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  • Title: Red cell distribution width is correlated with extensive coronary artery disease in patients with diabetes mellitus
    Authors: Atac Celik, Metin Karayakali, Fatih Altunkas, Kayihan Karaman, Arif Arisoy, Koksal Ceyhan, Hasan Kadi, Fatih Koc
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    Submitted 27/5/16, accepted 8/3/17
    DOI: 10.5830/CVJA-2017-015
    Online Publication Date: 23 August 2017
    Introduction: Previous studies have predicted an independent relationship between red cell distribution width (RDW) and the risk of death and cardiovascular events in patients with coronary artery disease (CAD). The aim of this study was to investigate the relationship between RDW and extensiveness of CAD in patients with diabetes mellitus (DM).
    Methods: Two hundred and thirty-three diabetic patients who underwent coronary angiographies at our centre in 2010 were included in the study. All of the angiograms were re-evaluated and Gensini scores were calculated. Triple-vessel disease was diagnosed in the presence of stenosis > 50% in all three coronary artery systems.
    Result: RDW was significantly higher in diabetic CAD patients (p < 0.001). Patients with CAD who had a RDW value above the cut-off point also had higher Gensini scores, higher percentages of obstructive CAD and triple-vessel disease (p ≤ 0.001 for all). According to the cut-off values calculated using ROC analysis, RDW > 13.25% had a high diagnostic accuracy for predicting CAD. RDW was also positively correlated with Gensini score, obstructive CAD and triple-vessel disease (r < 0.468 and p < 0.001 for all).
    Conclusion: RDW values were found to be increased in the diabetic CAD population. Higher RDW values were related to more extensive and complex coronary lesions in patients with DM.
    Keywords: red cell distribution width, coronary artery disease, diabetes mellitus, Gensini score

  • Title: A survey of non-communicable diseases and their risk factors among university employees: a single institutional study
    Authors: Emmanuel I Agaba, Maxwell O Akanbi, Patricia A Agaba, Amaka N Ocheke, Zumnan M Gimba, Steve Daniyam, Edith N Okeke
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    Submitted 18/7/16, accepted 4/4/17
    DOI: 10.5830/CVJA-2017-021
    Online Publication Date: 15 August 2017
    Background: The incidence of non-communicable diseases (NCDs) is rising globally, with its attendant morbidity and mortality, especially in developing countries. This study evaluated the prevalence of NCDs and their risk factors among members of a university community.
    Methods: All employees of the university were invited to the University health clinic for screening, using the World Health Organisation’s STEPwise approach to NCDs.
    Results: A total of 883 (521; 59.0% males) employees with a mean age of 44 ± 10 years were studied. The median (IQR) number of NCD risk factors was three (two to three) per participant. The most common NCD risk factors were inadequate intake of fruit and vegetables (94.6%; 95% CI: 92.8–95.9), physical inactivity (77.8%; 95% CI: 74.9–80.5%) and dyslipidaemia (51.8%; 95% CI: 48.4–51.6%). Others included obesity (26.7%; 95% CI: 23.9–29.8%), alcohol use (24.0%; 95% CI: 21.3–27.0%) and cigarette smoking (2.9%; 95% CI: 2.0–4.3). Hypertension was the most common NCD (48.5%; 95% CI: 45.1–51.8%), followed by chronic kidney disease (13.6%; 95% CI: 11.4–16.1) and diabetes mellitus (8.0%; 95% CI: 6.4–10.1). There was no gender-specific difference in the prevalence of NCDs.
    Conclusion: This study identified that NCDs and their modifiable risk factors are highly prevalent in this community. Workplace policy to support the adoption of healthy living is needed.
    Keywords: diabetes mellitus, hypertension, non-communicable disease, obesity, physical inactivity

  • Title: A comparative study on the cardiac morphology and vertical jump height of adolescent black South African male and female amateur competitive footballers
    Authors: Philippe Jean-Luc Gradidge, Demitri Constantinou
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    Submitted 25/7/16, accepted 13/7/17
    DOI: 10.5830/CVJA-2017-032
    Online Publication Date: 15 August 2017
    Objective: The aim of this comparative study was to determine the gender differences in cardiac morphology and performance in adolescent black South African footballers.
    Methods: Anthropometry, electrocardiography and echocardiography data were measured in 167 (85 males and 82 females) adolescent black South African footballers (mean age: 14.8 ± 1.3 years). Vertical jump height was used as a performance measure of explosive lower-limb power.
    Results: The males had less body fat compared with the females (12.1 ± 3.6 vs 16.8 ± 4.1%, p < 0.05), while females had higher left ventricular end-diastolic diameters compared with males (48.7 ± 3.7 vs 40.7 ± 8.1, p < 0.05). Vertical jump height was higher in males (37.2 ± 10.3) compared with females (31.2 ± 8) and was inversely associated with body fat (β = –0.2, p < 0.05) and positively associated with lean mass (β = 0.5, p < 0.05).
