CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 33, ISSUE
2, MARCH/APRIL 2022
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- Editorial: From the Editor’s Desk
Author: PJ Commerford
From: Cardiovascular Journal of Africa, Vol 33, Issue 2 March/April 2022
Page: 43
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- Title: The effectiveness of vacuum-assisted closure therapy in patients with infected venous leg ulcers
Authors: Esra Ertürk Tekin, Mehmet Ali Yeşiltaş, Ayhan Uysal, İsmail Haberal
From: Cardiovascular Journal of Africa, Vol 33, Issue 2 March/April 2022
Pages: 44–50
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DOI Number: 10.5830/CVJA-2021-034
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-034
Aim: In this study, we aimed to investigate the effect of vacuum-assisted closure therapy on venous stasis wound healing in patients with chronic venous leg ulcers.
Methods: Vacuum-assisted closure therapy was applied on a total of 14 venous leg ulcers. All patients had post-thrombotic syndrome. Quantitative wound culture samples were obtained before the procedure and local wound assessments were performed. The primary outcome measures included wound healing as assessed by a local wound examination during each dressing change and the rate and velocity of ulcer reduc tion. Wound healing was defined as the complete closure of the ulcer, while rapid wound healing was defined as a ≥ 30% reduction in the ulcer size by week four.
Results: No surgical debridement or surgical corrective procedure was applied in any patient. The mean length of hospital stay was 32.3 days. The mean number of vacuum assisted closure therapies for each case was 17.8 and the mean time to dressing change was 72.3 hours. Multidrug resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were detected in three and four patients, respectively. Wound culture results became negative after a mean duration of vacuum-assisted closure therapy of 12.1 days. None of the patients needed antibiotic therapy until the procedure was completed. Compared to baseline, the mean ulcer reduction rates were 46.4% for the first six applications and 72.8% for the subsequent applications.
Conclusion: Our study results suggest that vacuum-assisted closure therapy promotes rapid wound healing in patients with severe post-thrombotic syndrome with venous stasis leg ulcers, and reduces the need for antibiotics by reducing the biological burden.
- Title: Prevalence, patterns and predictors of dyslipidaemia in Nigeria: a report from the REMAH study
Authors: Babangida Chori, Benjamin Danladi, Peter Nwakile, Innocent Okoye, Umar Abdullahi, Kefas Zawaya, Ime Essien, Kabiru Sada, Maxwell Nwegbu, John Ogedengbe, Akinyemi Aje, Godsent Isiguzo, Augustine Odili
From: Cardiovascular Journal of Africa, Vol 33, Issue 2 March/April 2022
Pages: 52–59
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DOI Number: 10.5830/CVJA-2021-037
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-037
Aim: The aim of this study was to determine the prevalence and predictors of dyslipidaemia in adults in Nigeria.
Methods: Using the WHO criteria, we determined dyslipidaemia using serum lipid levels of 3 211 adult Nigerians, aged at least 18 years, obtained between March 2017 and February 2018 from two communities (rural and urban) in a state from each of the six geopolitical zones of Nigeria.
Results: The overall prevalence of low high-density lipoprotein cholesterol (l-HDL), elevated low-density lipoprotein cholesterol (e-LDL), hypertriglyceridaemia (h-TG) and hypercholesterolaemia (h-CHL) were 72.5,13.6, 21.4 and 7.5%, respectively. The adjusted odds of h-CHL [odds ratio (95% confidence interval) 1.47 (1.10–1.95)], h-TG [1.89 (1.48–2.41)] and e-LDL [1.51 (1.03–2.15)] increased with obesity. Being a rural dweller increased the odds of h-TG [1.55 (1.29–1.85)], e-LDL [1.38 (1.10–1.73)] and l-HDL [1.34 (1.14–1.58)]. The odds of h-CHL [2.16 (1.59–2.95)], h-TG [1.21 (1.01–1.47)], e-LDL [1.42 (1.13–1.80)] and l-HDL [0.78 (0.65–0.93)] increased with hypertension. Diabetes mellitus doubled only the odds of h-TG [2.04(1.36–3.03)].
Conclusion: The prevalence of dyslipidaemia, particularly low HDL-C, is high among adult Nigerians.
