TABLE OF CONTENT: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr 2009

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1. Title: Cardiovascular imaging : a radiological perspective : editorial
   Authors: Spottiswoode, Bruce; De Villiers, Jean Pierre
   From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
   Published: 2009
   Pages: 100-102
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   Abstract: Historically, conventional radiological imaging has had an important role in the diagnosis and imaging of acquired and congenital cardiovascular disease with modalities including chest radiography and fluoroscopy, and progressing to coronary catheterised angiography, echocardiography and nuclear medicine. Rapid technological advances and new clinical applications, coupled with an increase in therapeutic options for cardiovascular disease have resulted in a recent explosion in cardiovascular imaging. There is little doubt that multi-detector cardiac computed tomography (MDCT) and cardiac magnetic resonance imaging (MRI) are the hottest topics in cardiovascular imaging today. Although the number of 64-slice scanners and cardiac-enabled MRI units in clinical use is still relatively low, momentum is gathering fast as their versatility and striking capabilities become more apparent.
    
2. Title: From the Editor's desk : editorial
   Authors: Brink, A.J.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
   Published: 2009
   Pages: 103
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   Abstract: On this page of this issue of CVJA we publish a declaration by cardiologists in Africa, indicating strategies to combat the evergrowing burden of heart disease in Africa.
    
3. Title: Compatibility of concurrent aerobic and resistance training on maximal aerobic capacity in sedentary males : cardiovascular topics
   Authors: Shaw, B.S.; Shaw, I.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
   Published: 2009
   Pages: 104-106
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   Abstract: Aerobic and resistance training are often performed concurrently by inactive individuals and those patients undergoing cardiac rehabilitation, despite contradictory findings that this mode of training may impair the development of maximal aerobic capacity (VO2max). The aim of the study, therefore,was to compare the effects of 16 weeks of aerobic, resistance and concurrent aerobic or resistance training on VO2max development.
   Fifty apparently healthy males (25 years ± 8 months) were randomly assigned to a non-exercising control group (NonG) (n = 12), an aerobic training group (AerG) (n = 12), a resistance-training group (ResG) (n = 13), or a concurrent aerobic and resistance-training group (ConG) (n = 13). VO2max was measured pre- and post-experimentally using a continuous on-line oxygen analyser. Aerobic training consisted of exercise using a combination of treadmills, rowers, steppers and cycle ergometers, whereas resistance training consisted of eight prescribed exercises performed for three sets of 15 repetitions at 60% of the estimated one-repetition maximum (1-RM). In an attempt to equalise exercise duration across all three experimental groups, concurrent aerobic and resistance training consisted of a combination of aerobic training at 60% of heart rate maximum, and resistance training for two sets of 15 repetitions at 60% of the estimated 1-RM.
   The NonG were found to have decreased their VO2max by 3.36%, whereas the ResG increased their mean VO2max by 13.16%. The AerG and ConG increased their mean VO2max by 34.12 and 29.58%, respectively. In conclusion, concurrent training did not significantly interfere with development of aerobic capacity in sedentary males when compared to aerobic training. Therefore, this investigation did not support the concept of the universal nature of the interference effect that supposes the superiority of a single mode of training.
    
4. Title: Association between C-reactive protein and coronary calcium score in coronary artery disease : cardiovascular topics
   Authors: Hosseinsabet, Ali; Mohebbi, Ahmad; Almasi, Alireza
   From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
   Published: 2009
   Pages: 107-111
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   Abstract: Background : Both high-sensitivity C-reactive protein (hs-CRP) and spiral computed tomography coronary artery calcium score (CCS) are valid markers of cardiovascular risk. It is unknown whether hs-CRP is a marker of atherosclerotic burden or if it reflects a process leading to acute coronary events.
   Methods and results : We studied the association between hs-CRP and CCS in 143 patients who were candidates for coronary artery bypass grafting (CABG). In our cross-sectional study, we found no significant association between hs-CRP and the CCS in bivariant (p = 0.162) and multivariant (p = 0.062) analyses. However, in patients who did not use statins, this association was significant and positive in the bivariant analysis (p = 0.001), but in the multivariant analysis it was negative and significant (p = 0.008).
   Conclusion : High-sensitivity CRP was not correlated with CCS. The relationship between CRP and clinical events might not be related to atherosclerotic burden. Measures of inflammation, such as hs-CRP, and indices of atherosclerosis, such as CCS, are likely to provide distinct information regarding cardiovascular risk.
    
