Rafique Moosa - Academia.edu (original) (raw)

Papers by Rafique Moosa

PubMed, Jul 6, 1985

Two cases of solitary abscess of the spleen are presented and illustrate the clinical setting and... more Two cases of solitary abscess of the spleen are presented and illustrate the clinical setting and management of this potentially fatal condition. Both patients had presumed bacterial endocarditis with positive blood cultures yet failed to respond to appropriate antibiotic therapy. The clue to diagnosis was elevation of the left hemidaphragm. Outcome in each case was favourable after splenectomy.

PubMed, Oct 1, 1995

The prevalence of antibodies against hepatitis C virus (HCV) was determined in 103 haemodialysis ... more The prevalence of antibodies against hepatitis C virus (HCV) was determined in 103 haemodialysis patients who attended two dialysis units in South Africa. With the use of a second-generation enzyme-linked immunosorbent assay (UBI HCV EIA, Organon Teknika, The Netherlands) and a 4-recombinant immunoblot assay (Chiron Corporation, USA), antibodies to HCV were found in 22 patients (21%). Statistically significant associations with anti-HCV carrier status were duration of dialysis (P = 0.0005) and number of blood transfusions received (P = 0.008). With stepwise logistic regression analysis it was not possible to separate the effects of HCV status associated with these two variables. A transient elevation in alanine aminotransferase (ALT) occurred in 8 of the 22 anti-HCV-positive patients, compared with 14 of the 81 anti-HCV-negative patients (P = 0.054). As yet, no patients have clinical evidence of ongoing liver disease or persistently elevated ALT levels. Of the 45 dialysis staff members tested, none was positive for anti-HCV.

PubMed, Mar 1, 1995

The pulmonary complications in 110 consecutive renal transplant recipients on cyclosporin and low... more The pulmonary complications in 110 consecutive renal transplant recipients on cyclosporin and low-dose steroid immunosuppression were studied retrospectively. The pulmonary complications were: acute pulmonary oedema in 19 patients, pneumonia in 18, tuberculosis in 9, acute pulmonary embolism in 5, and lung abscess in 1. Sixty-nine patients (62.7%) had no pulmonary complications; 69% of the complications occurred in the first 4 months after the transplant. Pulmonary tuberculosis became evident later. The mean age, period of follow-up, human leucocyte antigen (HLA) B/DR mismatches, mean serum urea and serum creatinine concentrations, systolic and diastolic blood pressures, and cyclosporin dosage did not differ between the groups with no complications, infectious complications and non-infectious complications. The number of rejection episodes treated with bolus steroids was significantly higher in the infectious and non-infectious complications groups compared with the group with no complications. The incidence of pulmonary complications after renal transplantation, especially pneumonia and tuberculosis, was still high despite the use of low-dose steroids and cyclosporin. Pulmonary complications were the commonest cause of death in the first 3 years after the transplant. A high index of suspicion for pulmonary tuberculosis and pulmonary embolism in these patients is necessary.

Postgraduate Medical Journal, Oct 1, 1994

Acute accidental methyl bromide poisoning was treated with haemodialysis. The treatment was succe... more Acute accidental methyl bromide poisoning was treated with haemodialysis. The treatment was successful in removing bromide from the blood but the patient persists with severe neuropsychiatric sequelae. To the best of our knowledge haemodialysis has not been used previously for the treatment of organic bromide poisoning.