    Conclusion: The findings showed that adolescent black South African male footballers had a performance advantage over females for explosive lower-limb power, which was explained by differences in body composition and not cardiac morphology.
    Keywords: adolescent, black South African, footballers, cardiac morphology, vertical jump height

  • Title: Primary care in the prevention, treatment and control of cardiovascular disease in sub-Saharan Africa
    Authors: Dike B Ojji, Kim Lamont, Olubunmi I Ojji, Bibiana Nonye Egenti, Karen Sliwa
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    Submitted 26/4/16, accepted 14/8/16
    DOI: 10.5830/CVJA-2016-082
    Online Publication Date: 28 July 2017
    Abstract: Cardiovascular disease (CVD) is the frontrunner in the disease spectrum of sub-Saharan Africa, with stroke and ischaemicheart disease ranked seventh and 14th as leading causes of death, respectively, on this sub-continent. Unfortunately, this region is also grappling with many communicable, maternal, neonatal and nutritional disorders. Limited resources and the high cost of CVD treatment necessitate that primary prevention should have a high priority for CVD control in sub-Saharan Africa. One major challenge of such an approach is how to equip primary care to respond promptly and effectively to this burden. We present a practical approach on how primary care in sub-Saharan Africa could effectively address the prevention, treatment and control of CVD on the subcontinent. For effective prevention, control and treatment of CVD in sub-Saharan Africa, there should be strategic plans to equip primary care clinics with well-trained allied healthcare workers who are supervised by physicians.
    Keywords: cardiovascular disease, treatment, prevention, primary care

  • Title: Efficacy of cardiac magnetic resonance imaging in a sub-aortic aneurysm case
    Authors: Ruchika Meel, Richard Nethononda, Ferande Peters, Mohammed Essop
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    Submitted 25/1/17, accepted 1/5/17
    DOI: 10.5830/CVJA-2017-027
    Online Publication Date: 29 June 2017
    Abstract: Sub-aortic (SA) aneurysms are a rare entity of variable aetiology. We report the first case of a SA aneurysm assessed using cardiac magnetic resonance imaging (MRI). A 33-year-old female with human immunodeficiency virus and on highly active antiretroviral treatment presented with syncope and dyspnoea. Clinical examination suggested moderate to severe aortic regurgitation (AR) confirmed by transthoracic and transoesophageal echocardiograms. However, echocardiography was suboptimal in defining the precise mechanism and severity of AR. A cardiac MRI was done to elucidate the aetiology, severity and mechanism of regurgitation. It confirmed the presence of a SA aneurysm below the left coronary cusp and its retraction, resulting in an eccentric AR jet. An assessment of moderate AR, based on regurgitant volume, was made. Furthermore, the anatomical relationships of the aneurysm were clearly defined. Cardiac MRI allowed comprehensive assessment of this SA aneurysm.
    Keywords: cardiac magnetic resonance imaging, sub-aortic aneurysm, aortic regurgitation

  • Title: A preliminary review of warfarin toxicity in a tertiary hospital in Cape Town, South Africa
    Authors: Annemarie Jacobs, Fatima Bassa, Eric H Decloedt
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    Submitted 1/3/17, accepted 16/5/17
    DOI: 10.5830/CVJA-2017-029
    Online Publication Date: 21 June 2017
    Aim: Warfarin is a widely used anticoagulant for the prevention and treatment of thromboembolism. We conducted a retrospective review to determine the causes and management of warfarin toxicity of patients admitted to Tygerberg hospital between June 2014 and June 2015.
    Results: We identified and evaluated 126 patients who met the inclusion criteria. The cause of warfarin toxicity was identified and addressed in only 14.3% (18/126) of patients. Where the cause was identified, 56% (10/18) was due to dosing errors and 17% (3/18) drug–drug interaction (DDI). However, 77% (97/126) of patients were retrospectively identified as receiving concomitant medicines known to interact with warfarin at the time of admission. Twenty-eight per cent (35/126) of patients presented with major bleeding, which included seven cases of intracranial haemorrhage. Patients were admitted for a median of eight days at an average treatment cost of R10 578.
    Conclusion: We found that warfarin toxicity carries significant mortality and cost, but little attention is paid to the causes of toxicity.
    Keywords: warfarin, toxicity, bleeding, treatment, cost

  • Title: Effects of age on systemic inflamatory response syndrome and results of coronary bypass surgery
    Authors: Orhan Gokalp, Nihan Karakas Yesilkaya, Sahin Bozok, Yuksel Besir, Hasan Iner, Huseyin Durmaz, Yasar Gokkurt, Banu Lafci, Gamze Gokalp, Levent Yilik, Ali Gurbuz
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    Submitted 21/3/17, accepted 16/5/17
    DOI: 10.5830/CVJA-2017-030
    Online Publication Date: 23 May 2017
    Background: Coronary artery bypass (CAB) surgery triggers systemic inflammatory response syndrome (SIRS) via several mechanisms. Moreover, age is directly correlated with SIRS. We evaluated the effect of age on SIRS and postoperative outcome after CAB surgery.
