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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 2, March/April 2015
AFRICA
51
From the Editor’s Desk
It is difficult for those of us who trained in medicine prior
to the advent of the epidemic of HIV/AIDS to explain to
junior colleagues just how the epidemic has affected every
aspect of medical practice, and the degree of complexity it
has added. The timely review by Pillay and colleagues (page
70) of HIV-associated large-vessel vasculopathy, which surveys
both the current and emerging spectrum of the condition, as
seen in vascular surgical practice, serves to clarify some of the
uncertainties around this complex problem. It is difficult to
comprehend that the diverse disease spectrum of aneurysms,
occlusive disease, spontaneous arteriovenous fistulae and
dissections have a unifying pathogenesis and it may well be that
further advances in knowledge will lead to re-classification and
changes in terminology. The authors, importantly, highlight
areas of therapeutic uncertainty, which hopefully will change
with advances in the understanding of pathophysiology and a
more structured approach to interventions.
Further exploring the relationship of HIV/AIDS with
cardiovascular disease, Longo-Mbenza and co-workers (page 52),
in a cross-sectional study, examined the relationship between
H
pylori
infection and the metabolic syndrome among HIV-infected
black Africans. The results, showing that
H pylori
infection
was associated with the metabolic syndrome in HIV-infected
patients, are intriguing but require confirmation in larger studies
involving control subjects from a similar population who are not
HIV infected.
The proceedings of the recent meeting of the PASCAR
Hypertension Task Force, reported in this issue (page 82),
discusses the importance of hypertension in Africa, the reasons
for its increase and the urgent need for strategies to limit
and control the impact on life-expectancy and health of the
population. Notably, the document expresses the importance of
involving all relevant groups, societies and organisations with
influence in this area.
The publication of the proceedings in this issue provides
an opportunity for any individuals or groups who believe that
they should have an input into the process, and who have not
been involved, to contact PASCAR and voice their interest in
participation. Particularly fascinating in the PASCAR report
is the declared interest in re-examining the issues of prevention
and treatment in the African context rather than simply adopting
solutions developed elsewhere.
The proceedings review all the available evidence and express
an interest in examining critically relevant issues regarding
applicability of results of clinical trials and selection of drug
therapy in an African context. This roadmap, if brought to a
successful conclusion in the spirit expressed by those initiating it,
should have a significant impact on the problem of hypertension
in Africa.
It is helpful to be able to publish in the same issue, the article
from Magalhaes and colleagues (page 57), which examined the
24-hour urinary sodium excretion and knowledge, attitudes and
behaviour regarding salt intake of 123 Angolan medical students
at a single medical school in that country. The authors concluded
that the level of salt intake was excessive and the behaviour of
medical students was inappropriate and inadequate regarding
salt intake. The authors are to be congratulated for investigating
a difficult issue and for publishing their results. If we do not
recognise the deficiencies of our medical educational facilities we
will not improve them.
The research and publication by the authors of the Magalhaes
article challenge all of us involved in medical student education
to re-examine our own students and our own practice. Do
we as teachers know how many of our own students smoke,
drink excessively or use recreational drugs? The Magelhaes
article should be a resounding call to all of us to focus on our
trainees, as the attitudes and habits they learn while students
will significantly influence their management of patients in the
future.
Returning to the opening theme of what I have learned
during a career that leaves me astounded at the amount of
new information I have had to absorb (and have not done
so very well), I report my response to the Mouton article
(page 63). Forty years ago, hypertrophic cardiomyopathy was
a mystery. We agonised over the physical signs, argued about
the haemodynamic characteristics and had little information
about the treatment and natural history. The situation is now
dramatically different with definitive natural history studies
guiding therapeutic choices, and echocardiographic studies
establishing unequivocally the phenotypic characteristics and
correlating them with genotypic features.
Pat Commerford
Editor-in-Chief