CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 15, ISSUE 1, FEB 2004
Title: Impact factor : use and abuse
: editorial
Authors: Brink, A.J.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.5-7
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Title: The William Nelson ECG Quiz
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.7, 37
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Title: Pattern of occurrence of
microalbuminuria among dippers and non-dippers
(essential hypertensives) in a Nigerian
university teaching hospital : cardiovascular
topics
Authors: Alebiosu, C.O.; Odusan, B.; Familoni,
O.B.; Jaiyesimi, A.E.A.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.9-12
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Abstract: Objectives: Hypertensives who fail to
manifest the normal circadian nocturnal fall in
blood pressure have a higher incidence of
cardiovascular complications, early glomerular
injury and microalbuminuria. This study aims to
quantify the proportion of dippers and
nondippers among the essential hypertensive
population, and determine the frequency of
occurrence of microalbuminuria among them.
Materials and methods: Early morning urine
specimens were taken from 50 patients with
essential hypertension and 20 healthy,
normotensive subjects. Combined negative results
from albustic strip testing and sulfosalicylic
acid tests were taken as excluding
microalbuminuria. While collecting urine for
24-hour urinary protein and creatinine
clearance, hourly blood pressure readings were
recorded. Readings obtained between 07:00 and
23:00 were taken as daytime blood pressure
readings, whereas readings obtained between
23:00 and 07:00 were considered night-time blood
pressures. Dippers were considered to be those
patients in whom the difference between mean
daytime systolic/diastolic blood pressure and
mean night-time systolic/diastolic blood
pressure was 10/5 mm Hg or more.
Results: Thirty-six (72%) and 14 (28%) patients
with essential hypertension fulfilled the
criteria for dippers and non-dippers,
respectively. The night-time systolic and
diastolic blood pressures were significantly
higher in non-dippers than in dippers (P <
0.05). The mean daytime systolic and diastolic
blood pressures were not different between these
two groups. Twenty-nine out of 36 (80.6%)
urinary specimens from dippers were without
microalbuminuria, against six out of 14 (42.9%)
specimens from non-dippers, p < 0.05. Eighteen
out of 20 controls (90%) were without
microalbuminuria.
Conclusion: This study demonstrated that about
28% of the local essential hypertensive
population was nondippers and 57.1% of these had
microalbuminuria with the attendant
cardiovascular and renal risks.
Title: Infective endocarditis :
improving the diagnostic yield : cardiovascular
topics
Authors: Koegelenberg, C.F.N.; Doubell, A.F.;
Orth, H.; Reuter, H.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.14-20
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Abstract: Introduction: Isolating aetiological
agents in patients with infective endocarditis
(IE) remains problematical. We postulated that
the high local incidence of culturenegative IE
resulted from antibiotic exposure prior to blood
cultures and that a structured delay in therapy
in the subacute presentation would improve the
diagnostic yield.
Aim: We aimed to prospectively observe the
diagnostic approach and give an overview of
supplementary laboratory tests.
Study design: Patients with suspected IE were
enrolled into this analytical observational
study and followed up for six months (n = 92).
We compared the diagnostic yield and outcome in
cases where antibiotics were withheld for 72
hours, with those cases who received early
antimicrobials, despite being deemed safe for
delayed therapy.
Results: Definitive diagnoses (definite or
excluded IE) were made in 92.8% of patients
where antibiotics were delayed, compared to 60%
of patients who received empirical treatment (p
= 0.08). The mortality rates were 18.4% and
30.0% respectively (p = 0.18). Twenty-three of
26 patients with definite culture-negative IE
received antibiotics during the 48 hours
preceding cultures, compared to eight of 21
culture-positive patients (P < 0.001). Screening
for atypical bacteria did not improve the yield.
C-reactive protein (CRP) had a sensitivity of
97.9% (negative predictive value 87.5%), whereas
a positive rheumatoid factor (RF) had a
specificity of 93.8% (positive predictive value
91.7%).
Conclusions: We observed tendencies towards a
greater diagnostic yield and lower mortality
where antibiotics were initially withheld.
Antibiotics prior to blood cultures were an
important cause of culture-negative IE. A normal
CRP proved useful in excluding IE; a positive RF
strongly favoured IE.
Title: Renin-angiotensin system and
associated gene polymorphisms in myocardial
infarction in young South African Indians :
cardiovascular topics
Authors: Ranjith, N.; Pegoraro, R.J.; Rom, L.;
Lanning, P.A.; Naidoo, D.P.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.22-26
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Abstract: The renin-angiotensin system plays an
important role in cardiovascular regulation.
Abnormalities in genetic components of this
system, such as the angiotensinconverting enzyme
(ACE) gene, angiotensin II type 1 (AT1) receptor
gene and angiotensinogen (AGT) gene, may cause a
variety of adverse cardiovascular effects.
