CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 23, ISSUE
8, SEP 2012
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- Title: Publication subsidies : challenges
and dilemmas facing South African researchers :
editorial
Authors: Woodiwiss, Angela J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 421-427
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Abstract: In an attempt to encourage and enhance research productivity in higher educational institutions, various systems have been introduced. Currently in South Africa, a government subsidy is granted to higher educational institutions in reward for research outputs (primarily journal publications and postgraduate student graduations). The purpose of this article is not to attack the current or past publication subsidy systems but rather to enlighten researchers, especially emerging researchers, on the benefits and risks of the publication subsidy systems and other systems used to encourage research outputs.
With this aim in mind, a comparison of the current versus the previous South African funding formulae will be made and the positive and negative impacts of these formulae (focusing primarily on the one currently in use) will be discussed in the light of international experiences using similar such approaches. In essence I wish to highlight the challenges and dilemmas faced by South African researchers and higher education institutions as they strive to find ways to increase research outputs while simultaneously sustaining or enhancing the quality and impact of these research outputs, in order to maintain and/or gain national and international recognition.
- Title: Comparison of the effects of gelatin,
Ringer's solution and a modern hydroxyl ethyl
starch solution after coronary artery bypass
graft surgery : cardiovascular topic
Authors: Alavi, S.M.; Ahmadi, B. Baharvand; Baharestani, B.; Babaei, T.
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 428-431
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DOI Number: 10.5830/CVJA-2012-026
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-026
Abstract: Objective: The aim of this study was to compare the effect of 6% hydroxyl ethyl starch solution with 4% gelatin and Ringer's solutions on the haemodynamic stability of patients after coronary artery bypass graft (CABG) surgery and immediately after discontinuation of cardiopulmonary bypass (CPB).
Methods: This was a randomised, double-blind clinical trial of 92 patients who were candidates for on-pump CABG. After discontinuation of CPB, all patients were transferred to the intensive care unit (ICU) and divided randomly into three groups. The first group received Ringer's solution, the second group 4% gelatin, and the third 6% hydroxyl ethyl starch (HES) solution (Voluven). Haemodynamic parameters such as heart rate, mean arterial pressure, systolic blood pressure, diastolic blood pressure, central venous pressure, cardiac output and the presence of arrhythmias were documented.
Results: The volume needed for maintaining normal blood pressure and central venous pressure in the range of 10-14mmHg was less in the HES group than in the other groups. The volume was similar however in the gelatin and Ringer's groups in the first 24 hours after surgery. Urinary output in the first four and 24 hours after surgery were significantly higher in the HES group than in the other two groups. Mean creatinine levels were significantly lower in the HES group.
Conclusion: HES (6%) had a better volume-expanding effect than gelatin (4%) and Ringer's solutions, and its short-term effects on renal function were also better than gelatin and Ringer's solutions.
- Title: Cardiac surgical experience in
northern Nigeria : cardiovascular topic
Authors: Nwiloh, J.; Edaigbini, S.; Danbauchi, S.; Babaniyi, I.; Aminu, M.; Adamu, Y.; Oyati, A.
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 432-434
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DOI Number: 10.5830/CVJA-2012-028
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-028
Abstract: A pilot study was undertaken to determine the feasibility of establishing a heart surgery programme in northern Nigeria. During three medical missions by a visiting US team, in partnership with local physicians, 18 patients with heart diseases underwent surgery at two referral hospitals in the region. Sixteen (88.9%) patients underwent the planned operative procedure with an observed 30-day mortality of 12.5% (2/16) and 0% morbidity. Late complications were anticoagulant related in mechanical heart valve patients and included a first-trimester abortion one year postoperatively, and a death at two years from haemorrhage during pregnancy. This has prompted us to now consider bioprosthetics as the valve of choice in women of childbearing age in this patient population. This preliminary result has further stimulated the interest of all stakeholders on the urgency to establish open-heart surgery as part of the armamentarium to combat the ravages of heart diseases in northern Nigeria.
- Title: Increased relative wall thickness is a
marker of subclinical cardiac target-organ
damage in African diabetic patients :
cardiovascular topic
Authors: Chillo, Pilly; Lwakatare, Johnson; Lutale, Janet; Gerdts, Eva
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 435-441
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DOI Number: 10.5830/CVJA-2012-023
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-023
Abstract: Objective: To assess the prevalence and covariates of abnormal left ventricular (LV) geometry in diabetic outpatients attending Muhimbili National Hospital in Dar es Salaam, Tanzania.
