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- Volume 17, Issue 5, 2006
Cardiovascular Journal of South Africa - Volume 17, Issue 5, 2006
Volume 17, Issue 5, 2006
Hypoglycaemic and hypotensive effects of Momordica charantia Linn (Cucurbitaceae) whole-plant aqueous extract in rats : cardiovascular topicsSource: Cardiovascular Journal of South Africa 17, pp 227 –232 (2006)More Less
Various morphological parts (roots, stems, leaves and fruits) of Momordica charantia Linn (family: Cucurbitaceae) are used traditionally in African folk medicine to manage, control and / or treat a plethora of human ailments, including diabetes mellitus and hypertension. In order to scientifically appraise some of the folkloric, anecdotal and ethnomedical uses of M charantia, the present study was undertaken to investigate the hypoglycaemic and hypotensive effects of M charantia whole-plant aqueous extract (MCE) in rat experimental paradigms. <BR>The hypoglycaemic effect of the plant extract was examined in normal and diabetic rats, using streptozotocin (STZ)- induced diabetes mellitus models. Normotensive (normal), and hypertensive Dahl salt-sensitive rats were used to probe the hypotensive (antihypertensive) effect of the plant extract. Chlorpropamide was used as reference hypoglycaemic agent for comparison. Acute oral administrations of the plant extract caused dose-related, significant hypoglycaemia in normal (normoglycaemic) and STZ-treated, diabetic rats. Furthermore, acute intravenous administrations of MCE produced dose-dependent, significant reductions in systemic arterial blood pressure and heart rates of normal, and hypertensive Dahl salt-sensitive rats. <BR>Although the exact hypoglycaemic and hypotensive mechanisms of action of the plant extract remain speculative at the moment, it is unlikely that the herb causes hypotension in the mammalian experimental animal model used via cholinergic mechanisms, since its cardiovascular effects are resistant to atropine pretreatment. However, the findings of this experimental animal study indicate that the plant extract possesses hypoglycaemic and hypotensive properties, and therefore, lend pharmacological credence to folkloric, ethnomedical uses of the plant in the management and / or control of diabetes mellitus and hypertension in some rural African communities.
Experience with adjunctive corticosteroids in managing tuberculous pericarditis : cardiovascular topicsSource: Cardiovascular Journal of South Africa 17, pp 233 –238 (2006)More Less
Objectives: To compare the efficacy of intrapericardial corticosteroid therapy to either oral corticosteroid therapy or intrapericardial placebo in addition to closed pericardiocentesis and anti-tuberculous therapy in patients with tuberculous pericarditis. <BR>Methods: Patients with large pericardial effusions requiring pericardiocentesis were included. A short-course anti-tuberculous regimen was initiated and patients were randomised to one of three treatment groups: 200 mg intrapericardial triamcinolone hexacetonide; oral prednisone plus intrapericardial placebo; or 5 ml intrapericardial 0.9% saline (placebo). Patients were followed up for at least one year. <BR>Results: Fifty-seven patients were included in the study; 21 tested HIV positive (36.8%). Forty (70.0%) had microbiological and / or histological evidence of tuberculosis, and 17 (30.0%) had a diagnosis based on clinical and laboratory data. All patients responded well to initial pericardiocentesis. However, nine patients (16.0%) were lost to follow up. The hospitalisation duration for the steroid groups was shorter than for the placebo group. This difference was not significant. Complications were similar for all arms. <BR>Conclusions: Intrapericardial and systemic corticosteroids were well tolerated but did not improve the clinical outcome. The standard six-month regimen was effective regardless of HIV infection. The potential benefits from adjunctive corticosteroids in the management of effusive tuberculous pericarditis could not be demonstrated in this three-year study.
Melatonin prevents cardioprotection inducedby a multi-cycle ischaemic preconditioning protocol in the isolated perfused rat heart : cardiovascular topicsSource: Cardiovascular Journal of South Africa 17, pp 239 –244 (2006)More Less
The powerful cardioprotective actions of melatonin, the chief secretory product of the pineal gland, have been attributed largely to its free radical-scavenging properties. Free radicals play an important role in the triggering action of ischaemic preconditioning, the phenomenon whereby exposure of the heart to one or more short episodes of ischaemia leads to protection against a subsequent long period of ischaemia. The aim of this study was, therefore, to establish whether melatonin, in view of its free radical-scavenging ability, would affect the beneficial actions of preconditioning.
