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Achoki T, Sartorius B, Watkins D, Glenn SD, Kengne AP, Oni T, Wiysonge CS, Walker A, Adetokunboh OO, Babalola TK, Bolarinwa OA, Claassens MM, Cowden RG, Day CT, Ezekannagha O, Ginindza TG, Iwu CCD, Iwu CJ, Karangwa I, Katoto PD, Kugbey N, Kuupiel D, Mahasha PW, Mashamba-Thompson TP, Mensah GA, Ndwandwe DE, Nnaji CA, Ntsekhe M, Nyirenda TE, Odhiambo JN, Oppong Asante K, Parry CDH, Pillay JD, Schutte AE, Seedat S, Sliwa K, Stein DJ, Tanser FC, Useh U, Zar HJ, Zühlke LJ, Mayosi BM, Hay SI, Murray CJL, Naghavi M. Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study. J Epidemiol Community Health 2022; 76:jech-2021-217480. [PMID: 35046100 PMCID: PMC8995905 DOI: 10.1136/jech-2021-217480] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. METHODS We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. RESULTS Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. CONCLUSIONS Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.
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Affiliation(s)
- Tom Achoki
- Research, Africa Institute for Health Policy, Nairobi, Kenya
- Center for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, Netherlands
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - David Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Scott D Glenn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Andre Pascal Kengne
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Non-communicable Diseases Research Unit, Medical Research Council South Africa, Cape Town, South Africa
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Charles Shey Wiysonge
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Alexandra Walker
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Olatunji O Adetokunboh
- Centre of Excellence for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Tesleem Kayode Babalola
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Community Health and Primary Care, University of Lagos, Lagos, Nigeria
| | | | - Mareli M Claassens
- Department of Biochemistry and Microbiology, University of Namibia, Windhoek, Namibia
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Richard G Cowden
- Department of Psychology, University of the Free State, Park WEst, Free State, South Africa
| | - Candy T Day
- Health Systems Research Unit, Health System Trust, Westville, South Africa
| | - Oluchi Ezekannagha
- Independent Consultant, Awka, Nigeria
- International Institute of Tropical Agriculture, Ibadan, Nigeria
| | - Themba G Ginindza
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Chidozie C D Iwu
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Chinwe Juliana Iwu
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Innocent Karangwa
- Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
| | - Patrick Dmc Katoto
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Nuworza Kugbey
- University of Environment and Sustainable Development, Somanya, Ghana
| | - Desmond Kuupiel
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Nursing, Research for Sustainable Development Consult, Sunyani, Ghana
| | - Phetole Walter Mahasha
- Grants, Innovation and Product Development Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - George A Mensah
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Center for Translation Research and Implementation Science, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Chukwudi A Nnaji
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, University of Cape Town, Rondebosch, Western Cape, South Africa
- The Cardiac Clinic, Groote Schuur Hospital, Cape Town, South Africa
| | - Thomas Elliot Nyirenda
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- European and Developing Countries Clinical Trials Partnership (EDCTP), European Commission, Cape Town, South Africa
| | - Julius Nyerere Odhiambo
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Management Science and Technology, Technical University of Kenya, Nairobi, Nairobi, Kenya
| | | | - Charles D H Parry
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Julian David Pillay
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Aletta Elisabeth Schutte
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Karen Sliwa
- Hatter Institute Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council, Cape Town, South Africa
| | - Frank C Tanser
- University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, Berea, South Africa
| | - Ushotanefe Useh
- Health Sciences Department, North-West University, Mmbatho, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Unit on Child & Adolescent Health, Medical Research Council South Africa, Cape Town, South Africa
| | - Liesl J Zühlke
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Simon I Hay
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Kraus SM, Shaboodien G, Francis V, Laing N, Cirota J, Chin A, Pandie S, Lawrenson J, Comitis GAM, Fourie B, Zühlke L, Wonkam A, Wainwright H, Damasceno A, Mocumbi AO, Pepeta L, Moeketsi K, Thomas BM, Thomas K, Makotoko M, Brown S, Ntsekhe M, Sliwa K, Badri M, Gumedze F, Cordell HJ, Keavney B, Ferreira V, Mahmod M, Cooper LT, Yacoub M, Neubauer S, Watkins H, Mayosi BM, Ntusi NAB. Rationale and design of the African Cardiomyopathy and Myocarditis Registry Program: The IMHOTEP study. Int J Cardiol 2021; 333:119-126. [PMID: 33607192 DOI: 10.1016/j.ijcard.2021.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/27/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart failure (HF), the dominant form of cardiovascular disease in Africans, is mainly due to hypertension, rheumatic heart disease and cardiomyopathy. Cardiomyopathies pose a great challenge because of poor prognosis and high prevalence in low- and middle-income countries (LMICs). Little is known about the etiology and outcome of cardiomyopathy in Africa. Specifically, the role of myocarditis and the genetic causes of cardiomyopathy are largely unidentified in Africans. METHOD The African Cardiomyopathy and Myocarditis Registry Program (the IMHOTEP study) is a pan-African multi-centre, hospital-based cohort study, designed with the primary aim of describing the clinical characteristics, genetic causes, prevalence, management and outcome of cardiomyopathy and myocarditis in children and adults. The secondary aim is to identify barriers to the implementation of evidence-based care and provide a platform for trials and other intervention studies to reduce morbidity and mortality in cardiomyopathy. The registry consists of a prospective cohort of newly diagnosed (i.e., incident) cases and a retrospective (i.e., prevalent) cohort of existing cases from participating centres. Patients with cardiomyopathy and myocarditis will be subjected to a standardized 3-stage diagnostic process. To date, 750 patients have been recruited into the multi-centre pilot phase of the study. CONCLUSION The IMHOTEP study will provide comprehensive and novel data on clinical features, genetic causes, prevalence and outcome of African children and adults with all forms of cardiomyopathy and myocarditis in Africa. Based on these findings, appropriate strategies for management and prevention of the cardiomyopathies in LMICs are likely to emerge.
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Affiliation(s)
- Sarah M Kraus
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Gasnat Shaboodien
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Veronica Francis
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Nakita Laing
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; Division of Human Genetics, Department of Medicine, UCT, Cape Town, South Africa
| | - Jacqui Cirota
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Ashley Chin
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Shahiemah Pandie
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - John Lawrenson
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, UCT and Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - George A M Comitis
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, UCT and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Barend Fourie
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Liesl Zühlke
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, UCT and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Ambroise Wonkam
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; Division of Human Genetics, Department of Medicine, UCT, Cape Town, South Africa
| | - Helen Wainwright
- Department of Pathology, National Health Laboratory Service and UCT, Cape Town, South Africa
| | | | - Ana Olga Mocumbi
- Instituto Nacional de Saúde and Eduardo Mondlane University, Maputo, Mozambique
| | - Lungile Pepeta
- Department of Paediatrics, Port Elizabeth Hospital Complex and Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Khulile Moeketsi
- Division of Cardiology, Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Baby M Thomas
- Division of Cardiology, Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Kandathil Thomas
- Division of Cardiology, Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Makoali Makotoko
- Division of Cardiology, Universitas Hospital and University of the Free State, Bloemfontein, South Africa
| | - Stephen Brown
- Division of Cardiology, Universitas Hospital and University of the Free State, Bloemfontein, South Africa
| | - Mpiko Ntsekhe
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Karen Sliwa
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Motasim Badri
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; College of Medicine, King Saudi Bin Abdulaziz University for Medical Sciences, Riyadh, Saudi Arabia
| | | | - Heather J Cordell
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bernard Keavney
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Vanessa Ferreira
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Masliza Mahmod
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, USA
| | | | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Hugh Watkins
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Bongani M Mayosi
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Ntobeko A B Ntusi
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa.