Methods:Echocardiography was performed in 61 type 1 and 123 type 2 diabetes patients. LV hypertrophy was taken as LV mass/height 2.7 > 49.2 g/m 2.7 in men and > 46.7 g/m 2.7 in women. Relative wall thickness (RWT) was calculated as the ratio of LV posterior wall thickness to end-diastolic radius and considered increased if ≥ 0.43. LV geometry was defined from LV mass index and RWT in combination.
Results: The most common abnormal LV geometries were concentric remodelling in type 1 (30%) and concentric hypertrophy in type 2 (36.7%) diabetes patients. Overall, increased RWT was present in 58% of the patients. In multivariate analyses, higher RWT was independently associated with hypertension, longer isovolumic relaxation time, lower stress-corrected midwall shortening and circumferential endsystolic stress, both in type 1 (multiple R2 = 0.73) and type 2 diabetes patients (multiple R2 = 0.66), both p < 0.001. These associations were independent of gender, LV hypertrophy or renal dysfunction.
Conclusion: Increased RWT is common among diabetic sub-Saharan Africans and is associated with hypertension and LV dysfunction.
- Title: Association of waist circumference,
body mass index and conicity index with
cardiovascular risk factors in postmenopausal
women : cardiovascular topic
Authors: Shidfar, Farzad; Alborzi, Fatemeh; Salehi, Maryam; Nojomi, Marzieh
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 442-445
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DOI Number: 10.5830/CVJA-2012-038
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-038
Abstract: In menopause, changes in body fat distribution lead to increasing risk of cardiovascular disease and metabolic disorders. The aim of this study was to assess the association of adiposity using the conicity index (CI), body mass index (BMI) and waist circumference (WC) with cardiovascular risk factors (hypertension, diabetes and dyslipidaemia). The sample of this cross-sectional study was collected from June to October 2010 and 165 consecutive menopausal women who had attended the Health and Treatment Centre and Endocrine Research Centre of Firoozgar Hospital in Tehran, Iran were assessed. Age, weight, height, WC, waist-hip ratio(WHR), CI and fat mass were measured. Systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose, insulin, low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) levels were also determined. All statistical analyses were performed by SPSS version 17 (SPSS Inc, Chicago, IL, USA).
Results showed that BMI was positively and significantly associated with SBP (r = 0.21; p = 0.009). WC was positively and significantly correlated with SBP (r = 0.26; p = 0.02) andDBP (r = 0.16; p = 0.05). WHR was also significantly and positively associated with SBP (r = 0.29; p = 0.001). Age and WC were associated with CI quartiles at the 0.05 significance level. The correlation of CI quartiles with SBP and weight were at the 0.01 significance level.
We showed a significant association of WC with SBP and DBP, and that BMI could be an important determining factor of SBP. For assessing the association between CI and cardiovascular risk factors, future studies with larger sample sizes are recommended.
- Title: Accuracy of D-dimer : fibrinogen ratio
to diagnose pulmonary thromboembolism in
patients admitted to intensive care units :
cardiovascular topic
Authors: Hajsadeghi, Shokoufeh; Kerman, Scott R.; Khojandi, Mojtaba; Vaferi, Helen; Ramezani, Roza; Jourshari, Negar M.; Mousavi, Sayyed Aj; Pouraliakbar, Hamidezar
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 446-456
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DOI Number: 10.5830/CVJA-2012-041
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-041
Abstract: Introduction: Pulmonary thromboembolism (PTE) may increase D-dimer and decrease fibrinogen levels. However, in settings such as intensive care units (ICU) and in long-term hospitalised patients, several factors may influence D-dimer and fibrinogen concentrations and make them unreliable indicators for the diagnosis of PTE. The aim of this study was to evaluate the accuracy of D-dimer : fibrinogen ratio (DDFR)for the diagnosis of PTE in ICU patients.
Methods: ICU patients who were suspected of having a first PTE and had no history of using anti-coagulants and contraceptives were included in the study. Levels of D-dimer and fibrinogen were measured for each patient prior to any intervention. Angiography or CT angiography was done in orderto establish a definite diagnosis for each patient. Suitable analytical tests were performed to compare means.
