CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME  20, ISSUE 5, SEP 2009
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  1. Title: Healthcare in Africa : editorial
    Authors: Grigorov, V.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 275-277
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    Abstract: In 2006, just before the economic turmoil, United States hospitals provided $28.8 billion dollars worth of care for patients who had no form of medical insurance (uncompensated care). This is twice the amount proposed for the entire budget (R100 billion) of the South African National Health Insurance (NHI) scheme.
    The burden was heavier on certain hospitals than others. What they call in America a 'safety-net' hospital is one that provides in-patient care to a greater proportion of uninsured patients. Only 2% of the hospitals in America are members of the National Association of Public Hospitals and Health Systems (NAPH), and they have to care for about 25% of the uncompensated in-patient population. The safety-net hospitals are located in areas where many uninsured patients live. The hospitals recoup the cost of care by charging the insured population higher fees. Despite that, most safety-net hospitals have negative margins.
    Safety-net hospitals in America serve as educational centres as well as disaster recovery centres. (America does not have 'government' hospitals. They are all private in one sense or another, as they are either self-funded, funded by research, or receive additional help from the State through education.)
     
  2. Title: Heart rate variability as an indicator of left ventricular systolic dysfunction : cardiovascular topic
    Authors: Shehab, Abdullah; Elnour, Asim A.; Struthers, Allan D.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 278-283
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    Abstract: Objectives : The aim was to compare measures of heart rate variability (HRV) in patients who presented with non-cardiac vascular episodes with age- and gender-matched control patients.
    Methods : One hundred and fifty patients, randomly selected from a cohort of 522 subjects, were enrolled in a screening study. Of these, 256 were identified to have had a stroke or transient ischaemic attack (TIA), or to have peripheral vascular disease (PVD) at the first presentation to Ninewells Hospital, Dundee, Scotland. Only 114 patients remained in the study (100 cases and 14 controls). Multiple regression analysis was used to assess the association between HRV parameters and measures of mean heart rate and ejection fraction.
    Results : Heart rate and HRV indices were significantly inversely correlated with both normal left ventricular (LV) function [r = 0.2-0.5; p = 0.037-0.0001] and left ventricular systolic dysfunction (LVSD) [r = 0.3-0.5; p = 0.07-0.01] in the patients. HRV did not predict LVSD in this cohort of patients. Multiple regression analysis showed only ischaemic heart disease (IHD) and cigarette smoking had an independent relation to HRV parameters. Cigarette smoking (p = 0.008), IHD (p = 0.02) and diabetes (p = 0.03) were significant predictors of reduced HRV (standard deviation of the normal-to-normal interval: SDNN), independent of LVSD.
    Discussion : There were no significant differences in HRV indices between non-cardiac vascular patients (TIA, stroke, PVD) and their age- and gender-matched controls. HRV had no diagnostic value as a pre-screening test to identify suspected LVSD in these patients.
    Conclusion : HRV cannot be used as a screening test to identify hidden LVSD. Further studies will be needed to assess the possibilities that HRV is a convenient marker of endothelial dysfunction.
     
  3. Title: Quality of life-associated factors among patients undergoing coronary artery bypass surgery as measured using the WHOQOL-BREF : cardiovascular topic
    Authors: Najafi, Mahdi; Sheikhvatan, Mehrdad; Montazeri, Ali
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 284-289
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    Abstract: This was a study of the pre-operative factors that influence quality of life (QoL) in patients with coronary artery disease and the relationship between pre-operative QoL and early outcome after coronary artery bypass surgery (CABG). Using the WHOQOL-BREF questionnaire, 283 patients who underwent isolated coronary artery bypass surgery were interviewed and scores were obtained for the physical, psychological, social and environmental components.
    The study found that the independent physical component predictors for higher QoL included male gender and diabetes mellitus, while the independent psychological component predictors were male gender and high ejection fraction. Males, diabetics and patients with low education levels had higher social well-being than others. Among the postoperative complications, only respiratory failure was found to have a relationship with physical and psychological components.
    Women with coronary artery disease who were candidates for CABG had lower scores than the men in respect of all components of QoL. Furthermore, a lower pre-operative psychological score in patients undergoing CABG can influence postoperative complications, especially respiratory failure.
     