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3
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Ghidoni A, Elliott PM, Syrris P, Calkins H, James CA, Judge DP, Murray B, Barc J, Probst V, Schott JJ, Song JP, Hauer RNW, Hoorntje ET, van Tintelen JP, Schulze-Bahr E, Hamilton RM, Mittal K, Semsarian C, Behr ER, Ackerman MJ, Basso C, Parati G, Gentilini D, Kotta MC, Mayosi BM, Schwartz PJ, Crotti L. Cadherin 2-Related Arrhythmogenic Cardiomyopathy: Prevalence and Clinical Features. Circ Genom Precis Med 2021; 14:e003097. [PMID: 33566628 DOI: 10.1161/circgen.120.003097] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiac disease characterized by fibrofatty replacement of the right and left ventricle, often causing ventricular dysfunction and life-threatening arrhythmias. Variants in desmosomal genes account for up to 60% of cases. Our objective was to establish the prevalence and clinical features of ACM stemming from pathogenic variants in the nondesmosomal cadherin 2 (CDH2), a novel genetic substrate of ACM. METHODS A cohort of 500 unrelated patients with a definite diagnosis of ACM and no disease-causing variants in the main ACM genes was assembled. Genetic screening of CDH2 was performed through next-generation or Sanger sequencing. Whenever possible, cascade screening was initiated in the families of CDH2-positive probands, and clinical evaluation was performed. RESULTS Genetic screening of CDH2 led to the identification of 7 rare variants: 5, identified in 6 probands, were classified as pathogenic or likely pathogenic. The previously established p.D407N pathogenic variant was detected in 2 additional probands. Probands and family members with pathogenic/likely pathogenic variants in CDH2 were clinically evaluated, and along with previously published cases, altogether contributed to the identification of gene-specific features (13 cases from this cohort and 11 previously published, for a total of 9 probands and 15 family members). Ventricular arrhythmic events occurred in most CDH2-positive subjects (20/24, 83%), while the occurrence of heart failure was rare (2/24, 8.3%). Among probands, sustained ventricular tachycardia and sudden cardiac death occurred in 5/9 (56%). CONCLUSIONS In this worldwide cohort of previously genotype-negative ACM patients, the prevalence of probands with CDH2 pathogenic/likely pathogenic variants was 1.2% (6/500). Our data show that this cohort of CDH2-ACM patients has a high incidence of ventricular arrhythmias, while evolution toward heart failure is rare.
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Affiliation(s)
- Alice Ghidoni
- Center for Cardiac Arrhythmias of Genetic Origin (A.G., M.-C.K., P.J.S., L.C.), Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Perry M Elliott
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, United Kingdom (P.M.E., P.S.)
| | - Petros Syrris
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, United Kingdom (P.M.E., P.S.)
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (H.C., C.A.J., B.M.)
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (H.C., C.A.J., B.M.)
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, SC (D.P.J.)
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (H.C., C.A.J., B.M.)
| | - Julien Barc
- Université de Nantes (J.B.), CNRS, Inserm, l'Institut du Thorax, France
| | - Vincent Probst
- Université de Nantes, CHU Nantes (V.P., J.J.S.), CNRS, Inserm, l'Institut du Thorax, France.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.)
| | - Jean Jacques Schott
- Université de Nantes, CHU Nantes (V.P., J.J.S.), CNRS, Inserm, l'Institut du Thorax, France
| | - Jiang-Ping Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (J.-P.S.)
| | - Richard N W Hauer
- Netherlands Heart Institute (R.N.W.H., E.T.H., J.P.v.T.), University Medical Center Utrecht.,Department of Cardiology (R.N.W.H.), University Medical Center Utrecht
| | - Edgar T Hoorntje
- Netherlands Heart Institute (R.N.W.H., E.T.H., J.P.v.T.), University Medical Center Utrecht.,Department of Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (E.T.H.)
| | - J Peter van Tintelen
- Netherlands Heart Institute (R.N.W.H., E.T.H., J.P.v.T.), University Medical Center Utrecht.,Department of Genetics (J.P.v.T.), University Medical Center Utrecht
| | - Eric Schulze-Bahr
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.).,Institute for Genetics of Heart Diseases (IfGH), University Hospital Münster, Germany (E.S.-B.)
| | | | - Kirti Mittal
- Hospital for Sick Children, Toronto, ON, Canada (R.M.H., K.M.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, NSW, Australia (C.S.)
| | - Elijah R Behr
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.).,Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, St George's University of London, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (E.R.B.)
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology and Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, MN (M.J.A.)
| | - Cristina Basso
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.).,Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University and Hospital of Padua, Italy (C.B.)
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Cardiomyopathies Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan (G.P., L.C.).,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., L.C.)
| | - Davide Gentilini
- Bioinformatics and Statistical Genomics Unit (D.G.), Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Italy (D.G.)
| | - Maria-Christina Kotta
- Center for Cardiac Arrhythmias of Genetic Origin (A.G., M.-C.K., P.J.S., L.C.), Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Bongani M Mayosi
- Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, Groote Schuur Hospital and Division of Cardiology, Faculty of Health Sciences, University of Cape Town, South Africa (B.M.M.)
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin (A.G., M.-C.K., P.J.S., L.C.), Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.)
| | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin (A.G., M.-C.K., P.J.S., L.C.), Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (V.P., E.S.-B., E.R.B., C.B., P.J.S., L.C.).,Istituto Auxologico Italiano, IRCCS, Cardiomyopathies Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan (G.P., L.C.).,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., L.C.)
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4
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Matshabane OP, Campbell MM, Faure MC, Marshall PA, Mayosi BM, Stein DJ, Appelbaum PS, de Vries J. Exploring how a genetic attribution to disease relates to stigma experiences of Xhosa patients with schizophrenia in South Africa. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1679-1686. [PMID: 32409883 DOI: 10.1007/s00127-020-01875-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/02/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Over the past three decades, a range of international stakeholders have highlighted the possibility that genomic research may impact stigma associated with psychiatric disorders. Limited research has been conducted in Africa to investigate this relation. METHOD In the present study, using focus group discussions, we explored the relation between genetic attribution and stigma among 36 Xhosa people with schizophrenia. We addressed three main questions: (1) What causal beliefs do Xhosa people with schizophrenia use to explain their illness and to what extent do genetic explanations play a role in these beliefs? (2) What are the internalised stigma experiences of Xhosa people with schizophrenia? (3) How do genetic explanations relate to stigma experiences, if at all? RESULTS Most participants were able to define genetics and some linked genetics to disease causation. Despite adequate knowledge of genetics and an emphasis on genetic explanations of schizophrenia in the study, most participants held a multitude of causal explanations including: psychosocial, environmental, and cultural. Moreover, participants rarely mentioned disease cause when describing their stigma experiences. DISCUSSION For this population group, there was no straight-forward relation between a genetic attribution and stigma. Therefore, we did not find evidence that genetic attribution may significantly increase stigma. Although North American and European literature provides conflicting evidence regarding this relation, there is increased consensus that biomedical explanations for psychiatric disorders may reduce blame. This study found evidence supporting that consensus. This study provides an empirical foundation to inform ongoing work on the psychosocial implications of psychiatric genomics research in non-Western contexts.
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Affiliation(s)
- Olivia P Matshabane
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Megan M Campbell
- Department of Psychology, Rhodes University, Grahamstown, South Africa
| | - Marlyn C Faure
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Bongani M Mayosi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, USA
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Sani MU, Damasceno A, Davison BA, Cotter G, Mayosi BM, Edwards C, Azibani F, Adam T, Arif G, Jessen N, Sliwa K. N-terminal pro BNP and galectin-3 are prognostic biomarkers of acute heart failure in sub-Saharan Africa: lessons from the BAHEF trial. ESC Heart Fail 2020; 8:74-84. [PMID: 33247624 PMCID: PMC7835570 DOI: 10.1002/ehf2.13032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/22/2020] [Accepted: 09/10/2020] [Indexed: 11/28/2022] Open
Abstract
Aims The relationship between N‐terminal pro‐brain natriuretic peptide (NT‐pro‐BNP) and galectin‐3 and outcomes has not been studied in African patients with acute heart failure (AHF). The current analysis sought to describe the association between plasma levels of NT‐pro‐BNP and galectin‐3 and cardiovascular (CV) death or heart failure (HF) hospitalization, as well as their associations with symptoms and echocardiography markers of left and right ventricular remodelling among AHF patientsv in sub‐Saharan Africa. Methods and results In a subset of 80 patients with complete data in a study assessing the effects of hydralazine and nitrates in patients with AHF (BAHEF trial; NCT01822808), NT‐pro‐BNP and galectin‐3 analyses were performed, and the association with various characteristics and outcome measures assessed. The mean age of the patients for whom the aforementioned biomarkers were measured was 52.6 years, with 52.5% women. Galectin‐3 at baseline predicted changes (Week 24 to baseline) in left ventricular ejection fraction, left ventricular end‐systolic diameter, left ventricular end‐diastolic diameter, and tricuspid annular plane systolic excursion. Biomarkers and their changes were not associated with changes in 6 min walk test at 24 weeks. Baseline galectin‐3 and change in NT‐pro‐BNP were associated with improvements in dyspnoea at 24 weeks. Nine patients had an HF readmission or died of CV causes through 24 weeks (11.6%). Both biomarkers at baseline predicted combined CV death or HF hospitalization through Week 24 (P‐values = 0.0328 and 0.0001, respectively). Conclusions In a cohort of patients with AHF from sub‐Saharan Africa, NT‐pro‐BNP and galectin‐3 at baseline and their changes were associated with some changes in dyspnoea, echocardiographic remodelling, and CV death or HF hospitalization through Week 24. These tests have potential of being used for risk stratification of AHF patients in sub‐Saharan Africa where resources are scarce.