Results: Eighty-one patients were included in the study, of whom 41 had PTE and 40 did not. Mean values of D-dimer and fibrinogen were 3.97 ± 3.22 μg/ml and 560.6 ± 197.3 mg/dl, respectively. Significantly higher levels of D-dimer (4.65 ± 3.46 vs 2.25 ± 2.55 μg/ml, p = 0.006) and DDFR (0.913 ± 0.716 vs 483 ± 0.440 × 10-3, p = 0.003) were seen in PTE patientsthan in those without PTE. Receiver operating characteristic (ROC) analysis showed a 70.3% sensitivity and 70.1% specificity with a D-dimer value of 2.43 μg/ml (AUC = 0.714, p = 0.002) as the best cut-off point; and a 70.3% sensitivity and 61.6% specificity with a DDFR value of 0.417 × 10-3 (AUC = 0.710, p = 0.004) as the best cut-off point. In backward stepwise regression analysis, DDRF (OR = 0.72, p = 0.025), gender (OR = 0.76, p = 0.049) and white blood cell count (OR = 1.11, p = 0.373) were modelled (p = 0.029, R2 = 0.577).
- Title: Role of four-week resistance exercise
in preserving the heart against ischaemia-reperfusion-induced
injury : cardiovascular topic
Authors: Doustar, Yousef; Soufi, Farhad G.; Jafary, Afshar; Saber, Mohaddeseh M.; Ghiassie, Rafigheh
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 451-455
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DOI Number: 10.5830/CVJA-2012-050
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-050
Abstract: Objective: We studied the cardioprotective effect of resistance training against ischaemia-reperfusion-induced injury.
Methods: Forty male rats were divided into trained andsedentary groups (n = 20 for each). The trained rats were exercised at 12 repetitions/set, four sets/day and five days/week for four weeks. Transient regional ischaemia of the left anterior descending coronary artery (40 min) was followed by 80 min of reperfusion.
Results: Baseline developed and diastolic pressures and coronary flow were similar in the two groups. While diastolic pressure increased and developed pressure and coronary flow decreased in both the ischaemic and perfusion periods (as indices of cardiac damage), there were no statistically significant differences between the trained and sedentary groups in these parameters. Resistance training did not significantly change the infarct size and apoptosis rate.
Conclusion: We did not see a cardioprotective effect of resistance exercise against ischaemia-reperfusion-induced injury in this study. A precise conclusion about this issue needs more investigations.
- Title: The effect of the first office blood
pressure reading on hypertension-related
clinical decisions : cardiovascular topic
Authors: Oladdipo, Idris; Ayoade, Adedokun
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 456-462
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DOI Number: 10.5830/CVJA-2012-052
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-052
Abstract: The effect of the first office blood pressure reading (FBPR) on hypertension-related decisions was evaluated using blood pressure (BP) readings taken with the BpTRU BPM-100 device. BP readings were grouped into three pairs: (1) single readings (first and second readings), (2) computed average of three readings (one including and one excluding the first reading), and (3) computed average of five readings (one including and one excluding the first reading). Categorisation of BP readings under JNC-7 classes and distribution into < 140/90 and ≥ 140/90 mmHg groups were selected as parameters guiding hypertension-related decisions. Readings including FBPR had strong positive correlations to those excluding FBPR (Pearson's correlation coefficient ranged from 0.86–1.00). Also, FBPR-included and FBPR-excluded readings did not differ statistically in JNC'7 categorisation or distribution into < 140/90 or ≥ 140/90 mmHg groups. Our findings suggest that exclusion of FBPR may have no significant impact on hypertension-related clinical decisions.
- Title: The effects of medicinal plants on
renal function and blood pressure in diabetes
mellitus : review article
Authors: Musabayane, C.T.
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 462-468
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DOI Number: 10.5830/CVJA-2012-025
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-025
Abstract: Diabetes mellitus is one of the most common chronic global diseases affecting children and adolescents in both the developed and developing nations. The major types of diabetes mellitus are type 1 and type 2, the former arising from inadequate production of insulin due to pancreatic β-cell dysfunction, and the latter from reduced sensitivity to insulin in the target tissues and/or inadequate insulin secretion. Sustained hyperglycaemia is a common result of uncontrolled diabetes and, over time, can damage the heart, eyes, kidneys and nerves, mainly through deteriorating blood vessels supplying the organs. Microvascular (retinopathy and nephropathy) and macrovascular (atherosclerotic) disorders are the leading causes of morbidity and mortality in diabetic patients. Therefore, emphasis on diabetes care and management is on optimal blood glucose control to avert these adverse outcomes.
