CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 30, ISSUE
6, NOV/DEC 2019
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- Title: The challenges of improving benzathine penicillin usage for prevention of rheumatic fever in Africa
Authors: Ana Olga Mocumbi
From: Cardiovascular Journal of Africa, Vol 30, Issue 6 November/December 2019
Pages: 313-314
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- Title: What is in a number: the impact factor, citation analysis and 30 years of publishing the Cardiovascular Journal of Africa
Authors: Paul A Brink
From: Cardiovascular Journal of Africa, Vol 30, Issue 6 November/December 2019
Pages: 315
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- Title: Factors associated with sub-optimal control of anticoagulation in patients with prosthetic heart valves taking oral anticoagulants in a sub-Saharan African setting
Authors: Tigist Chalachew, Dejuma Yadeta, Endale Tefera
From: Cardiovascular Journal of Africa, Vol 30, Issue 6 November/December 2019
Published: 2019
Pages: 316–320
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DOI Number: 10.5830/CVJA-2019-024
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-024
Background: Replacement of diseased valves reduces the morbidity and mortality rate associated with native valvular disease but comes at the expense of risking complications related to the implanted prosthetic device. Establishing the desired anticoagulation level in a sub-Saharan African setting may be a challenge.
Objectives: This study was conducted to determine the challenges of maintaining a desired level of anticoagulation and factors associated with sub-optimal anticoagulation in patients with prosthetic heart valves on chronic anticoagulation.
Methods: We reviewed 73 patients who had undergone prosthetic valve replacement for chronic rheumatic valvular heart disease and were taking warfarin. The follow up ranged from one to 13 years. We studied international normalised ratio (INR) profiles of the patients for the six months preceding the study and defined optimal control as an INR of 2.5–3.5. We aimed to determine if there were factors associated with sub-optimal control of INR.
Results: Forty-two patients (57.5%) were female. Mean age of the participants was 21.5 ± 3.1 years (range 14–25 years). Warfarin was the anticoagulant in 55 (75.3%) of the patients and 18 (24.7%) were on combined warfarin and aspirin anticoagulation. Thirty-five (47.9%) patients had optimal control of their INR. Educational level of primary school or less, distance from follow-up medical facility of more than 300 km, quarterly or less-frequent check-up visit, and public health institution as a source of free warfarin supply were found to be significantly associated with sub-optimal control of INR.
Conclusion: Educational level, distance from follow-up facility, number of follow-up visits and source of warfarin supply were found to be significantly associated with sub-optimal control of INR.
- Title: Associations between body fat distribution and cardiometabolic risk factors in mixed-ancestry South African women and men
Authors: Florence E Davidson, Tandi E Matsha, Rajiv T Erasmus, Andre Pascal Kengne, Julia H Goedecke
From: Cardiovascular Journal of Africa, Vol 30, Issue 6 November/December 2019
Published: 2019
Pages: 321–330
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DOI Number: 10.5830/CVJA-2019-028
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-028
Objective: To investigate the relationship between body fat distribution and cardiometabolic risk in mixed-ancestry South African (SA) men and women, and to explore the effect of menopausal status on these relationships in women.
Methods: In a cross-sectional study, 207 mixed-ancestry SA women and 46 men underwent measurement of body composition using dual-energy X-ray absorptiometry, blood pressure, oral glucose tolerance, lipid profile and high-sensitivity C-reactive protein determination. The associations between different body fat compartments and associated cardiometabolic risk factors were explored.
Results: Men had less percentage fat mass (%FM) [26.5% (25–75th percentiles: 19.9–32.5) vs 44.0% (39.8–48.6), p ≤ 0.001], but more central and less peripheral fat (both p < 0.001) than women. Post-menopausal women had greater %FM, waist and visceral adipose tissue (VAT), and less gynoid %FM than pre-menopausal women (all p ≤ 0.004). After adjusting for age and gender, VAT accounted for the greatest variance in insulin resistance (R2 = 0.27), while trunk %FM and leg %FM accounted for the greatest variance in triglyceride (R2 = 0.13) and high-density lipoprotein cholesterol concentrations (R2 = 0.14). The association between fat mass and regional subcutaneous adipose tissue and cardiometabolic risk factors differed by gender and menopausal status.
