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- Volume 18, Issue 1, 2007
Cardiovascular Journal of South Africa - Volume 18, Issue 1, 2007
Volume 18, Issue 1, 2007
A statement of intent on the formation of the NCRP on Cardiovascular and Metabolic Disease : a new initiative to fight heart disease, stroke, diabetes and obesity in South Africa : editorialAuthor B. MayosiSource: Cardiovascular Journal of South Africa 18, pp 4 –6 (2007)More Less
Hypoglycaemic and hypotensive effects of Globimetula cupulata (DC) Van Tieghem (Loranthaceae) aqueous leaf extract in rats : cardiovascular topicsSource: Cardiovascular Journal of South Africa 18, pp 9 –15 (2007)More Less
The leaves of some mistletoes, specifically Loranthus micranthus Linn, Tapinanthus dodoneifolius (DC) Danser and Globimetula cupulata (DC) Van Tieghem (family:Loranthaceae), are used traditionally in Nigerian 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, ethnomedical uses of Globimetula species, the present study was undertaken to investigate the hypoglycaemic and hypotensive effects of Globimetula cupulata aqueous leaf extract (GCE, 50-800 mg/kg po) in rat experimental paradigms. The hypoglycaemic effect of the plant extract was examined in normal (normoglycaemic) and diabetic (hyperglycaemic) rats using a streptozotocin (STZ)-induced diabetes model.
Normotensive Wistar and hypertensive Dahl salt sensitive-rats were used to investigate the hypotensive (antihypertensive) effect of the plant extract. Metformin (MFM, 500 mg/kg po) was used as the reference hypoglycaemic agent for comparison. Acute oral administrations of G cupulata aqueous leaf extract (GCE, 50-800 mg/kgpo) caused dose-related, significant (p < 0.05-0.001) hypoglycaemia in normal and STZ-treated diabetic rats. Furthermore, acute intravenous administrations of GCE (50-800 mg/kg iv) produced dose-dependent, significant reductions (p < 0.05-0.001) in systemic arterial blood pressure and heart rates of the normotensive and hypertensive rats used.
Although the exact hypoglycaemic and hypotensive mechanisms of action of the plant extract still remain speculative, it is unlikely that the extract induced hypotension in the mammalian experimental animal model via cholinergic mechanisms, since its cardiovascular effects were resistant to atropine pretreatment. However, the findings of this experimental study indicated that Globimetula cupulata aqueous leaf extract possesses hypoglycaemic and hypotensive properties. This therefore lends pharmacological support to the folkloric, ethnomedical uses of the plant in the management and / or control of diabetes mellitus and hypertension among the Yoruba-speaking people of western Nigeria.
Source: Cardiovascular Journal of South Africa 18, pp 16 –19 (2007)More Less
Background and objectives: It is uncertain whether high serum uric acid levels are a true independent risk factor for coronary atherosclerosis or whether the association is due to other confounding variables. We therefore studied the relationship between elevated serum uric acid levels and coronary atherosclerosis after adjustment was made for confounding factors such as age, gender, body mass index, smoking, lipid profile, blood pressure and blood glucose levels.
Methods: A cross-sectional study was conducted on 240 patients referred for coronary angiography to heart centres in the Shahid-Chamran and Sina hospitals, Isfahan, Iran. Blood chemistry data as well as traditional risk factors and uric acid levels were measured at enrollment. We used vessel, stenosis and extent scores to indicate the degree of coronary artery involvement.
Results: This study was conducted on 240 patients with a mean age of 56 + 10.9 years (66% male; 37% female) who underwent coronary angiography. Student's t-test analyses revealed that there were significant differences in the mean uric acid levels between male and female patients (p = 0.001). We found no statistically significant correlation between serum uric acid levels and coronary atherosclerosis (p > 0.05). In addition, multivariate logistic regression analyses, using coronary atherosclerosis as dependent variable and traditional risk factors and uric acid levels as independent variables, did not show any significant difference.