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Affiliation(s)
- Mahmoud U Sani
- Department of Medicine, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Beth A Davison
- Momentum Research Inc., Durham, NC, USA.,Inserm 942 MASCOT, Paris, France
| | - Gad Cotter
- Momentum Research Inc., Durham, NC, USA.,Inserm 942 MASCOT, Paris, France
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | | | - Feriel Azibani
- Hatter Institute for Cardiovascular Research in Africa & IDM, Inter Cape Heart Group South African Medical Research Council, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tasneem Adam
- Hatter Institute for Cardiovascular Research in Africa & IDM, Inter Cape Heart Group South African Medical Research Council, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | | | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa & IDM, Inter Cape Heart Group South African Medical Research Council, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Karthikeyan G, Connolly SJ, Ntsekhe M, Benz A, Rangarajan S, Lewis G, Yun Y, Sharma SK, Maklady F, Elghamrawy AE, Kazmi K, Cabral TTJ, Dayi H, Changsheng M, Gitura BM, Avezum A, Zuhlke L, Lwabi P, Haileamlak A, Ogah O, Chillo P, Paniagua M, ElSayed A, Dans A, Gondwe-Chunda L, Molefe-Baikai OJ, Gonzalez-Hermosillo JA, Hakim J, Damasceno A, Kamanzi ER, Musuku J, Davletov K, Connolly K, Mayosi BM, Yusuf S. The INVICTUS rheumatic heart disease research program: Rationale, design and baseline characteristics of a randomized trial of rivaroxaban compared to vitamin K antagonists in rheumatic valvular disease and atrial fibrillation. Am Heart J 2020; 225:69-77. [PMID: 32474206 DOI: 10.1016/j.ahj.2020.03.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/23/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a neglected disease affecting 33 million people, mainly in low and middle income countries. Yet very few large trials or registries have been conducted in this population. The INVICTUS program of research in RHD consists of a randomized-controlled trial (RCT) of 4500 patients comparing rivaroxaban with vitamin K antagonists (VKA) in patients with RHD and atrial fibrillation (AF), a registry of 17,000 patients to document the contemporary clinical course of patients with RHD, including a focused sub-study on pregnant women with RHD within the registry. This paper describes the rationale, design, organization and baseline characteristics of the RCT and a summary of the design of the registry and its sub-study. Patients with RHD and AF are considered to be at high risk of embolic strokes, and oral anticoagulation with VKAs is recommended for stroke prevention. But the quality of anticoagulation with VKA is poor in developing countries. A drug which does not require monitoring, and which is safe and effective for preventing stroke in patients with valvular AF, would fulfill a major unmet need. METHODS The INVestIgation of rheumatiC AF Treatment Using VKAs, rivaroxaban or aspirin Studies (INVICTUS-VKA) trial is an international, multicentre, randomized, open-label, parallel group trial, testing whether rivaroxaban 20 mg given once daily is non-inferior (or superior) to VKA in patients with RHD, AF, and an elevated risk of stroke (mitral stenosis with valve area ≤2 cm2, left atrial spontaneous echo-contrast or thrombus, or a CHA2DS2VASc score ≥2). The primary efficacy outcome is a composite of stroke or systemic embolism and the primary safety outcome is the occurrence of major bleeding. The trial has enrolled 4565 patients from 138 sites in 23 countries from Africa, Asia and South America. The Registry plans to enroll an additional 17,000 patients with RHD and document their treatments, and their clinical course for at least 2 years. The pregnancy sub-study will document the clinical course of pregnant women with RHD. CONCLUSION INVICTUS is the largest program of clinical research focused on a neglected cardiovascular disease and will provide new information on the clinical course of patients with RHD, and approaches to anticoagulation in those with concomitant AF.
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Affiliation(s)
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Alexander Benz
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Gayle Lewis
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Yan Yun
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | - Hu Dayi
- People Hospital of Peking University, Beijing, China
| | - Ma Changsheng
- People Hospital of Peking University, Beijing, China
| | | | | | - Liesl Zuhlke
- Red Cross War Memorial Childrens Hospital, Cape Town, South Africa
| | | | | | | | - Pilly Chillo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Antonio Dans
- Philippines General Hospital, Manila, Philippines
| | | | | | | | | | | | | | - John Musuku
- University Teaching Hospital, Lusaka, Zambia
| | | | - Katherine Connolly
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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7
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Gouda HN, Charlson F, Sorsdahl K, Ahmadzada S, Ferrari AJ, Erskine H, Leung J, Santamauro D, Lund C, Aminde LN, Mayosi BM, Kengne AP, Harris M, Achoki T, Wiysonge CS, Stein DJ, Whiteford H. Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the Global Burden of Disease Study 2017. Lancet Glob Health 2020; 7:e1375-e1387. [PMID: 31537368 DOI: 10.1016/s2214-109x(19)30374-2] [Citation(s) in RCA: 397] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/19/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the burden of disease in sub-Saharan Africa continues to be dominated by infectious diseases, countries in this region are undergoing a demographic transition leading to increasing prevalence of non-communicable diseases (NCDs). To inform health system responses to these changing patterns of disease, we aimed to assess changes in the burden of NCDs in sub-Saharan Africa from 1990 to 2017. METHODS We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to analyse the burden of NCDs in sub-Saharan Africa in terms of disability-adjusted life-years (DALYs)-with crude counts as well as all-age and age-standardised rates per 100 000 population-with 95% uncertainty intervals (UIs). We examined changes in burden between 1990 and 2017, and differences across age, sex, and regions. We also compared the observed NCD burden across countries with the expected values based on a country's Socio-demographic Index. FINDINGS All-age total DALYs due to NCDs increased by 67·0% between 1990 (90·6 million [95% UI 81·0-101·9]) and 2017 (151·3 million [133·4-171·8]), reflecting an increase in the proportion of total DALYs attributable to NCDs (from 18·6% [95% UI 17·1-20·4] to 29·8% [27·6-32·0] of the total burden). Although most of this increase can be explained by population growth and ageing, the age-standardised DALY rate (per 100 000 population) due to NCDs in 2017 (21 757·7 DALYs [95% UI 19 377·1-24 380·7]) was almost equivalent to that of communicable, maternal, neonatal, and nutritional diseases (26 491·6 DALYs [25 165·2-28 129·8]). Cardiovascular diseases were the second leading cause of NCD burden in 2017, resulting in 22·9 million (21·5-24·3) DALYs (15·1% of the total NCD burden), after the group of disorders categorised as other NCDs (28·8 million [25·1-33·0] DALYs, 19·1%). These categories were followed by neoplasms, mental disorders, and digestive diseases. Although crude DALY rates for all NCDs have decreased slightly across sub-Saharan Africa, age-standardised rates are on the rise in some countries (particularly those in southern sub-Saharan Africa) and for some NCDs (such as diabetes and some cancers, including breast and prostate cancer). INTERPRETATION NCDs in sub-Saharan Africa are posing an increasing challenge for health systems, which have to date largely focused on tackling infectious diseases and maternal, neonatal, and child deaths. To effectively address these changing needs, countries in sub-Saharan Africa require detailed epidemiological data on NCDs. FUNDING Bill & Melinda Gates Foundation, National Health and Medical Research Centre (Australia).
