hours, in 16 neonates whose mothers were infected with human immunodeficiency virus type 1 (HIV-1). The prospective mothers had been stabilized on a zidovudine/lamivudine regimen since week 36 of pregnancy to prevent mother-to-child transmission of HIV. During 1 week postpartum, the mothers received zidovudine 300 mg plus lamivudine 150 mg every 12 hours and breastfed. Neonatal treatment was initiated 12 hours following birth with 4 mg/kg of zidovudine suspension plus 2 mg/kg of lamivudine solution every 12 hours; this regimen was continued for 1 week. Between days 1 and 7 of neonatal treatment, the neonatal oral clearance (CL/F) of zidovudine and lamivudine increased by 2-fold (p < 0.001) and 1.6-fold (p = 0.004), respectively, possibly reflecting maturation of intestinal hepatic and renal function occurring during the first week of life. Day 7/day 1 ratios for exposure (area under the serum concentration-time curve [AUC]) and maximum observed serum concentration (Cmax) were 0.48 and 0.63, respectively, for zidovudine and 0.64 and 0.73, respectively, for lamivudine. At the time of delivery, the geometric mean cord/maternal concentration ratio was 1.24 for zidovudine and 1.12 for lamivudine, indicating free passage of each drug across the placenta. The maternal and neonatal treatment regimens were well tolerated. The results of this study confirm that in the neonate, a convenient regimen combining zidovudine 4 mg/kg and lamivudine 2 mg/kg, administered orally every 12 hours, provides zidovudine serum exposure very similar to that reported with the standard neonatal zidovudine regimen of 2 mg/kg every 6 hours, as well as lamivudine serum exposure within the range reported in adults receiving lamivudine 150 mg twice a day and children receiving 4 mg/kg twice a day.
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Affiliation(s)
- D Moodley
- Pregnancy and Hypertension Research Department, University of Natal, Durban, South Africa
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Pillay T, Adhikari M, Mokili J, Moodley D, Connolly C, Doorasamy T, Coovadia HM. Severe, rapidly progressive human immunodeficiency virus type 1 disease in newborns with coinfections. Pediatr Infect Dis J 2001; 20:404-10. [PMID: 11332665 DOI: 10.1097/00006454-200104000-00007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To describe a severe form of rapidly progressive HIV-1 infection manifesting in the neonatal period. METHOD Prospective cohort study, King Edward VIII Hospital, Durban, South Africa. HIV-1-exposed neonates with hepatosplenomegaly, lymphadenopathy or persistent pneumonia within the first 28 days of life were investigated for perinatal infections. Confirmation of neonatal HIV-1 infection, HIV-1 subtype and clinical outcomes were studied. RESULTS Twenty-three (72%) of 32 symptomatic HIV-1-exposed neonates recruited at a mean of 15.2 days were HIV-1-infected. HIV-1 infection was detected in 5 patients who were tested within 48 h of birth, confirming congenital infection. Congenital infection was not excluded in any case. Median neonatal viral load at recruitment was 471,932 copies/ml and median CD4 was 777 cells/mm3. The predominant clinical presentation was growth retardation and prematurity. Perinatal infections detected included: tuberculosis (8), syphilis (6) and cytomegalovirus (10). All of the neonates with perinatal tuberculosis were HIV-1-coinfected. Maternal and neonatal viral load and CD4 at recruitment were not statistically different between the groups with tuberculosis vs. other coinfections. Gag gene sequence analysis confirmed closely aligned HIV-1 subtype C in mothers and neonates. Nineteen (83%) died by 9 months, with a mean age at death of 3.5 months. CONCLUSIONS A distinct group of HIV-1-infected babies may clinically manifest in the neonatal period with perinatal coinfections, subsequent rapidly progressive HIV-1 and early death.
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Affiliation(s)
- T Pillay
- Department of Paediatrics and Child Health, University of Natal, Medical School, South Africa
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18
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Abstract
One of the major obstacles to the eradication of perinatal transmission of syphilis is the delay in obtaining the results of syphilis serological tests. The availability of on-site syphilis testing lead to this study which attempted to evaluate on-site syphilis testing performed by nursing staff. The seroprevalence of syphilis by laboratory rapid plasma reagin (RPR) was 8.2% (n=42). Twenty-one of the 42 women were correctly identified by the on-site test. The overall sensitivity of on-site testing was 50% [95% confidence interval (CI)=34.4-65.6]; specificity of 90.9% (95% CI=87.8-93.2). The on-site test correctly identified as uninfected 429 of the 471 women reported as RPR negative by the laboratory, giving a specificity of 91.1% (95% CI=88.1-93.4). The results of the study show that on-site RPR test had a sensitivity of 75% in respect of the clinically important titres of > or = 1:8. The specificity of the on-site test was 91.1% and on-site testing only failed to detect syphilis in those patients with titres of 1:1 and 1:2. On-site testing is a practical and cost-effective option to prevent congenital syphilis, in settings of a high prevalence of syphilis and using skilled testers.