Conclusion: Central fat was the most significant correlate of cardiometabolic risk and lower body fat was associated with reduced risk. These relationships were influenced by gender and menopausal status.
- Title: Fluorine-18 fluorodeoxyglucose positron emission tomography in assessing myocardial viability in a tertiary academic centre in Johannesburg, South Africa: a pilot study
Authors: Dineo Mpanya, Nqoba Tsabedze, Carlos Libhaber, Brenda Kagodora, Mboyo-Di-Tamba Vangu
From: Cardiovascular Journal of Africa, Vol 30, Issue 6 November/December 2019
Published: 2019
Pages: 331–335
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DOI Number: 10.5830/CVJA-2019-029
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-029
Background: Positron emission tomography detects patients with myocardial contractile dysfunction secondary to ischaemic heart disease who may benefit from coronary revascularisation.
Methods: We reviewed technetium-99m sestamibi singlephoton emission computed tomography (SPECT) and fluorine- 18 fluorodeoxyglucose (F18-FDG) positron emission tomography (PET) data from 236 patients imaged between January 2009 and June 2015. The patients were grouped into three groups: no evidence of viability, viability 1–10% and viability > 10%.
Results: Viability exceeding 10% was evident in 55% of the patients. On multivariate analysis, aspirin intake [OR: 1.92; 95% CI: 1.08–3.41; p = 0.026] and hypertension [OR: 1.89; 95% CI: 1.07–3.33; p = 0.029] were clinical factors associated with the presence of myocardial viability.
Conclusion: Our study demonstrated that F18-FDG PET was able to identify 55% of patients with ischaemic heart disease with viability in more than 10% of the total myocardium when using a 17-segment model.
- Title: Effects of cardiopulmonary bypass on pulmonary function in COPD patients undergoing beating heart coronary artery bypass surgery
Authors: Erdem Çetin, Levent Altınay
From: Cardiovascular Journal of Africa, Vol 30, Issue 6 November/December 2019
Published: 2019
Pages: 336–340
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DOI Number: 10.5830/CVJA-2019-030
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-030
Background: The aim of this study was to compare the effects of cardiopulmonary bypass (CPB) on the postoperative course of patients with chronic obstructive pulmonary disease (COPD) following coronary artery bypass graft (CABG) surgery.
Methods: This retrospective study included 375 COPD patients who underwent isolated CABG surgery with either on-pump (group 1) or off-pump beating heart techniques (group 2) between April 2014 and August 2018.
Results: Group 1 included 42 (11.2%) and group 2 included 333 (88.8%) patients. The mean mechanical ventilatory support times of groups 1 and 2 were 10.6 ± 36.2 and 5.1 ± 2.61 hours, respectively (p = 0.561). The mortality rates of groups 1 and 2 were 4.76% (two patients) and 1.50% (five patients), respectively (p = 0.142).
Conclusion: The on-pump beating heart CABG surgery did not affect the postoperative mechanical ventilatory support times in patients with COPD.
- Title: The walking estimated limitation stated by history (WELSH): a visual tool to self-reported walking impairment in a predominantly illiterate population
Authors: Wendsèndaté Yves Sempore, Alassane Ilboudo, Samir Henni, Jeanne Hersant, Myriam Ammi, Aimé Arsène Yameogo, Nafi Ouedraogo, Téné Marcéline Yameogo, Pierre Abraham
From: Cardiovascular Journal of Africa, Vol 30, Issue 6 November/December 2019
Published: 2019
Pages: 341–346
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DOI Number: 10.5830/CVJA-2019-032
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-032
Background: The prevalence of cardiovascular diseases is increasing in low-income countries. Various questionnaires to estimate walking capacity in patients are available in multiple languages but they are not suitable for illiterate patients.