    Methods: We retrospectively reviewed the records of 229 patients who had undergone CAB surgery. The patients were divided into three groups according to age: group 1, < 40 years (n = 61); group 2, 40–75 years (n = 83); and group 3, > 75 years old (n = 85). Pre- and peri-operative data were assessed in all patients. SIRS was diagnosed according to the criteria established by the 2001 SCCM/ESICM/ACCP/ATS/ SIS International Sepsis Definitions Conference.
    Results: The average pre-operative EuroSCORE value in group 3 was higher than in the other groups and body surface areas were significantly lower in group 3 than in the other groups (p < 0.05). The postoperative SIRS rates were 68.9% in group 1, 84.3% in group 2 and 91.8% in group 3 (group 1 vs group 3; p < 0.05). Mortality rates were not significantly different between the groups (p > 0.05). The predictive factors for SIRS were age, EuroSCORE rate, on-pump CAB surgery and intra-aortic balloon pump use.
    Conclusion: Age was an important risk factor for SIRS during the postoperative period after CAB.
    Keywords: systemic, inflammation, coronary, bypass

  • Title: Pilot study of risk factors associated with cardiovascular disease in northern and southern Cameroonians
    Authors: Jeanne Durendale Chiadak, Jason Perret, Hilaire Macaire Womeni, Jules Roger Kuiaté, Pierre Cullus, Christelle Senterre, Christine Delporte
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    Submitted 24/6/16, accepted 30/10/16
    DOI: 10.5830/CVJA-2016-094
    Online Publication Date: 17 May 2017
    Aim: The aim of the study was to evaluate whether the risk factors for cardiovascular disease (CVD) are similar in the northern and southern regions of Cameroon.
    Methods: The participants answered a questionnaire concerning their lifestyle. Anthropometric and blood pressure measurements were evaluated in 192 individuals and biochemical parameters in 50 randomly selected volunteers. 
    Results: Northerners displayed low alcohol and tobacco consumption, little practice of sport but physically demanding professions, and consumption of soybean, refined palm and other polyunsaturated oils. Southerners consumed alcohol, practiced sport, had intellectually based professions, and consumed crude and refined palm oils. Waist circumference and body mass index were higher in the southerners compared to the northerners. Blood glucose levels, and systolic and diastolic blood pressures were higher among the northerners than the southerners. Among the southerners, there were positive correlations between total cholesterol levels and systolic or diastolic blood pressure, low-density lipoprotein cholesterol and blood glucose levels or diastolic blood pressure, triglyceride levels and systolic blood pressure.
    Conclusion: Providing region-adapted, health-related advice for northern and southern Cameroonians would contribute to reducing risk factors for CVD.
    Keywords: cardiovascular diseases, risk factor, lifestyle, nutrition, diet, fatty acids

  • Title: Clinical profile, management and outcomes of patients with pulmonary embolism: a retrospective tertiary centre study in Angola
    Authors: Ana Manuel, Adelina Aufico, Rui Africano, Tomáz Peralta, Abel Salas, Adelaide Silva, José Ricardo, Pedro Sabola, Domingas Baião, Carlos Sotolongo, António Dias Neto, Telmo Martins, Vasco Sabino, Joaquim van Dúnem, António Pedro Filipe Júnior
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    Submitted 10/4/16, accepted 4/4/17
    DOI: 10.5830/CVJA-2017-017
    Online Publication Date: 17 May 2017
    Objective: Pulmonary embolism (PE) is a potentially fatal disease. In Angola, few data are available on its occurrence. The aim of the study was to characterise the clinical profile, management and outcomes of patients with PE.
    Methods: A retrospective observational study was conducted at the Girassol Clinic in Luanda, Angola. The medical records of patients admitted to the intensive care unit were analysed from 2011 to 2015.
    Results: Fifty patients were included and the median age was 50.5 ± 17.8 years. Dyspnoea and immobilisation for more than 72 hours were the most frequently seen risk factors at admission; 28% of the patients had massive PE, 36% sub-massive PE, 28% were haemodynamically unstable at admission and 30% had a very high risk of mortality. The in-hospital mortality rate was 20%.
    Conclusions: The clinical characteristics of our patients were similar to those described in the literature. The high prevalence of patients with very high risk at admisson highlights the need to investigate the cause of worst cardiovascular disease outcomes in Africans.
    Keywords: pulmonary embolism, pulmonary CT angiography, anticoagulation, cardiovascular disease, Angola, Africa
  • Title: Role of melatonin in glucose uptake by cardiomyocytes from insulin-resistant Wistar rats
    Authors: Frederic Nduhirabandi, Barbara Huisamen, Hans Strijdom, Amanda Lochner
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    Submitted 24/5/16, accepted 4/4/17
    DOI: 10.5830/CVJA-2017-018
    Online Publication Date: 17 May 2017
    Aim: Melatonin supplementation reduces insulin resistance and protects the heart in obese rats. However, its role in myocardial glucose uptake remains unknown. This study investigated the effect of short-term melatonin treatment on glucose uptake by cardiomyocytes isolated from obese and insulin-resistant rats.