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Affiliation(s)
- A Patel
- Department of Obstetrics & Gynaecology and MRC/UN Pregnancy Hypertension Research Unit, University of Natal Medical School, Durban, South Africa
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19
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Kuhn L, Coutsoudis A, Moodley D, Trabattoni D, Mngqundaniso N, Shearer GM, Clerici M, Coovadia HM, Stein Z. T-helper cell responses to HIV envelope peptides in cord blood: protection against intrapartum and breast-feeding transmission. AIDS 2001; 15:1-9. [PMID: 11192849 DOI: 10.1097/00002030-200101050-00003] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acquired HIV-specific cell-mediated immune responses have been observed in exposed-uninfected individuals, and it has been inferred, but not demonstrated, that these responses constitute a part of natural protective immunity to HIV. This inference was tested prospectively in the natural exposure setting of maternal-infant HIV transmission in a predominantly breast-fed population. METHODS Cord blood from infants of HIV-seropositive women in Durban, South Africa, were tested for in vitro reactivity to a cocktail of HIV envelope peptides (Env) using a bioassay measuring interleukin-2 production in a murine cell line. Infants were followed with repeat HIV RNA tests up to 18 months of age to establish which ones acquired HIV-infection. RESULTS T-helper cell responses to Env were detected in 33 out of 86 (38%) cord blood samples from infants of HIV-seropositive women and in none of nine samples from seronegative women (P = 0.02). Among infants of HIV-seropositive mothers, three out of 33 with T-helper responses to Env were already infected before delivery (HIV RNA positive on the day of birth), two were lost to follow-up, and none of the others (out of 28) were found to be HIV infected on subsequent tests. In comparison, six out of 53 infants unresponsive to Env were infected before delivery, and eight out of 47 (17%) of the others were found to have acquired HIV infection intrapartum or post-partum through breast-feeding (P = 0.02). CONCLUSIONS T-helper cell responses to HIV envelope peptides were detected in more than one-third of newborns of HIV-infected women; no new infections were acquired by these infants at the time of delivery or post-natally through breast-feeding if these T-helper cell responses were detected in cord blood.
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Affiliation(s)
- L Kuhn
- Gertrude H Sergievsky Center, College of Physicians and Surgeons, Division of Epidemiology, Joseph L. Mailman School of Public Health,Columbia University, New York, New York 10032, USA
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20
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Abstract
AIM To evaluate and compare the in-vitro shear bond strength, microleakage and dentine-restorative interface of a self-etching/self-priming dentine bonding agent with a three-component dentine-bonding agent. METHOD For shear bond strength (SBS) testing 30 non-carious human molars were used of which 15 were tested with Non-Rinse Conditioner (NRC)/Prime&Bond NT (PBNT) and Dyract AP and 15 were tested with Scotchbond Multi-Purpose Plus (SBMP) and F2000. For the microleakage evaluation cavity preparations were made on the facial surfaces of 30 non-carious human premolars of which 15 were restored with NRC and PBNT with Dyract AP and 15 were restored with SBMP and F2000. The dentine-restorative interface was examined through a confocal scanning laser microscope (CSLM). RESULTS The mean SBS of PBNT and SBMP were 12.8 and 18.1 MPa, respectively. The microleakage scores showed NRC/PBNT leaked on the dentine side in 13 of the 15 specimens examined. On the enamel side two of the 15 specimens showed microleakage. With SBMP no microleakage was observed on either enamel or dentine sides. The CSLM images show clear resin tag and hybrid layer formation for both the materials examined although SBMP showed better and deeper penetration into the dentine with longer resin tags. SBMP showed resin tags measuring about 150 mm while the hybrid layer measured about 5 mm. The length of the resin tags as well as the thickness of the hybrid layer for PBNT were 20 mm Pounds and 2 mm Pounds, respectively. CONCLUSIONS The acid-etch technique of SBMP produced higher bond strength and no microleakage when compared with the self-etching/self-priming 'non-rinse technique' of NRC with PBNT. Thus it can only be speculated that SBMP should be the superior in the clinical situation.