Isolated, perfused, working hearts were subjected to 1 x 5 minute or 3 x 5 min ischaemic preconditioning protocols, in the presence or absence of melatonin (50 mM), followed by 20 minutes global ischaemia and 30 minutes reperfusion.Use was also made of sodium nitroprusside (100 mM), a nitric oxide (NO) donor and preconditioning mimetic. Using functional recovery as the endpoint, melatonin abolished the cardioprotective effects of a multi-cycle (3 x 5 min) preconditioning protocol, while having no effect on a one-cycle (1 x 5 min) protocol or SNP (1 x 5 or 3 x 5 min) preconditioning.
The results suggest that free radicals play an important role in the cardioprotection induced by a multi-cycle ischaemic preconditioning protocol and that this process could be attenuated by a potent scavenger such as melatonin.
The prevalence of microalbuminuria and ECG left ventricular hypertrophy in hypertensive patients in private practices in South Africa : cardiovascular topicsSource: Cardiovascular Journal of South Africa 17, pp 245 –249 (2006)More Less
Introduction : In South Africa a cluster of cardiovascular diseases accounts for 17% of all deaths. It is also predicted that South Africa will face an epidemic of chronic kidney disease due to obesity, type 2 diabetes and hypertension. It is important to estimate the burden of underlying cardiovascular and renal disease in South Africa.
Objectives : The primary objective of the study was to establish the prevalence of left ventricular hypertrophy by ECG criteria, and micro- and macroalbuminuria in mild, moderate and severe hypertensive groups. The secondary objective was to establish the prevalence of left ventricular hypertrophy and micro- and macroalbuminuria in hypertensive patients with underlying type 2 diabetes.
Methods: Patients ≥ 35 years with essential hypertension with or without type 2 diabetes were recruited from 100 general practices throughout South Africa. BP, weight, height, waist circumference and urinary albumin / creatinine ratio were measured, and an ECG was performed. The Sokolow-Lyon and Cornell criteria were used for estimation of left ventricular hypertrophy. An overall prevalence rate was determined using weights from the severity category distribution inside the study population.
Results: One thousand and ninety-one patients were available for analysis. There were 530 (48.5%) males and 561 (51.5%) females, 691 (63.3%) whites, 162 (14.8%) blacks, 150 (13.7%) Asians and 88 (8.1%) Coloureds. Of the patients, 10.9% had newly diagnosed hypertension, 20% had type 2 diabetes, and 38.1% mild, 32.1% moderate and 30.6% severe hypertension. The prevalence of left ventricular hypertrophy in the sample weighted to the hypertensive population over the age of 35 years with access to medical aids was 18.9%. Relative to white ethnicity, black ethnicity (OR 2, p < 0.03), and relative to mild hypertension, moderate (OR 2.2, p < 0.05) and severe hypertension (OR 4.9, p < 0.0001) were independent predictors of left ventricular hypertrophy.
The overall prevalence of micro- and macroalbuminuria in the weighted sample was 21.3 and 4.1%, respectively. In the diabetics the prevalence of microalbuminuria was 32.3% and macroalbuminuria 10.4%, respectively. The independent predictors of microalbuminuria or worse were severe hypertension (OR 2.9, p < 0.0001), type 2 diabetes (OR 2.5, p < 0.002), and Asian ethnic group (OR 2, p < 0.02).
Conclusions: The study, based on a convenience sample of hypertensives from private practices in South Africa showed that the prevalence of left ventricular hypertrophy and microalbuminuria or worse was 18.9 and 25.4%, respectively.
Prophylaxis of venous thrombosis in medical patients : a real-world perspective : cardiovascular topicsSource: Cardiovascular Journal of South Africa 17, pp 251 –254 (2006)More Less
Background: Although low-molecular weight heparins (LMWH) have been proven to be efficacious for prophylaxis of venous thrombo-embolism (VTE) in non-surgical patients, their use and safety outside the setting of a clinical trial has not been investigated. <BR>Objective: The objective of this survey was to determine the efficacy and safety of LMWH (enoxaparin) in the prevention of VTE in a study population comprising general medical patients. <BR>Methods: The study involved an open-label, non-controlled, multicentre survey of any patient confined to bed due to medical illness, where the physician had made an independent decision to prescribe LMWH as prophylaxis for VTE. The demographic information and risk factors for venous thrombosis and dose of enoxaparin were recorded. Patients were assessed for clinical evidence of VTE. Only if this was present were further invasive investigations performed. Adverse events relating to the use of LMWH were recorded. <BR>Results: Four hundred and seventy-one patients were enrolled from 53 centres. Five per cent of the patients were treated for up to and including three days, 24.4% for four days or less, 49.6% for six days or less, and a further 45.5 % for seven to 21 days. The most frequently prescribed dose was enoxaparin 40 mg once daily (86%). Of the enrolled patients, 28.2% had one risk factor and 69.8% had two or more risk factors for the development of VTE. The incidence of clinically suspected deep-vein thrombosis (DVT) or pulmonary embolism (PE) in this survey was three out of 457 patients at risk, ie, 0.66%. One serious adverse event occurred in an incorrectly enrolled surgical patient and 22 minor adverse events occurred that were thought by the enrolling physician to be related to the study drug.