  4. Title: Comparison of aerobic and combined aerobic and resistance training on low-density lipoprotein cholesterol concentrations in men : cardiovascular topic
    Authors: Shaw, Ina; Shaw, Brandon S.; Krasilshchikov, Oleksandr
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 290-295
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    Abstract: While aerobic training and, to a lesser degree, resistance training are known to reduce blood concentrations of low-density lipoprotein cholesterol (LDL-C), little is known about the effects of a combination of aerobic and resistance training on LDL-C concentrations. The aim of the investigation was to examine the effects of 16 weeks of no exercise, aerobic training or a combination of aerobic and resistance training on lowering blood concentrations of LDL-C.
    Thirty-eight healthy, previously untrained men (mean age: 25 years and six months) with borderline high blood LDL-C concentrations volunteered to participate in this investigation. Each subject's blood LDL-C concentrations were measured following a nine- to 12-hour fasting period and prior to any exercise. Aerobic training consisted of exercise using a combination of treadmills, rowers, steppers and cycle ergometers. Combined aerobic and resistance training consisted of a combination of aerobic training at 60% of heart rate maximum, and resistance training using eight prescribed exercises performed for two sets of 15 repetitions at 60% of the estimated one-repetition maximum (1-RM).
    The no-exercise group was found to have had no significant (p ≤ 0.05) change in blood LDL-C concentrations (from 4.12 ± 0.27 to 4.21 ± 0.42 mmol.l-1), whereas the aerobic training and combined training groups showed significant and similar (p = 0.123) decreases in blood LDL-C concentrations (from 3.64 ± 2.87 to 2.87 ± 0.64 mmol.l-1 and from 4.39 ± 1.04 to 3.23 ± 0.71 mmol.l-1, respectively). This investigation indicates that a larger dose of aerobic exercise does not necessarily equate to a greater improvement in LDL-C concentrations if the lost aerobic exercise time is replaced with resistance exercise.
     
  5. Title: The effect of sympathomimetic medication on cardiovascular functioning of children with attention-deficit / hyperactivity disorder : cardiovascular topic
    Authors: Negrao, Bianca Lee; Crafford, Dalene; Viljoen, Margaretha
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 296-299
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    Abstract: Objective : The aim of this study was to investigate the effects of sympathomimetic medication on the cardiovascular system of children with attention-deficit / hyperactivity disorder (ADHD).
    Methods : Cardiovascular functioning of children with ADHD (n = 19) was tested while the children were stimulant free and during a period in which they were on stimulant medication. Electrocardiograms (ECGs) were obtained by means of a Schiller CardioLaptop AT-110 ECG recorder using the standard 12-lead cable positioning for a resting ECG. Blood pressure was measured by means of a stethoscope and mercury sphygmomanometer.
    Results : The main findings of this study were that methylphenidate usage is associated with increases in heart rate (HR) and blood pressure (BP), and that it does not adversely affect HR-corrected QT and JT intervals or cardiac dispersion values.
    Conclusion : Methylphenidate causes an increase in HR as well as increases in both systolic and diastolic BP, but no change in cardiac depolarisation and repolarisation duration or homogeneity.
     
  6. Title: Letter to the Editor
    Authors: Omar, Mak; Friedland, Gerald W.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 299
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    Abstract: In the editorial by G Friedland, 'Discovery of the function of the heart and circulation of blood' he omits the important contribution made by Ibn al-Nafis (born 1213) on the subject. About 400 years before Harvey's observation, Al-Nafis, a Syrian Arab physician correctly described the pulmonary circulation. In fact, Servitus, the Spanish physician (born 1511) whom he cites, was probably influenced by Al-Nafis in this regard.

  7. Title: Coronary artery bypass grafting and concomitant descending aorta-to-bifemoral artery bypass via sternotomy : case report
    Authors: Suzer, Kaya; Omay, Oguz; Ozker, Emre; Indelen, Cenk; Gumus, Burcak
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 300-302
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    Abstract: Introduction : We evaluated a new approach of combined coronary and aorto-bifemoral artery bypass grafting performed through median sternotomy using the descending aorta as the inflow source.
    Materials and methods : Four patients with advanced coronary and aorto-iliac disease were operated on in the same session. Following the coronary artery bypass grafting (CABG), we performed a proximal anastomosis of a bifurcated Dacron graft to the descending aorta through the posterior pericardium. The limbs of the graft were passed through the diaphragm into the retroperitoneal space. They were then passed through tunnels in the groins, and distal anastomoses in the groins were performed.
    Results : The postoperative course was uneventful in all four patients. In the second year, follow-up multi-slice computerised tomographies (CT) and magnetic resonance angiographies were done and all grafts were patent.
    Discussion : We believe this technique is a reliable alternative procedure to consider in CABG patients who are not suitable candidates for standard aorto-femoral operations. It has a reasonable rate of morbidity and perfect patency.

