CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME  21, ISSUE 2, MARCH 2011
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  1. Title: Bioequivalence : tried and tested : editorial
    Authors: Schall, Robert; Endrenyi, Lazlo
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Two drug products are considered bioequivalent 'if their bioavailabilities ... are similar to such a degree that their effects, with respect to both efficacy and safety, will essentially be the same'. The bioequivalence of two drug products is generally demonstrated through a clinical study in healthy volunteers, the so-called bioequivalence study. If bioequivalence is shown for two drug products, therapeutic equivalence of the drug products is implied. Chow and Liu call this assumption, namely that bioequivalence implies therapeutic equivalence, the 'fundamental bioequivalence assumption'.
     
  2. Title: AMP kinase activation and glut4 translocation in isolated cardiomyocytes : cardiovascular topics
    Authors: Webster, Ingrid; Friedrich, Sven O.; Lochner, Amanda; Huisamen, Barbara
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Activation of AMP-activated protein kinase (AMPK) results in glucose transporter 4 (GLUT4) translocation from the cytosol to the cell membrane, and glucose uptake in the skeletal muscles. This increased activation of AMPK can be stimulated by a pharmacological agent, AICAR (5'-aminoimidazole-4-carboxamide ribonucleoside), which is converted intracellularly into ZMP (5'-aminoimidazole-4-carboxamideribonucleosidephosphate), an AMP analogue. We utilised AICAR and ZMP to study GLUT4 translocation and glucose uptake in isolated cardiomyocytes.
    Adult ventricular cardiomyocytes were treated with AICAR or ZMP, and glucose uptake was measured via [3H]-2-deoxyglucose accumulation. PKB/Akt, AMPK and acetyl-CoA-carboxylase phosphorylation and GLUT4 translocation were detected by Western blotting or flow cytometry.
    AICAR and ZMP promoted AMPK phosphorylation. Neither drug increased glucose uptake but on the contrary, inhibited basal glucose uptake, although GLUT4 translocation from the cytosol to the membrane occurred. Using flow cytometry to detect the exofacial loop of the GLUT4 protein, we showed ineffective insertion in the membrane under these conditions. Supplementing with nitric oxide improved insertion in the membrane but not glucose uptake.
    We concluded that activation of AMPK via AICAR or ZMP was not sufficient to induce GLUT4-mediated glucose uptake in isolated cardiomyocytes. Nitric oxide plays a role in proper insertion of the protein in the membrane but not in glucose uptake.
     
  3. Title: Correlates of left ventricular mass in hypertensive Nigerians : an echocardiographic study : cardiovascular topics
    Authors: Ogah, Okechukwu S.; Bamgboye, Afolabi E.
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Background : Studies have shown that left ventricular mass, diagnosed by echocardiography, correlated poorly with blood pressure, even when the 24-hour ambulatory blood pressure monitoring was taken into account in the analysis. This may be partly because there are other determinants of left ventricular mass such as age, gender, neurohormonal factors and heredity.
    Knowledge of the correlates of left ventricular mass could help design individual and population strategies to prevent or reverse left ventricular hypertrophy. To the best of our knowledge, there is a paucity of such studies in native Africans. Hence the purpose of this study was to define the correlates of left ventricular mass in hypertensive Nigerians.
    Methods : The study was a retrospective analysis of prospectively collected data in 285 hypertensive subjects. Echocardiographic left ventricular mass was determined using the standard formula. Stepwise multiple regression analysis was used to determine the independent predictors of left ventricular mass with a probability value to enter and remove of p < 0.05.
    Results : There were 153 men (53.7%) and 132 women (46.3%) in the study. The mean age of all subjects was 58.2 ± 13.7 years. There was no significant gender difference in most of the echocardiographic parameters. In a stepwise multiple regression analysis, left ventricular wall tension, left ventricular wall stress, left atrial size, diastolic blood pressure, alcohol consumption and a family history of hypertension were the independent predictors of left ventricular mass in this population. The optimum multivariate linear regression main effects had an adjusted model, r2 of 0.945, thus explaining about 95% of left ventricular mass variability.
    Conclusion : Mechanical or haemodynamic factors possibly interacting with genetic and social factors are the likely determinants of left ventricular mass in hypertensive Nigerians. Therefore modulation of some of these factors pharmacologically or non-pharmacologically will be of benefit in the management of this patient population.
     