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Abstract
The renal kallikrein-kinin system is involved in sodium and water homeostasis, blood pressure regulation and inflammation. Tissue kallikrein and kinin levels were measured in the urine of patients with renal disease and in the urine of living related kidney donors prior to uninephrectomy who served as controls. Tissue kallikrein and kinin B1 and B2 receptors were immunolocalised by confocal microscopy in renal biopsy material from patients with renal disease and controls (fresh autopsy material and normal kidney tissue from nephrectomies for malignancy). Urinary tissue kallikrein excretion was significantly decreased in patients with mild renal disease (16.6 +/- 6.7 ng tissue kallikrein (TK)/ng protein; p < 0.05) and more markedly so (1.8 +/- 0.7 ng TK/microg protein; p < 0.01) in patients with severe renal failure requiring dialysis compared to normal controls (78.9 +/- 31.7 ng TK/microg protein). Basal kinin values were unchanged in patients with renal disease (14 +/- 0.8 ng/ml) compared to controls (13.3 +/- 0.56 ng/ml). In control kidney tissue kallikrein was immunolocalised in the distal connecting tubules and collecting ducts whereas decreased immunolabelling was observed with renal disease. Kinin B2 receptor labelling was present in the entire nephron in the normal control kidney but was reduced with renal disease. While kinin B1 receptor immunolabelling was not observed in the control kidneys, labelling of distal tubules and collecting ducts was noted in renal disease, suggesting an upregulation of B1 receptors in renal parenchymal disease.
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Affiliation(s)
- S Naicker
- Department of Medicine, University of Natal Medical School, Durban, South Africa
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Affiliation(s)
- J A Matambo
- Department of Obstetrics, University of Natal Medical School, Durban, South Africa
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23
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Bobat R, Coovadia H, Moodley D, Coutsoudis A. Mortality in a cohort of children born to HIV-1 infected women from Durban, South Africa. S Afr Med J 1999; 89:646-8. [PMID: 10443216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
OBJECTIVES To describe mortality in a cohort of infants with vertically transmitted HIV-1 infection. PATIENTS AND METHODS Children of HIV-1 infected women were followed up from birth and a record was made at each visit of growth, development and all illnesses. Details surrounding death were obtained from hospital records. RESULTS The final cohort comprised 48 infected and 93 uninfected children; there were 25 deaths, 17 of which (35%) were regarded as being HIV-related. The mean age at death of HIV-related cases was 10.1 months (range 1-48 months), with 83% of HIV-related deaths occurring before the age of 10 months. The commonest diagnoses at the time of death were diarrhoea, pneumonia, failure to thrive and severe thrush. These findings, together with neurological abnormalities, often presaged rapid deterioration and death. CONCLUSIONS Mortality among children with vertically acquired HIV infection is high in the first year of life. Death in these subjects was due to the common causes of morbidity and mortality among all children in developing countries. A combination of diarrhoea, pneumonia, failure to thrive, and neurological abnormalities should alert one to the possibility of rapidly progressive disease and death.
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Affiliation(s)
- R Bobat
- Department of Paediatrics and Child Health, University of Natal
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24
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Bobat R, Coovadia H, Coutsoudis A, Moodley D, Gouws E. Neonatal characteristics and outcome in a cohort of infants born to HIV-1-infected African women from Durban, South Africa. J Acquir Immune Defic Syndr Hum Retrovirol 1999; 20:408-9. [PMID: 10096587 DOI: 10.1097/00042560-199904010-00013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Engelbrecht S, Smith TL, Kasper P, Faatz E, Zeier M, Moodley D, Clay CG, van Rensburg EJ. HIV type 1 V3 domain serotyping and genotyping in Gauteng, Mpumalanga, KwaZulu-Natal, and Western Cape Provinces of South Africa. AIDS Res Hum Retroviruses 1999; 15:325-8. [PMID: 10082115 DOI: 10.1089/088922299311286] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
More than 20.8 million people are living with HIV/AIDS in sub-Saharan Africa, with southern Africa the worst affected area and accounting for one of the fastest growing AIDS epidemics worldwide. Samples from 81 patients, including 25 from KwaZulu-Natal, 26 from Gauteng, 5 from Mpumalanga, and 25 from Western Cape Province, were serotyped using a competitive V3 peptide enzyme immunoassay (cPEIA). Viral RNA was also isolated from serum and the V3 region amplified by reverse transcriptase polymerase chain reaction (RT-PCR) to obtain a 240-bp product for direct sequencing of 29 samples. CLUSTAL W was used to make multiple sequence alignments. Distance calculation, tree construction methods, and bootstrap analysis were done using TREECON. Subtype C-like V3 loop sequences predominate in all provinces tested in South Africa. Discordant sero- and genotype results were observed in one patient only. The correlation between sero- and genotyping was 96% (24 of 25) in KwaZulu-Natal and 100% in Gauteng and Mpumalanga. In Western Cape Province 18% of patients were identified as sero/genotype B and 82% as sero/genotype C. Our data show that results of the second-generation V3 cPEIA correlated well with V3 sequencing and would be a rapid and affordable screening test to monitor the explosive southern African HIV-1 epidemic.
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Affiliation(s)
- S Engelbrecht
- Department of Medical Virology, University of Stellenbosch and Tygerberg Hospital, South Africa.