5. Title: NAPM becomes global member
   From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
   Published: 2009
   Pages: 111
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   Abstract: In an important announcement for the future of generic medication on the African continent, made by the International Generic Pharmaceutical Alliance (IGPA) management committee at the 11th annual IGPA conference held in December 2008 in Geneva, the National Association of Pharmaceutical Manufacturers (NAPM) was granted observer-member status of the IGPA for a period of two years - a prelude to full membership.
    
6. Title: Cardiac abnormalities of Sudanese patients with Down's syndrome and their short-term outcome : cardiovascular topics
   Authors: Sulafa Ali, K.M.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
   Published: 2009
   Pages: 112-115
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   Abstract: Background : Congential heart disease (CHD) is an important cause of morbidity and mortality in patients with Down's syndrome (DS).
   Methods : All patients with DS seen at the Sudan Heart Centre from July 2004 to November 2007 were included in the study. All patients were examined clinically and echocardiographically, and cardiac catheterisation was carried out in selected patients. All patients were prospectively followed up.
   Results : In the study period, 1 566 patients were evaluated forheart disease. Of these, 80 patients with DS were identified (5%). Their ages ranged from 15 days to 18 years. Cardiac abnormalities included atrioventricular septal defect (AVSD) in 38 patients (48%), with the complete form in 25, a partialform in seven, AVSD with intact atrial septum in one, and complex AVSD in four patients. In one patient there was AVSD with right atrioventricular valve malformation with severe valve regurgitation and functional pulmonary atresia. The other main lesions were ventricular septal defect (VSD) in 19 patients (23%) and tetralogy of Fallot (TOF) in five (6%). Cardiac catheterisation was done in four patients with AVSD to measure pulmonary pressures and resistance, and in one patient with patent ductus arteriosus for device closure. Ten percent of the patients had Eisenmenger's syndrome at the time of presentation. Only 15% of patients who were in need of surgery were operated on ; all had an uneventful postoperative course and a good outcome at a mean follow-up period of one year.
   Conclusion : The pattern of CHD in Sudanese patients with DS was comparable with that in the literature, including the rare occurrence of AVSD with intact atrial septum. In addition, we described an unreported association with right atrioventricular valve malformation. Although there was a significant delay in diagnosis and surgery, surgical results and short-term follow up were good.
    
7. Title: Carotid artery stump pressure and associated neurological changes in predominantly symptomatic carotid artery disease patients undergoing awake carotid endarterectomy : cardiovascular topics
   Authors: Mulaudza, T.V.; Biccard, B.M.; Robbs, J.V.; Paruk, N.; Pillay, B.; Rajaruthnam, P.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
   Published: 2009
   Pages: 116-118
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   Abstract: Aim : To determine the mean carotid artery stump pressure (SP) at which patients develop neurological changes while undergoing awake carotid artery endarterectomy (CEA) under cervical block anaesthesia (CBA).
   Methods : A prospective analysis was carried out of patients undergoing awake CEA under CBA between February 2004 and April 2007. All patients had mean SP measured, with selective shunting on those who developed neurological symptoms on carotid artery clamping regardless of stump pressure. A ball connected to a pressure sensor was put in the patient's contra-lateral hand.
   Results : Fifty-nine patients had awake CEA, 40 were males with a mean age of 64 years. Indications for CEA were asymptomatic high-grade stenosis in 12 (20%) patients and symptomatic stenosis in 47 (80%). Seven (12%) patients required shunting, one for transient ischaemic attack (TIA) and six for loss of consciousness. Six of these patients had presented with symptomatic disease.
   Taking the threshold of mean carotid SP of 50 mmHg as an indication for shunting, 22% (6 / 27) of patients with a mean SP of < 50 mmHg required shunting and only 3% (1 / 32) with a mean carotid SP of > 50 mmHg needed a shunt. This was not statistically significant. Using a mean carotid SP of ≤ 40 mmHg as the threshold for shunting, 40% (4 / 10) of patients required shunting and 3% (1 / 31) with a mean carotid SP of > 40 mmHg required shunting. This was statistically significant. Thirteen (22%) patients were complicated by transient hoarseness of voice. One (2%) had a haematoma that required re-exploration. None of these patients had any major postoperative neurological or cardiological complications.
   Conclusion : Even though the sample in this study was small, awake CEA under local anaesthesia was seen as a safe procedure. It would appear to be safe to use the mean SP of 40 mmHg as a threshold for selective shunting in CEA under general anaesthesia.
    