- Title: Outcome of concomitant left atrial ablation during valvular heart surgery: an African perspective
Authors: Dambuza Nyamande, Risenga F Chauke, Siphosenkosi M Mazibuko, Shere P Ramoroko
From: Cardiovascular Journal of Africa, Vol 33, Issue 2 March/April 2022
Pages: 60–64
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DOI Number: 10.5830/CVJA-2021-038
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-038
Objectives: The aim of this study was to determine the success rates of left atrial radiofrequency cardiac ablation for atrial fibrillation during heart valve surgery.
Methods: This was a three-year retrospective study of 53 patients who had valve surgery and cardio-ablation. Immediate and long-term overall outcomes were analysed at three, six, nine, 12 and 24 months. The results were tested for significance by comparing to a chance outcome (50:50 probability) using the Z-test for the normal approximation of the binomial distribution.
Results: A total of 56.9% of patients converted immediately to sinus rhythm, with that number increasing over time. Pre-operative poor ejection fraction was the only predictor of low success rates following ablation. Long-term rhythm was determined by the patient’s rhythm between three and six months.
Conclusions: Concomitant left atrial ablation during valve surgery is effective in treating atrial fibrillation. Routine use of anti-arrhythmic medication after surgical ablation is not recommended.
- Title: Interleukin-6 and its correlations with maternal characteristics and echocardiographic parameters in pre-eclampsia, gestational hypertension and normotensive pregnancy
Authors: Dolina Gencheva, Fedya Nikolov, Ekaterina Uchikova, Rosen Mihaylov, Blagovesta Pencheva, Maria Vasileva
From: Cardiovascular Journal of Africa, Vol 33, Issue 2 March/April 2022
Pages: 65–73
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DOI Number: 10.5830/CVJA-2021-040
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-040
Background: Pre-eclampsia and gestational hypertension are pregnancy-related disorders with major maternal cardiovascular implications later in life.
Objectives: The aim of this study was to determine interleukin-6 levels in women with pre-eclampsia and gestational hypertension and in healthy pregnant controls, and to examine their correlations with characteristics of the women and echocardiographic findings.
Methods: The ELISA method was used to determine serum interleukin-6 in 36 women with gestational hypertension, 37 women with pre-eclampsia and 50 pregnant controls. The echocardiographic examination was performed according to current recommendations by the European Association of Cardiovascular Imaging and the American Society of Echocardiography.
Results: Mean serum interleukin-6 levels were 2.77 pg/ml in the controls, 5.08 pg/ml in the gestational hypertension group and 8.06 pg/ml in the pre-eclampsia group. A significant difference in these levels was present between the controls and both hypertensive groups, but not between the two hypertensive groups. Higher levels correlated with heart chamber enlargement and worse ventricular function.
Conclusion: Interleukin-6 levels in gestational hypertension and pre-eclampsia were significantly elevated compared to those in healthy pregnancy. Higher levels also corresponded to echocardiographical changes.
- Title: The role of immature platelet count and immature platelet fraction in determining the need for transfusion in patients undergoing CABG
Authors: Cihan Yücel, Serkan Ketenciler, Hüseyin Gemalmaz, Nihan Kayalar
From: Cardiovascular Journal of Africa, Vol 33, Issue 2 March/April 2022
Pages: 74–78
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DOI Number: 10.5830/CVJA-2021-041
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-041
Background: Platelet dysfunction has been shown to play a role in postoperative bleeding, however it is not clear whether immature platelets (IP) can induce appropriate homeostasis to prevent excessive bleeding in patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to evaluate the postoperative change in IP count (IPC), IP fraction (IPF) and mean platelet volume (MPV), an d to examine their relationship with postoperative bleeding and blood transfusion.
Methods: One hundred and forty-nine consecutive patients undergoing elective CABG were included in this prospective study. All CABGs were performed by the same surgical team in a standardised method, utilising the on-pump technique. IPC, MPV and IPF were measured pre-operatively, after the completion of surgery, and at the postoperative first, third and fifth days. The primary outcome measure of this study was whether the need for transfusion was associated with IP, IPF, MPV and platelet count.
Results: There was a significant decrease of 7.77% in IPC on the day of the operation. Pre-operative IPC and IPF were correlated with postoperative drainage (p < 0.001), intraoperative blood transfusion (p < 0.001) and intensive care unit blood transfusion (p < 0.001). Pre-operative haemoglobin levels were significantly correlated with length of hospital stay. However, neither pre-operative IPC nor IPF were associated with length of hospital stay. Postoperative IPC was however associated with the length of hospital and intensive care unit stay (p = 0.008 and p = 0.009, respectively).