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26
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Moodley J, Moodley D, Pillay K, Coovadia H, Saba J, van Leeuwen R, Goodwin C, Harrigan PR, Moore KH, Stone C, Plumb R, Johnson MA. Pharmacokinetics and antiretroviral activity of lamivudine alone or when coadministered with zidovudine in human immunodeficiency virus type 1-infected pregnant women and their offspring. J Infect Dis 1998; 178:1327-33. [PMID: 9780252 DOI: 10.1086/314431] [Citation(s) in RCA: 152] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The safety, pharmacokinetics, and antiretroviral activity of lamivudine alone and in combination with zidovudine was studied in pregnant women infected with human immunodeficiency virus type 1 (HIV-1) and their neonates. Women received the drugs orally from week 38 of pregnancy to 1 week after delivery. Neonate therapy began 12 h after delivery and continued for 1 week. Both treatment regimens were well-tolerated in women and newborns. Lamivudine and zidovudine pharmacokinetics in pregnant women were similar to those in nonpregnant adults. Lamivudine and zidovudine freely crossed the placenta and were secreted in breast milk. Neonatal lamivudine clearance was about half that in pediatric patients; zidovudine clearance was consistent with previous reports. HIV-1 RNA could be quantified in 17 of the 20 women. At the onset of labor/delivery, mean virus load had decreased by approximately 1.5 log10 copies/mL in both treatment cohorts. Although not definitive for HIV-1 infection status, all neonates had HIV-1 RNA levels below the limit of quantification at birth and at ages 1 and 2 weeks.
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Affiliation(s)
- J Moodley
- Department of Obstetrics and Paediatrics, University of Natal, Durban, South Africa. @relay
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Bobat R, Moodley D, Coutsoudis A, Coovadia H, Gouws E. The early natural history of vertically transmitted HIV-1 infection in African children from Durban, South Africa. Ann Trop Paediatr 1998; 18:187-96. [PMID: 9924555 DOI: 10.1080/02724936.1998.11747946] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Forty-eight children with vertically transmitted HIV-1 infection and 93 uninfected infants were followed up at regular intervals from birth for a mean of 26 months. They were examined physically, growth and development were assessed and illnesses recorded. Seventy per cent of infected infants were symptomatic by 6 months. Relative risks in the infected infants were highest for lymphadenopathy (4.56; CI 2.7-7.7), failure to thrive (4.48; 2.57-7.81), and neurological abnormalities (3.32; 1.9-5.58). The most frequent findings were diarrhoea (78%), pneumonia (76%) and lymphadenopathy (70%). Thrush and pneumonia occurred early but declined over time, whereas diarrhoea and neurological abnormalities occurred later and increased in frequency. A diagnosis of AIDS was made in 44% of infected infants by 12 months of age. Mortality in infected infants was 35.4%, and 76% of deaths occurred within the 1st year. About two-thirds of HIV-infected infants survived into early childhood. In South African children with vertically acquired HIV-1 infection the onset of disease is early and deterioration to AIDS and death are rapid. Infected infants can be easily recognized clinically, the majority by 6 months of age.
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Affiliation(s)
- R Bobat
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, South Africa
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Moodley D, Smith TL, Van Rensburg EJ, Moodley J, Engelbrecht S. HIV type 1 V3 region subtyping in KwaZulu-Natal, a high-seroprevalence South African region. AIDS Res Hum Retroviruses 1998; 14:1015-8. [PMID: 9686648 DOI: 10.1089/aid.1998.14.1015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Moodley
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Natal, Durban, South Africa
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Moodley D, Moodley J, Coovadia HM. Preventing perinatal HIV transmission in developing countries--do we know enough? S Afr Med J 1998; 88:431-2. [PMID: 9594982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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30
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Abstract
BACKGROUND Women in developing countries have the difficult choice of balancing the risk of transmitting HIV through breast milk against the substantial benefits of breastfeeding. It is not known, however, whether the benefits of breastfeeding are the same when the mother is HIV-infected. Therefore, we examined the impact of breastfeeding on infections, growth and mortality in the infants of HIV-1-infected women. METHODS Infants of HIV-1-positive women were followed from birth and at each visit they were examined, growth parameters were recorded and notes were made of feeding method, and of current and interim illnesses. RESULTS Of the 43 HIV-infected and 90 non-infected infants for whom feeding data were available, 36 infants (27%) were exclusively breastfed, 76 (57%) received mixed feeding, and 21 (16%) received formula only. The HIV transmission rate was 39% in those exclusively breastfed, 24% in those fed exclusively on formula and 32% in those receiving mixed feeding [relative risk (RR), 7.39; 95% confidence interval (CI), 1.67-32.6 between the exclusive breast and formula only groups]. There was a stepwise increase in the transmission rate with duration of exclusive breastfeeding of 1, 2 and 3 months (45%, 64%, and 75%, respectively). Of the infected infants, seven (50%) exclusively breastfed, 13 (51%) of those on mixed feeds and none on formula only developed AIDS; exclusively breastfed infants had a slower rate of progression to AIDS (mean age, 7.5 months versus 5.0 months, P = 0.2242) than those on mixed feeds. Mortality (which occurred in the infected infants only) was 19% in the exclusively breastfed infants; 13% in those on mixed feeds and 0% in those exclusively formula-fed. The frequency of failure to thrive and episodes of diarrhoea and pneumonia were not significantly different between the three groups in both the infected and non-infected infants. CONCLUSIONS Exclusive breastfeeding by HIV-infected women does not appear to protect their infants against common childhood illnesses and failure to thrive, nor does it significantly delay progression to AIDS. The implication of the trend towards differential mortality rates according to feeding groups is uncertain and requires further investigation.