8. Title: Can left internal mammary artery side branches affect blood flow rate? : cardiovascular topics
   Authors: Biceroglu, S.; Karaca, M.; Yildiz, A.; Ildizili Demirbas, M.; Yilmaz, H.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
   Published: 2009
   Pages: 119-121
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   Abstract: The left internal mammary artery (LIMA) is the most commonly used arterial graft for coronary artery bypass graft (CABG) surgery, and occluding the LIMA side branches during surgery is important to avoid myocardial ischaemia afterwards. In this study we investigated the incidence of patent LIMA graft side branches in our coronary angiography series, and compared LIMA flow rate changes by means of the thrombolysis in myocardial infarction (TIMI) frame count in patients with and without LIMA graft side branches.
   Patients with a history of CABG surgery and who were scheduled for coronary angiography in our centre between 1 January and 15 December 2006 were enrolled in the study.
   We compared LIMA graft TIMI frame counts between patients with and without side branches. The incidence of LIMA graft side branches in our study was 18% (seven patients). Mean TIMI frame count was 27.28 ± 3.4 in patients with LIMA graft side branches and 15.67 ± 2.3 in patients without. There was a significant difference between the two groups (p < 0.0001). Patients with LIMA graft side branches were more likely to have anterior ischaemia, determined by myocardial perfusion scintigraphy.
   We suggest that TIMI frame count may be helpful in evaluating the effect of side branches on LIMA graft flow rate. The increased TIMI frame count of a LIMA graft with side branch is associated with insufficient LIMA flow.
    
9. Title: Vascular graft infection by Staphylococcus aureus : efficacy of linezolid, teicoplanin and vancomycin systemic prophylaxis protocols in a rat model : cardiovascular topics
   Authors: Ataham, Erhan; Katrancioglu, Nurkay; Oztop, Yasemin; Tuncer, Ersin; Ozer, Hatice; Sinasi, Manduz; Engin, Aynur; Yalta, Tulin Deniz; Berkan, Ocal; Dogan, Kasim
   From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
   Published: 2009
   Pages: 122-125
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   Abstract: Objective : We investigated experimentally the in vivo prophylactic efficacies of linezolid, teicoplanin and vancomycin in subcutaneously implanted dacron graft infection caused by methicillin-resistant Staphylococcus aureus (MRSA).
   Materials and methods : Dacron grafts (1 cm2) were aseptically implanted into subcutaneous pockets that were surgically prepared in the backs of 50 rats. Ten of these rats were used as the control group (group I). Grafts in the remaining 40 rats were infected by inoculation of MRSA at the concentration of 2 x 107 colony-forming units (CFU) / ml. Ten of these rats constituted the contaminated, untreated group II. The other three study groups comprising 10 rats each were contaminated and then treated with linezolid (group III), teicoplanin (group IV) and vancomycin (group V), respectively. All rats were sacrificed and the grafts were removed after seven days and evaluated.
   Results : The bacterial count decreased in the rats from the groups treated with linezolid, teicoplanin and vancomycin. The linezolid and teicoplanin groups, however, showed a significantly lower bacterial number than the vancomycin group (p = 0.009 and p = 0.01). The intensity of inflammation was highest in the contaminated, untreated group, as expected.
   Conclusions : Single-dose linezolid, teicoplanin and vancomycin for peri-operative prophylaxis may prevent bacterial growth in vascular graft infections. The effect of linezolid and teicoplanin seemed similar and their effect was greater than that of vancomycin.
    
