Cardiovascular Journal of Africa: Vol 32 No 6 (NOVEMBER/DECEMBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 AFRICA 291 From the Editor’s Desk A high rate of complications in a review of pregnant women with cardiac disease, with one maternal death, only 62 live births out of 74 pregnancies, and a high rate of prematurity and low birth weight is reported by Balieva and colleagues (page 301) in a retrospective review of maternal and neonatal outcomes in a tertiary hospital in Johannesburg, South Africa. Maternal, foetal and neonatal morbidity and mortality are generally recognised as useful indicators of the efficiency and effectiveness of healthcare systems. In this regard the report highlights the serious deficiencies in the South African public healthcare services. Importantly, the study was conducted in a tertiary-care setting in a metropolitan area. One shudders to contemplate what a similar investigation would reveal at primary care or rural level. Furthermore, the report reveals a that nearly 30% of the young women had rheumatic heart disease (RHD) and presentation late in pregnancy was common, which argues for a failure of care at primary level. One can only hope that the author’s sage conclusion that ‘Education of women with high-risk disease, improved pre-conceptual counselling, frequent antenatal care and early recognition of signs and symptoms of cardiac disease should be a priority to improve outcomes of cardiac disease in pregnancy for mothers and babies. Mothers with RHD in particular experienced more complications and should be closely followed’ will be heeded and acted upon by relevant public healthcare authorities. I am not optimistic. That is what I was taught as a medical student decades ago and practiced when I was employed at primary-care level in 1973, and now in the next century, it seems that the message has still not got through to the relevant providers and funders of public healthcare in South Africa. I wonder if it has in other African countries, and would welcome correspondence in this regard. Cardiac surgery with cardiopulmonary bypass is known to contribute towards the incidence of acute kidney injury (AKI) and peri-operative morbidity and mortality. Leballo and colleagues explore this (page 308). Numerous modifiable factors, including pre-operative renal dysfunction, were found to be associated with the development of AKI and mortality, and that is important. What I am not able to be certain about is the effect of an episode of AKI on the future risk of developing chronic kidney disease requiring renal replacement therapy (dialysis or transplantation). This is the answer we, as clinicians, really need. Given the paucity of renal replacement therapy in Africa, that information should guide all clinicians when recommending any form of treatment that may impair kidney function, with the long-term consequence of chronic kidney disease, when there is no rescue available. The SARs-Cov-2 pandemic continues unabated, with new variants of the virus perhaps contributing to the recurrence of waves of infection. The results of investigations of the effects of the disease on the cardiovascular system have shown a spectrum of manifestations and it is often difficult to untangle the effects of the infection and pre-existing cardiovascular disease and risk factors. Lasisi and colleagues (page 297) report on cardiac manifestations in a small but well-characterised group of patients identified retrospectively from a larger patient cohort in Nigeria. Both human immunodeficiency virus (HIV) infection and highly active antiretroviral therapy (HAART) have been reported to be implicated in causing cardiovascular diseases. In this issue (page 320), Njoku and co-authors report clinical and echocardiographic findings in a cross-sectional study of HIV-infected adults in Nigeria. Strengths of the study are that it covered a wide age range, and included persons on HAART, HAART-naïve subjects and controls known to be HIV negative, and did not rely on normal laboratory values for echocardiographic dimensions. PJ Commerford Editor-in-Chief A warm thank you from the management and staff of Clinics Cardive Publishing (publishers of the Cardiovascular Journal of Africa and the South African Journal of Diabetes & Vascular Disease ) to our authors, reviewers and clients for your continued support and collaboration. May your holiday season and the new year be filled with much joy, happiness, health and success. Our office will close on 15 December 2021 and open on Monday 17 January 2022. We look forward to being of service to you in the new year.