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Affiliation(s)
- R Bobat
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, South Africa
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31
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Madurai S, Moodley D, Coovadia HM, Gopaul W, Smith AN, York DF. Infant-maternal HIV-specific immunoglobulin G1 antibody ratios as an indicator of vertical transmission. AIDS 1997; 11:1191-3. [PMID: 9233473 DOI: 10.1097/00002030-199709000-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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32
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Coutsoudis A, Moodley D, Pillay K, Harrigan R, Stone C, Moodley J, Coovadia HM. Effects of vitamin A supplementation on viral load in HIV-1-infected pregnant women. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 15:86-7. [PMID: 9215661 DOI: 10.1097/00042560-199705010-00015] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Moodley D, Bobat RA, Coovadia HM, Doorasamy T, Munsamy S, Gouws E. Lymphocyte subset changes between 3 and 15 months of age in infants born to HIV-seropositive women in South Africa. Trop Med Int Health 1997. [DOI: 10.1111/j.1365-3156.1997.tb00162.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Moodley D, Bobat RA, Coovadia HM, Doorasamy T, Munsamy S, Gouws E. Lymphocyte subset changes between 3 and 15 months of age in infants born to HIV-seropositive women in South Africa. Trop Med Int Health 1997; 2:415-21. [PMID: 9217696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The evolution of T-lymphocyte subsets during infancy in perinatally HIV-infected African babies has not been previously described. In a hospital-based cohort study, T-lymphocyte subset changes were investigated in 72 South African black children born to HIV seropositive mothers. Sixteen (22.2%; children were classified as infected and 56 (77.8%) as uninfected by 18 months of age. Four (25%) of the infected infants died before the age of 9 months from HIV-related disease. The CD4 and CD8 T-lymphocyte subsets, expressed in absolute numbers, as percentages, percentiles or as ratios, were clear indicators of HIV infection at all ages between 3 and 15 months. The most marked changes were a decreased percentage of CD4 cells and an increase in percentage of CD8 cells in the infected group. In the 4 infected infants who died, CD8 count and CD4:CD8 ratio clearly predicted poor clinical outcome at 3 months. Taken together, both CD4:CD8 ratio and CD4 percentage are reliable markers of HIV infection in an African paediatric population; however, a raised CD8 lymphocyte count rather than a CD4 count is a more specific prognostic marker of disease progression in HIV infected children.
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Affiliation(s)
- D Moodley
- Department of Paediatrics and Child Health, University of Natal, Durban, South Africa
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Moodley D, Bobat RA, Coovadia HM, Doorasamy T, Munsamy S, Gouws E. Lymphocyte subset changes between 3 and 15 months of age in infants born to HIV-seropositive women in South Africa. Trop Med Int Health 1997. [DOI: 10.1046/j.1365-3156.1997.d01-291.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Moodley D, Coovadia HM, Bobat RA, Madurai S, Sullivan JL. The relationship between maternal-infant antibody levels and vertical transmission of HIV-1 infection. J Trop Pediatr 1997; 43:75-9. [PMID: 9143175 DOI: 10.1093/tropej/43.2.75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study assesses the predictive value of the ratio of HIV-1 antibodies in the newborn at birth to that in the mother for perinatally transmitted infection confirmed subsequently by age 18 months. The ratio of HIV-1 (EIA) antibody levels in the baby at birth to that in the seropositive mother after the first trimester (sequenstration index SI) was available in 114 of a perinatal cohort of 137 infants. We related this ratio to the HIV infection status of the children by 18 months, HIV-1 DNA PCR and HIV-specific IgA antibody detection at birth, between 3 and 6 months, and morbidity and mortality. Thirty-five of the 137 (26 per cent) children were diagnosed as infected by 18 months. The mean (SD) HIV SI was 1.57 (0.88) in 29 infected and 0.83 (0.42) in 85 uninfected infants (P < 0.0001). Sensitivity and specificity of a threshold SI of 1.27 (mean +/- 2 SD of uninfected group) for the prediction of perinatal HIV-1 infection were 41 and 98 per cent, respectively. The reason for the higher SI in the infected babies is the combination of lower antibody titres in the transmitting mothers with raised levels in the infected babies. A similar analysis of antibody ratios showed no statistical differences for measles and tetanus (P > 0.1) between HIV infected and uninfected groups. There was a tendency to increased morbidity (Pearson's correlation coefficient r = 0.31) and more severe disease in those with higher HIV-1 SI. Three of 17 (18 per cent) peripheral blood samples from infected children at birth were PCR positive; all had SI's above the threshold. Overall sensitivity and specificity of PCR were 85 per cent each. Eleven of the 29 infected children were HIV-1 specific IgA positive at birth; six (64 per cent) of these had an SI > 1.27. This simple SI of HIV-1 EIA antibodies at birth is comparable to elaborate techniques in its power to predict perinatally acquired infection. It may be a cheap, reliable and rapid screening test for vertically transmitted HIV-1 infection.
