TABLE OF CONTENT: Cardiovascular Journal of Africa, Vol 15, Issue 1, Jan / Feb 2004

1. Title: Impact factor : use and abuse : editorial
   Authors: Brink, A.J.
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
   Published: 2004
   Pages: p.5-7
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2. Title: The William Nelson ECG Quiz
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
   Published: 2004
   Pages: p.7, 37
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3. Title: Pattern of occurrence of microalbuminuria among dippers and non-dippers (essential hypertensives) in a Nigerian university teaching hospital : cardiovascular topics
   Authors: Alebiosu, C.O.; Odusan, B.; Familoni, O.B.; Jaiyesimi, A.E.A.
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
   Published: 2004
   Pages: p.9-12
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   Abstract: Objectives: Hypertensives who fail to manifest the normal circadian nocturnal fall in blood pressure have a higher incidence of cardiovascular complications, early glomerular injury and microalbuminuria. This study aims to quantify the proportion of dippers and nondippers among the essential hypertensive population, and determine the frequency of occurrence of microalbuminuria among them.
   Materials and methods: Early morning urine specimens were taken from 50 patients with essential hypertension and 20 healthy, normotensive subjects. Combined negative results from albustic strip testing and sulfosalicylic acid tests were taken as excluding microalbuminuria. While collecting urine for 24-hour urinary protein and creatinine clearance, hourly blood pressure readings were recorded. Readings obtained between 07:00 and 23:00 were taken as daytime blood pressure readings, whereas readings obtained between 23:00 and 07:00 were considered night-time blood pressures. Dippers were considered to be those patients in whom the difference between mean daytime systolic/diastolic blood pressure and mean night-time systolic/diastolic blood pressure was 10/5 mm Hg or more.
   Results: Thirty-six (72%) and 14 (28%) patients with essential hypertension fulfilled the criteria for dippers and non-dippers, respectively. The night-time systolic and diastolic blood pressures were significantly higher in non-dippers than in dippers (P < 0.05). The mean daytime systolic and diastolic blood pressures were not different between these two groups. Twenty-nine out of 36 (80.6%) urinary specimens from dippers were without microalbuminuria, against six out of 14 (42.9%) specimens from non-dippers, p < 0.05. Eighteen out of 20 controls (90%) were without microalbuminuria.
   Conclusion: This study demonstrated that about 28% of the local essential hypertensive population was nondippers and 57.1% of these had microalbuminuria with the attendant cardiovascular and renal risks.
    
4. Title: Infective endocarditis : improving the diagnostic yield : cardiovascular topics
   Authors: Koegelenberg, C.F.N.; Doubell, A.F.; Orth, H.; Reuter, H.
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
   Published: 2004
   Pages: p.14-20
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   Abstract: Introduction: Isolating aetiological agents in patients with infective endocarditis (IE) remains problematical. We postulated that the high local incidence of culturenegative IE resulted from antibiotic exposure prior to blood cultures and that a structured delay in therapy in the subacute presentation would improve the diagnostic yield.
   Aim: We aimed to prospectively observe the diagnostic approach and give an overview of supplementary laboratory tests.
   Study design: Patients with suspected IE were enrolled into this analytical observational study and followed up for six months (n = 92). We compared the diagnostic yield and outcome in cases where antibiotics were withheld for 72 hours, with those cases who received early antimicrobials, despite being deemed safe for delayed therapy.
   Results: Definitive diagnoses (definite or excluded IE) were made in 92.8% of patients where antibiotics were delayed, compared to 60% of patients who received empirical treatment (p = 0.08). The mortality rates were 18.4% and 30.0% respectively (p = 0.18). Twenty-three of 26 patients with definite culture-negative IE received antibiotics during the 48 hours preceding cultures, compared to eight of 21 culture-positive patients (P < 0.001). Screening for atypical bacteria did not improve the yield. C-reactive protein (CRP) had a sensitivity of 97.9% (negative predictive value 87.5%), whereas a positive rheumatoid factor (RF) had a specificity of 93.8% (positive predictive value 91.7%).
   Conclusions: We observed tendencies towards a greater diagnostic yield and lower mortality where antibiotics were initially withheld. Antibiotics prior to blood cultures were an important cause of culture-negative IE. A normal CRP proved useful in excluding IE; a positive RF strongly favoured IE.
    
