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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 6, November/December 2015
AFRICA
203
From the Editor’s Desk
This issue provides an array of articles on a variety of
cardiovascular topics ranging from clinical registries to basic
laboratory science.
Most healthcare providers involved in clinical medicine and
cardiology in Africa agree that rheumatic heart disease (RHD)
remains common, and the consequences for affected individuals
are devastating. Despite the perception of its importance,
there are a limited number of detailed studies documenting
with any degree of accuracy the number of patients affected.
Registries serve many useful purposes, one of which describes
the scale of the problem and allows planners and providers of
healthcare to appropriately allocate resources and to measure
whether those allocated are, over time, effective in alleviating the
situation. Individual patients identified and recorded in registries
may benefit from longitudinal monitoring of compliance with
secondary prophylaxis, which is central to control of RHD. The
data generated from good registries will greatly benefit research
into RHD.
Paper-based registries are available but often not used as
well as they should be. On page 227, van Dam and co-authors
describe the development of an open-access mobile, compatible,
electronic patient-register system based on the World Heart
Federation paper-based registry forms. The system functions on
mobile phones and other mobile devices, as well as on computer
systems in clinics and hospitals. This is a description of an
exciting development, which if implemented, could potentially
change the way we measure and treat RHD.
Raynaud’s phenomenon remains one of those unusual,
quirky ‘illnesses’, the pathogenesis of which we do not really
understand. It causes considerable discomfort to some sufferers
without serious long-term sequelae and may be effectively treated
by vasodilating calcium-channel blocking agents. Karabacak
and others (page 214) report that in a Turkish male cohort there
was evidence of autonomic dysfunction, as measured by heart
rate variability, when compared to an age- and gender-matched
control cohort. The authors acknowledge that there have been
other reports of autonomic dysfunction in this condition. It is
not clear why the researchers chose to investigate this condition,
which as they report is more common in women, in an exclusively
male cohort.
Glaucoma and atrioventricular (AV) block both occur more
frequently with increasing age and so it is not surprising
that conduction disturbances are found in patients treated for
glaucoma with
β
-blocker-containing eye-drops, as reported
by Ozcan and co-workers (page 210). Whether the AV block
is caused by the drops or not remains, as the authors state,
controversial. What is important is that permanent pacing allows
continuation of effective therapy for the glaucoma.
The goal of cardioprotection in the setting of acute myocardial
infarction is important and has received intense attention and
interest in the last decades. Despite much basic science effort
and the pursuit of theoretically promising avenues, the only
interventions that have proven to be clinically effective in humans
have been the restoration of blood flow and maintenance of
that blood flow by mechanical therapies or pharmacological
treatments interfering with blood coagulation. The report by
Gwanyanya and others (page 242) of the failure of magnesium
to provide protection against experimentally induced myocardial
infarction is another example of a theoretically impressive
intervention that fails to deliver. Clinicians will continue
(hopefully) to implement strategies of proven benefit and avoid
untested interventions.
PJ Commerford
Editor-in-Chief
Please note our offices will close on 17 December and we will be open from 11 January 2016.
The management and staff of Clinics
Cardive Publishing (publishers of the
Cardiovascular Journal of Africa
and
the
South African Journal of Diabetes &
Vascular Disease
) take this opportunity to
thank you for your loyal support during
2015 and we look forward to being of
service during 2016.
We wish you and your family
a merry festive season and
a prosperous new year.