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Affiliation(s)
- D Moodley
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, Durban, South Africa
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Moodley D, Coovadia HM, Bobat RA, Sullivan JL. HIV-1 specific immunoglobulin A antibodies as an effective marker of perinatal infection in developing countries. J Trop Pediatr 1997; 43:80-3. [PMID: 9143176 DOI: 10.1093/tropej/43.2.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
HIV-1 specific IgA antibody testing using commercially available reagents was evaluated at birth to 15 months in a group of infants born to HIV-seropositive South African women. Following IgG depletion of serum samples, 33/35 (94 per cent) of the infected infants and 3/99 (3 per cent) of the uninfected infants showed positive IgA reactivity. Sensitivity at birth was 24 per cent and improved with age; 82 per cent at 3 months, 87 per cent at 6 months and 94 per cent at 12 months. The overall positive and negative predictive values were 92 and 98 per cent, respectively. An evaluation of IgA and PCR in a subsample of infants indicated a better sensitivity of PCR within 3 months of birth, but IgA detection offered a higher overall sensitivity (87 v. 83 per cent) and specificity (91 v. 85 per cent). No significant difference in IgA level was observed between transmitting mothers and non-transmitting mothers. A moderate correlation existed between IgA level in the infant and the cumulative morbidity score, however a stronger association was observed between high IgA levels in the infected infant and rapid disease progression. The viral specific IgA assay is a simple, reliable and cost-effective diagnostic and prognostic test for perinatal HIV infection in developing countries.
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Affiliation(s)
- D Moodley
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, Durban, South Africa
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Moodley D, Coovadia HM, Bobat RA, Gouws E, Munsamy Y. Age-related pattern of immunoglobulins G, A and M in children born to HIV-seropositive women. Ann Trop Paediatr 1997; 17:83-7. [PMID: 9176583 DOI: 10.1080/02724936.1997.11747868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In a cohort of 56 children born to HIV-seropositive African women, 19 met the criteria for HIV-infected children and 37 remained antibody-negative at 18 months of age. Blood samples taken at birth and 3-monthly until 18 months of age were processed and analysed by laser nephelometry for serum immunoglobulin (IgG, IgA and IgM) levels. In the infected group of children. higher levels of IgG were observed during their 1st 18 months of life reaching statistical significance at 3, 6, 15 and 18 months. Higher levels of IgA at 3 months and at 15 and 18 months, and higher levels of IgM at 3 months and 18 months later were statistically significant. All four infected children who died before the age of 6 months showed signs of hypergammaglobulinaemia (IgG and IgA) by 3 months of age. In this study the earliest and most common immunological abnormality was hypergammaglobulinaemia and infected infants with higher morbidity and mortality had more evident immunoglobulin abnormalities than infected children who survived. However, the immunological abnormalities in this small cohort did not precede the onset of severe symptoms and cannot therefore be used to predict clinical outcome.
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Affiliation(s)
- D Moodley
- Department of Paediatrics and Child Health, University of Natal, South Africa
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Madurai S, Moodley D, Coovadia HM, Bobat RA, Gopaul W, Smith AN, York DF. Use of HIV-1 specific immunoglobulin G3 as a serological marker of vertical transmission. J Trop Pediatr 1996; 42:359-61. [PMID: 9009564 DOI: 10.1093/tropej/42.6.359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of the study was to indicate HIV infection in infants. The patients were part of a longitudinal cohort of 43 infants born to HIV seropositive mothers. A modified Genelavia EIA primarily directed against HIV envelope proteins was used. An alkaline phosphatase labelled IgG3 conjugate was substituted in place of the kit conjugate. HIV specific IgG3 clearance was optimal at 6 months, whilst HIV total antibody was reliable only from age 12 months onwards. At 6 months no detectable IgG3 were found in 91 per cent of uninfected infants where more of these infants had reduced their total HIV antibody titres at the same period. We confirm that HIV specific IgG3 measurement is a reliable and cost effective means of identifying HIV infected infants from 6 months of age onwards.