    Methods: Cardiomyocytes were isolated from obese rats fed a high-calorie diet for 16 to 23 weeks, their age-matched controls, as well as young control rats aged four to eight weeks. After incubation with melatonin with or without insulin, glucose uptake was initiated by the addition of 2-deoxy-D-[3H] glucose and measured after 30 minutes. Additional control and obese rats received melatonin in the drinking water (4 mg/kg/day) for the last six weeks of feeding (20 weeks) and glucose uptake was determined in isolated cardiomyocytes after incubation with insulin. Intraperitoneal glucose tolerance and biometric parameters were also measured.
    Results: Obese rats (fed for more than 20 weeks) developed glucose intolerance. Cardiomyocytes isolated from these obese rats had a reduced response to insulin-stimulated glucose uptake (ISGU) (p < 0.05). Melatonin administration in vitro had no effect on glucose uptake per se. However, it increased ISGU by cardiomyocytes from the young rats (p < 0.05), while having no effect on ISGU by cardiomyocytes from the older control and obese groups. Melatonin in vivo had no significant effect on glucose tolerance, but it increased basal (p < 0.05) and ISGU by cardiomyocytes from the obese rats (50.1 ± 1.7 vs 32.1 ± 5.1 pmol/mg protein/30 min, p < 0.01).
    Conclusion: These data suggest that short-term melatonin treatment in vivo but not in vitro improved glucose uptake and insulin responsiveness of cardiomyocytes in obesity and insulin-resistance states.
    Keywords: cardiomyocytes, glucose homeostasis, glucose uptake, insulin resistance, melatonin, obesity
  • Title: Atorvastatin inhibits cholesterol-induced caspase-3 cleavage through down-regulation of p38 and up-regulation of Bcl-2 in the rat carotid artery
    Authors: Roshanak Bayatmakoo, Nadereh Rashtchizadeh, ParichehrehYaghmaei, Mehdi Farhoudi, Pouran Karimi
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    Submitted 28/5/16, accepted 12/1/17
    DOI: 10.5830/CVJA-2017-005
    Online Publication Date: 10 May 2017
    Aim: Atherosclerotic lesions in the carotid arteries lead to a broad range of cerebrovascular disorders such as vascular dementia and ischaemic stroke. Recent studies have verified the beneficial role of atorvastatin (AV) in atherosclerosis. Despite a large body of studies, the mechanisms underlying this effect have not been completely explained. In this study, several experiments were performed on atherosclerotic rat models to investigate the anti-inflammatory and anti-apoptotic effect of AV in the carotid artery.
    Methods: In this experimental study, 40 male Wistar rats (250 ± 25 g) were randomly divided into four groups: rats on a normal diet (ND; n = 10); a high-cholesterol diet (HD; n = 10); a high-cholesterol diet plus AV (HD + AV; n = 10); and the AV control group (AV; n = 10). Cleavage of caspase-3 protein, expression of B-cell lymphoma 2 (Bcl-2) as well as phosphorylation of p38 mitogen-activated protein kinase (MAPK) were determined by immunoblotting assay in the carotid artery homogenate. Plasma atherogenic indices, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured by colorimetric assay at the end of the experiment. Plasma levels of oxidised LDL (oxLDL) were measured by sandwich enzyme-linked immunosorbent assay (ELISA).
    Results: After eight weeks of feeding with a high-cholesterol diet, an elevated level of oxLDL was observed in the plasma in the HD group compared with the ND group [214.42 ± 17.46 vs 69.13 ± 9.92 mg/dl (5.55 ± 0.45 vs 1.78 ± 0.26 mmol/l); p < 0.01]. AV administration significantly reduced oxLDL levels in the HD + AV compared to the HD group [126.52 ± 9.46 vs 214.42 ± 17.46 mg/dl (3.28 ± 0.25 vs 5.55 ± 0.45 mmol/l); p < 0.01]. Results also showed that compared with the HC group, the HC + AV group had lower levels of p38 phosphorylation (p < 0.05) and higher levels of Bcl-2 expression (p < 0.05). Lower levels of cleaved caspase-3 were observed in the HC + AV group in comparison with the HC group (p < 0.05).
    Conclusions: The resultant data suggest that the anti-apoptotic effect of AV could be partially mediated by the pro-inflammatory protein p38 MAPK and the anti-apoptotic protein Bcl-2 in the rat carotid artery. Atorvastatin can therefore be considered a target drug in the prevention or development of atherosclerotic events.
    Keywords: atherosclerosis, Bcl-2 protein, cholesterol, caspase-3, p38 mitogen-activated protein kinase
  • Title: Relationship between coronary tortuosity and plateletcrit coronary tortuosity and plateletcrit
    Authors: Levent Cerit, Zeynep Cerit
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    Submitted 2/6/16, accepted 11/4/17
    DOI: 10.5830/CVJA-2017-023
    Online Publication Date: 26 April 2017
    Background: Coronary tortuosity (CorT) is a common angiographic finding and may be associated with myocardial ischaemia, even without coronary artery disease. Platelets play a crucial role in inflammatory and thrombotic processes and the physiopathology of cardiovascular disease. Larger platelets are more active enzymatically and have higher thrombotic ability compared to smaller platelets. Plateletcrit (PCT) provides complete information on total platelet mass. We aimed to evaluate the relationship between CorT and PCT in patients with chronic stable angina.
