CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 26, ISSUE 2, MAR/APR 2015
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  1. Title: From the Editor’s Desk
    Authors: Commerford, P
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: 51
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    Abstract: It is difficult for those of us who trained in medicine prior to the advent of the epidemic of HIV/AIDS to explain to junior colleagues just how the epidemic has affected every aspect of medical practice, and the degree of complexity it has added. The timely review by Pillay and colleagues (page 70) of HIV-associated large-vessel vasculopathy, which surveys both the current and emerging spectrum of the condition, as seen in vascular surgical practice, serves to clarify some of the uncertainties around this complex problem. It is difficult to comprehend that the diverse disease spectrum of aneurysms, occlusive disease, spontaneous arteriovenous fistulae and dissections have a unifying pathogenesis and it may well be that further advances in knowledge will lead to re-classification and changes in terminology. The authors, importantly, highlight areas of therapeutic uncertainty, which hopefully will change with advances in the understanding of pathophysiology and a more structured approach to interventions.

  2. Title: Association of Helicobacter pylori infection with the metabolic syndrome among HIV-infected black Africans receiving highly active antiretroviral therapy: cardiovascular topic
    Authors: Longo-Mbenza, B; Apalata, T; Longokolo, M; Mambimbi, MM; Mokondjimobe, E; Gombet, T; Ellenga, B; Buassa-bu-Tsumbu, B; Dipa, GM; Luila, EL; Okwe, AN
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: 52-56
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    DOI Number: 10.5830/CVJA-2015-012
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-012
    Abstract: Introduction: The metabolic syndrome (MetS) is common in human immune deficiency virus (HIV)-infected individuals receiving highly active antiretroviral therapy (HAART). Immune deficiencies caused by HIV give rise to numerous opportunistic gastrointestinal pathogens such as Helicobacter pylori, the commonest cause of chronic gastritis. The study sought to determine the relationship between H pylori infection and the MetS among HIV-infected clinic attendees.
    Methods: This cross-sectional study was carried out in a specialised heart clinic in Kinshasa, DR Congo. Between January 2004 and December 2008, 116 HIV-infected patients (61 with MetS and 55 without MetS) who underwent upper gastrointestinal endoscopy for dyspeptic symptoms were included in the study following an informed consent. Univariate associations were determined by odds ratios (OR), while multivariate logistic regression analysis was used to identify factors associated with the MetS.
    Results: H pylori infection (OR = 13.5, 95% CI: 10.3–17.6; p < 0.0001) and peripheral obesity (median hip circumference ≥ 97 cm) (OR = 4.7, 95% CI: 1.2–18.8; p = 0.029) were identified as MetS-related factors in HIV-infected patients. Higher rates of the MetS were associated with increased incidence of HIV-related immunocompromise using World Health Organisation (WHO) staging criteria. There was a univariate significant difference in the prevalence of the MetS between antiretroviral therapy (ART)-naïve patients and patients treated by means of a first-line HAART regimen of stavudine (d4T), lamivudine (3TC) and nevirapine (NVP). However, this difference was not significant in multivariate logistic analysis.
    Conclusion: H pylori infection was significantly associated with the MetS in HIV-infected patients.

  3. Title: Knowledge, attitude and behaviour regarding dietary salt intake among medical students in Angola: cardiovascular topic
    Authors: Magalhães, P; Sanhangala, EJR; Dombele, IM; Ulundo, HSN; Capingana, DP; Silva, ABTFrom: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: 57-62
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    DOI Number: 10.5830/CVJA-2015-018
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-018
    Abstract: Background: Levels of salt consumption and its awareness among medical students in Angola remain insufficiently studied. This study determined salt intake and assessed medical students’ knowledge, attitude and behaviour regarding salt consumption.
    Methods: Were collected 24-hour urine samples from a random sample of 123 undergraduate medical students aged 17–43 years who were studying at the University of Agostinho Neto in Luanda. Their knowledge, attitude and behaviour regarding dietary salt were surveyed. Socio-demographic, clinical and anthropometric data were collected.
    Results: Average salt intake was 14.2 ± 5.1 g/day, without significant difference between genders (p = 0.221). In total, 96.7% consumed over 5 g/day, but only 6.5% of participants were aware of their excessive salt intake. The majority knew about salt-related health consequences and 45.5% reported they controlled their salt intake.
    Conclusions: This study indicated a high salt intake and inadequate behaviour regarding dietary salt consumption among medical students studying at the University of Agostinho Neto. This highlights the need for nutritional education to improve their dietary habits and future role in counselling.

