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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016
AFRICA
3
From the Editor’s Desk
It is interesting to one trained in the era that preceded the
availability of new and sophisticated imaging modalities to
see just how well the ‘old’ and often currently poorly regarded
imaging techniques still serve. Ganie and colleagues (page 31)
record how in seven of eight patients with vascular rings, the chest
radiograph was abnormal, and they propose a diagnostic imaging
algorithm for such patients, which includes chest radiographs.
My own observations suggest that the chest radiograph is often
neglected and may not be performed in current practice when
patients are evaluated with symptoms or signs of cardiovascular
disease, and are referred for echocardiography before a chest
radiograph is performed. Echocardiography may fail to detect
extra-cardiac abnormalities and mis-assess the severity of intra-
cardiac abnormalities unless clinically directed. The authors are
to be congratulated on pointing out how simple investigations,
performed at low cost, may be valuable in evaluating patients
with complex cardiovascular abnormalities.
In exploring the genetic contribution to hypertension, Sun and
colleagues (page 21) have identified genes that were risk factors
for nocturnal hypertension in this Chinese Han population, and
their combined effects played an important role in nocturnal
hypertension. However, as the authors acknowledge, even if a
gene were considered associated with hypertension in certain
populations, to expand the conclusion to all human populations
is unwise at this stage. In diseases such as hypertension, obesity
or diabetes, not only genetic factors but many other factors, such
as environment or geographic location, could be important. All
these factors could have different effects on obesity or diabetes
and they could impact on each other. Therefore whether or how
single genes may be associated with nocturnal hypertension is
complicated. Long-term population-based studies are needed to
clarify the relationship.
Arodiwe and co-authors (page 26) point out the paucity of
information on the frequency of cardiac involvement in children
with HIV/AIDS in sub-Saharan Africa, and the importance
of such information given the extent of the epidemic. They
conducted a descriptive cross-sectional echocardiographic study
of HIV-infected children and uninfected controls at a Nigerian
teaching hospital and showed left ventricular systolic dysfunction
in 27% of HIV-infected children and 81% of those with AIDS.
The systolic dysfunction was asymptomatic. This is important
information and hopefully there will be further information
forthcoming from the authors regarding follow up and prognosis
of this particular group of patients, as well as the effects of anti-
retroviral therapy. The impact of usual cardio-active medication
for systolic dysfunction, such as angiotensin converting enzyme
inhibitors and beta-blockers, should also be explored in this
population.
The clinical, laboratory and ECG profiles of 62 children with
sickle cell anaemia (SCA) attending a paediatric haematology
clinic in Nigeria and 40 age- and gender-matched haemoglobin
AA controls were compared (page 16). Adegoke and colleagues
found that ECG abnormalities were common in children with
SCA, and in their discussion, speculate on the mechanisms and
significance of the ECG abnormalities.
Patrick Commerford
Editor-in- Chief
Professor PJ Commerford