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Affiliation(s)
- Hebe N Gouda
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.
| | - Fiona Charlson
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Katherine Sorsdahl
- Alan J Fisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sanam Ahmadzada
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Alize J Ferrari
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Holly Erskine
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Janni Leung
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Damian Santamauro
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Crick Lund
- Centre for Global Mental Health, King's Global Health Institute, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Bongani M Mayosi
- Dean's Office and Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Andre Pascal Kengne
- Dean's Office and Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Meredith Harris
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Tom Achoki
- MIT Sloan School of Management, Boston, MA, USA
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; South Africa Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Harvey Whiteford
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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8
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Akpa OM, Made F, Ojo A, Ovbiagele B, Adu D, Motala AA, Mayosi BM, Adebamowo SN, Engel ME, Tayo B, Rotimi C, Salako B, Akinyemi R, Gebregziabher M, Sarfo F, Wahab K, Agongo G, Alberts M, Ali SA, Asiki G, Boua RP, Gómez-Olivé FX, Mashinya F, Micklesfield L, Mohamed SF, Nonterah EA, Norris SA, Sorgho H, Tollman S, Parekh RS, Chishala C, Ekoru K, Waddy SP, Peprah E, Mensah GA, Wiley K, Troyer J, Ramsay M, Owolabi MO. Regional Patterns and Association Between Obesity and Hypertension in Africa: Evidence From the H3Africa CHAIR Study. Hypertension 2020; 75:1167-1178. [PMID: 32172619 PMCID: PMC7176339 DOI: 10.1161/hypertensionaha.119.14147] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/12/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022]
Abstract
Hypertension and obesity are the most important modifiable risk factors for cardiovascular diseases, but their association is not well characterized in Africa. We investigated regional patterns and association of obesity with hypertension among 30 044 continental Africans. We harmonized data on hypertension (defined as previous diagnosis/use of antihypertensive drugs or blood pressure [BP]≥140/90 mmHg/BP≥130/80 mmHg) and obesity from 30 044 individuals in the Cardiovascular H3Africa Innovation Resource across 13 African countries. We analyzed data from population-based controls and the Entire Harmonized Dataset. Age-adjusted and crude proportions of hypertension were compared regionally, across sex, and between hypertension definitions. Logit generalized estimating equation was used to determine the independent association of obesity with hypertension (P value <5%). Participants were 56% women; with mean age 48.5±12.0 years. Crude proportions of hypertension (at BP≥140/90 mmHg) were 47.9% (95% CI, 47.4-48.5) for Entire Harmonized Dataset and 42.0% (41.1-42.7) for population-based controls and were significantly higher for the 130/80 mm Hg threshold at 59.3% (58.7-59.9) in population-based controls. The age-adjusted proportion of hypertension at BP≥140/90 mmHg was the highest among men (33.8% [32.1-35.6]), in western Africa (34.7% [33.3-36.2]), and in obese individuals (43.6%; 40.3-47.2). Obesity was independently associated with hypertension in population-based controls (adjusted odds ratio, 2.5 [2.3-2.7]) and odds of hypertension in obesity increased with increasing age from 2.0 (1.7-2.3) in younger age to 8.8 (7.4-10.3) in older age. Hypertension is common across multiple countries in Africa with 11.9% to 51.7% having BP≥140/90 mmHg and 39.5% to 69.4% with BP≥130/80 mmHg. Obese Africans were more than twice as likely to be hypertensive and the odds increased with increasing age.
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Affiliation(s)
- Onoja M. Akpa
- From the Center for Genomic and Precision Medicine, College of Medicine, (O.M.A., B.S., R.A., M.O.O.), University of Ibadan, Ibadan, Nigeria
- Department of Epidemiology and Medical Statistics, College of Medicine (O.M.A.), University of Ibadan, Ibadan, Nigeria
- Institute of Cardiovascular Diseases, College of Medicine (O.M.A.), University of Ibadan, Ibadan, Nigeria
- Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (O.M.A., F. Made, S.A.A., M.R.)
| | - Felix Made
- The Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Services, Gauteng Region, South Africa (F. Made)
- Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (O.M.A., F. Made, S.A.A., M.R.)
| | - Akinlolu Ojo
- Clinical research and global health initiatives, University of Arizona Health Sciences (A.O.)
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco CA, USA (B.O.)
| | - Dwomoa Adu
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana (D.A.)
| | - Ayesha A. Motala
- Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa (A.A.M.)
| | - Bongani M. Mayosi
- Department of Medicine, Groote Schuur Hospital (B.M.M.), University of Cape Town, South Africa
| | - Sally N. Adebamowo
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA (S.N.A.)
| | - Mark E. Engel
- Division of Cardiology, Department of Medicine (M.E.E., C.C.), University of Cape Town, South Africa
| | - Bamidele Tayo
- Department of Preventive Medicine and Epidemiology, Loyola University Chicago Stritch School of Medicine, Maywood, IL (B.T.)
| | - Charles Rotimi
- Center for Research on Genomics and Global Health, NHGRI, NIH, Bethesda, MD, USA (C.R.)
| | - Babatunde Salako
- From the Center for Genomic and Precision Medicine, College of Medicine, (O.M.A., B.S., R.A., M.O.O.), University of Ibadan, Ibadan, Nigeria
| | - Rufus Akinyemi
- From the Center for Genomic and Precision Medicine, College of Medicine, (O.M.A., B.S., R.A., M.O.O.), University of Ibadan, Ibadan, Nigeria
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA (M.G.)
| | - Fred Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S.)
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Nigeria (K. Wahab)
| | - Godfred Agongo
- Navrongo Health Research Centre, Ghana (G. Agongo, E.A.N.)
| | - Marianne Alberts
- Department of Pathology and Medical Science, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa (M.A., F. Mashinya)
| | - Stuart A. Ali
- Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (O.M.A., F. Made, S.A.A., M.R.)
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya (G. Asiki, S.F.M.)
| | - Romuald P. Boua
- Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Burkina Faso (R.P.B., H.S.)
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (F.X.G.-O., S.T.)
| | - Felistas Mashinya
- Department of Pathology and Medical Science, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa (M.A., F. Mashinya)
| | - Lisa Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (L.M., S.A.N.)
| | - Shukri F. Mohamed
- African Population and Health Research Center, Nairobi, Kenya (G. Asiki, S.F.M.)
| | | | - Shane A. Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (L.M., S.A.N.)
| | - Hermann Sorgho
- Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Burkina Faso (R.P.B., H.S.)
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (F.X.G.-O., S.T.)
| | - Rulan S. Parekh
- Departments of Pediatrics, Medicine and Epidemiology, Hospital for Sick Children, University Health Network and University of Toronto, Canada (R.S.P.)
| | - Chishala Chishala
- Division of Cardiology, Department of Medicine (M.E.E., C.C.), University of Cape Town, South Africa
| | - Kenneth Ekoru
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (K.E.)
| | - Salina P. Waddy
- Department of Neurology, Atlanta Veterans Affairs Medical Center, Decatur, GA (S.P.W.)
| | - Emmanuel Peprah
- College of Global Public Health, New York University, New York, NY (E.P.)
| | - George A. Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD (G.A.M.)
| | - Ken Wiley
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD (K. Wiley)
| | - Jennifer Troyer
- Human Heredity and Health in Africa, Division of Genome Sciences (J.T.), National Institutes of Health, Bethesda, MD
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (O.M.A., F. Made, S.A.A., M.R.)
| | - Mayowa O. Owolabi
- From the Center for Genomic and Precision Medicine, College of Medicine, (O.M.A., B.S., R.A., M.O.O.), University of Ibadan, Ibadan, Nigeria
| | - as members of the CVD Working Group of the H3Africa Consortium
- From the Center for Genomic and Precision Medicine, College of Medicine, (O.M.A., B.S., R.A., M.O.O.), University of Ibadan, Ibadan, Nigeria
- Department of Epidemiology and Medical Statistics, College of Medicine (O.M.A.), University of Ibadan, Ibadan, Nigeria
- Institute of Cardiovascular Diseases, College of Medicine (O.M.A.), University of Ibadan, Ibadan, Nigeria
- The Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Services, Gauteng Region, South Africa (F. Made)
- Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (O.M.A., F. Made, S.A.A., M.R.)
- Clinical research and global health initiatives, University of Arizona Health Sciences (A.O.)
- Department of Neurology, University of California, San Francisco CA, USA (B.O.)
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana (D.A.)
- Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa (A.A.M.)
- Department of Medicine, Groote Schuur Hospital (B.M.M.), University of Cape Town, South Africa
- Division of Cardiology, Department of Medicine (M.E.E., C.C.), University of Cape Town, South Africa
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA (S.N.A.)
- Department of Preventive Medicine and Epidemiology, Loyola University Chicago Stritch School of Medicine, Maywood, IL (B.T.)