  4. Title: Diagnostic disparity and identification of two TNNI3 gene mutations, one novel and one arising de novo, in South African patients with restrictive cardiomyopathy and focal ventricular hypertrophy
    Authors: Mouton, JM; Pellizzon, AS; Goosen, A; Kinnear, CJ; Herbst, PG; Brink, PA; Moolman-Smook, JC
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: 63-69
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    DOI Number: 10.5830/CVJA-2015-019
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-019
    Abstract: Introduction: The minimum criterion for the diagnosis of hypertrophic cardiomyopathy (HCM) is thickening of the left ventricular wall, typically in an asymmetrical or focal fashion, and it requires no functional deficit. Using this criterion, we identified a family with four affected individuals and a single unrelated individual essentially with restrictive cardiomyopathy (RCM). Mutations in genes coding for the thin filaments of cardiac muscle have been described in RCM and HCM with ‘restrictive features’. One such gene encodes for cardiac troponin I (TNNI3), a sub-unit of the troponin complex involved in the regulation of striated muscle contraction. We hypothesised that mutations in TNNI3 could underlie this particular phenotype, and we therefore screened TNNI3 for mutations in 115 HCM probands.
    Methods: Clinical investigation involved examination, echocardiography, chest X-ray and an electrocardiogram of both the index cases and close relatives. The study cohort consisted of 113 South African HCM probands, with and without known founder HCM mutations, and 100 ethnically matched control individuals. Mutation screening of TNNI3 for diseasecausing mutations were performed using high-resolution melt (HRM) analysis.
    Results: HRM analyses identified three previously described HCM-causing mutations (p.Pro82Ser, p.Arg162Gln, p.Arg170Gln) and a novel exonic variant (p.Leu144His). A previous study involving the same amino acid identified a p.Leu144Gln mutation in a patient presenting with RCM, with clinical features of HCM. We observed the novel p.Leu144His mutation in three siblings with clinical RCM and varying degrees of ventricular hypertrophy. The isolated index case with the de novo p.Arg170Gln mutation presented with a similar phenotype. Both mutations were absent in a healthy control group.
    Conclusion: We have identified a novel disease-causing p.Leu144His mutation and a de novo p.Arg170Gln mutation associated with RCM and focal ventricular hypertrophy, often below the typical diagnostic threshold for HCM. Our study provides information regarding TNNI3 mutations underlying RCM in contrast to other causes of a similar presentation, such as constrictive pericarditis or infiltration of cardiac muscle, all with marked right-sided cardiac manifestations. This study therefore highlights the need for extensive mutation screening of genes encoding for sarcomeric proteins, such as TNNI3 to identify the underlying cause of this particular phenotype.

  5. Title: HIV-associated large-vessel vasculopathy: a review of the current and emerging clinicopathological spectrum in vascular surgical practice: review article
    Authors: Pillay, B; Ramdial, PK; Naidoo, DP
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: 70-81
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    DOI Number: 10.5830/CVJA-2015-017
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-017
    Abstract: An established relationship exists between human immunodeficiency virus (HIV) and the vascular system, which is characterised by clinical expressions of aneurysmal and occlusive disease that emanate from a common pathological process. The exact pathogenesis is currently unknown; attempts to implicate opportunistic pathogens have been futile. Theories converge on leucocytoclastic vasculitis with the vaso vasora as the vasculopathic epicentre. It is thought that the virus itself or viral proteins trigger the release of inflammatory mediators that cause endothelial dysfunction and smooth muscle proliferation leading to vascular injury and thrombosis. The beneficial effects of highly active anti-retroviral therapy alter the natural history of the disease profile and promote longevity but are negated by cardiovascular complications. Atherosclerosis is an emerging challenge. Presently patients are managed by standard surgical protocols because of nonexistent universal surgical interventional guidelines. Clinical response to treatment is variable and often compounded by complications of graft occlusion, sepsis and poor wound healing. The clinical, imaging and pathological observations position HIV-associated large-vessel vasculopathy as a unique entity. This review highlights the spectrum of HIV-associated large-vessel aneurysmal, occlusive and atherosclerotic disease in vascular surgical practice.