It was the aim of this study, therefore, to
investigate the involvement of the ACE
insertion/deletion (I/D), AT1 receptor 1166
A-->C and AGT M235T polymorphisms as
predisposing factors for myocardial infarction
(MI) in 195 young South African Indians (< 45
years). Results were compared with those
obtained in 107 unaffected siblings (18-45 years
old) and 300 healthy age- and racematched
control subjects.
The distribution of the ACE genotypes was the
same in each of the three study groups (p-value
ranged between 0.83 and 0.98). No differences
were observed in the 1166 A-->C AT1 receptor
polymorphism with respect to both genotype and
allelotype (p > 0.70), or in the genotype or
allele frequency distribution of the AGT M235T
polymorphism (p > 0.44). However, a significant
increase was noted for both the AT1 receptor C
variant (p = 0.025) and the AGT T variant (p =
0.047) in hypertensive patients compared with
those who were normotensive.
In conclusion, results of this study indicate
that the ACE I/D, the 1166 A-->C AT1 receptor
and AGT M235T polymorphisms do not confer any
increased risk for MI in young South African
Indians.
Title: First South African summit on
atherothrombosis to address critical CV
conditions
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.26
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Title: Percutaneous closure of
interatrial defects : the Free State experience
: cardiovascular topics
Authors: Brown, S.C.; Bruwer, A.D.; Harrisberg,
J.; Govendrageloo, K.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.28-31
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Abstract: Objective: Atrial septal defects and
patent foramen ovale can now be closed
percutaneously. This report describes our
initial and follow-up experience, especially in
relation to efficacy and complications.
Methods: During a 2-year period, seven atrial
septal defects and one patent foramen ovale were
closed. The Amplatzer(R) atrial septal defect
occluder was used in five, the Cardioseal(R)
device in two and the Amplatzer(R) patent
foramen ovale occluder in one. A compliant
sizing balloon was used to assess the stretched
diameter of the defects.
Results: Percutaneous closure was successful in
all patients. The median age was 5.4 years
(range: 3.7-16.6 years) and median weight was 18
kg (range: 14-65 kg). The mean duration of the
procedure was 2.3 hours. There were no acute
complications. Patients were followed up for a
mean of 1.1 years. One child experienced severe
headaches and another developed an atrial
flutter and a small leak 7 months after
implantation, both of which resolved.
Conclusion: Percutaneous closure of atrial
septal defects and patent foramen ovale is
effective and safe. In selected children, this
may be offered as an alternative to surgery.
Title: Potential renoprotective
effects of the angiotensin receptor blocker
eprosartan : a review of preliminary renal
studies : review article
Authors: Rayner, B.; Jaeger, B.; Verboom, C.N.;
Pascoe, M.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.32-37
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Abstract: The importance of the
renin-angiotensin-aldosterone system (RAAS) in
the pathogenesis of hypertension and in renal
disease, particularly in patients with diabetes,
has become increasingly evident. Pharmacological
blockade of the RAAS offers potential for the
therapeutic management of these pathologies.
Angiotensin converting enzyme (ACE) inhibitors
and angiotensin II (AII) receptor blockers have
been shown to exhibit effectiveness in the
treatment of hypertension. AII receptor blockers
have a renal protective effect owing to their
ability to reduce systemic blood and
intraglomerular pressures. Eprosartan is a
chemically distinct AII blocker, which displays
a dual mode of action whereby it blocks both
pre- and postsynaptic AT1 receptors, potentially
benefiting patients with hypertension and renal
disease. In addition, evidence suggests that
eprosartan is well tolerated by both healthy
subjects and patients with varying degrees of
renal impairment, such that the dose does not
need to be - modified in patients with mild to
moderate renal impairment.
Results from preliminary studies demonstrate
that eprosartan doses well below those required
for blood pressure control have a pronounced
effect on the kidney and do not compromise renal
autoregulatory mechanisms. Therefore, eprosartan
may have a benefit in the prevention or delay of
renal damage in hypertensive patients with renal
impairment, although this remains to be
determined in a clinical setting.
Title: Carrying short-acting
nitrates is not a contra-indication to the use
of PDE5 inhibitors : drug trends in cardiology
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.38
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Title: New Premier study suggests
Preterax(R) as a first-line antihypertensive :
drug trends in cardiology
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.40-41
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Title: The CHARM programme raises
the profile of candesartan cilexetil in the
treatment of chronic heart failure : drug trends
in cardiology
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.42-45
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Title: VALIANT trial results support
use of valsartan in acute myocardial infarction
: drug trends in cardiology
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.45, 47
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Title: Cardio news
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 1, Jan / Feb
Published: 2004
Pages: p.48
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