South African Medical Journal, Mar 29, 2019

The first kidney transplant on the African continent was performed in Johannesburg, South Africa ... more The first kidney transplant on the African continent was performed in Johannesburg, South Africa (SA), by Thomas Starzl and Bert Myburgh in 1966, [1] preceding the world's first heart transplant performed by Christiaan Barnard in Cape Town in 1967. [2] Transplant activity in SA remains lower than that achieved by other countries with comparable economic capacity. [3] Currently there are seven centres each in the public and private sectors offering kidney transplantation, distributed between five cities and four provinces. These transplant centres serve the 30 dialysis units in the public sector and the 228 units in the private sector. [4] Kidney disease is increasing in SA and has become one of the leading causes of mortality, accounting for a staggering 1 000 deaths per million population (pmp). [5] The challenge of coping with this situation is starkly illustrated in a recent report from a renal unit in Western Cape Province that currently accepts only 25% of patients with endstage kidney disease (ESKD) referred for treatment, down from 50% a decade ago. [6,7] The growing demand for renal replacement treatment places enormous pressure on already overburdened dialysis units around the country; the units in the public sector are particularly stressed. [8,9] SA has a two-tiered health system: a private health system is available to the 16% of the population that is able to afford medical insurance, and benefits from world-class medical care, while the remaining majority (84%) of uninsured individuals are served by state facilities that are generally under-staffed and under-resourced. [10] The marked discrepancy in healthcare is poignantly reflected in the access to renal replacement treatment: in 2015 the treatment rate in the public sector was 72 pmp compared with 799 pmp in the private sector. [4] The higher treatment rate in the private sector is because dialysis is a 'prescribed minimum benefit' introduced in SA in 1998 and requiring health insurers, among other obligations, to guarantee treatment for 25 chronic diseases, including chronic renal failure, regardless of the benefit option selected by the patient. To cope with the demand for renal replacement treatment, the number of private dialysis units increased dramatically from 5 in 1994 to 228 in 2015; during the same period, the number of units in the public sector merely increased from 26 to 30. [4] Haemodialysis was the predominant form of renal replacement in both sectors, with 46% of patients in the public sector and 85% in the private sector receiving this treatment. Only 25% of renal replacement patients in the public sector and a mere 8% in the private sector were kidney transplant recipients. [4] Objectives With kidney transplantation recognised as the most effective treatment for ESKD, both clinically and economically, the author interrogated the pattern of kidney transplantation in SA in the hope of assisting clinicians and health authorities in both the public and private sectors to develop strategies to improve kidney transplantation rates in SA. The primary objective of this study was to establish the pattern of kidney transplantation in ESKD patients in SA during the period 1991-2015, and determine any differences in rates and donor sources of kidney transplants performed in the public and private sectors. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Clinical transplantation, Jun 29, 2005

Clinical transplantation, Jun 1, 2004

ABSTRACT The introduction of cyclosporine revolutionized the practice of solid organ transplantat... more ABSTRACT The introduction of cyclosporine revolutionized the practice of solid organ transplantation. Although early studies showed better short-term results, the long-term benefits of cyclosporine appear to be more contentious. Our study investigated the outcome of sustained cyclosporine usage on patient and renal allograft survival in a developing country setting. All patients receiving primary renal transplants at our institution over a 23-yr period were included and data analysed for patient and graft survival rates using the Kaplan-Meier actuarial method. The patients receiving cyclosporine were compared with historical controls receiving conventional treatment. Early graft survival was superior in patients under cyclosporine but this benefit disappeared after the first year. There was no significant improvement in early patient survival in patients under cyclosporine but late survival was better in patients under conventional treatment. In our setting cyclosporine only improves early graft survival and does not have long-term benefit either on patient or graft survival.

Renal Failure - The Facts, 2012

The South African journal of clinical nutrition, Feb 16, 2010

The aim of this systematic review was to determine the strength and direction of the association ... more The aim of this systematic review was to determine the strength and direction of the association between body mass index (BMI), subjective global assessment (SGA) and mortality in adult patients on maintenance haemodialysis. Electronic data sources included Medline, Science Citation Index, Academic Search Premier, the Cochrane Library and Embase for the period 1963–2008. Data extraction and quality assessment were done by two independent reviewers. During meta-analysis of 12 studies reporting on BMI and four studies reporting on SGA results were pooled using the random effects model. Cochran’s Q was used to identify heterogeneity. Higher levels of BMI were associated with a weak but significant reduction in overall mortality (log HR -0.0413, CI -0.0588 to -0.0237) with no significant difference between all-cause and cardiovascular mortality (p = 0.4197). The relationship between mortality and SGA was also not significant (log HR 0.0643, CI -0.1713 to 0.2999). A high degree of hetero...

Hemodialysis International, Oct 1, 2007

Infection is the most common cause of death in hemodialysis patients, after cardiovascular diseas... more Infection is the most common cause of death in hemodialysis patients, after cardiovascular disease. Dialysis access infections, with secondary septicemia, contribute significantly to patient mortality. The most common source is temporary catheterization. Bacteremia occurs commonly in patients receiving hemodialysis, with infective endocarditis being a relatively uncommon, but potentially lethal complication. Valvular calcification is the most significant risk factor. The diagnosis of infective endocarditis is made clinically and confirmed with the echocardiographic modified Duke's criteria. The most common pathogen is Staphylococcus aureus and the mitral valve is the most common site. Staphylococcus aureus infective endocarditis is commonly associated with embolic phenomenon. A high index of suspicion is critical in the early recognition and management of infective endocarditis. However, prevention of bacteremia is undoubtedly the best strategy with the early placement of arteriovenous fistulae. In the case of temporary catheterization, the use of topical mupirocin or polysporin and gentamicin and/or citrate locking is beneficial. Although catheter salvage has not been studied in randomized trials, catheter removal remains standard therapy during bacteremia.