- Center for Research on Genomics and Global Health, NHGRI, NIH, Bethesda, MD, USA (C.R.)
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA (M.G.)
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S.)
- Department of Medicine, University of Ilorin, Nigeria (K. Wahab)
- Navrongo Health Research Centre, Ghana (G. Agongo, E.A.N.)
- Department of Pathology and Medical Science, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa (M.A., F. Mashinya)
- African Population and Health Research Center, Nairobi, Kenya (G. Asiki, S.F.M.)
- Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Burkina Faso (R.P.B., H.S.)
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (F.X.G.-O., S.T.)
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (L.M., S.A.N.)
- Departments of Pediatrics, Medicine and Epidemiology, Hospital for Sick Children, University Health Network and University of Toronto, Canada (R.S.P.)
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (K.E.)
- Department of Neurology, Atlanta Veterans Affairs Medical Center, Decatur, GA (S.P.W.)
- College of Global Public Health, New York University, New York, NY (E.P.)
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD (G.A.M.)
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD (K. Wiley)
- Human Heredity and Health in Africa, Division of Genome Sciences (J.T.), National Institutes of Health, Bethesda, MD
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9
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Owolabi MO, Akpa OM, Made F, Adebamowo SN, Ojo A, Adu D, Motala AA, Mayosi BM, Ovbiagele B, Adebamowo C, Tayo B, Rotimi C, Akinyemi R, Gebregziabher M, Sarfo F, Wahab KW, Parekh RS, Engel ME, Chisala C, Peprah E, Mensah G, Wiley K, Troyer J, Ramsay M. Data Resource Profile: Cardiovascular H3Africa Innovation Resource (CHAIR). Int J Epidemiol 2020; 48:366-367g. [PMID: 30535409 DOI: 10.1093/ije/dyy261] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Onoja M Akpa
- Center for Genomic and Precision Medicine.,Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Felix Made
- Epidemiology and Surveillance Section, National Health Laboratory Services, Braamfontein, Gauteng Region, South Africa.,Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, University of the Witwatersrand, Johannesburg, South Africa
| | - Sally N Adebamowo
- Department of Epidemiology and Public Health, and Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Akinlolu Ojo
- Clinical Research and Global Health Initiatives, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Dwomoa Adu
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Bruce Ovbiagele
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Clement Adebamowo
- Department of Epidemiology and Public Health, and Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, and Institute of Human Virology, Abuja, Nigeria.,Center for Bioethics and Research, Department of Medicine, Ibadan, Nigeria
| | - Bamidele Tayo
- Department of Preventive Medicine and Epidemiology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Charles Rotimi
- Center for Research on Genomics and Global Health, NHGRI, NIH, Bethesda, MD, USA
| | | | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Fred Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Rulan S Parekh
- Department of Pediatrics, Medicine and Epidemiology, Hospital for Sick Children, Research Institute, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Mark E Engel
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Chisala Chisala
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Emmanuel Peprah
- Global Health Program, Department of Social and Behavioral Sciences, New York University, NY, USA
| | | | | | - Jennifer Troyer
- Division of Genome Sciences, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, University of the Witwatersrand, Johannesburg, South Africa
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10
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Barth DD, Moloi A, Mayosi BM, Engel ME. Prevalence of group A Streptococcal infection in Africa to inform GAS vaccines for rheumatic heart disease: A systematic review and meta-analysis. Int J Cardiol 2019; 307:200-208. [PMID: 31864789 DOI: 10.1016/j.ijcard.2019.11.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prevalence of group A streptococcal (GAS) disease is estimated at >18.1 million cases with an incidence of >1.78 million cases per year. While a significant cause of mortality and morbidity on the global scale, the burden of GAS disease in Africa is unknown. We conducted a systematic review on the prevalence of GAS disease among children and adults in Africa and the frequency and distribution of emm types among isolates. METHODS We performed a comprehensive literature search in a number of databases, using an African search filter. Two reviewers independently selected articles meeting pre-specified criteria and extracted relevant data as per a data extraction form. We applied the random-effects meta-analysis model to aggregate GAS prevalence estimates with 95% CI for GAS prevalence, incorporating the Freeman-Tukey transformation to account for between-study variability. RESULTS Twenty-five studies were included. Invasive GAS disease prevalence ranged from 0.6% to 10.8% in samples from normally-sterile sites including blood, CSF and soft tissue. A single study reported a prevalence of 74% in skin infections. Prevalence of emm types varied with up to 88 different strains reported, corresponding to a vaccine coverage of 28% to 65%. The pooled prevalence of GAS in persons presenting with pharyngitis was 21% (95% CI, 17% to 26%). CONCLUSIONS The prevalence of GAS remains high among symptomatic individuals residing in Africa. Data on molecular strain characterisation of GAS in Africa is largely non-existent, thus the need for further studies is warranted to inform current prevention efforts including vaccine development.
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Affiliation(s)
- Dylan D Barth
- Department of Medicine, Faculty of Health Sciences, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa; Wesfarmer's Centre for Vaccines and Infectious diseases, Telethon Kids Institute, Nedlands, Perth, Western Australia, Australia; Faculty of Health and Medical Sciences, University of Western Australia, Nedlands, Perth, Western Australia, Australia
| | - Annesinah Moloi
- South African Medical Research Council, Cape Town, South Africa; Department of Medicine, Faculty of Health Sciences, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | - Bongani M Mayosi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | - Mark E Engel
- Department of Medicine, Faculty of Health Sciences, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa.
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11
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Noubiap JJ, Agbor VN, Bigna JJ, Kaze AD, Nyaga UF, Mayosi BM. Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies. Sci Rep 2019; 9:17022. [PMID: 31745178 PMCID: PMC6863880 DOI: 10.1038/s41598-019-53540-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022] Open
Abstract
This systematic review and meta-analysis aimed to provide a contemporaneous estimate of the global burden of rheumatic heart disease (RHD) from echocardiographic population-based studies. We searched multiple databases between January 01, 1996 and October 17, 2017. Random-effect meta-analysis was used to pool data. We included 82 studies (1,090,792 participant) reporting data on the prevalence of RHD and 9 studies on the evolution of RHD lesions. The pooled prevalence of RHD was 26.1‰ (95%CI 19.2–33.1) and 11.3‰ (95%CI 7.2–16.2) for studies which used the World Heart Federation (WHF) and World Health Organization (WHO) criteria, respectively. The prevalence of RHD varied inversely with the level of a country’s income, was lower with the WHO criteria compared to the WHF criteria, and was lowest in South East Asia. Definite RHD progressed in 7.5% (95% CI 1.5–17.6) of the cases, while 60.7% (95% CI 42.4–77.5) of cases remained stable over the course of follow-up. The proportion of cases borderline RHD who progressed to definite RHD was 11.3% (95% CI 6.9–16.5). The prevalence of RHD across WHO regions remains high. The highest prevalence of RHD was noted among studies which used the WHF diagnostic criteria. Definite RHD tends to progress or remain stable over time.
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Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Valirie N Agbor
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon. .,School of Public Health, Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France.
| | - Arnaud D Kaze
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Bongani M Mayosi
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,The Dean's Office, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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12
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Nethononda RM, McGurk KA, Whitworth P, Francis J, Mamasoula C, Cordell HJ, Neubauer S, Keavney BD, Mayosi BM, Farrall M, Watkins H. Marked variation in heritability estimates of left ventricular mass depending on modality of measurement. Sci Rep 2019; 9:13556. [PMID: 31537879 PMCID: PMC6753112 DOI: 10.1038/s41598-019-49961-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/29/2019] [Indexed: 11/09/2022] Open
Abstract
Left ventricular (LV) hypertrophy is a strong risk factor for heart failure and cardiovascular death. ECG measures of LV mass are estimated as heritable in twin and family-based analyses and heritability estimates of LV mass measured by echocardiography are lower. We hypothesised that CMR-derived measurements, being more precise than echocardiographic measurements, would advance our understanding of heritable LV traits. We phenotyped 116 British families (427 individuals) by CMR and ECG, and undertook heritability analyses using variance-components (QTDT) and GWAS SNP-based (GCTA-GREML) methods. ECG-based traits such as LV mass and Sokolow-Lyon duration showed substantial estimates of heritability (60%), whereas CMR-derived LV mass was only modestly heritable (20%). However, the ECG LV mass was positively correlated with the lateral diameter of the chest (rho = 0.67), and adjustment for this attenuated the heritability estimate (42%). Finally, CMR-derived right ventricular mass showed considerable heritability (44%). Heritability estimates of LV phenotypes show substantial variation depending on the modality of measurement, being greater when measured by ECG than CMR. This may reflect the differences between electrophysiological as opposed to anatomical hypertrophy. However, ECG LV hypertrophy traits are likely to be influenced by genetic association with anthropometric measures, inflating their overall measured heritability.