  4. Title: Medication adherence, self-care behaviour and knowledge on heart failure in urban South Africa : the Heart of Soweto study : cardiovascular topics
    Authors: Ruf, Verena; Stewart, Simon; Pretorius, Sandra; Kubheka, Maureen; Lautenschlager, Christine; Presek, Peter; Sliwa, Karen
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Background : There is a paucity of data on treatment adherence in patients with chronic heart failure (CHF) in Africa.
    Methods : We examined the pattern of treatment adherence, self-care behaviour and treatment knowledge in 200 consecutive patients with CHF attending the Chris Hani Baragwanath Hospital, Soweto, South Africa via a combination of questionnaire (100%, n = 200) and pill count (41%, n = 82).
    Results : Mean age was 56 ± 14 years, 157 were black African (79%) and 109 (55%) were male. CHF-specific treatment included loop diuretics (93%), beta-blockers (84%), ACE inhibitors (74%), spironolactone (64%) and cardiac glycosides (24%); mean number of medications was 6 ± 2. Overall, 71% (58 of 82) adhered to their prescribed CHF regimen and individual medication adherence ranged from 64 to 79%. Behavioural adherence varied from 2.5 to 98%. Patient treatment knowledge was poor; 56% could not name medication effects or side effects. However, an average knowledge score of 69% was achieved on 10 questions concerning CHF management.
    Conclusion : As in other regions of the world, non-adherence to complex CHF treatment is a substantial problem in Soweto. Our data confirm the need for a dedicated CHF management programme to optimise CHF-related outcomes in a low-resource environment.
     
  5. Title: Blood pressure response to an exercise treadmill test, and echocardiographic left ventricular geometry in Nigerian normotensive diabetics : cardiovascular topics
    Authors: Ajayi, E.A.; Balogun, M.O.; Akintomide, O.A.; Adebayo, R.A.; Ajayi, O.E.; Ikem, R.T.; Ogunyemi, S.A.; Oyedeji, A.T.
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Objectives : This study evaluated normotensive diabetic patients' blood pressure response to graded exercise and their echocardiographic pattern of left ventricular geometry.
    Methods : A descriptive, cross-sectional, hospital-based study was carried out on 30 normotensive type 2 diabetic patients and 34 controls, aged 30 to 60 years. The outcome measures were to determine the exercise-related variable, blood pressure response, and left ventricular geometry by means of echocardiography.
    Results : Nineteen (29.7%) and 11 (17.2%) normotensive diabetic subjects had normal left ventricular geometry and concentric left ventricular remodelling, respectively. None of the subjects had concentric or eccentric left ventricular hypertrophy. On this basis, the normotensive diabetic subjects were divided to two groups: G1 (normal) and G2 (concentric left ventricular remodelling). The groups had comparable mean age, body mass index (BMI), fasting blood glucose (FBG) and two-hour post-prandial blood glucose values, and heart rate, systolic (SBP) and diastolic blood pressure (DBP) at rest. G2 patients had higher mean duration of diabetes than G1 subjects (69.0 ± 9.48 vs 18.7 ± 8.7 months; p = 0.007). Peak systolic blood pressure was significantly higher in G2 than G1 subjects (213.6 ± 20.1 vs 200.0 ± 15.3 mmHg; p = 0.04). Although there was no statistically significant difference in the left ventricular (LV) mass index between the groups, G2 patients had significantly higher relative wall thicknesses than G1 patients (0.53 ± 0.03 vs 0.41 ± 0.04; p < 0.001).
    Conclusion : Normotensive diabetic subjects with concentric left ventricular remodelling have increased blood pressure reactivity to exercise. It is probable, as suggested in earlier studies, that increased blood pressure reactivity to exercise is an indicator of target-organ damage, particularly in normotensive diabetics.
     