Conclusion: Pre-operative IPC and IPF were significantly correlated with postoperative drainage and blood transfusion frequency. In patients undergoing CABG, these can be seen as serious guiding parameters in the estimation of postoperative bleeding.
- Title: First Malian series of surgery for rheumatic valve disease: opening of the centre, clinical features and peri-operative realities
Authors: Mahamadoun Coulibaly, Siriman A Koita, Modibo Doumbia, Binta Diallo, Salia I Traore, Baba I Diarra, Brehima Coulibaly, Sanoussy Daffe, Asmaou Maiga, Mamadou Toure, Rakiswendé A Zongo, Gaoussou Fofana, Seydina A Beye, Boubacar Diallo, Mamadou B Diarra, Djibo M Diango, Youssouf Coulibaly
From: Cardiovascular Journal of Africa, Vol 33, Issue 2 March/April 2022
Pages: 79–83
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DOI Number: 10.5830/CVJA-2021-042
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-042
Introduction: Over the past two decades, the incidence of acute rheumatic fever (ARF) and chronic rheumatic heart disease (RHD) have dramatically declined in wealthier regions of the world as a result of preventative programmes, improved living standards and access to cardiac surgery. Nevertheless, ARF and RHD are still public health problems in less-developed regions of the world such as Oceania, south Asia and sub-Saharan Africa. Aim: We report on clinical, therapeutic and prognostic aspects as well as the difficulties encountered during this first series of surgery for rheumatic valve disease in Mali.
Methods: This was a prospective, descriptive study conducted at the Andre Festoc Cardiac Surgery Centre from September 2018 to August 2019.
Results: The frequency of patients having been operated on for rheumatic valve disease was 44.73% (68 patients). The mean age of the patients was 18 ± 10 years with extremes of five and 60 years. The gender ratio was 0.7. The delay to treatment was between one and three years for 39.7% of the patients. The main diagnoses found were: mitral regurgitation in 50% of patients, mitral stenosis in 16.2% and aortic regurgitation in 10.3%. Pulmonary artery systolic pressure was 35–50 mmHg in 19.1% of patients and more than 50 mmHg in 25%. The median cardiopulmonary bypass time was 132 minutes (60–276) and median extubation time was three hours (0–96). The main complications were cardiac, renal, neurological, respiratory, gastrointestinal and infectious. In the immediate postoperative period, we recorded three deaths, which is a mortality rate of 4.4%.
Conclusion: Humanitarian efforts have led non-governmental organisations (NGOs) to launch surgical programmes in lowand middle-income countries in an attempt to fill the gap in these fragile healthcare systems. Cardiac surgery requires much expertise from the medical staff, as well as many material and financial resources. Empowerment of the local team is a challenge that is being realised since taking these essential steps of companionship with the NGO la Chaine de l’Espoir.
- Title: The effect of different anaesthesia techniques on postoperative pain and hospital discharge in varicose vein surgery
Authors: Mehmet Mutlu, Seray Turkmen
From: Cardiovascular Journal of Africa, Vol 33, Issue 2 March/April 2022
Pages: 84–87
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DOI Number: 10.5830/CVJA-2021-061
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-061
Introduction: Venous insufficiency caused by varicose veins, especially in the lower extremities, is widespread and can cause severe complications. Anaesthesia is essential for any surgical approaches in varicose vein surgery. This study evaluated the effect of single-dose epidural anaesthesia on postop erative pain scores and length of hospitalisation after varicose vein surgery, comparing it with general anaesthesia.
Methods: The study was conducted on a total of 100 patients, aged 18 years and older, with the American Society of Anesthesiologists (ASA) physical status classification I–III, undergoing unilateral lower-extremity stripping due to varicose veins within a six-month period at the Prof Dr Cemil Taşçioğlu City Hospital Anesthesiology and Reanimation Service. Fifty patients with single-dose epidural anaesthesia were consecutively included in the EA group. For comparison, 50 patients who were operated on under general anesthesia were included in the GA group.
Results: The groups showed statistically significant differences between the 30th-minute and first-, second-, fourth- and sixth = < hour visual analogue scale (VAS) scores (p 0.001; p 0.01). Patients with epidural anaesthesia had lower 30th-minute VAS scores compared to those administered general anaesthe sia. There were statistically significant differences identified between the groups for the additional analgesia requirements = < of patients (p 0.001; p 0.01). Subjects with epidural anaesthesia had lower additional analgesic requirements than those administered general anaesthesia.
Conclusion: Epidural anaesthesia provided adequate anaesthesia with more effective postoperative analgesia compared to patients operated on under general anaesthesia and receiving multimodal analgesia for postoperative analgesia.