5. Title: Renin-angiotensin system and associated gene polymorphisms in myocardial infarction in young South African Indians : cardiovascular topics
   Authors: Ranjith, N.; Pegoraro, R.J.; Rom, L.; Lanning, P.A.; Naidoo, D.P.
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
   Published: 2004
   Pages: p.22-26
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   Abstract: The renin-angiotensin system plays an important role in cardiovascular regulation. Abnormalities in genetic components of this system, such as the angiotensinconverting enzyme (ACE) gene, angiotensin II type 1 (AT1) receptor gene and angiotensinogen (AGT) gene, may cause a variety of adverse cardiovascular effects.
   It was the aim of this study, therefore, to investigate the involvement of the ACE insertion/deletion (I/D), AT1 receptor 1166 A-->C and AGT M235T polymorphisms as predisposing factors for myocardial infarction (MI) in 195 young South African Indians (< 45 years). Results were compared with those obtained in 107 unaffected siblings (18-45 years old) and 300 healthy age- and racematched control subjects.
   The distribution of the ACE genotypes was the same in each of the three study groups (p-value ranged between 0.83 and 0.98). No differences were observed in the 1166 A-->C AT1 receptor polymorphism with respect to both genotype and allelotype (p > 0.70), or in the genotype or allele frequency distribution of the AGT M235T polymorphism (p > 0.44). However, a significant increase was noted for both the AT1 receptor C variant (p = 0.025) and the AGT T variant (p = 0.047) in hypertensive patients compared with those who were normotensive.
   In conclusion, results of this study indicate that the ACE I/D, the 1166 A-->C AT1 receptor and AGT M235T polymorphisms do not confer any increased risk for MI in young South African Indians.
    
6. Title: First South African summit on atherothrombosis to address critical CV conditions
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
   Published: 2004
   Pages: p.26
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7. Title: Percutaneous closure of interatrial defects : the Free State experience : cardiovascular topics
   Authors: Brown, S.C.; Bruwer, A.D.; Harrisberg, J.; Govendrageloo, K.
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
   Published: 2004
   Pages: p.28-31
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   Abstract: Objective: Atrial septal defects and patent foramen ovale can now be closed percutaneously. This report describes our initial and follow-up experience, especially in relation to efficacy and complications.
   Methods: During a 2-year period, seven atrial septal defects and one patent foramen ovale were closed. The Amplatzer(R) atrial septal defect occluder was used in five, the Cardioseal(R) device in two and the Amplatzer(R) patent foramen ovale occluder in one. A compliant sizing balloon was used to assess the stretched diameter of the defects.
   Results: Percutaneous closure was successful in all patients. The median age was 5.4 years (range: 3.7-16.6 years) and median weight was 18 kg (range: 14-65 kg). The mean duration of the procedure was 2.3 hours. There were no acute complications. Patients were followed up for a mean of 1.1 years. One child experienced severe headaches and another developed an atrial flutter and a small leak 7 months after implantation, both of which resolved.
   Conclusion: Percutaneous closure of atrial septal defects and patent foramen ovale is effective and safe. In selected children, this may be offered as an alternative to surgery.
    
8. Title: Potential renoprotective effects of the angiotensin receptor blocker eprosartan : a review of preliminary renal studies : review article
   Authors: Rayner, B.; Jaeger, B.; Verboom, C.N.; Pascoe, M.
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
   Published: 2004
   Pages: p.32-37
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   Abstract: The importance of the renin-angiotensin-aldosterone system (RAAS) in the pathogenesis of hypertension and in renal disease, particularly in patients with diabetes, has become increasingly evident. Pharmacological blockade of the RAAS offers potential for the therapeutic management of these pathologies. Angiotensin converting enzyme (ACE) inhibitors and angiotensin II (AII) receptor blockers have been shown to exhibit effectiveness in the treatment of hypertension. AII receptor blockers have a renal protective effect owing to their ability to reduce systemic blood and intraglomerular pressures. Eprosartan is a chemically distinct AII blocker, which displays a dual mode of action whereby it blocks both pre- and postsynaptic AT1 receptors, potentially benefiting patients with hypertension and renal disease. In addition, evidence suggests that eprosartan is well tolerated by both healthy subjects and patients with varying degrees of renal impairment, such that the dose does not need to be - modified in patients with mild to moderate renal impairment.
   Results from preliminary studies demonstrate that eprosartan doses well below those required for blood pressure control have a pronounced effect on the kidney and do not compromise renal autoregulatory mechanisms. Therefore, eprosartan may have a benefit in the prevention or delay of renal damage in hypertensive patients with renal impairment, although this remains to be determined in a clinical setting.
    
9. Title: Carrying short-acting nitrates is not a contra-indication to the use of PDE5 inhibitors : drug trends in cardiology
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
   Published: 2004
   Pages: p.38
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10. Title: New Premier study suggests Preterax(R) as a first-line antihypertensive : drug trends in cardiology
    From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
    Published: 2004
    Pages: p.40-41
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11. Title: The CHARM programme raises the profile of candesartan cilexetil in the treatment of chronic heart failure : drug trends in cardiology
    From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
    Published: 2004
    Pages: p.42-45
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12. Title: VALIANT trial results support use of valsartan in acute myocardial infarction : drug trends in cardiology
    From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
    Published: 2004
    Pages: p.45, 47
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13. Title: Cardio news
    From: Cardiovascular Journal of South Africa, Vol 15, Issue 1, Jan / Feb
    Published: 2004
    Pages: p.48
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