  6. Title: Boehringer Ingelheim launches Care foundation and get-together of its sponsored medical students
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Boehringer Ingelheim launched its collective Corporate Social Investment (CSI) initiatives under one umbrella, the Care foundation, at a special function in Cape Town recently.
     
  7. Title: Factors associated with mortality when chronic betablocker therapy is withdrawn in the peri-operative period in vascular surgical patients : a matched case-control study : cardiovascular topics
    Authors: Biccard, Bruce M.
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Background : Withdrawal of chronic beta-blockade following vascular surgery is associated with peri-operative mortality. The aim of this study was to examine risk factors associated with mortality in patients where chronic beta-blockade was withdrawn.
    Methods : Two matched case-control studies were conducted, one of patients withdrawn from beta-blockade who survived and the other of patients who were maintained on beta-blockade and survived. Each case was matched with two controls. Three potential risk factors were analysed : the increase in heart rate postoperatively, the use of inotropes, and whether withdrawal for the first three postoperative days was more predictive than withdrawal for a single day. Multivariate conditional logistic regression was conducted.
    Results : The only independent predictor of in-hospital mortality was a change in the mean daily heart rate of ≥ six beats per minute from the day of surgery to the third postoperative day, or death or discharge if this happened before the third day (OR 13.7, 95% CI: 1.7-110, p = 0.014). The area under the curve for the receiver operating characteristic curve was 0.787.
    Conclusion : Use of a postoperative heart rate threshold may be clinically useful as an 'early warning system' in patients withdrawn from chronic beta-blockade in the peri-operative period.
     
  8. Title: Save these dates
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Save these dates
     
  9. Title: Inflammation and dyslipidaemia : a possible interplay between established risk factors in North Indian males with coronary artery disease : cardiovascular topics
    Authors: Goswami, Binita; Rajappa, Medha; Singh, Bhawna; Ray, P.C.; Kumar, Suresh; Mallika, V.
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Objectives : Coronary artery disease (CAD) is a leading cause of morbidity and mortality in the developed world and is rapidly assuming epidemic proportions in developing countries, including India. This has led to extensive research to determine the risk factors and the pathways that may predispose to the elevated risk of this disease. Important among them include lipoproteins, homocysteine, lipoprotein (a), pro-inflammatory cytokines and others. The following study was undertaken to determine a possible inter-relationship between inflammation and dyslipidaemia, which are important risk factors for CAD in the atherosclerosis-prone North Indian male population.
    Methods : The study groups comprised 150 clinically assessed North Indian male patients with acute myocardial infarction (AMI), diagnosed on electrocardiographic and biochemical criteria, and 150 healthy controls. Apolipoprotein-AI (Apo-AI), apolipoprotein-B (Apo-B) and C-reactive protein (CRP) levels were estimated using kits based on the immunoturbidimetric assay from Randox, UK. Tumour necrosis factor-α (TNF-α) and lipoprotein (a) were assayed using commercially available ELISA kits from Diaclone Research, Belgium and Innogenetics, Belgium, respectively.
    Results : The patients with AMI showed highly significant elevations in the levels of total serum cholesterol, triglycerides, LDL cholesterol, Apo-B and a significant decline in HDL cholesterol, compared with healthy controls. Significantly elevated serum levels of inflammatory markers, TNF-α and CRP were seen in patients with AMI, compared to the control subjects. A significantly positive correlation of TNF-α was observed with lipoprotein (a) in patients with CAD.
    Conclusion : The data clearly underlines a possible interplay between inflammation and dyslipidaemia in the pathogenesis of CAD in the Indian context. This insight into the aetiopathogenesis of CAD will prove highly beneficial for devising better preventive measures and pharmacological interventions for CAD.
     