Propionibacter acnes complicating HIV-associated tuberculous pericardial effusion in Cameroon : case reportSource: Cardiovascular Journal of South Africa 17, pp 255 –256 (2006)More Less
Large pericardial effusions are common in sub-Saharan Africa. They are most often caused by tuberculosis and are frequently associated with HIV infection. We report on a case of massive pericardial effusion in a 32-year-old HIV-positive male with smear-positive pulmonary tuberculosis. This was found to be colonised by Propionibacter acnes, which is normally found in anaerobic skin flora. Despite management, including appropriate antibiotic treatment based on culture and sensitivity, the patient died several weeks later. <BR>While cases of bacterial pericarditis have been described previously, this is the first report of Propionibacter isolated from a pericardial effusion. This case suggests that superinfection could have occurred iatrogenically as a result of pericardiocentesis three weeks prior to admission. We feel that proper sterile techniques, including generous use of povidone-iodine, which is readily available in resource-poor settings, may improve clinical outcomes in immunosuppressed patients undergoing invasive procedures.
Off-pump myocardial rrevascularisation in an octogenarian patient with dextrocardia and situs inversus : case reportSource: Cardiovascular Journal of South Africa 17, pp 257 –258 (2006)More Less
Dextrocardia associated with situs inversus totalis is a rare condition and there are few reports of myocardial revascularisation in such patients. An 82-year-old woman with dextrocardia and situs inversus totalis underwent successful off-pump coronary artery bypass grafting using internal mammary arteries. The operative technique was similar to that of off-pump coronary artery bypass grafting for situs solitus. However, for a right-handed surgeon the operation was easier standing on the left side of the patient.
Bilateral axillary and suprascapular neuropathy after coronary artery bypass surgery : short communicationSource: Cardiovascular Journal of South Africa 17, pp 259 –261 (2006)More Less
Neuropathies after coronary artery bypass (CABG) and cardiac surgery are usually transient and have been described fairly frequently. Our patient presented with an acute onset of a surprisingly symmetrical bilateral axillary and suprascapular neuropathy during the immediate CABG period (which to our knowledge has not been reported on before). The patient, aged 64 years, suffered from diabetes mellitus type 2 and hypertension, and underwent a triple CABG. Electroneuronographic and electromyographic examination confirmed the presence of the bilateral axillary and suprascapular neuropathy, which showed only minimal improvement 15 months later. The surmise is that the neuropathy developed as result of compression or overstretching of the involved nerves during the surgical procedure, associated with suboptimal positioning of the arms. The 'hands-up position', with careful sternal retraction (Cooley retractor), may appear to prevent the posterior displacement of the shoulders and plexus injuries. The diabetes mellitus may have acted as an aggravating factor.
Amlodipine-based regimen to lower blood pressure, reduces risk of new-onset diabetes in hypertensives by more than a third : drug trends in cardiologySource: Cardiovascular Journal of South Africa 17, pp 262 –263 (2006)More Less
New clinical data shows enoxaparin reduces risk of repeat heart attacks and stroke in patients undergoing PCI : drug trends in cardiologySource: Cardiovascular Journal of South Africa 17 (2006)More Less
From the World Congress of Cardiology, Barcelona, 2006 Support for wider metformin usage in type 2 diabetes : drug trends in cardiologySource: Cardiovascular Journal of South Africa 17 (2006)More Less
Effective disease management : today's clinical interventions to control hypercholesterolemic patients : drug trends in cardiologySource: Cardiovascular Journal of South Africa 17 (2006)More Less
Source: Cardiovascular Journal of South Africa 17, pp 272 –273 (2006)More Less
Low awareness of impact of cardiovascular disease in low- and middle-income countries : drug trends in cardiologySource: Cardiovascular Journal of South Africa 17 (2006)More Less
Effective BP control, aspirin use and emphasis on post-prandial glucose control : cornerstones of modern CV risk management : drug trends in cardiologySource: Cardiovascular Journal of South Africa 17, pp 274 –276 (2006)More Less
CIBIS III trial : bisoprolol treatment for CHF leads to 46% reduction in sudden death after one year : drug trends in cardiologySource: Cardiovascular Journal of South Africa 17 (2006)More Less