Studies have demonstrated that diabetic nephropathy is associated with increased cardiovascular mortality. In general, about one in three patients with diabetes develops end-stage renal disease (ESRD) which proceeds to diabetic nephropathy (DN), the principal cause of significant morbidity and mortality in diabetes. Hypertension, a well established major risk factor for cardiovascular disease contributes to ESRD in diabetes. Clinical evidence suggests that there is no effective treatment for diabetic nephropathy and prevention of the progression of diabetic nephropathy. However, biomedical evidence indicates that some plant extracts have beneficial effects on certain processes associated with reduced renal function in diabetes mellitus. On the other hand, other plant extracts may be hazardous in diabetes, as reports indicate impairment of renal function. This article outlines therapeutic and pharmacological evidence supporting the potential of some medicinal plants to control or compensate for diabetes-associated complications, with particular emphasis on kidney function and hypertension.
- Title: A systematic overview of prospective
cohort studies of cardiovascular disease in
sub-Saharan Africa : reply to Bovet et al., and Gao et al. : letter to the editor
Authors: Kengene, Andre Pascal; Mayosi, Bongani M.
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 469-470
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Abstract: Two groups of investigators have recently provided evidence supporting the need for elaborated longitudinal studies to inform successful health service and policy solutions to the growing problem of chronic and cardiovascular disease in sub-Saharan Africa (SSA). In one of those studies, published in the Cardiovascular Journal of Africa, our group reached such a conclusion on the basis of a systematic review of relevant existing cohort studies conducted in SSA, published and indexed to MEDLINE from 1966 to October 2009.
- Title: High patient compliance with nicacin
/ laropiprant in large clinical trial : interim
safety and tolerability results from HPS-2
THRIVE study released at 2012 ESC congress :
drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 471
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Abstract: Of the patients randomised to niacin/laropiprant in the HPS-2 THRIVE study, 75% remained compliant after three years of therapy with the combination of an extended-release niacin and the non-flushing agent, laropiprant. HPS-2 THRIVE is a heart-protection study focused on treating high-density lipoprotein (HDL) cholesterol to reduce the incidence of vascular events.
- Title: New cookbook to help disarm South
Africa's heart disease time bomb : cardio news
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: 472
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Abstract: Dr Vash Mungal-Singh, CEO of the Heart and Stroke Foundation South Africa (HSF), officially kicked off National Heart Awareness month with the launch of what the HSF says is another potent tool in its fight to stem the tide of cardiovascular disease, which currently claims about 200 lives in South Africa every day.
The new 'tool' is a recipe book, titled Cooking from the Heart, which will be distributed free to the public thanks to Pharma Dynamics, the leading provider of cardiovascular medication in the country. And there are already plans for hospitals and public institutions across South Africa to adopt its recipes and 'healthier eating' guidelines.
- Title: Echocardiographic patterns in
treatment-naïve HIV-positive patients in Lagos,
south-west Nigeria : cardiovascular topic -
online article
Authors: Olusegun-Joseph, D.A.; Ajuluchukwu, J.N.A.; Okany, C.C.; Mbakwem, A.C.; Oke, D.A.; Okubadejo, N.U.
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: e1-e6
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DOI Number: 10.5830/CVJA-2012-048
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-048
Abstract: Introduction: Cardiovascular abnormalities are common in HIV-infected patients, although often clinically quiescent. This study sought to identify by echocardiography early abnormalities in treatment-naïve patients.
Methods: One hundred patients and 50 controls with no known traditional risk factors for cardiovascular disease were recruited for the study. The cases and controls werematched for age, gender and body mass index. Both groups had clinical and echocardiographic evaluation for cardiac abnormalities, and CD4 count was measured in all patients.
Results: The cases comprised 57 females (57.0%) and 43 males (43.0%), while the controls were 28 females (56.0%) and 22 males (44.0%) (χ2 = 0.01; p = 0.913). The mean age of the cases was 33.2 ± 7.7, while that of the controls was 31.7 ± 9.7 (t = 1.02; p = 0.31). Echocardiographic abnormalities were significantly more common in the cases than the controls (78 vs 16%; p = 0.000), including systolic dysfunction (30 vs 8%; p = 0.024) and diastolic dysfunction (32 vs 8%; p = 0.002). Other abnormalities noted in the cases were pericardial effusion in 47% (χ2 = 32.10; p = 0.000) and dilated cardiomyopathy in 5% five); none of the controls had either complication. One patient each had aortic root dilatation, mitral valve prolapse and isolated right heart dilatation and dysfunction.
Conclusion: Cardiac abnormalities are more common in HIV-infected people than in normal controls. A careful initial and periodic cardiac evaluation to detect early involvement of the heart in the HIV disease is recommended.