    Methods: The medical records of consecutive patients who underwent coronary angiography from January 2013 to January 2016 were retrospectively reviewed for CorT. CorT and clinical, echocardiographic, haematological and biochemical parameters were evaluated. Taking into consideration the inclusion criteria, 106 patients with CorT and 108 with normal coronary angiographies (control group) were included in the study. CorT was defined as three fixed bends during both systole and diastole, with each bend ≥ 45°.
    Results: The median PCT, mean platelet volume (MPV), platelet:large-cell ratio (P-LCR), neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) of the CorT group were significantly higher than those of the control group (0.26 ± 0.02 vs 0.2 ± 0.03%, p < 0.001; 10.6 ± 0.14 vs 9.6 ± 0.65 fl, p < 0.001; 29.3 ± 6.7 vs 23.4 ± 5.1, p < 0.001; 2.3 ± 1 vs 1.47 ± 0.48, p < 0.001; 1.28 ± 0.5 vs 0.82 ± 0.23, p < 0.001, respectively). The incidence of diabetes mellitus, hypertension and female gender were significantly higher in the CorT group (18.9 vs 1.9%, p < 0.001, 90.6 vs 50%, p < 0.001, 70.8 vs 44.4%, p < 0.001, respectively). Multivariate logistic regression analysis revealed age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT.
    Conclusion: CorT was associated with increased PCT, MPV, P-LCR, NLR and PLR, even in the absence of coronary artery disease. Age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT.
    Keywords: coronary angiography, plateletcrit, mean platelet volume
  • Title: Clinical presentation and outcomes of patients with acute rheumatic fever and rheumatic heart disease seen at a tertiary hospital setting in Port Elizabeth, South Africa
    Authors: Zongezile Masonwabe Makrexeni, Lungile Pepeta
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    Submitted 22/6/16, accepted 26/1/17
    DOI: 10.5830/CVJA-2017-019
    Online Publication Date: 20 April 2017
    Background: The incidence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) has waned in Western countries, however that is not the situation in developing nations.
    Methods: Records were reviewed of patients from the Eastern Cape municipal districts who presented to the Paediatric Cardiology Unit with ARF and RHD from January 2008 to August 2015.
    Results: Total of 56 patients with ARF/RHD was reviewed. The majority of patients (n = 52) presented for the first time with RHD. Four patients presented with ARF and two had recurrent ARF. Six patients presented with a combination of RHD and congenital heart disease. Twenty-three patients were operated on for chronic rheumatic valve disease, with good outcomes.
    Conclusion: The true burden of ARF/RHD is unknown in the Eastern Cape. Prospective studies are needed to accurately determine the prevalence of RHD in this province.
    Keywords: acute rheumatic fever, rheumatic heart disease, left ventricular dysfunction, rheumatic valve surgery, disease outcomes, prevention
  • Title: Electrocardiographic abnormalities in treatment-naïve HIV subjects in south-east Nigeria
    Authors: Innocent Chukwuemeka Okoye, Ernest Ndukaife Anyabolu
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    Submitted 22/6/16, accepted 26/1/17
    DOI: 10.5830/CVJA-2017-013
    Online Publication Date: 24 March 2017
    Background: Cardiac complications of human immunodeficiency virus (HIV) infection are important causes of morbidity and mortality. We set out to determine the electrocardiographic (ECG) abnormalities in treatment-naïve HIV-positive patients in Enugu, south-east Nigeria.
    Methods: This was a cross-sectional study involving 250 HIV-positive and 200 HIV-negative subjects. Demographic and anthropometric data, relevant investigations and ECG results were compared between the groups.
    Results: An abnormal ECG was present in 70% of the HIV-positive patients, sinus bradycardia in 64%, QTC prolongation in 48%, T-wave inversion in 21.6%, Wolf–Parkinson– White syndrome in 0.8%, abnormal P waves in 12.8%, 1st degree heart block in 2.4%, ST depression in 30%, and left-axis deviation in 1.6%. Underweight was associated with ECG abnormalities (p = 0.001). The HIV-positive patients had more ECG abnormalities than the HIV-negative subjects (p = 0.001).
    Conclusion: Electrocardiographic abnormalities were common in treatment-naïve HIV-positive patients in Enugu, Nigeria.The 70% prevalence of ECG abnormalities in treatment-naïve HIV-positive patients was high. There is a need to evaluate HIV-positive patients at onset for cardiac and non-cardiac abnormalities detectable by ECG.
