CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 AFRICA 3 From the Editor’s Desk When the Covid-19 pandemic erupted, many of us older clinicians were barred from our hospitals and could only look on from the sidelines as our younger colleagues continued to look after patients under very difficult circumstances. I for one was pleased to be spared the trauma of working under the very difficult circumstances that prevailed but also somehow resented missing out on managing a new and challenging illness. The involvement of the cardiovascular system was unexpected in the early days and publications on pathophysiology and outcomes of those affected remain confusing. This issue of the Journal offers four articles addressing some of those issues. In a retrospective, single-centre study, Bagirtan and colleagues (page 4), report that traditional clinical predictive scores for pulmonary embolism had little discriminatory power in patients with COVID-19 and pulmonary embolism, demonstrated by computed tomography pulmonary angiography. These authors suggest that a higher D-dimer cut-off value should be considered to better screen such patients for pulmonary embolism. In another retrospective study Stavileci and others (page 16) identified several clinical markers of in-hospital mortality. Not unexpectedly troponin I and D-dimer follow-up values in the serum were more effective than other inflammatory markers in predicting mortality and the need for intensive care. Two unusual cases expand the literature about Covid-19. Govind and co-authors (page 40) describe two patients who presented with severe type B lactic acidosis and shock, initially thought to be due to bowel ischaemia/myocardial infarction and pulmonary sepsis, respectively. This led to a delay in the diagnosis of thiamine deficiency. In both cases there was a dramatic response to intravenous thiamine, confirming the diagnosis of Shoshin beriberi. Both patients admitted to drinking home-brewed alcohol during the time of COVID19 restrictions on alcohol consumption. The authors are to be congratulated on their clinical acumen in considering this all-too-often missed diagnosis. The report is also a sobering reminder of the unintended consequences of well-intentioned legislation such as the ban on all legal alcohol sale, which was imposed in South Africa during the pandemic. The SA Heart consensus statement on closure of patent foramen ovale 2021 (page 35) from Hitzeroth and co-authors provides some helpful guidelines on management of a condition that is common, being present in up to 25% of the general population. Percutaneous closure is readily available. The question remains as to when closure is indicated. The guidelines offer some useful answers. Pat Commerford Editor-in-Chief Professor PJ Commerford
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