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Affiliation(s)
- S Madurai
- Department of Virology, Faculty of Medicine, University of Natal, Durban, South Africa
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Bobat R, Coovadia H, Coutsoudis A, Moodley D. Determinants of mother-to-child transmission of human immunodeficiency virus type 1 infection in a cohort from Durban, South Africa. Pediatr Infect Dis J 1996; 15:604-10. [PMID: 8823855 DOI: 10.1097/00006454-199607000-00009] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the vertical transmission rate of HIV-1 infection and to assess the influence of maternal risk factors on transmission in infants born to HIV-1-infected black women in Durban. DESIGN A prospective, hospital-based cohort study conducted at King Edward VIII hospital, Durban. HIV-1-seropositive women were enrolled into the study, and their infants were followed up at regular intervals from birth to early childhood. The infection status of the children was classified and the transmission rate was computed according to the recommendations of the workshop held in Ghent, Belgium (1992). RESULTS The final cohort of 181 infants were classified as 48 infected, 93 not infected and 40 indeterminate. Clearance of maternal antibodies was achieved by 12 months of age in virtually all infants who became seronegative. The intermediate transmission rate was 34% (95% confidence interval, 26 to 42). Deliveries by cesarean section had significantly lower transmission (relative risk, 0.46; 95% confidence interval 0.23 to 0.91). Women with lower hemoglobin concentrations during pregnancy (< 10 g/dl) had an increased risk of transmission (relative risk, 1.99; 95% confidence interval, 1.18 to 3.34). Advanced maternal age, multiparity, positive syphilis serology, duration of ruptured membranes, preterm delivery and breast-feeding were not associated with an increased risk of transmission. CONCLUSIONS This study, the first from South Africa, has confirmed that the rate of vertical transmission of HIV-1 is as high as that reported from most African cohorts. Cesarean sections were protective against transmission, whereas low hemoglobin values values were associated with an increased risk of transmission. Twelve months could be used as the cutoff age for teh diagnosis of vertical infection using antibody tests.
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Affiliation(s)
- R Bobat
- Department of Paediatrics and Child Health, University of Natal Medical School, Durban, South Africa
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Moodley D, Coovadia HM, Bobat RA. beta 2-Microglobulin and CD4/CD8 ratio as HIV-1 markers of maternal transmissibility, neonatal infection and disease progression. Ann Trop Paediatr 1996; 16:155-60. [PMID: 8790680 DOI: 10.1080/02724936.1996.11747819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A hospital-based cohort study assessing the function of surrogate markers (beta 2-microglobulin and CD4/CD8 ratio) in predicting maternal HIV transmissibility and disease progression in infants was conducted in 110 seropositive black South African mother-infant pairs. There were no differences in beta 2-microglobulin (beta 2-M) levels between the 27 transmitting and 83 non-transmitting mothers (P = 36). beta 2-M levels were higher in the infected that in the uninfected infants, but were significantly higher at 1 month (P = 0.04) and again at 12 months (0.03). A CD4/CD8 ratio < 1 was increasingly reported in the infected infants from 3 months (60.9%) to 15 months (93.8%) of age, and in three (5.4%) uninfected infants. Of the eight infected infants who rapidly progressed to death by 9 months, increased beta 2-M levels at birth and 1 month and inverted CD4/CD8 ratios at 3 months were strongly associated with the objective morbidity score. However, the CD4/CD8 ratio (positive predictive value 82.4%, negative predictive value 82.8%) at 3 months or later remained a better indicator of disease progression than beta 2-M (positive predictive value 33.3%, negative predictive value 74.4%).
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Affiliation(s)
- D Moodley
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, Durban, South Africa
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Affiliation(s)
- D Moodley
- Department of Experimental and Clinical Pharmacology, University of Natal Medical School, Durban, South Africa
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Naicker S, Moodley D, Nadar A, Gathiram P. Functional role of atrial natriuretic peptide in acute renal transplant rejection. Immunopharmacology 1996; 33:161-3. [PMID: 8856139 DOI: 10.1016/0162-3109(96)00033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- S Naicker
- Department of Medicine, University of Durban-Westville, South Africa
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Kuhn L, Bobat R, Coutsoudis A, Moodley D, Coovadia HM, Tsai WY, Stein ZA. Cesarean deliveries and maternal-infant HIV transmission: results from a prospective study in South Africa. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 11:478-83. [PMID: 8605593 DOI: 10.1097/00042560-199604150-00008] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Data from a prospective study undertaken at an urban hospital in Durban, South Africa, were used to investigate associations between maternal-infant HIV transmission, mode of delivery, and specific circumstances of cesarean deliveries. A total of 141 children of HIV-infected women were followed until the children were 15 months of age to determine their HIV status. supplementary data were collected from obstetric records, masked to the HIV status of the children. In this African and predominantly breast-fed population, infants delivered vaginally were more likely to be infected (39.8% infected) than were infants delivered by cesarean section [22.9% infected; odds ratio (OR), 0.45; 95% confidence interval (CI), 0.20-0.99]. There were no significant differences between cesarean deliveries undertaken following prior rupture of membranes and those undertaken with membranes intact, but numbers for this comparison were small. Singleton cesarean deliveries without concurrent obstetric complications had lower rates of transmission than did vaginal deliveries (OR, 0.20; 95% CI, 0.04-0.94). These results suggest that certain intrapartum events may modify the risk of HIV transmission and highlight the importance of collecting more detailed intrapartum information in order to clarify the route by which mode of delivery may be associated with maternal-infant HIV transmission.