    Keywords: ECG, cardiac abnormalities, non-cardiac ECG abnormalities, HIV, Enugu, Nigeria
  • Title: Medication adherence among cardiac patients in Khartoum State, Sudan: a cross-sectional study
    Authors: Abdelmoneim Awad, Nahid Osman, Siham Altayib
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    Submitted 23/9/16, accepted 8/3/17
    DOI: 10.5830/CVJA-2017-016
    Online Publication Date: 24 March 2017
    Introduction: Non-adherence to medication among cardiac patients is often the major risk factor for poor clinical outcomes, increased mortality rates and higher healthcare costs. The literature evaluating the prevalence of and reasons for non-adherence in resource-poor settings is extremely limited compared to resource-rich settings. There is a scarcity of data about medication adherence in Sudan hence this study was performed to identify prevalence, predictors and barriers of non-adherence to medication among cardiac patients in Khartoum State.
    Methods: A descriptive, cross-sectional survey was performed using a pre-tested, self-administered questionnaire on a sample of 433 randomly selected cardiac patients attending the largest three cardiac centres located in Khartoum State. Descriptive and multivariate logistic regression analyses were used for data analysis.
    Results: The response rate was 89.1%. The mean (± SD) number of chronic diseases among respondents was 2.3 (± 1.3) and that of medication use was 4.2 (± 1.9). The mean (± SD) duration of medication use among participants was 6.4 (± 5.4) years. Optimal adherence was defined as having a score of greater than six on the eight-item Morisky medication adherence scale. Using this cut-off point, 49% (95% CI: 43.9–54.1) of respondents had optimal adherence and 51% (95% CI: 45.9–56.1) had poor adherence. Respondents with a high level of education, low and middle income levels, and those taking five or more medications daily were found to be significantly more non-adherent to medication use than those with low to intermediate education levels (p < 0.001), those with high income levels (p < 0.001), and those taking one to four medications daily (p = 0.039). The top four barriers for poor medication adherence among the study participants were the high cost of drugs, polypharmacy and lack of pharmacist and physician communication with patients about their drug therapy.
    Conclusions: The current findings highlight the need for urgent, multifaceted interventions, given the burden of cardiovascular diseases and the clinical and economic consequencesof medication non-adherence. These interventions include affordable medications, easy-to-use medication regimens with fewer daily doses, ongoing communication between patients and healthcare providers, and improvement of the patient– provider partnership.
    Keywords: non-adherence, adherence, cardiac patients, cardiovascular medications, Khartoum State, Sudan
  • Title: An unusual case of aorta–right atrial tunnel with windsock aneurysm: imaging, diagnosis and treatment
    Authors:Shehzaadi Aneesah Mohamed Khan, Leonie Scholtz, F Adriaan Snyders, Johan de Villiers
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    Submitted 27/10/15, accepted 10/7/16
    DOI: 10.5830/CVJA-2016-073
    Online Publication Date: 15 March 2017
    Abstract: The first successfully diagnosed and treated case of aorta– right atrial tunnel was reported by Coto et al. in 1980. The most common cause of aorta–right atrial tunnel is a ruptured aneurysm of the sinus of Valsalva. Sinus of Valsalva aneurysms had been reported as early as 1840 by Thurnam; these were diagnosed at autopsy. With the advances in radiology, many cases of aorta–right atrial tunnel have been reported since then, each with its own subtle variations.
    We report on a unique case of aorta–right atrial tunnel with a windsock aneurysm in the right atrium. A 55-yearold male presented with abdominal pain and the chest X-ray revealed cardiomegaly. On further investigation with echocardiography and computed tomography angiography, there was an incidental aorta–right atrial tunnel with a windsock aneurysm in the right atrium. He was treated successfully with surgery. A similar case has been reported only once before by Iyisoy et al. in 2014.
    Keywords: aorta–right atrial tunnel, aneurysms of the sinus of Valsalva
  • Title: Prevalence of rheumatic valvular heart disease in Rwandan school children: echocardiographic evaluation using the World Heart Federation criteria
    Authors: J Mucumbitsi, B Bulwer, L Mutesa, V Ndahindwa, M Semakula, E Rusingiza, P Arya, S Breakey, C Patton-Bolman, E L Kaplan
    Full text: Click here to download PDF »
    Submitted 21/7/16, accepted 11/1/17
    DOI: 10.5830/CVJA-2017-007
    Online Publication Date: 1 March 2017
    Background: Rheumatic fever (RF) and rheumatic valvular heart disease (RHD) remain important medical, surgical and public health concerns in many parts of the world, especially in sub-Saharan Africa. However, there are no published datafrom Rwanda. We performed a RHD prevalence study in a randomly selected sample of Rwandan school children using the 2012 World Heart Federation (WHF) criteria.
    Methods: Echocardiographic assessment of 2 501 Rwandan school children from 10 schools in the Gasabo district near Kigali was carried out. Resulting data were evaluated by four experienced echocardiographers. Statistical analyses were carried out by statisticians.
    Results: RHD prevalence was 6.8/1 000 children examined (95% CI: 4.2/1 000–10.9/1 000). Seventeen met WHF criteria for RHD, 13 fulfilled criteria for ‘borderline’ RHD and four were ‘definite’ RHD. None of these 17 had been previously identified.