  10. Title: Amiodarone-induced QT prolongation in a newly transplanted heart associated with recurrent ventricular fibrillation : case report
    Authors: Schwarz, Ernst R.; Czer, Lawrence S.; Simsir, Sinan A.; Kass, Robert M.; Trento, Alfredo
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Anti-arrhythmic drugs such as amiodarone have the potential to prolong QT intervals, which can result in torsades de point arrhythmia. It is unknown whether amiodarone, given to a recipient prior to cardiac transplantation, can cause arrhythmia in a newly transplanted donor heart. We report on a case of a 71-year-old male patient who had received intravenous and oral amiodarone prior to transplantation, which was associated with QT prolongation in the transplanted heart after re-exposure to the drug during subsequent episodes of ventricular fibrillation. An ICD was implanted, which has not been described that soon after cardiac transplantation. Amiodarone, given to a recipient, might cause QT prolongation in a donor heart after transplantation, possibly due to its long half-life and increased bioavailability caused by interaction with immunosuppressive drugs.
     
  11. Title: Innovative approaches offer more at 2010 South African Heart Association congress, 8-11 August, Sun City
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: The organisers of the 2010 South African Heart Association congress (SAHA) are offering an innovative programme with sessions in cardio-oncology (a first for South Africa), womens'cardiovascular health, ethics, and South African scientific contributions within the plenary sessions. Parallel sessions, although necessary to cope with special-interest groups, will be kept to a minimum. Interventional cardiology will be well covered.
     
  12. Title: The unicuspid aortic valve : case report
    Authors: Yuan, Shi-Min; Jing, Hua; Lavee, Jacob
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: The unicuspid aortic valve is a very rare congenital anomaly, which usually presents as aortic stenosis, incompetence, or a combination of both. Other congenital disorders may accompany this phenomenon and aortic dilatation and left ventricular hypertrophy are frequent complications. We present a case report of a young, symptomatic patient with a unicuspid aortic valve, complicated by dilatation of the aortic root and ascending aorta, with left ventricular hypertrophy. The patient recovered fully after a Bentall procedure.
     
  13. Title: Focus on the American College of Cardiology Congress, 2010 : drug trends in cardiology
    Authors: Aalbers, J.
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Reduced blood pressure variability in ASCOT-BPLA trial favours use of amlodipine / perindopril combination to reduce stroke risk
    Comparison of ivabradine plus β-blockers versus β-blocker therapy only
    ACCORD LIPID study results strengthen guideline approach of adding fenofibrate to therapy of dyslipidaemic type 2 diabetic patients
    INVEST study warns on too-low BP in diabetic patients with CAD
     
  14. Title: Combination therapy in hypertension : new recommendations : drug trends in cardiology
    Authors: Aalbers, J.
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: The recent publication of the American Hypertension Society (ASH) position paper on combination therapy in the treatment of hypertension is essential reading for all physicians and for South African medical aid funders.
     
  15. Title: The use of anticoagulants for venous thrombo-embolism : advertorial
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: Pulmonary embolism is a life-threatening condition with mortality as high as 17.5% within three months of onset. Pulmonary embolism is also the most common preventable cause of hospital death. Despite these unacceptably high risks, the effective use of anticoagulants to prevent venous thrombo-embolisms (VTEs) remains inconsistent.
     
  16. Title: Opinions in hypertension management : drug trends in cardiology
    Authors: Aalbers, J.
    From: Cardiovascular Journal of Africa, Vol 21, Issue 2, Mar / Apr
    Published: 2010
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    Abstract: All patients with hypertension are at increased risk for vascular events and hypertension is widely regarded as one of the most important risk factors for cardiovascular disease. At all ages, there is a positive and graded relationship between usual blood pressure and the risk of cardiovascular and stroke mortality.
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