Objective: The walking estimated limitation stated by history (WELSH) tool aims at rating individual walking disability using only drawings and four items.
Methods: A six-month prospective study was performed on new patients referred to the Department of Cardiology at the Centre Hospitalier Universitaire Sourô Sanou in Bobo- Dioulasso, Burkina Faso. We administered the WELSH tool after a short oral presentation in the patient’s language or dialect. Thereafter, patients performed a six-minute walking test in the hospital corridor under the supervision of a nurse who was blinded to the results of the WELSH score. We performed a step-by-step multilinear regression analysis to determine the factors predicting maximal walking distance (MWD).
Results: There were 40 female and 10 male patients in this study. Their ages ranged from 54.8 ± 10.7 years. Only 32% of the patients had attended primary school. Most patients were classified as stage I to III of the New York Heart Association (NYHA) classification. The objective measurement of MWD during a six-minute walking test showed no association with the subjects’ educational level, body mass index, NYHA stage or gender, but a significant correlation with the WELSH scores. The Spearman r-value for the WELSH score-to- MWD relationship was 0.605 (p < 0.001).
Conclusions: The WELSH tool is feasible and correlated with measured MWD in a population of predominantly illiterate patients.
- Title: Ellisras Longitudinal Study 2017: body frame variation and adiposity among Polokwane private school children (ELS 9)
Authors: RB Sebati, MS Monyeki, KD Monyeki
From: Cardiovascular Journal of Africa, Vol 30, Issue 6 November/December 2019
Pages: 347–351
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DOI Number: 10.5830/CVJA-2019-033
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-033
Objective: Obesity affects both developed and developing countries and it affects children worldwide. The aim of this study was to investigate the relationship between body frame size and adiposity among Polokwane private school children.
Methods: A total of 2 162 children (1 126 boys and 1 036 girls) aged five to 15 years attending three private schools in Polokwane, a city in the Limpopo Province of South Africa, participated in the study. Most of the participants were black children (99.77%), whereas 0.2% were white, 0.01% were coloureds and 0.02% were Indians. Subjects underwent anthropometric measurements including weight and height, skinfolds including triceps and subscapular, and body frame including bi-iliocristal and transverse chest.
Results: There was a negative significant correlation between body mass index (BMI) (reflects adiposity) and height only (reflects body frame) (r2 = –0.268 and r2 = –0.303, respectively) among children in age group five to seven years. BMI was also significantly and positively correlated with skinfolds and vice versa (both reflect adiposity) (r = 0.345–0.571).
Conclusion: There was a positive significant correlation between adiposity (reflected by skinfolds and BMI) and several measures of body frame size among Polokwane private school children. Moreover, body frame size can be used in the detection of risk for obesity.
- Title: A 10-year follow-up study of demographic and cardiometabolic factors in HIV-infected South Africans
Authors: Edith Phalane, Carla Maria Theresia Fourie, Catharina Martha Cornelia Mels, Aletta Elisabeth Schutte
From: Cardiovascular Journal of Africa, Vol 30, Issue 6 November/December 2019
Published: 2019
Pages: 352–360
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DOI Number: 10.5830/CVJA-2019-034
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-034
Objectives: Understanding of the interplay between human immunodeficiency virus (HIV) and cardiovascular disease, especially in Africa, is limited to evidence from longitudinal studies. Therefore the demographic profile and cardiometabolic, renal and liver function of an HIV-infected South African population were profiled from 2005 to 2015.
Methods: The study included 117 HIV-infected and 131 uninfected controls that were examined at baseline, five and 10 years.
Results: Mortality rate declined from 24% (2005–2010) to 0% (2010–2015) after the introduction of ART. Longitudinal increases in C-reactive protein (p = 0.002), alanine transaminase (p = 0.006) and gamma-glutamyl transferase (p = 0.046) levels and estimated glomerular filtration rate (p < 0.001) were seen only in the HIV-infected group. This group also showed increased high-density lipoprotein cholesterol (HDL-C) (p < 0.001) and total cholesterol (p < 0.001) levels and decreased triglyceride:HDL-C (p = 0.011) levels. Low-density lipoprotein cholesterol decreased in both groups (p < 0.001).