    Conclusion: These data indicate a significant burden of RHD in Rwanda and support a need for defined public health RF control programmes in children there.
    Keywords: rheumatic heart disease, rheumatic fever, echocardiography, prevalence, epidemiology
  • Title: Factors affecting interest in cardiothoracic surgery among junior surgical residents in Nigeria
    Authors: Emeka B Kesieme, Umar Abubakar, Olugbenga Olusoji, Ismail Mohammed Inuwa, John Kefas, Ndubuisi Anumenechi
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    Submitted 21/4/16, accepted 12/1/17
    DOI: 10.5830/CVJA-2017-004
    Online Publication Date: 1 March 2017
    Objective: A survey was undertaken to determine the factors that affect interest in cardiothoracic surgery (CTS) among junior surgical residents in Nigeria.
    Methods: A cross-sectional study was done using a pilottested, 56-item, semi-structured questionnaire, which was filled in by 238 junior surgical residents in accredited hospitals in Nigeria.
    Results: Few of the respondents (8.4%) were committed to specialising in CTS. A minority of them, 28.2 and 2.1%, had assisted in major thoracic procedures and open-heart surgeries, respectively. The relationship between the level of training, rotation in CTS in junior residency and interest in CTS were statistically significant (p < 0.05). The main important factors responsible for the low interest in CTS include the lack of equipment (92%), limited training positions (64.9%), poor or lack of exposure in CTS as a junior resident (63%) and in medical school (58.8%).
    Conclusion: There is a dire need to provide facilities and training opportunities to improve the cardiothoracic workforce in Nigeria.
    Keywords: open-heart surgery, thoracic surgery, developing countries
  • Title: New World’s old disease: cardiac hydatid disease and surgical principles
    Authors: Omer Tanyeli, Yuksel Dereli, Ilker Mercan, Niyazi Gormus, Tahir Yuksek
    Full text: Click here to download PDF »
    Submitted 10/6/16, accepted 12/1/17
    DOI: 10.5830/CVJA-2017-006
    Online Publication Date: 20 February 2017
    Background: Hydatid cyst is a parasitic disease caused by infection with the Echinococcus granulosus tapeworm larva. It is a major public health problem in endemic regions. Cardiac involvement of the disease is rare.
    Methods: Between 1985 and 2015, 12 patients were admitted to our clinic with a possible diagnosis of cardiac hydatid disease. Of these patients, six (50%) were male and six (50%) were female. Mean age of the patients was 42.6 years.
    Results: The most common location of cardiac hydatid disease was left sided (six patients, 50%). Five (41.7%) patients had cysts located in the right heart, whereas one (8.3%) had a cyst in the interventricular septum. Eleven (91.7%) of the patients were operated on via median sternotomy and the remaining one was operated on via a left anterolateral thoracotomy. Ten (83.3%) of the patients were operated on using cardiopulmonary bypass under moderate hypothermia, whereas the remaining two (16.7%) had off-pump surgery. There was no surgical mortality in our series. All patients were discharged with medical therapy (mebendazole or albendazole) for the duration of six months. No recurrences were observed in their follow ups.
    Conclusion: Although cardiac hydatid disease is rare, its prevalence seems to have increased in the last decade. Any patient with suspected cardiac symptoms suggesting mass lesions should be considered for a differential diagnosis of cardiac hydatid disease, especially in developing countries. Definitive treatment is removal of the cyst, combined with medical therapy.
    Keywords: hydatid cyst, cardiac hydatid cyst, Echinococcus granulosus
  • Title:The prevalence and radiological findings of pulmonary embolism in HIV-positive patients referred for computed tomography pulmonary angiography in the Western Cape of South Africa
    Authors: Raksha Ramlakhan, Savvas Andronikou, Ashmitha Rajkumar
    Full text: Click here to download PDF »
    Submitted 5/6/16, accepted 21/9/16
    DOI: 10.5830/CVJA-2016-083
    Online Publication Date: 15 February 2017
    Aim: To provide imaging data and report associations between human immunodeficiency virus (HIV), tuberculosis (TB) and pulmonary embolism (PE) in a South African population that underwent computed tomography pulmonary angiography (CTPA) for suspected PE.
    Methods: A validated Qanadli severity scoring system for PE was used for 164 CTPA scans, and parenchymal, pleural and cardiovascular complications were reported. Serological confirmation of HIV testing and microbiological confirmation of TB were recorded.
    Results: Prevalence of PE in the CTPA population was 26% (95% CI: 19.67–33.65%). HIV-positive prevalence in patients with PE was 67% (95% CI: 48.17–82.04%), however it was not statistically significantly different when compared with the patients without PE (p = 1). HIV-positive patients had more extensive partial thrombus in the right middle lobe (p = 0.045), but no other differences when compared with HIV-negative patients. TB prevalence in patients with PE was 57% (95% CI: 34.49–76.81%). This was statistically significantly different when compared with the patients without PE (p = 0.073 at the 10% level). Prevalence of TB co-morbidity in the HIV-positive group with proven PE was 71% (95% CI: 41.90– 91.61%), however there was no statistically significant difference in comparison with the HIV-negative patients with TB and PE (p= 0.305).