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Affiliation(s)
- Richard M Nethononda
- Division of Cardiology, Chris Hani Baragwanath Hospital, Soweto and the University of Witwatersrand, Johannesburg, South Africa
| | - Kathryn A McGurk
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Polly Whitworth
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Oxford Cardiovascular Clinical Research Facility (CCRF), John Radcliffe Hospital, Oxford, UK
| | - Jane Francis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, UK
| | | | - Heather J Cordell
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, UK.,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Bernard D Keavney
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Bongani M Mayosi
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Martin Farrall
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. .,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK.
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13
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Bonny A, Ngantcha M, Jeilan M, Okello E, Kaviraj B, Talle MA, Nel G, Marijon E, Sani MU, Yousef Z, Karaye KM, Touré IA, Awad MA, Millogo G, Kologo J, Kane A, Houndolo R, Dzudié A, Mbakwem A, Mayosi BM, Chin A. Statistics on the use of cardiac electronic devices and interventional electrophysiological procedures in Africa from 2011 to 2016: report of the Pan African Society of Cardiology (PASCAR) Cardiac Arrhythmias and Pacing Task Forces. Europace 2019; 20:1513-1526. [PMID: 29309556 PMCID: PMC6123943 DOI: 10.1093/europace/eux353] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/07/2017] [Indexed: 11/14/2022] Open
Abstract
Aims To provide comprehensive information on the access and use of cardiac implantable electronic devices (CIED) and catheter ablation procedures in Africa. Methods and results The Pan-African Society of Cardiology (PASCAR) collected data on invasive management of cardiac arrhythmias from 2011 to 2016 from 31 African countries. A specific template was completed by physicians, and additional information obtained from industry. Information on health care systems, demographics, economics, procedure rates, and specific training programs was collected. Considerable heterogeneity in the access to arrhythmia care was observed across Africa. Eight of the 31 countries surveyed (26%) did not perform pacemaker implantations. The median pacemaker implantation rate was 2.66 per million population per country (range: 0.14–233 per million population). Implantable cardioverter-defibrillator and cardiac resynchronization therapy were performed in 12/31 (39%) and 15/31 (48%) countries respectively, mostly by visiting teams. Electrophysiological studies, including complex catheter ablations were performed in all countries from Maghreb, but only one sub-Saharan African country (South Africa). Marked variation in cost (up to 1000-fold) was observed across countries with an inverse correlation between implant rates and the procedure fees standardized to the gross domestic product per capita. Lack of economic resources and facilities, high cost of procedures, deficiency of trained physicians, and non-existent fellowship programs were the main drivers of under-utilization of interventional cardiac arrhythmia care. Conclusion There is limited access to CIED and ablation procedures in Africa. A quarter of countries did not have pacemaker implantation services, and catheter ablations were only available in one country in sub-Saharan Africa.
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Affiliation(s)
- Aimé Bonny
- University Hospital Laquintinie, Cardiac unit, University of Douala, BP, Douala, Cameroon.,Cameroon Cardiovascular Research Network, BP, Douala, Cameroon.,Centre Hospitalier V. Dupouy, service de cardiologie, 69, rue du Lt-col Prudhon, Argenteuil Cedex, France
| | - Marcus Ngantcha
- Cameroon Cardiovascular Research Network, BP, Douala, Cameroon
| | - Mohamed Jeilan
- Aga Khan University hospital, Department of Medicine, 3rd Parklands Rd, Nairobi, Kenya
| | - Emmy Okello
- Makerere University, Uganda Heart Institute, Mulago Hospital Complex, Department of Cardiology, Mulago Hill Road, PO Box 7051, Kampala, Uganda
| | - Bundhoo Kaviraj
- Dr A.G Jeetoo Hospital, Department of Cardiology, Port Louis, Mauritius
| | - Mohammed A Talle
- Maiduguri Teaching University Hospital, Department of Cardiology, Maiduguri, Nigeria
| | - George Nel
- Pan-African Society of Cardiology (PASCAR), Department of Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Eloi Marijon
- European Georges Pompidou Hospital, Cardiology Department and Global Health Unit (Inserm U970), 20 rue Leblanc, Paris, France
| | - Mahmoud U Sani
- Bayero University/Aminu Kano Teaching Hospital, Department of Medicine, Kano, Nigeria
| | - Zaheer Yousef
- University Hospital of Wales, Department of Cardiology, Cardiff, UK
| | - Kamilu M Karaye
- Bayero University/Aminu Kano Teaching Hospital, Department of Medicine, Kano, Nigeria
| | - Ibrahim A Touré
- Centre Hospitalier Lamorde, service de médecine interne et de cardiologie, Niamey, Niger
| | - Mohamed A Awad
- University of Khartoum, Department of Medicine, Elgaasr street, Khartoum, Sudan
| | - George Millogo
- Centre Hospitalier Yalgado Ouedraogo, Ouagadougou, service de cardiologie, Burkina Faso
| | - Jonas Kologo
- Centre Hospitalier Yalgado Ouedraogo, Ouagadougou, service de cardiologie, Burkina Faso
| | - Adama Kane
- CHU Aristide Le Dantec, service de cardiologie, Dakar, Senegal
| | - Romain Houndolo
- CHU Aristide Le Dantec, service de cardiologie, Dakar, Senegal
| | - Anastase Dzudié
- Douala General Hospital, Department of Internal Medicine, BP, Douala, Cameroon
| | - Amam Mbakwem
- University of Lagos and Lagos University Teaching Hospital, College of Medicine, Department of Medicine, PMB, Lagos, Nigeria
| | - Bongani M Mayosi
- Dean's Office, Barnard Fuller Building, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Ashley Chin
- Groote Schuur Hospital and University of Cape Town, Cardiac Clinic, Department of Medicine, Main Road, Observatory, Cape Town, South Africa
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14
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Mweemba O, Musuku J, Mayosi BM, Parker M, Rutakumwa R, Seeley J, Tindana P, De Vries J. Use of broad consent and related procedures in genomics research: Perspectives from research participants in the Genetics of Rheumatic Heart Disease (RHDGen) study in a University Teaching Hospital in Zambia. Glob Bioeth 2019; 31:184-199. [PMID: 33343192 PMCID: PMC7734073 DOI: 10.1080/11287462.2019.1592868] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The use of broad consent for genomics research raises important ethical questions for the conduct of genomics research, including relating to its acceptability to research participants and comprehension of difficult scientific concepts. To explore these and other challenges, we conducted a study using qualitative methods with participants enrolled in an H3Africa Rheumatic Heart Disease genomics study (the RHDGen network) in Zambia to explore their views on broad consent, sample and data sharing and secondary use. In-depth interviews were conducted with RHDGen participants (n = 18), study staff (n = 5) and with individuals who refused to participate (n = 3). In general, broad consent was seen to be reasonable if reasons for storing the samples for future research use were disclosed. Some felt that broad consent should be restricted by specifying planned future studies and that secondary research should ideally relate to original disease for which samples were collected. A few participants felt that broad consent would delay the return of research results to participants. This study echoes findings in other similar studies in other parts of the continent that suggested that broad consent could be an acceptable consent model in Africa if careful thought is given to restrictions on re-use.
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Affiliation(s)
- Oliver Mweemba
- Department of Health Promotion and Education, University of Zambia, Lusaka, Zambia
| | - John Musuku
- Children Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - Bongani M Mayosi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Michael Parker
- Wellcome Centre for Ethics and Humanities (Ethox), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rwamahe Rutakumwa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Jantina De Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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15
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Affiliation(s)
- Mohammed R Essop
- Faculty of Health Sciences, Department of Health Sciences, Division of Cardiology, University of the Witwatersrand, Johannesburg, South Africa (M.R.E). Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa (B.M.M.).
| | - Bongani M Mayosi
- Faculty of Health Sciences, Department of Health Sciences, Division of Cardiology, University of the Witwatersrand, Johannesburg, South Africa (M.R.E). Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa (B.M.M.)