- Title: An unusual embolic complication of
percutaneous coronary artery intervention and
simple percutaneous treatment : case report -
online article
Authors: Ilhan, Erkan; Soylu, Ozer; Guvenc, Tolga S.; Canga, Yigit; Ergelen, Mehmet
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: e7-e8
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Abstract: Emboli are among the most feared complications of interventional cardiology. Although surgery is needed in most cases for the removal of peripheric foreign body emboli, some may be extracted by percutaneous intervention. We present a case of retrieval of a femoral sheath fragment via contralateral femoral access, wiring of the sheath fragment, and retrieval with an 'anchoring balloon' system.
- Title: Anomalous left coronary artery
arising from the pulmonary artery : case report
- online article
Authors: Durand, M.; Nguyen, E.T.; Crean, A.M.
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: e9-e10
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DOI Number: 10.5830/CVJA-2012-031
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-031
Abstract: A 24-year-old female presented to her general practitioner with shortness of breath. She was referred for an echocardiogram, which demonstrated features suggestive of a right coronary artery fistula, and referred to our institute. We performed a contrast-enhanced, prospectively triggered cardiac CT angiogram, which demonstrated the primary and secondary features of anomalous left coronary artery arising from the pulmonary artery (ALCAPA), also known as the Bland-White-Garland syndrome, a rare congenital abnormality of the origin of the left main coronary artery.
- Title: A case of unexplained cyanosis : case
report - online article
Authors: Soma, Prashilla; Ellemdin, Shiraz
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: e11-e12
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DOI Number: 10.5830/CVJA-2012-033
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-033
Abstract: It is now clear that hepatopulmonary syndrome (HPS) may occur and contribute significantly to gas exchange abnormalities in the setting of other cardiopulmonary abnormalities. Since there is no gold-standard diagnostic test for HPS, diagnosis rests on documenting arterial oxygenation abnormalities resulting from intrapulmonary vasodilatation in the setting of liver disease. Retrospective studies suggest that many patients with HPS develop progressive intrapulmonary vasodilatation over time and that mortality is significant. This case highlights the clinical value in investigating for HPS and right-to-left shunts when confronted with a patient presenting with unexplained hypoxia in combination with platypnoea and/or orthodeoxia.
- Title: Single coronary artery from the right
coronary sinus with proximal origin of the left
anterior descending coronary artery and left
circumflex as distal continuation of the right
coronary artery : a rare variant : case report -
online article
Authors: Subban, Vijayakumar; Victor, Suma M.; Ajit, Mullasari S.; Kalidoss, Latchumanadhas
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: e13-e14
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DOI Number: 10.5830/CVJA-2012-034
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-034
Abstract: A single coronary artery is a rare coronary anomaly. A 68-year-old male underwent coronary angiography for recent inferior wall myocardial infarction. It revealed a common coronary trunk arising from the right sinus of Valsalva and bifurcated into the right coronary artery (RCA) and anterior descending coronary arteries. The RCA, after its usual distribution in the right atrioventricular groove, continued as the left circumflex artery in the left atrioventricular groove. There were significant stenoses in the mid and distal RCA, which were treated percutaneously.
- Title: A young patient with coronary artery
anomaly, whose left anterior descending artery
originated from the pulmonary artery, underwent
cardiac arrest : case report - online article
Authors: Sahin, Tayfun; Bozyel, Serdar; Acar, Eser; Bildirici, Ulas; Yavuz, Sadan; Baris, Ozgur; Ural, Ertan; Ural, Dilek
From: Cardiovascular Journal of Africa, Vol 23, Issue 8, Sep
Published: 2012
Pages: e15-e18
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DOI Number: 10.5830/CVJA-2012-037
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-037
Abstract: A rare congenital anomaly of the coronary arteries, in which the left coronary arterial system starts from the arteria pulmonalis, is known as Bland-White-Garland (BWG) syndrome. Isolated left anterior descending (LAD) or circumflex (Cx) arteries originating from the pulmonary artery are even more rare. These anomalies may cause myocardial ischaemia, myocardial infarction, arrhythmia and sudden death. Even if the patient is asymptomatic, he/she should undergo corrective surgery. Here we present the case of an 18-year-old male who survived sudden cardiac arrest during exercise. We identified intra-myocardial blood flow from transthoracic echocardiography, and performed coronary and computed tomographic (CT) angiography, which showed that all the coronary arteries were ectatic and curly and there were disseminated collaterals among the coronary arteries. We diagnosed 'anomalous left coronary artery from the pulmonary artery' (ALCAPA) syndrome, as additionally, the LAD originated from the pulmonary artery. We treated the patient with a left internal mammarian artery - left anterior descending artery (LIMA-LAD) graft.