Journal of Renal Nutrition, Sep 1, 2010

ABSTRACT The primary objective of this systematic review was to determine the relationship betwee... more ABSTRACT The primary objective of this systematic review was to determine the relationship between body mass index (BMI) and all-cause and cardiovascular mortality. Systematic review of primarily observational studies. Adult patients from all gender, race, or ethnic groups on maintenance hemodialysis. Medline, Science Citation Index, Academic Search Premier, Cochrane Library, and Embase electronic databases covering the period 1966 to December 2008 were searched with the help of a qualified librarian. Reference lists of included papers and collections also were searched. Each study was reviewed by 2 independent reviewers who also performed the data extraction from full papers. Differences between reviewers were resolved by consensus or by a third reviewer in the case of disagreements. The quality of studies selected for inclusion in the systematic review was also assessed by 2 independent reviewers. BMI and mortality. Eighteen studies (60%) reported a significant inverse relationship between all-cause mortality and BMI. This inverse relationship was more prevalent in older patients, larger retrospective studies, and studies that did not adjust for inflammation. On the other hand, 57% of the 7 studies reporting on cardiovascular mortality found no significant relationship with BMI. This systematic review shows evidence of an inverse relationship between BMI and all-cause mortality in adult patients on maintenance HD, especially in older patients, but the relationship with cardiovascular mortality is less clear.

PubMed, Sep 1, 2003

Background: Optimising renal allograft survival is crucially important in developing countries be... more Background: Optimising renal allograft survival is crucially important in developing countries because of limited resources to treat irreversible renal failure. However, although many factors can be manipulated to improve outcome, certain demographic factors are immutable in individual patients. The present study evaluated the impact of age, gender and race on the outcome of renal transplantation. Methods: Relevant data were reviewed for 542 patients receiving primary renal allografts over a 23-year period. The survival of patients and grafts were calculated using the Kaplan-Meier method. Both univariate and multivariate analyses were used to determine the association between the demographic factors and patient and graft survival. Results: Actuarial survival of both patients and grafts decreased with increasing age. The most striking differences were demonstrated when patients older than 40 years were compared with younger patients. However, when patient survival was censored for death with functioning grafts--a very important cause of graft loss--then actuarial graft survival improved with increasing age. There was no gender difference in graft survival, but female recipients of renal allografts had a higher mortality than their male counterparts. There were no racial differences in either patient or graft survival. Conclusions: Age is an important determinant of outcome after renal transplantation, but race is not. Gender does not influence graft survival, but females do have a higher overall mortality rate following renal transplantation at our centre.

Seminars in Nephrology, May 1, 2021

Priority-setting dilemmas arise when trade-offs must be made regarding the kinds of services that... more Priority-setting dilemmas arise when trade-offs must be made regarding the kinds of services that should be provided and to whom, thereby withholding other services from individuals or groups that could benefit from them. Currently, it is practically impossible for lower-income countries to provide dialysis for all patients with kidney failure; however, the fundamental premise of the human right to health, while acknowledging the current resource constraints, is the progressive realization of access to care for all. In this article we outline the rationale for priority setting, starting with the global goal of achieving universal health coverage, the prerequisites for fair and transparent priority setting, and discuss how these may apply to expensive care such as dialysis. Priority is inherently a value-laden process, and cannot be whittled down to technical considerations of clinical or cost effectiveness alone. Fair and transparent priority setting should originate from population health needs, be based on evidence, and be associated with ethical values or principles. This requires effective engagement with relevant stakeholders. Once policies are developed and implemented, good oversight is crucial to ensure accountability and to provide iterative feedback such that the goals of universal health coverage may be progressively realized.

Nature Reviews Nephrology, Aug 25, 2020

Chronic kidney disease (CKD) is a rapidly growing public health problem, especially in disadvanta... more Chronic kidney disease (CKD) is a rapidly growing public health problem, especially in disadvantaged populations. Major political interventions are required to mitigate the social and socioeconomic inequities that contribute to the development and progression of CKD and its disproportionate impact on low and middle-income countries.