Conclusion: These findings indicated that uric acid is not associated with coronary atherosclerosis. Any correlation reported in other studies was probably due to the relationship between high serum uric acid levels and other cardiovascular risk factors.
The management of tuberculous pericardial effusion : experience in 233 consecutive patients : cardiovascular topicsSource: Cardiovascular Journal of South Africa 18, pp 20 –25 (2007)More Less
Aim: We report on the 30-day and one-year outcome of consecutive effusive pericarditis patients, including those with tuberculous pericarditis, over a six-year-period.
Methods and Results: Patients with large pericardial effusions requiring pericardiocentesis were included in the study after having given written informed consent. Clinical and radiological evaluations were followed by echo-guided pericardiocentesis, and extended daily intermittent drainage via an indwelling pigtail catheter. A standard short-course anti-tuberculous regimen was initiated. A total of 233 patients was included. One hundred and sixty-two patients had pericardial tuberculosis (TB), including 118 (73%) with microbiological and / or histological evidence of TB and 44 (27%) diagnosed on clinical and supportive laboratory data. Over the six-year period, two patients developed fibrous constrictive pericarditis after receiving adjuvant corticosteroid therapy. The 30-day mortality (8.0%) was statistically higher for HIV-positive patients (corresponding mortality 9.9%) than for HIV-negative patients (6.2%; p 5 0.04). The one year all-cause mortality was 17.3%. It was also higher for HIV-positive (22.2%) than for HIV-negative patients (12.3%; p 5 0.03). Cardiac mortality was equal for HIV-positive and -negative patients.
Conclusion: Tuberculous pericardial effusions responded well to closed pericardiocentesis and a six-month treatment of antituberculous chemotherapy. The former was effective and safe irrespective of HIV status.
Source: Cardiovascular Journal of South Africa 18, pp 26 –29 (2007)More Less
Background: In this study the results of off-pump bypass in patients with advanced left ventricular dysfunction (LVD) and without bypassable circumflex disease were analysed retrospectively.
Methods: Fifty-five patients with advanced LVD underwent off-pump coronary bypass. Their ages ranged from 39 to 82 years (mean 62.3 + 8.4). Forty-two of the patients (76.3%) were in NYHA class III or IV. Mean left ventricular ejection fraction (LVEF) was 23.8 + 5.1%. Pre- and intra-operative variables, and postoperative complications and mortality of the patients were analysed. Mid-term follow-up was done telephonically either with the referring cardiologist or the patients.
Results: The mean number of coronary artery bypass grafts (CABG) per patient was 2.22 + 0.63. Eight coronary endarterectomies were achieved; early mortality was 3.6%. Pre-operative myocardial infarction (MI) occurred in one patient (1.8%). Two patients (3.6%) were supported with an intra-aortic balloon pump (IABP) and 10 (18.1%) needed inotropic support. Mean postoperative blood loss was 425 + 50 cm3. A significant improvement in ejection fraction was observed in the postoperative course. Mean intensive care unit stay was 2.1 + 1.1 days and mean hospital stay was 7.2 + 1.3 days. The mean follow-up period was 21.8 + 6.2 months and mid-term survival was 92.4%. Freedom from cardiac events requiring hospital admission was 89.7%. Most of the patients enjoyed symptomatic relief, however 16 patients (32.6% of survivors) remained in NYHA class III.
Conclusion: These results support the effectiveness of off-pump coronary bypass with good early and mid-term results in patients with ischaemic cardiomyopathy and without bypassable circumflex lesion.
Frequency of the metabolic syndrome in screened South African corporate executives : cardiovascular topicsSource: Cardiovascular Journal of South Africa 18, pp 30 –33 (2007)More Less
Aim: The aim of the study was to determine the frequency of the metabolic syndrome in a specific group of people.