  6. Title: Development of the roadmap and guidelines for the prevention and management of high blood pressure in Africa: proceedings of the PAS CAR Hypertension Task Force meeting: Nairobi, Kenya, 27 October 2014: conference proceedings
    Authors: Dzudie, A; Ojji, D; Anisiuba, BC; Abdou, BAS; Cornick, R; Damasceno, A; Kane, Al; Mocumbi, AO; Mohamed, A; Nel, G; Ogola, E; Onwubere, B; Otieno, H; Rainer, B; Schutte, A; Ali, IT; Twagirumukiza, M; Poulter, N; Mayosi, B; on behalf of the PASCAR Hypertension Task Force members
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: 82-85
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    Abstract: Africa has one of the fastest growing economies in the world. The economic changes are associated with a health transition characterised by a rise in cardiovascular risk factors and complications, which tend to affect the African population at their age of maximum productivity.
    Recent data from Africa have highlighted the increasing importance of high blood pressure in this region of the world. This condition is largely underdiagnosed and poorly treated, and therefore leads to stroke, renal and heart failure, and death. Henceforth, African countries are taking steps to develop relevant policies and programmes to address the issue of blood pressure and other cardiovascular risk factors in response to a call by the World Health Organisation (WHO) to reduce premature deaths from non-communicable diseases (NCDs) by 25% by the year 2025 (25 × 25).
    The World Heart Federation (WHF) has developed a roadmap for global implementation of the prevention and management of raised blood pressure using a health system approach to help realise the 25 × 25 goal set by the WHO. As the leading continental organisation of cardiovascular professionals, the Pan-African Society of Cardiology (PASCAR) aims to contextualise the roadmap framework of the WHF to the African continent through the PASCAR Taskforce on Hypertension.
    The Taskforce held a workshop in Kenya on 27 October 2014 to discuss a process by which effective prevention and control of hypertension in Africa may be achieved. It was agreed that a set of clinical guidelines for the management of hypertension are needed in Africa. The ultimate goal of this work is to develop a roadmap for implementation of the prevention and management of hypertension in Africa under the auspices of the WHF.

  7. Title: Spontaneous coronary artery dissection associated with fibromuscular dysplasia: case report
    Authors: Dalby, AJ; Levien, LJ
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: 86-90
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    DOI Number: 10.5830/CVJA-2015-009
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-009
    Abstract: This case presentation concerns a woman known to have fibromuscular dysplasia (FMD) who presented with an acute coronary syndrome (ACS). The coronary angiogram was considered to be normal. However, as spontaneous coronary artery dissection (SCAD) has a close association with FMD, subsequent meticulous review of the angiogram revealed a dissection within the circumflex coronary artery. SCAD causes 10% of ACS seen in women under 55 years of age. Both FMD and SCAD are underdiagnosed and SCAD may be overlooked or misdiagnosed on coronary angiography. The recommended management of SCAD differs from that of the usual presentations of ACS. For this reason, one should be alert to the possibility of SCAD when confronted by ACS in a younger woman, especially when she is known to have FMD.

  8. Title: Sudden cardiac death in low-resource settings: lessons from a resuscitated cardiac arrest: case report
    Authors: Bonny, A; Amougou, SN; Mbenoun, M-L; Karaye, K
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: 91-95
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    DOI Number: 10.5830/CVJA-2015-020
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-020
    Abstract: We report on the case of an adult black African who was resuscitated from several cardiac arrests but suffered behavioural impairment, and discuss diagnostic pitfalls. The aetiology of coronary free lesion myocardial infarction with depressed left ventricular function was diagnosed when the patient travelled abroad. The low prevalence of recognised sudden cardiac arrest (SCA), as well as the lack of diagnostic and appropriate resuscitation facilities in parts of sub-Saharan Africa lead to the mismanagement of victims. Increased awareness of SCA and its causes is urgently needed.

  9. Title: Two cases of cardiac sarcoidosis in pregnant women with supraventricular arrhythmia: case report
    Authors: Ertekin, E; Moosa, S; Roos-Hesselink, JW; Sliwa, K
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: 96-100
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    DOI Number: 10.5830/CVJA-2015-022
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-022
    Abstract: We present two cases of cardiac sarcoidosis whose first presentation was in pregnancy. All findings confirmed the diagnosis of sarcoidosis with cardiac involvement in both patients.
    The first patient, a 37-year-old, presented with dizziness and atrial fibrillation at 16 weeks’ gestation. Echocardiography revealed thickened interventricular septum with a speckled pattern. Cardiac MRI after delivery showed myocardial oedema/inflammation corresponding with the same regions with early enhancement and epicardial delayed enhancement in the basal to mid-inferoseptal and basal anterior left ventricular myocardial segments. Transbronchial biopsy revealed histology of scanty fragments of inflamed bronchial mucosa.
    The second patient, a 31-year-old, was 17 weeks pregnant when she presented with daily palpitations and shortness of breath. She had prolonged episodes of supraventricular tachycardia. Echocardiography revealed a speckled septal and right ventricular wall pattern. Cardiac MRI after delivery showed basal and mid-ventricular mesocardial and epicardial enhancement, most compatible with sarcoidosis.