  8. Title: Nitric oxide in the cardiovascular system : a simple molecule with complex actions : review article
    Authors: Strijdom, Hans; Chamane, Nontuthuko; Lochner, Amanda
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 303-310
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    Abstract: Since it was identified as the elusive endothelium-derived relaxing factor (EDRF) in the 1980s, nitric oxide (NO) has rapidly gained status as one of the most important signalling molecules in the cardiovascular system. Now, 20 years later, NO is regarded by most to be a ubiquitous mediator of cardioprotection. However, due to various complex underlying cellular mechanisms, the actions of NO often seem to be contradictory. This article sheds light on some of the mechanisms that may influence the variable actions of NO in the heart. Its role in conditions of oxygen deprivation (ischaemia and hypoxia) in particular is relevant to basic scientists and clinicians alike, since the prevalence of ischaemic heart disease is on the rise (in both the developed and the developing worlds) and novel therapeutic options are in constant demand. NO is a promising candidate molecule that could find therapeutic application. For this to be achieved, a sound understanding of this simple molecule and its complex actions is required.
     
  9. Title: Dabigatran : safer, more effective and easier to use than warfarin : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 311-313
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    Abstract: The extent of the benefit of using dabigatran for the reduction of atrial fibrillation related stroke surprised experts at the 2009 European Society of Cardiology congress. The risk of stroke was lowered by 34% when the higher dose of dabigatran was used, the lower dose equalled warfarin's benefits, and both doses reduced haemorrhagic stroke, which is normally part of the cost equation of anti-coagulation.
     
  10. Title: Cardio news
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 313
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    Abstract: Servier South Africa sponsored a special meeting of all registrars in cardiology in South Africa.
     
  11. Title: Ivabradine reduces cardiovascular events in angina patients : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 315-319
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    Abstract: Slowing heart rate selectively with ivabradine (Coralan) therapy has been shown in a subgroup of angina patients in the BEAUTIfUL study to significantly reduce the primary endpoint of the risk of cardiovascular death, hospitalisation for myocardial infarction and new-onset or worsening heart failure by 24%. Hospitalisation for fatal or non-fatal myocardial infarction was reduced by a very significant 42% in all angina patients receiving ivabradine, regardless of whether their heart rate was raised or not (Fig. 1).
     
  12. Title: Residual risk of patients at LDL cholesterol goal : new insights and initiatives from 2009 ESC congress : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 319-320
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    Abstract: Low levels of high-density lipoprotein cholesterol (HDL-C) and raised triglyceride (TG) levels are strongly linked to significantly increased risk of coronary heart disease (CHD), even in patients who achieve or surpass the current low-density lipoprotein cholesterol (LDL-C) targets. This has been demonstrated in new analyses of the landmark PROspective CArdiovascular Münster (PROCAM) and the REsiduAl risk LIpids and Standard Therapies (REALIST) surveys.
     
  13. Title: Early and effective treatment of hypertension : ONTARGET provides some answers : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 323
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    Abstract: The earlier hypertension is treated with anti-hypertensives that provide effective target-organ protection without side effects, the greater the cost benefit to the patient and the providing healthcare service.
     
  14. Title: Irbesartan reduced heart failure in ACTIVE-I trial of patients with atrial fibrillation : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 324
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    Abstract: The addition of irbesartan to the treatment of normotensive patients with atrial fibrillation in the ACTIVE-I study resulted in a significant reduction in hospitalisation for heart failure and an overall reduction in the number of days spent in hospital for any cardiovascular-related reason. While the increased risk of stroke is perhaps most feared in atrial fibrillation, heart failure is the 'neglected complication' of atrial fibrillation.
     
  15. Title: Lowering systolic blood pressure in angina patients : adding nifedipine GITS to RAS blockade reduces cardiovascular morbidity : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 326-327
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    Abstract: Presenting the preferential benefits of nifedipine GITS when added to RAS blockade in patients with angina and isolated systolic hypertension (ISH), Dr P Meredith of the University of Glasgow, UK, pointed out that relying on only RAS blockade misses the significant advantages of adding further blood pressure lowering drugs to control the still-raised systolic blood pressure.
     
  16. 16. Title: Bayer Healthcare symposium focuses on new cardiovascular agents : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 328
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    Abstract: Bayer Schering Pharma presented its cardiology franchise at the 2009 ESC congress, bringing together the company's comprehensive portfolio of marketed and in-the-pipeline products designed to prevent or treat both acute and chronic disease for cardiovascular and cardiopulmonary health. This dedicated approach is aimed at addressing the unmet medical needs in cardiovascular disease.
     
  17. 17. Title: Meeting the needs for antiplatelet therapy in at-risk acute coronary syndrome patients : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 5, Sep / Oct
    Published: 2009
    Pages: 329-333
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    Abstract: This CME symposium set out to describe areas of unmet need in reducing cardiovascular events in at-risk acute coronary syndrome (ACS) patients, providing the context for the imminent results from the PLATO study and the CURRENT OASIS 7 trials, which would be presented later during the ESC 2009 congress.
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