    Conclusion: The high number of patients presenting for CTPA who were HIV infected (and also infected with TB) highlights that PE evaluation should include severity/extent of the disease, as these patients may have more severe disease in specific lung lobes. The use of a validated scoring system, such as the Qanadli score, when reporting PE may have a profound effect on patient risk stratification, management and prognosis and would also provide a system for collecting larger volumes of data for analysis.
    Keywords: pulmonary embolism, computed tomography pulmonary angiography (CTPA), HIV, Western Cape
  • Title: Right ventricular strain as predictor of pulmonary complications in patients with femur fracture
    Authors: Hyun-Jin Kim, Hyung-Bok Park, Yongsung Suh, Hyun-Sun Kim, Yoon-Hyeong Cho, Tae-Young Choi, Eui-Seok Hwang, Deok-Kyu Cho
    Full text: Click here to download PDF »
    Submitted 22/8/16, accepted 12/1/17
    DOI: 10.5830/CVJA-2017-011
    Online Publication Date: 01 February 2017
    Background: Following femur fracture, medullary fat enters the systemic circulation and altered pulmonary haemodynamics may contribute to pulmonary complications. This study evaluated the association between right ventricular (RV) function and pulmonary complications in patients with femur fracture.
    Methods: Patients with a femur fracture who had undergone pre-operative echocardiography that included RV peak global longitudinal strain (RV GLS) were evaluated retrospectively between March 2015 and February 2016. Pulmonary complications were defined as the development of pneumonia or pulmonary thromboembolism during the first postoperative month.
    Results: Among 78 patients, pulmonary complications developed in eight (10.3%). The RV GLS value of all patients was lower than the normal range. In addition, the RV GLS value of patients with pulmonary complications was significantly lower than that of patients without pulmonary complications. Multivariate regression analyses found that worse RV GLS values independently predicted pulmonary complications [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.047–4.151, p = 0.037]. Receiver operating characteristic curve analysis found that a RV GLS value of –14.85% was the best cut-off value to predict pulmonary complications; sensitivity: 75.0%; specificity: 62.9%. Moreover, patients with RV GLS values > –14.85% had significantly lower pulmonary complication-free survival.
    Conclusion: In patients with femur fracture, RV GLS values could help predict pulmonary complications. Therefore, patients with RV GLS values > –14.85 should be monitored closely before and after surgery for femur fracture.
    Keywords: femur fracture, RV peak global longitudinal strain, pneumonia, pulmonary thromboembolism
  • Title: Atrial myxoma: a rare cause of hemiplegia in children
    Authors: Uchenna Onubogu, Boma West, Boma Orupabo-Oyan
    Full text: Click here to download PDF »
    Submitted 17/5/16, accepted 30/10/16
    DOI: 10.5830/CVJA-2016-093
    Online Publication Date: 09 Desember 2016
    Background: Atrial myxoma is an uncommon cause of hemiplegia in children. However hemiplegia is the commonest manifestation of atrial myxoma in the paediatric age group.
    Case report: An 11-year-old girl presented with left hemiplegia and palpitations. Three months later she had a deepvein thrombosis of the right common iliac vein. MRI of the brain showed a subacute right thalamic infarct, and an ECG showed left atrial and left ventricular hypertrophy. Transthoracic echocardiography revealed a left atrial myxoma impinging on the mitral valve. A diagnosis of left atrial myxoma with multiple thromboembolic events was made. She was placed on anticoagulants until she died while awaiting surgical tumour resection.
    Conclusion: Echocardiography should be done early in children presenting with ischaemic thromboembolic diseases in order to reduce morbidity and mortality rates resulting from cardiac pathology.
    Keywords: atrial myxoma, hemiplegia, thromboembolic, cardiac, children
  • Title: Left ventricular haematoma mimicking lateral wall myocardial infarction secondary to percutaneous coronary intervention
    Authors: Omer Senarslan, Necdet Batuhan Tamci, Umut Hasan Kantarci, Mehmet Eyuboglu, Dilsad Amanvermez Senarslan
    Full text: Click here to download PDF »
    Submitted 10/4/16, accepted 16/10/16
    DOI: 10.5830/CVJA-2016-090
    Online Publication Date: 10 November 2016
    Abstract: Dissecting intra-myocardial haematoma is a rare disease and a potentially fatal complication after cardiac surgery. Patients with previous heart surgery have more risk for dissecting intra-myocardial haematoma after percutaneous coronary intervention. Management of this issue is challenging. We describe a rare case of a 63-year-old woman with a left ventricular wall-dissecting intra-myocardial haematoma, which developed 30 minutes after percutaneous coronary intervention. The patient was treated conservatively, with a successful outcome.
    Keywords: percutaneous coronary intervention, complication, dissecting intra-myocardial haematoma


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