Patients and methods: The ATP III criteria were used to identify the metabolic syndrome in a group of 1 410 corporate executives belonging to a specialist health and fitness company in South Africa.
Results: Using three criteria as specified by the ATP III panel, 31% of this group of corporate executives fulfilled the criteria for the diagnosis of the metabolic syndrome. In a small subset of black executives, a similar finding was obtained. Another one-third of the executives had two criteria of the metabolic syndrome.
Conclusion: The metabolic syndrome was common in a group of corporate executives.
Inadvertent retrieval of a broken PTCA catheter from the aorta during off-pump coronary bypass : case reportSource: Cardiovascular Journal of South Africa 18, pp 34 –35 (2007)More Less
To cut costs, many centres around the world utilise previously used, resterilised balloon catheters to perform coronary angioplasty. The fracture and lodging of an angioplasty device within the coronary arteries is a rare but increasingly noted complication. In this article, we report on the inadvertent retrieval of a coronary angioplasty catheter during off-pump coronary bypass. The accidental removal of the catheter, which extended to the descending aorta, has obviously been life saving. This experience has shown that a high degree of caution is required when planning an operation for the retrieval of PTCA hardware.
The positive predictive value of myocardial perfusion imaging in screening patients for suspected coronary artery disease : short communicationSource: Cardiovascular Journal of South Africa 18, pp 36 –38 (2007)More Less
Background: In patients with known or suspected coronary artery disease, diagnosis and risk stratification can be aided by non-invasive tests for myocardial ischaemia. The main indications for the use of radionuclide perfusion imaging (sestamibi) rather than exercise electrocardiography include complete left bundle branch block, inconclusive stress electrocardiography and an inability to exercise. The published data on myocardial perfusion imaging is limited to eight studies of only 628 patients with widely varying ranges of sensitivities and specificities and the major problem being the bias created when patients with positive test results are referred far more frequently for coronary angiography than those with negative results. Furthermore, certain categories of patients are postulated to have a high number of false positives, especially obese patients and women, but this hypothesis has not been tested.
Methods and Results: A retrospective descriptional study on patients with positive sestamibi scans, who had coronary angiography within six months of each other, was performed. The study population consisted of 132 patients, 53.8% of whom were male and 44.7% had a body mass index of less than 28. The overall positive predictive value of the sestamibi scan in predicting significant coronary angiographic stenosis was 63.6%. This value increased significantly to 80.3% in males (p 5 = 0.000). The positive predictive value did not differ in the different age categories, nor did it change with the different indications for sestamibi scanning.
Conclusions: The sestamibi scan remains a useful screening test for coronary artery disease in patients who are exercise intolerant or those with inconclusive stress electrocardiography. The test is highly predictive in males rather than females.
Enteric-coated aspirin : review shows similar inhibition of platelet aggregation to ordinary dispersible aspirin : drug trends in cardiologySource: Cardiovascular Journal of South Africa 18, pp 41 –43 (2007)More Less
Source: Cardiovascular Journal of South Africa 18, pp 43 –44 (2007)More Less
Special report on South African Cardiovascular Risk Management Symposium : drug trends in cardiologySource: Cardiovascular Journal of South Africa 18, pp 45 –52 (2007)More Less
Metformin and cardiovascular disease : report from 2006 World Cardiology Congress, Barcelona : drug trends in cardiologyAuthor Louis Van ZylSource: Cardiovascular Journal of South Africa 18, pp 53 –54 (2007)More Less
Abbott launches special programme for babies at high risk for respiratory syncytial virus : drug trends in cardiologySource: Cardiovascular Journal of South Africa 18 (2007)More Less
Rimonabant offers intriguing opportunities in early type 2 diabetes management : drug trends in cardiologySource: Cardiovascular Journal of South Africa 18 (2007)More Less
Simvastatin reduces cholesterol synthesis in the face of raised baseline glucose : drug trends in cardiologySource: Cardiovascular Journal of South Africa 18 (2007)More Less