10. Title: Perindopril : do randomised, controlled trials support an ACE inhibitor class effect? A meta-analysis of clinical trials : review article
    Authors: Snyman, Jacques R.; Wessles, Francois
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 127-134
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    Abstract: Background : Due to the lack of face-to-face trials between ACE inhibitors, clinicians and third-party funders may assume they provide similar outcomes. As a result, ACE inhibitors may be prescribed interchangeably and deemed to provide the same outcomes for all patients when used chronically, that is for more than six months.
    Objective : This meta-analysis aims to dispute the assumption of a class effect when prescribing ACE inhibitors (ACEIs), since the evidence from all the clinical trials is not uniform and therefore a direct comparison is impossible.
    Methods : Published randomised, controlled trials were selected using an applicable literature search for all ACEIs, irrespective of drug combination, for any cardiovascular outcome (both composite and individual outcomes were included). The average length of ACEI exposure per trial had to be longer than six months). This meta-analysis was performed using odds ratios as the parameter of efficacy in a fixed-effects model.
    Results / Conclusion : Perindopril resulted in significantly fewer patients reaching the primary endpoint versus all other ACEIs combined. The results were consistent for myocardial infarction, stroke and mortality (5 vs 11%, p = 0.0001).
    Perindopril alone or as part of combination therapy in clinical trials seemed to deliver clear and consistent outcome differences compared to other ACEI trials. In the presence of positive outcomes from robust randomised, controlled trials for perindopril, one cannot assume a class effect for all ACEIs.
     
11. Title: Pfizer launches global regenerative medicine research unit
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 135
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    Abstract: Pfizer recently announced the launch of a new research unit known as Pfizer Regenerative Medicine. This independent research unit will build on recent scientific progress in understanding the biology of stem cells and the opportunity this provides to discover and develop a new generation of regenerative medicines for major medical needs.
     
12. Title: Resection of left anterior descending coronary artery aneurysm on a beating heart : case report
    Authors: Misthos, Panagiotis; Kokotsakis, John M.; Lioulias, Achilleas G.; Skouteli, Eleni Anna T.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 136-137
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    Abstract: We report on the case of a 65-year-old man with unstable angina due to a left anterior descending (LAD) coronary artery single aneurysm. On a beating heart, the aneurysm was partially resected and the left internal thoracic artery was grafted in situ as a patch to the LAD opening. The patient remains well and free of symptoms two years after the operation.
     
13. Title: Deep-vein and intracardiac thrombosis of unclear aetiology : possible association with intermittent low-voltage electrical trauma : case report
    Authors: Mocumbi, Ana Olga H.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 138-141
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    Abstract: Extensive deep-vein thrombosis (DVT) may result from a high-voltage electrical injury. Little is known about the effects of long-term, low-voltage electrical stimulation. We report on the unusual finding of deep-vein thrombosis in a black patient, affecting the superior vena cava and right femoral vein, in association with a right atrial mural thrombus, following low-voltage electrical stimulation of the body for analgesic purposes. The patient had slightly decreased blood levels of proteins C and S, with no other known risk factors. The diagnosis, management and prognosis are discussed. This case demonstrates the need to investigate the cardiovascular effects of chronic, low-voltage electrical stimulation.
     
14. Title: Gold nanoparticles and a microscopic view of platelets : a preliminary observation : short communication
    Authors: Wiwanikit, Viroj; Sereemaspun, Amornpun; Rojanathanes, Rojrit
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 141-142
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    Abstract: There is limited information on the use of nanoparticles in medicine, and in particular, the effect of gold nanoparticles on human platelets. We carried out an experimental study at Chulalongkorn University, Bangkok, Thailand to demonstrate the direct effect of gold nanoparticles on platelets. A solution of gold nanoparticles was mixed with a blood sample and analysed. The results showed platelet aggregation. This finding could be useful for the development of new haemostatic drugs.
     
15. Title: Review of randomised clinical trials of cardiovascular genericversus brand name drugs : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 143
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    Abstract: A recent systematic review of the clinical equivalence of generic and brand name drugs used in cardiovascular medicine, by the Department of Phamacoepidemiology and Economics at the Brigham and Women's Hospital, Harvard Medical School, provides clinicians with evidence based data for drug selection in their clinical practice.
     
16. Title: How do recent developments affect the angiotensin receptor blockers as a class? : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 145
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    Abstract: How do we interpret recent clinical trial data that suggest the angiotensin receptor blockers (ARBs) have not fulfilled their promise and may have lost some of their gloss? This was the question posed by Prof Brian Rayner, head of the hypertension division at the University of Cape Town, at a recent diabetes cardiothrombosis meeting sponsored by sanofiaventis.
     
17. Title: JUPITER study highlights C-reactive protein as a cardiac risk factor : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 146
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    Abstract: JUPITER (Justification for the Use of statins in Primary prevention : an Intervention Trial Evaluating Rosuvastatin) was the first long-term, randomised, doubleblind, placebo-controlled study designed to determine if rosuvastatin decreased the risk of heart attack, stroke and other major cardiovascular events in patients with no evidence of pre-existing cardiovascular disease and low-to-normal LDL cholesterol (LDL-C) levels, but who were nonetheless at increased cardiovascular (CV) risk as determined by elevated concentrations of the inflammatory marker C-reactive protein (CRP). The study included over 17 802 men and women and was conducted in 26 countries worldwide.
     