Kidney international supplements, Mar 1, 2020

nd-stage kidney disease (ESKD) and its management has significant clinical, social, and economic ... more nd-stage kidney disease (ESKD) and its management has significant clinical, social, and economic implications for patients, caregivers, and health care systems. 1,2 The burden of kidney disease is borne disproportionately by low-and middle-income countries (LMICs), where prevention, screening, and early detection are not commonly practiced and access to treatment for ESKD is limited. 3,4 Growing

Both immunosuppression and immunostimulation are thought to play a role in the development of Kap... more Both immunosuppression and immunostimulation are thought to play a role in the development of Kaposi's sarcoma after renal transplantation. We investigated the quantitative and qualitative aspects of the immune system of patients who had developed Kaposi's sarcoma. Stellenbosch University http://scholar.sun.ac.za/ The lymphocyte phenotypes were established using flow cytometry while transformation studies were performed using mitogens. Pokeweed was used as the B-cell mitogen, and concanavalin A and phytahaemagglutinin were the T-cell mitogens. Cell mediated immunity was also tested using delayed type hypersensitivity skin tests and the serum immunoglobulin levels were estimated. Firstly, with regard to humoral immunity, 2/3 of the patients had normal serum immunoglobulin levels, although the B-cell count was reduced in all the patients on immunosuppression. B-cell transformation tests with pokeweed mitogen revealed that B-cell function was not impaired in patients with Kaposi's sarcoma. The patients with decreased immunoglobulin levels also appeared to be malnourished as evidenced by low albumin levels. Secondly, CD3 and CD4, but not CD8, cell counts were reduced in patients with Kaposi's sarcoma. The transformation analyses revealed significant differences compared to controls, with reduced responses in patients with Kaposi's sarcoma. Thirdly, natural killer (NK) cell numbers were also reduced in patients with Kaposi's sarcoma. There were no significant differences in delayed type hypersensitivity skin reactions that could not be accounted for by racial differences. Cellular immunity is impaired in patients with Kaposi's sarcoma with a reduction in the number of NK cells. Both of these components of the immune system are important in protection against malignant transformation. SECTION 3 Kaposi's sarcoma is an important complication of renal transplantation. If the human herpesvirus 8 (HHV-8) causes Kaposi's sarcoma, the virus should be present in all Kaposi's sarcoma lesions and be drastically reduced or cleared from involved tissue on remission of the Kaposi's sarcoma. Fourteen renal transplant patients with cutaneous Kaposi's sarcoma, including autopsy material from two cases, were investigated for the presence of HHV-8. A second skin biopsy was taken from 11 survivors, after remission of Kaposi's sarcoma, from normal skin in the same anatomical region as the first biopsy. Stellenbosch University http://scholar.sun.ac.za/ A successful kidney transplant is undoubtedly the best treatment for the patient with endstage renal failure. For the individual patient, not only is it the most cost-effective option, but it also holds the promise of improved quality of life (Hathaway et a/., 1998) and longevity compared to dialysis therapy (Basadonna et a/., 1992;Denton et Stellenbosch University http://scholar.sun.ac.za/ Adequate Immunosuppression Fia • 1 i t a delicate balance exists between under-immunosuppression that may result in acute rejection and over-immunosuppression that may produce adverse events. Stellenbosch University http://scholar.sun.ac.za/ address the problems of transplant malignancies. We recount in detail our experience with Kaposi's sarcoma and compare it with experience elsewhere. Our treatment of the disease confirms what has been suggested by the literature but never proven until this study. The unique pattern of malignancies in the black Stellenbosch University http://scholar.sun.ac.za/ We attempt to answer the question by investigating the presence of antibodies to the virus in different groupings including transplant recipients, Renal Unit staff, healthy blood donors, relatives and contacts of Kaposi's sarcoma patients. Also unique to this project is the study of organ donor-recipient pairs and the assessment of the risk for the development of Kaposi's sarcoma. An important thread that runs through this dissertation is the fact that we are reporting our experience from a developing country. Most of the data that exist today has been reported from countries with developed economies. We show that Stellenbosch University http://scholar.sun.ac.za/ H istorical Aspects 2-4 animals as donors when he performs the transplants as penitence for his brash actions. These accounts are reputedly 5000 years old and probably represent the oldest accounts of transplantation in history (Bhandari et a/., 1997). CHINESE MYTHOLOGY Judge Lu (Figs. 2-1 and 2-2) The Chinese legends are less gruesome and are acts of kindness rather than acts of retribution and include two popular stories. The story of Judge Lu tells of a brave but simple man, Zhu Ertan, who was encouraged by his mischievous companions, in the middle of the night, to bring the Infernal Judge back to them. To their surprise he returned with a full-length effigy of the Judge. Zhu proceeded to invoke the image and invited it to drink with him whenever he felt the fancy to do so. He then returned the image to its rightful place. The following evening the judge walked into Zhu's humble abode and the poor man pleaded for his life. But the good Judge did not intend to punish the imbecile and instead accepted the offer of the drink. The judge became a regular visitor thereafter stopping by 2 to 3 days a week. One evening Zhu awoke with a throbbing pain in his chest to find the judge at his bedside. The judge had cut open his chest and was about to remove his heart. Zhu pleaded for FiQ. 2-2 Another depiction ol

The South African journal of clinical nutrition, 2010