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16
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Talle MA, Bonny A, Scholtz W, Chin A, Nel G, Karaye KM, Anzouan-Kacou JB, Damasceno A, Lubenga YR, Sani MU, Mayosi BM. Status of cardiac arrhythmia services in Africa in 2018: a PASCAR Sudden Cardiac Death Task Force report. Cardiovasc J Afr 2019; 29:115-121. [PMID: 29745966 PMCID: PMC6008897 DOI: 10.5830/cvja-2018-027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 04/18/2018] [Indexed: 12/02/2022] Open
Abstract
Background There is limited information on the availability of health services to treat cardiac arrhythmias in Africa. Methods The Pan–African Society of Cardiology (PASCAR) Sudden Cardiac Death Task Force conducted a survey of the burden of cardiac arrhythmias and related services over two months (15 October to 15 December) in 2017. An electronic questionnaire was completed by general cardiologists and electrophysiologists working in African countries. The questionnaire focused on availability of human resources, diagnostic tools and treatment modalities in each country. Results We received responses from physicians in 33 out of 55 (60%) African countries. Limited use of basic cardiovascular drugs such as anti–arrhythmics and anticoagulants prevails. Non–vitamin K–dependent oral anticoagulants (NOACs) are not widely used on the continent, even in North Africa. Six (18%) of the sub–Saharan African (SSA) countries do not have a registered cardiologist and about one–third do not have pacemaker services. The median pacemaker implantation rate was 2.66 per million population per country, which is 200–fold lower than in Europe. The density of pacemaker facilities and operators in Africa is quite low, with a median of 0.14 (0.03–6.36) centres and 0.10 (0.05–9.49) operators per million population. Less than half of the African countries have a functional catheter laboratory with only South Africa providing the full complement of services for cardiac arrhythmia in SSA. Overall, countries in North Africa have better coverage, leaving more than 110 million people in SSA without access to effective basic treatment for cardiac conduction disturbances. Conclusion The lack of diagnostic and treatment services for cardiac arrhythmias is a common scenario in the majority of SSA countries, resulting in sub–optimal care and a subsequent high burden of premature cardiac death. There is a need to improve the standard of care by providing essential services such as cardiac pacemaker implantation.
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Affiliation(s)
- M A Talle
- Cardiology Unit, Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - A Bonny
- University of Douala, Cameroon Cardiovascular Research Network, Douala, Cameroon; Hopital Forcilles, Ferolles-Attilly, France
| | - W Scholtz
- Pan-Africa Society of Cardiology (PASCAR)
| | - A Chin
- Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - G Nel
- Pan-Africa Society of Cardiology (PASCAR)
| | - K M Karaye
- Bayero University and Aminu Kano Teaching Hospital, Department of Cardiology, Kano, Nigeria
| | - J B Anzouan-Kacou
- Felix Houphouet Boigny University, Abidjan, Ivory Coast; Cardiology Institute of Abidjan, Ivory Coast
| | - A Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Y R Lubenga
- Department of Cardiology, University Hospital of Kinshasa, Democratic Republic of Congo
| | - M U Sani
- Bayero University and Aminu Kano Teaching Hospital, Department of Cardiology, Kano, Nigeria
| | - B M Mayosi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
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17
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Zilla P, Yacoub M, Zühlke L, Beyersdorf F, Sliwa K, Khubulava G, Bouzid A, Mocumbi AO, Velayoudam D, Shetty D, Ofoegbu C, Geldenhuys A, Brink J, Scherman J, du Toit H, Hosseini S, Zhang H, Luo XJ, Wang W, Mejia J, Kofidis T, Higgins RS, Pomar J, Bolman RM, Mayosi BM, Madansein R, Bavaria J, Yanes-Quintana AA, Kumar AS, Adeoye O, Chauke RF, Williams DF. Global Unmet Needs in Cardiac Surgery. Glob Heart 2018; 13:293-303. [DOI: 10.1016/j.gheart.2018.08.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022] Open
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18
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Abstract
Contextual functional interpretation of -omics data derived from clinical samples is a classical and difficult problem in computational systems biology. The measurement of thousands of data points on single samples has become routine but relating ‘big data’ datasets to the complexities of human pathobiology is an area of ongoing research. Complicating this is the fact that many publicly available datasets use bulk transcriptomics data from complex tissues like blood. The most prevalent analytic approaches derive molecular ‘signatures’ of disease states or apply modular analysis frameworks to the data. Here we describe ANIMA (association network integration for multiscale analysis), a network-based data integration method using clinical phenotype and microarray data as inputs. ANIMA is implemented in R and Neo4j and runs in Docker containers. In short, the build algorithm iterates over one or more transcriptomics datasets to generate a large, multipartite association network by executing multiple independent analytic steps (differential expression, deconvolution, modular analysis based on co-expression, pathway analysis) and integrating the results. Once the network is built, it can be queried directly using Cypher (a graph query language), or by custom functions that communicate with the graph database via language-specific APIs. We developed a web application using Shiny, which provides fully interactive, multiscale views of the data. Using our approach, we show that we can reconstruct multiple features of disease states at various scales of organization, from transcript abundance patterns of individual genes through co-expression patterns of groups of genes to patterns of cellular behaviour in whole blood samples, both in single experiments as well in meta-analyses of multiple datasets.
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Affiliation(s)
- Armin Deffur
- Department of Medicine, University of Cape Town, Cape Town, 7925, South Africa
| | - Robert J Wilkinson
- Department of Medicine, University of Cape Town, Cape Town, 7925, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, 7925, South Africa.,Francis Crick Institute, London, NW1 1AT, UK.,Imperial College London, London, W2 1PG, UK
| | - Bongani M Mayosi
- Department of Medicine, University of Cape Town, Cape Town, 7925, South Africa
| | - Nicola M Mulder
- Computational Biology Division, Department Integrative Biomedical Sciences, IDM, University of Cape Town, Cape Town, 7925, South Africa
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19
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Thomas V, Schulein S, Millar RN, Mayosi BM. Clinical characteristics and outcome of lone atrial fibrillation at a tertiary referral centre: the Groote Schuur Hospital experience. Cardiovasc J Afr 2018; 29:268-272. [PMID: 30395140 DOI: 10.5830/cvja-2018-005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 01/14/2018] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is a relatively common arrhythmia. When AF represents an electrophysiological phenomenon in structurally normal hearts, it is termed lone AF. This study was a retrospective, case-based analysis of patients attending the Cardiac Clinic at Groote Schuur Hospital (GSH) and describes the clinical characteristics and outcomes of patients classified as having lone atrial fibrillation. To the best of our knowledge there are no such studies reported from Africa. METHODS This was a retrospective, descriptive study in which 289 medical records of patients with AF at the GSH Cardiac Clinic were reviewed from 1992 to 2006. The clinical data were interrogated to exclude identifiable causes of AF. Information on clinical characteristics and outcomes were entered into a data-entry form. Baseline descriptive statistics were expressed as means and range for continuous variables, and counts with percentages for categorical variables. RESULTS Fifteen per cent (n = 42) of patients were identified as having lone AF, with a mean follow-up time of 5.8 years. Males comprised 57% (n = 24) and females 43% (n = 18). Fifty per cent (n = 21) of the patients had paroxysmal AF, 29% (n = 12) had persistent AF, and 12% (n = 5) progressed from paroxysmal to permanent AF. Subsets of lone AF included concomitant atrial flutter (17%) (n = 7) and sick sinus syndrome (21%) (n = 9). Complications were stroke (10%) (n = 4), tachycardia-related cardiomyopathy (17%) (n = 7) and bleeding complications on warfarin (11%) (n = 3). CONCLUSIONS Lone AF is not an uncommon arrhythmia, with a preponderance in thin, middle-aged males. The symptoms of lone AF can be debilitating. It has associated morbidity, including tachycardia-related cardiomyopathy and thromboembolism. Rate control and appropriate anticoagulation are the cornerstones of patient management.