  10. Title: Application of radiofrequency ablation procedure on a morbidly obese patient with a venous ulcer and large saphenous vein: case report
    Authors: Yener, AÜ; Yener, Ö; Gedik, HS; Korkmaz, K; Özkan, T; Lafçı, A; Çağlı, K
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: e1-e2
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    DOI Number: 10.5830/CVJA-2014-065
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2014-065
    Abstract: Venous ulcers that occur due to chronic venous insufficiency are seen on the upper medial malleol of the ankle. Treatment of venous ulcers is protracted and generally the success rate is low. Co-morbid factors play an important role in the success of treatment of venous ulcers. In this case report, we demonstrate successful venous ulcer treatment in a morbidly obese patient with co-morbid conditions.

  11. Title: A case of May-Thurner syndrome with inconsistent radiological and surgical findings: case report
    Authors: Akin, F; Aygun, S; Gormus, N; Kar, YD; Susam, HT; Ozel, A
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: e3-e5
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    DOI Number: 10.5830/CVJA-2015-013
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-013
    Abstract: May–Thurner syndrome is the result of compression of the left common iliac vein between the right common iliac artery and the overlying vertebrae. In this case report, we describe an 11-year-old boy presenting with swelling of the left lower extremity. An iliac MR venography showed compression of the left proximal iliac vein between the vertebra and the left iliac artery. In surgery, it was seen that the left common iliac vein was connected to the postero-inferior part of the inferior vena cava, and it was compressed between the right common iliac artery and the columna vertebralis, which was inconsistent with the radiological findings. An interposition of the great saphenous vein graft between the left common iliac vein and the inferior vena cava was made, with a successful outcome. Our case is interesting in that it showed inconsistent findings between the radiological images and surgery.

  12. Title: Endocardite tricuspide sub-aigue du post abortum: a propos d’un cas: case report
    Authors: Codjo, LH; de Tove, K-MS; Hounkponou, FA; Dohou, SHM; Houenassi, MD
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: e6-e8
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    DOI Number: 10.5830/CVJA-2015-023
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-023
    Abstract: Tricuspid infective endocarditis is rare and represents five to 10 % of all cases of infective endocarditis. It occurs predominantly in intravenous drug users, and patients with central venous catheters or intracardiac probes. We report on the case of subacute tricuspid infective endocarditis in a girl of 17 years. She had no particular cardiovascular history. She was admitted for a persistent fever with cachexy, cough and thoracic pains, and right heart failure that appeared one month after a clandestine abortion. Transthoracic echocardiography found several vegetations on the tricuspid valve with massive tricuspid regurgitation. The chest X-ray showed bilateral excavated lung abscesses and condensation areas. Blood culture was not done and broad-spectrum antibiotic therapy was given. She was apyretic after 10 days. However, the massive tricuspid regurgitation with right heart failure persisted. She was discharged from hospital after 40 days of treatment. Although rare, infective endocarditis is one of the more serious complications of gynaecological procedures, particularly clandestine abortion. Therefore any young girl with persistent fever must be suspected of clandestine abortion.

  13. Title: Removal of broken catheter piece with snare device during endovascular treatment of post-traumatic brachial artery pseudo-aneurysm: case report
    Authors: Temizkan, V; Ucak, A; Alp, I; Can, MF; Arslan, G; Yilmaz, AT
    From: Cardiovascular Journal of Africa, Vol 26, Issue 2, March/April
    Published: 2015
    Pages: e9-e11
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    DOI Number: 10.5830/CVJA-2015-025
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-025
    Abstract: Post-traumatic pseudo-aneurysm is a rare complication of penetrating vascular injury. Endovascular stent implantation has become an alternative approach in the management of this pathology. In our case, we present a brachial artery pseudo-aneurysm that was treated with endovascular stent implantation, and removal of a broken catheter part with a three-dimensional snare device.
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