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Affiliation(s)
- L Kuhn
- Division of Epidemiology, Columbia University, New York, NY 10032, USA
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Moodley D, Payne AJ, Moodley J. Maternal mortality in Kwazulu/Natal: need for an information database system and confidential enquiry into maternal deaths in developing countries. Trop Doct 1996; 26:50-4. [PMID: 8685964 DOI: 10.1177/004947559602600202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In a 2-year retrospective analysis of 147 maternal deaths in South African urban and rural hospitals, the maternal mortality rate (MMR) was estimated to be 144 per 100,000 live births. MMR was significantly higher (P = 0.025) in urban hospitals (160 per 100,000) and the main causes of death were hypertensive disease in pregnancy (33%), of which eclampsia contributed to 70% of deaths and haemorrhage (18%). Only 49.7% of women who died, attended an antenatal clinic. The MMR in South Africa is lower than sub-Saharan countries but unacceptably high for a country with a mix of private and public medicine. Disparities have been noted in maternal mortality rates within the country due to different study rates within the country due to different study designs and poor documentation, Structural changes in the health care system would only be possible if a common information database system were established and confidential enquiries held into maternal deaths.
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Affiliation(s)
- D Moodley
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Natal, Durban, South Africa
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Abstract
The evolution of human immunodeficiency virus type 1 (HIV-1) antibody titers determined by enzyme-linked immunosorbent assay between birth and 18 months of age was investigated in 118 babies born to HIV-1-seropositive South African mothers. By 18 months 41 (34.7%) children were diagnosed as HIV-1-infected by standard criteria. All 77 uninfected babies cleared maternal antibodies by 15 months; 94.5% of these babies seroreverted by 12 months. By 9 months of age a significant difference (P < 0.05) was noted between antibody decay rates in infected and uninfected children. Of the children subsequently shown to be uninfected, 95.8% demonstrated > or = 50% decay in antibody titers between 6 and 9 months; only 1 in the infected group showed a similar pattern (sensitivity, 97.8%; specificity, 93.8%). The approach of assessing the progression of antibody decay in infected and uninfected babies makes it a feasible and useful tool for estimating vertical transmission rates and diagnosis of perinatal HIV-1 infection earlier than standard practice.
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Affiliation(s)
- D Moodley
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, Durban, South Africa
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Abstract
OBJECTIVE To investigate free alpha-human chorionic gonadotropin (hCG) as a marker of preeclampsia. METHODS Four groups of patients were studied: normal pregnancies, preeclampsia, eclampsia and normal pregnant women <20 weeks' gestation. Patients were further divided according to parity and gestational age (< or =20, 21-30, 31-40 weeks). An immunoradiometric assay employing monoclonal antibodies specific for free alpha-hCG was used. RESULTS A total of 313 patients were analyzed. Thirty-four patients < or =20 weeks' gestation were followed until delivery: five (14.7%) developed preeclampsia; none had abnormal alpha-hCG levels before onset of preeclampsia. Patients with preeclampsia (21-30 weeks' gestation) demonstrated a mean alpha-hCG level greater than that of normotensive controls but this was not statistically significant. Between 31 and 40 weeks' gestation, mean alpha-hCG levels in the hypertensive and control groups were 210.8 ng/ml and 115.8 ng/ml, respectively (P < 0.001). A stronger association was observed between alpha-hCG and preeclampsia with increasing gestational age (relative risk [RR] 2.07, 21-30 weeks; RR 3.02, 31-40 weeks) and severity (RR 4.51, mild; RR 12.15, severe; RR 16.88, eclampsia). CONCLUSION There is a strong association between alpha-hCG and preeclampsia, nevertheless this test is unsuitable for predicting preeclampsia.
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Affiliation(s)
- D Moodley
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Natal, Durban, South Africa
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Bobat R, Coutsoudis A, Moodley D, Coovadia HM. Moving from AIDS to symptomatic HIV infection. S Afr Med J 1995; 85:495. [PMID: 7652625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Moodley D, Reddy K, Smuts H, Govender T, Coovadia HM. Heterogeneity of HIV-1 in South Africa detected by polymerase chain reaction. AIDS 1993; 7:1538-9. [PMID: 8280430 DOI: 10.1097/00002030-199311000-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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