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Affiliation(s)
- Vinod Thomas
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
| | - Simone Schulein
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Robert N Millar
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Bongani M Mayosi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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Ramasamy V, Mayosi BM, Sturrock ED, Ntsekhe M. Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis. World J Cardiol 2018; 10:87-96. [PMID: 30344956 PMCID: PMC6189073 DOI: 10.4330/wjc.v10.i9.87] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/06/2018] [Accepted: 04/22/2018] [Indexed: 02/06/2023] Open
Abstract
This review article aims to: (1) discern from the literature the immune and inflammatory processes occurring in the pericardium following injury; and (2) to delve into the molecular mechanisms which may play a role in the progression to constrictive pericarditis. Pericarditis arises as a result of a wide spectrum of pathologies of both infectious and non-infectious aetiology, which lead to various degrees of fibrogenesis. Current understanding of the sequence of molecular events leading to pathological manifestations of constrictive pericarditis is poor. The identification of key mechanisms and pathways common to most fibrotic events in the pericardium can aid in the design and development of novel interventions for the prevention and management of constriction. We have identified through this review various cellular events and signalling cascades which are likely to contribute to the pathological fibrotic phenotype. An initial classical pattern of inflammation arises as a result of insult to the pericardium and can exacerbate into an exaggerated or prolonged inflammatory state. Whilst the implication of major drivers of inflammation and fibrosis such as tumour necrosis factor and transforming growth factor β were foreseeable, the identification of pericardial deregulation of other mediators (basic fibroblast growth factor, galectin-3 and the tetrapeptide Ac-SDKP) provides important avenues for further research.
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Affiliation(s)
- Vinasha Ramasamy
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Integrative Biomedical Sciences, University of Cape Town, Observatory 7925, South Africa
| | - Bongani M Mayosi
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Division of Cardiology, University of Cape Town, Observatory 7925, South Africa
| | - Edward D Sturrock
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Integrative Biomedical Sciences, University of Cape Town, Observatory 7925, South Africa
| | - Mpiko Ntsekhe
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Division of Cardiology, University of Cape Town, Observatory 7925, South Africa
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21
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Karthikeyan G, Devasenapathy N, Zühlke L, Engel ME, Rangarajan S, Teo KK, Mayosi BM, Yusuf S. Digoxin and clinical outcomes in the Global Rheumatic Heart Disease Registry. Heart 2018; 105:363-369. [PMID: 30209123 DOI: 10.1136/heartjnl-2018-313614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Digoxin is widely used in patients with rheumatic heart disease (RHD) despite a lack of data on its impact on clinical outcomes. We aimed to determine the association of digoxin use on clinical outcomes in patients with RHD. METHODS We performed a retrospective analysis of the association of digoxin use with mortality at 2 years in a large RHD registry. Secondary outcomes were recurrent heart failure (HF) and hospitalisation for any cause. We assessed associations using multivariable logistic regression in the entire cohort and in subgroups of patients with atrial fibrillation (AF) and HF. We also estimated average treatment effects from propensity-adjusted analyses using inverse probability treatment weighting. RESULTS Information on digoxin use at baseline was available for 98.7% (3298/3343) of patients. In the overall population, digoxin was significantly associated with mortality (OR 1.63, 95% CI 1.30 to 2.04, p<0.0001) and recurrent HF (OR 1.48, 95% CI 1.07 to 2.04, p=0.019). On propensity-weighted analyses, this effect was markedly attenuated (OR 1.05, 95% CI 1.01 to 1.09, p=0.005). Patients in sinus rhythm without HF had a higher propensity-adjusted odds of death with digoxin use (OR 1.06, 95% CI 1.01 to 1.12, p=0.015), but those with both AF and HF had lower mortality (OR 0.88, 95% CI 0.80 to 0.98, p=0.019). CONCLUSION Digoxin use is associated with higher mortality in patients with RHD, but this is greatly attenuated on propensity adjustment, indicating the presence of substantial treatment bias. The adjusted estimates may therefore not be reliable, and large randomised trials are needed to determine the true effect of digoxin in patients with RHD.
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Affiliation(s)
- Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Liesl Zühlke
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa.,Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Mark Emmanuel Engel
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Koon K Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
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Zilla P, Bolman RM, Yacoub MH, Beyersdorf F, Sliwa K, Zühlke L, Higgins RS, Mayosi BM, Carpentier A, Williams D. The Cape Town Declaration on Access to Cardiac Surgery in the Developing World. Cardiovasc J Afr 2018; 29:256-259. [PMID: 30080213 PMCID: PMC6291809 DOI: 10.5830/cvja-2018-046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mission to urge all relevant entities within the international cardiac surgery, industry and government sectors to commit to develop and implement an effective strategy to address the scourge of rheumatic heart disease in the developing world through increased access to life-saving cardiac surgery.
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Affiliation(s)
- P Zilla
- Christiaan Barnard Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - R Morton Bolman
- Division of Cardiothoracic Surgery, University of Vermont, Burlington, Vermont, USA
| | | | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Universitäts- Herzzentrum Freiburg-Bad Krotzingen, Freiburg, Germany
| | - Karen Sliwa
- Hatter Institute of Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Liesl Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Robert S Higgins
- Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Bongani M Mayosi
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - David Williams
- Wake Forest Institute of Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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23
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Ojji DB, Poulter N, Damasceno A, Sliwa K, Smythe W, Kramer N, Badri M, Francis V, Aje A, Barasa F, Dzudie A, Jones E, Kana SS, Mntla P, Mondo C, Ogah O, Ogola EN, Ogunbanjo G, Okpechi I, Shedul G, Sani MU, Shedul G, Mayosi BM. Rationale and design of the comparison of 3 combination therapies in lowering blood pressure in black Africans (CREOLE study): 2 × 3 factorial randomized single-blind multicenter trial. Am Heart J 2018; 202:5-12. [PMID: 29800784 DOI: 10.1016/j.ahj.2018.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/13/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Current hypertension guidelines recommend the use of combination therapy as first-line treatment or early in the management of hypertensive patients. Although there are many possible combinations of blood pressure(BP)-lowering therapies, the best combination for the black population is still a subject of debate because no large randomized controlled trials have been conducted in this group to compare the efficacy of different combination therapies to address this issue. METHODS The comparison of 3 combination therapies in lowering BP in the black Africans (CREOLE) study is a randomized single-blind trial that will compare the efficacy of amlodipine plus hydrochlorothiazide versus amlodipine plus perindopril and versus perindopril plus hydrochlorothiazide in blacks residing in sub-Saharan Africa (SSA). Seven hundred two patients aged 30-79 years with a sitting systolic BP of 140 mm Hg and above, and less than 160 mm Hg on antihypertensive monotherapy, or sitting systolic BP of 150 mm Hg and above, and less than 180 mm Hg on no treatment, will be centrally randomized into any of the 3 arms (234 into each arm). The CREOLE study is taking place in 10 sites in SSA, and the primary outcome measure is change in ambulatory systolic BP from baseline to 6 months. The first patient was randomized in June 2017, and the trial will be concluded by 2019. CONCLUSIONS The CREOLE trial will provide unique information as to the most efficacious 2-drug combination in blacks residing in SSA and thereby inform the development of clinical guidelines for the treatment of hypertension in this subregion.
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Affiliation(s)
- Dike B Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja/University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Neil Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Karen Sliwa
- Hatter Institute of Cardiovascular Research in Africa, Cape Town, South Africa
| | - Wynand Smythe
- Clinical Research Centre, Faculty of Clinical Sciences, University of Cape Town, Cape Town, South Africa
| | - Nicky Kramer
- Clinical Research Centre, Faculty of Clinical Sciences, University of Cape Town, Cape Town, South Africa
| | - Motasim Badri
- Department of Basic Sciences, College of Sciences & Health Professions King Saud Bin Abdul-Aziz University for Health Sciences NGHA, Riyadh, Saudi Arabia; Department of Medicine, Faculty of Clinical Sciences, University of Cape Town, Cape Town, South Africa
| | - Veronica Francis
- Clinical Research Centre, Faculty of Clinical Sciences, University of Cape Town, Cape Town, South Africa
| | | | | | | | - Erika Jones
- Department of Medicine, Faculty of Clinical Sciences, University of Cape Town, Cape Town, South Africa
| | - Shehu S Kana
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Pindile Mntla
- Department of Cardiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | | | - Elijah N Ogola
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Gboyega Ogunbanjo
- Department of Family Medicine & Primary Health Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Ikechi Okpechi
- Department of Medicine, Faculty of Clinical Sciences, University of Cape Town, Cape Town, South Africa
| | - Gabriel Shedul
- Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja
| | | | - Grace Shedul
- Department of Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Bongani M Mayosi
- Department of Medicine, Faculty of Clinical Sciences, University of Cape Town, Cape Town, South Africa.
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24
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Musuku J, Engel ME, Musonda P, Lungu JC, