Bridging the Divide

The theme for the 2014 congress “Bridging the Divide” was selected to highlight the idea that improving the overall health of a population requires partnerships and interdependence with structures within and outside the healthcare domain. A health care delivery system is thought to account foraround 10% of preventable deaths with the remainder attributable to social and environmental determinants, personal behaviour and genetic predisposition.(1) This interdependence comes from the knowledge that increased life expectancy, on the one hand due to a reduction in premature mortality from improved sanitation, nutrition and vaccinations in the childhood years, at the other end is linked to the health and survival of the elderly due to innovations in science and technology

GST polymorphisms and early-onset coronary artery disease in young South African Indians

Background. Glutathione S-transferases (GSTs) detoxify environmental agents which influence the onset and progression of disease. Dysfunctional detoxification enzymes are responsible for prolonged exposure to reactive molecules and can contribute to endothelial damage, an underlying factor in coronary artery disease (CAD).Objectives. We aimed to assess 2 common polymorphic variant isoforms in GSTM1 and GSTP1 of GST in young CAD patients.Methods. All patients (N=102) were South Africans of Indian ancestry, a population associated with high CAD risk. A corresponding age-, sex- and race-matched control group (N=100) was also recruited. Frequency of the GSTM1 +/0 (v. +/0 and 0/0) and GSTP1 A105/G105 (v. wild-type A105/A105) genotypes was assessed by differential polymerase chain reaction (PCR) and PCR restriction fragment length polymorphism (PCR-RFLP), respectively.Results. The GSTM1 0/0 and GSTP1 A105/A105 genotypes occurred at higher frequencies in CAD patients compared with the control group (36% v. 18% and 65% v. 48%, respectively). A significant association with CAD was observed in GSTM1 0/0 (odds ratio (OR)=2.593; 95% confidence interval (CI) 1.353 - 4.971; p=0.0043) and GSTP1 A105/A105 OR=0.6011; 95% CI 0.3803 - 0.9503; p=0.0377). We found a significant association between smoking and CAD; the presence of either of the respective genotypes together with smoking increased the CAD risk (GSTP1 A105 relative risk (RR)=1.382; 95% CI 0.958 - 1.994; p=0.0987 and GSTM1 null RR=1.725; 95% CI 1.044 - 2.851; p=0.0221).Conclusion. Our findings support the association of genotypes GSTM1 0/0 and GSTP1 A105/A105 and smoking with CAD.S Afr Med J 2012;102(7):627-630

Interventional cardiology during the COVID-19 epidemic

The impact of the COVID-19 pandemic on our lives is unprecedented and major adjustments to our practices as physicians are required. Although our comments are applicable at the time of writing, the situation changes daily and the content of this article should be adjusted accordingly.Cath lab: An unambiguous cath lab protocol should be drawn up for each facility, appropriate to local circumstances. This should include standard procedures in preparation for arrival at the lab, in the performance of procedures, and, importantly, in maintaining due diligence when removing protective gear. All team members should be well trained in these procedures.Acute coronary syndromes: Standard timing for the invasive management of patients should not change during the pandemic. Due to delays often unavoidable during the pandemic, alternative strategies such as thrombolysis may be more readily available and therefore more appropriate.Drugs: The sick COVID-19 patient often represents a pro-thrombotic state and operators should ensure adequate anti-thrombotic therapy. Knowledge of interactions between cardiac drugs and investigational antiviral treatments is important.Elective procedures: Patients with chronic cardiac conditions are at high risk and may require non-urgent procedures to avert major complications. Selecting these cases requires consideration of multiple risks and benefits

Sirtuin 1 rs1467568 and rs7895833 in South African Indians with early-onset coronary artery disease

BACKGROUND : Sirtuin 1 (SIRT1), a class III histone deacetylase, has been identified as a candidate molecule affecting the epigenetic mechanisms of cardiovascular disease (CVD). Previous studies have shown that some SIRT1 single-nucleotide polymorphisms (SNPs) are associated with body mass index, diabetes, blood pressure, cholesterol metabolism and coronary artery calcification. We investigated two A>G SIRT1 SNPs, rs1467568 and rs7895833, in young South African (SA) Indians with coronary artery disease (CAD) and compared them to Indian and black controls. METHODS : For rs1467568, a total of 287 subjects were recruited into this study (104 CAD patients, 99 age-, gender- and race-matched controls, and 84 age- and gender-matched black controls). For rs7895833, a total of 281 subjects were recruited into this study (100 CAD patients, 99 age-, gender- and race-matched controls, and 82 age- and gender-matched black controls). All patients were male, of Indian ethnicity, stable CAD confirmed on angiography, mean age 37.5 years; range 24–45. All subjects were genotyped using TaqMan SNP genotyping assays. RESULTS : The variant allele for both SNPs was found at a higher frequency in the total Indian group compared to the total black population (rs1467568: 41 vs 18.5%, respectively, p < 0.0001, OR = 3.190, 95% CI: 2.058–40943; and rs7895833: 41 vs 22%, respectively, p < 0.0001, OR = 2.466, 95% CI: 1.620– 3.755). Indian controls presented with a higher frequency for both SNPs compared to black controls (rs1467568: 40 vs 18.5%, respectively, p < 0.0001, OR = 2.996, 95% CI: 1.850– 4.853; and rs7895833: 41 vs 22%, respectively, p < 0.0001, OR = 2.513, 95% CI: 1.578–4.004). No difference was seen in the distribution of both SNPs between CAD patients and either control group. We did not observe any association between the SNPs and clinical parameters in CAD patients and controls. CONCLUSION : Both SNP variant alleles occurred more frequently in SA Indians than in SA blacks. A larger study group and further analysis is required to assess whether these SIRT1 SNPs may serve as risk factors that contribute to Indians developing early-onset CAD.The National Research Foundation (NRF) for a scholarship and UKZN (College of Health Sciences).www.cvja.co.zaam2016Physiolog

Cardiology–cardiothoracic subspeciality training in South Africa : a position paper of the South Africa Heart Association

Over the past decades, South Africa has undergone rapid demographic changes, which have led to marked increases in specific cardiac disease categories, such as rheumatic heart disease (now predominantly presenting in young adults with advanced and symptomatic disease) and coronary artery disease (with rapidly increasing prevalence in middle age). The lack of screening facilities, delayed diagnosis and inadequate care at primary, secondary and tertiary levels have led to a large burden of patients with heart failure. This leads to suffering of the patients and substantial costs to society and the healthcare system. In this position paper, the South African Heart Association (SA Heart) National Council members have summarised the current state of cardiology, cardiothoracic surgery and paediatric cardiology reigning in South Africa. Our report demonstrates that there has been minimal change in the number of successfully qualified specialists over the last decade and, therefore, a de facto decline per capita. We summarise the major gaps in training and possible interventions to transform the healthcare system, dealing with the colliding epidemic of communicable disease and the rapidly expanding epidemic of non-communicable disease, including cardiac disease.http://www.cvja.co.zaam2016Cardiolog

SA Heart® Statement on COVID-19 and cardiovascular disease

The South African Heart Association (SA HeartR) is an association of cardiologists, paediatric cardiologists, cardiac surgeons, as well as allied cardiac professionals, whose vision is to advance cardiovascular care for each of our country’s citizens and to be the scientific leaders in South African cardiac healthcare delivery, education and research. As such, we are ideally placed to advise the National Department of Health (NDoH) about the cardiac implications of the COVID-19 pandemic, as well as how we tackle non-communicable cardiovascular disease (NCD) going forward

Hydrothermal carbonization of lignocellulosic biomass for carbon rich material preparation : a review

Hydrothermal carbonization (HTC) is an active area of research in synthesizing carbon-rich materials because of its ability to transform wet biomass into valuable products. Carbon-rich materials have received a great deal of attention because carbon is a raw material for several industrial products and their production from various biomasses is currently an active area of research. In addition, lignocellulosic biomass has been of great interest as precursors for the preparation of carbon-rich materials because of their low cost and due to environmental concerns. This review exhibits the research on the hydrothermal carbonization of lignocellulosic biomass, production of carbon-rich materials or carbon spheres or hydrochar by the HTC process and the role of water and the proposed mechanism in the HTC process. This research on hydrothermal carbonization mostly focused on lignocellulosic biomass materials and the effect of process parameters including the temperature, pressure residence time, pH, heating rate and substrate concentration are also discussed. The reaction mechanisms of hydrolysis, dehydration or decarboxylation and carbonization are elaborated in detail. Solid carbon-rich materials have a wide range of applications as environmental additives, biofuels, catalysts and energy storage and have been covered in detail. At the end of the review, we deliver an outlook on future research prospects and applications of hydrothermal carbon-rich materials