- Title: The joint 15th Pan-African Society of Cardiology and Kenya Cardiac Society congress proceedings, 2021
Authors: Lilian Mbau, Caroline Mutai, Redempta Kimeu, Barbara Karau, Peter Mugo, Hazel Mburu, Bernard Samia, Bernard Gitura, Njambi Mathenge, Karen Sliwa, Ahmed Suliman, Liesl Zühlke, Mpiko Ntsekhe, Anders Barasa, Anastase Dzudie, Dike Ojji, Ali Toure Ibrahim, George Nel, Ntobeko Ntusi, Friedrich Thienemann, Mahmoud Sani, Awad Mohamed, Elijah Ogola, Mohamed Jeilan
From: Cardiovascular Journal of Africa, Vol 33, Issue 2 March/April 2022
Pages: 88–94
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DOI Number: 10.5830/CVJA-2022-020
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-020
Abstract: The 15th biennial Pan-African Society of Cardiology (PASCAR) congress held in Mombasa, Kenya, in November 2021, convened in its legacy of being the largest Pan-African conference on cardiovascular diseases (CVDs). The congress brough together members of cardiovascular societies from across the continent in the shared mission of advancing cardiovascular health in Africa. In partnership with the Kenyan Cardiac Society (KCS), the specific aims of the PASCAR conference were to (1) advance knowledge on CVDs in the region; (2) share local data, clinical cases, challenges and solutions and reinforce collaborative capac ity initiatives in research and workforce training; (3) engage with policy makers to address health-system issues affecting access to CVD care in Africa; and (4) bring together local and international thought leaders in cardiovascular medicine to strengthen the partnerships between PASCAR, KCS, other African cardiac societies and key global stakeholders. Due to the COVID-19 pandemic, this congress demonstrated great success in providing both an in-person and a virtual platform of attendance, therefore making this an inaugural hybrid PASCAR congress, with inclusive and widespread participation from across the globe. We highlight the key areas of focus, various educational programmes and innovative initiatives that shaped the 15th PASCAR congress, including expert consensus on the future directions for advancing CVD care in Africa.
- Title: Restrictive cardiomyopathy caused by diffuse calcification of the left ventricle after 20 years of haemodialysis
Authors: Cheng-Chieh Yang, Chien-Sung Tsai, Yi-Ting Tsai, Chih-Yuan Lin, Jia-Lin Chen, Po-Shun Hsu
From: Cardiovascular Journal of Africa, Vol 33, Issue 2 March/April 2022
Pages: 95–97
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DOI Number: 10.5830/CVJA-2021-031
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-031
Abstract: Valvular and vascular calcifications are common among patients with end-stage renal disease, but diffuse calcification of the left ventricle is rarely reported. We report on a rare case of restrictive cardiomyopathy resulting from severe myocardial calcification and review the literature. A 77-year old man was diagnosed with end-stage renal disease after having received regular haemodialysis for 20 years. He was referred to our emergency room due to exertional dyspnoea and exacerbated shortness of breath. A chest X-ray revealed severe pulmonary oedema and bilateral massive pleural effusion. Transthoracic echocardiography revealed impaired diastolic function of the left ventricle but preserved systolic function with a 50% ejection fraction. Repeat chest computed tomography demonstrated exacerbation of the calcification from the mitral annulus to the whole circular left ventricle. A coronary angiogram revealed non-significant stenosis, and right heart catheterisation demonstrated elevated pulmonary capillary wedge pressure. He was discharged after two weeks of conservative medication.
- Title: Electrocardiogram manifestations of hyponatraemia
Authors: Shi Zou, Qian Zhang, Shicheng Gao, Mingqi Luo, Xuedong Gan, Ke Liang
From: Cardiovascular Journal of Africa, Vol 33, Issue 2 March/April 2022
Pages: 98–100
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DOI Number: 10.5830/CVJA-2021-036
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-036
Abstract: Electrolytes play a vital role in myocardial electrophysiological activities in the human body. Electrolyte disturbances can affect depolarisation and repolarisation of myocardial cells and thus result in arrhythmia. The most common electrolyte disturbance among hospitalised patients is hyponatraemia. We report on a case of an acquired immune deficiency syndrome patient with decompensated cirrhosis, who developed sinus arrest from hyponatraemia. The electrocardiogram manifestations at different sodium concentrations were also recorded in subsequent therapeutic processes.