18. Title: Secondary prevention of stroke : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 147-148
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    Abstract: 'A transient ischaemic attack (TIA) is a medical emergency.' This is the view of Prof Hans-Christoph Diener, of the Department of Neurology, and Stroke Centre, University Hospital Essen, Germany. He was addressing delegates at the annual Neurology Association of South Africa congress, which took place in the second week of March.
    'Population-based studies have shown that immediate action is necessary and the treatment the patient receives in the first few days is critical. A TIA is often followed by a stroke and the risk of this is highest during the first 48 hours. Structured care can reduce this risk however, but we don't have too much time to evaluate the patient. General practitioners therefore need to refer patients to a TIA clinic where recommendations can be made for secondary prevention. There after a neurologist should implement these measures in a stroke centre. This has the potential to reduce the possibility of recurrent stroke by 80%.'
     
19. Title: Management of acute stroke : new aspects : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 148
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    Abstract: Prof Hans-Christoph Diener of the Department of Neurology, and Stroke Centre, University Hospital, Essen, Germany, commenced his overview of the management of acute stroke according to the new European Stroke Organisation ischaemic stroke management guidelines by endorsing several other speakers' calls for the ongoing promotion of the stroke unit concept of care. 'It's important to have a dedicated part of the hospital, staffed by multidisciplinary personnel with the necessary medical expertise. This means that a patient who has suffered an acute ischaemic stroke can bypass the emergency room and be assessed immediately by expert staff in the stroke unit. Early management of all physiological parameters can prevent complications. This can then be followed by ongoing rehabilitation by a co-ordinated team of professionals who are also qualified to assess the patient's post-discharge needs.'
     
20. Title: Heart rate can now be lowered safely and patients feel better for it! : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 150
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    Abstract: Coralan is the first and only agent in a new class of heart rate-lowering agents that specifically inhibit the If (pacemaker) current in the sino-atrial node of the heart. The consequence of the pure manner in which Coralan slows the heart rate is powerful anti-anginal and anti-ischaemic efficacy, with no effect on blood pressure,myocardial contraction or conduction.
     
21. Title: Atorvastatin reduced hs-CRP levels in patients with stable CAD : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 150
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    Abstract: Patients treated with atorvastatin calcium 80 mg had a significant 55% reduction in levels of high-sensitivity C-reactive protein (hs-CRP), while those taking atorvastatin 10 mg had a significant 21% reduction in hs-CRP levels at the end of 26 weeks compared to baseline. This is according to the results from the primary endpoint of a new study, the Comparative Atorvastatin Pleiotropic effects (CAP) study.
     
22. Title: Accomplish more blood pressure lowering with initial fixed-dose combination therapy : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 153
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    Abstract: The key to effective blood pressure lowering is giving a fixed combination of two antihypertensive medications at the outset of treatment, one of which should be a renin-angiotensin system (RAS) inhibitor. This defined approach to the effective management of hypertension was advocated by Prof Matthew Weir of Maryland University, Baltimore, USA to South African clinicians attending a series of recent Novartis-sponsored CME events.
     
23. Title: Cardio news
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 154-155
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    Abstract: Photographs from the celebration of the 20th anniversary of the Cardiovascular Journal of South Africa / Cardiovascular Journal of Africa, held at Zewenwacht Wine Estate on 2 April 2009.
     
24. Title: Servier and Aspen sign technology transfer : cardio news
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 156
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    Abstract: Servier, a leading French research-based pharmaceutical company and Aspen Pharmacare (Aspen), the largest generics pharmaceutical manufacturer in the southern hemisphere, have signed a memorandum of understanding (MOU) for themanufacture of perindopril. Perindopril is primarily used for the treatment of hypertension and heart failure.
     
25. Title: Sanofi leverages 'YouTube' for diabetics : cardio news
    From: Cardiovascular Journal of Africa, Vol 20, Issue 2, Mar / Apr
    Published: 2009
    Pages: 156
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    Abstract: Sanofi-Aventis launched its inaugural 'YouTube' channel on 4 February. Titled GoInsulin, the channel features testimonial videos and links to GoInsulin.com, a companion website.