Conclusion: Despite trajectories of deranged lipid and inflammatory profiles, the cardiometabolic disease risk seems stable in HIV-infected South Africans. Inflammation and renal and liver function warrant regular monitoring.
- Title: Relationship between obesity and blood pressure among employees in the Vhembe district municipality of Limpopo Province, South Africa
Authors: Takalani Clearance Muluvhu, Makama Andries Monyeki, Gert Lukas Strydom, Abel Lamina Toriola
From: Cardiovascular Journal of Africa, Vol 30, Issue 6 November/December 2019
Published: 2019
Pages: 361–368
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DOI Number: 10.5830/CVJA-2019-035
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-035
Objective: The aim of this study was to investigate the relationship between obesity and blood pressure among employees of the Vhembe district municipality of Limpopo province.
Methods: A cross-sectional study was conducted among 452 local government employees (207 males, 245 females) aged 24–65 years. Body mass index (BMI), blood pressure (BP) and waist circumference (WC) measurements, and waistto- height ratio (WHtR) were assessed. Data were analysed using Statistical Package for Social Sciences (SPSS) statistics, version 21.
Results: The results showed that 27% of the participants were classified as overweight and 34% as obese, with females being more overweight and obese (29 and 48%, respectively) compared to males (24 and 17%, respectively). Twenty-five per cent of the participants were hypertensive, with females (27%) showing a higher prevalence compared to males (22%). Based on BMI categories, the obese group (35%) had a higher prevalence of hypertension in contrast to groups that were of normal weight (18%) and overweight (22%). The results also showed that systolic blood pressure (SBP) was positively (p ≤ 0.05) correlated with BMI (r = 0.15), WC (r = 0.26) and WHtR (r = 0.29) in the normal and overweight groups (WC, r = 0.23 and WHtR, r = 0.26), and WHtR correlated with SBP (r = 0.26) and diastolic blood pressure (DBP) (r = 0.19).
Conclusion: The study showed a high prevalence of overweight, obesity and hypertension, with females more affected than their male counterparts. BMI, WC and WHtR were positively correlated with SBP in the normal and overweight groups, with WHtR positively correlated with both SBP and DBP in the overweight group. Therefore, it is recommended that intervention regimes designed to address obesity and hypertension should consider risk awareness for cardiovascular diseases, impaired quality of life and productivity among local government employees.
- Title: Availability and administration of benzathine penicillin G for the prevention of rheumatic fever in Africa: report of the Working Group on Penicillin, Pan-African Society of Cardiology Task Force on Rheumatic Heart Disease
Authors: Sulafa Ali, Aidan Long, Jean B Nikiema, Geoffrey Madeira, Rosemary Wyber
From: Cardiovascular Journal of Africa, Vol 30, Issue 6 November/December 2019
Published: 2019
Pages: 369–372
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DOI Number: 10.5830/CVJA-2019-042
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-042
Methods: Penicillin is the cornerstone of management for rheumatic heart disease (RHD), an important public health problem in Africa. An online survey was used to collect data from African health workers about availability and administration of penicillin.
Results: There were 30 respondents from 14 countries. Unavailability of benzathine penicillin G (BPG) was reported by 30% of respondents. Skin testing was practiced by 40% of respondents, 30% did not have administration guides and only 30% had emergency kits available. The interval of BPG for secondary prophylaxis varied between two and four weeks. Major adverse reactions were observed by 30% of respondents, including anaphylactic shock/death in six cases. Fortythree per cent of respondents reported that health workers had concerns about BPG administration, including worry about reactions, pain and the viscosity of the solution, and 50% were not confident to manage BPG allergy.
Conclusion: BPG availability should be addressed and African health workers’ knowledge and practices need to be augmented.
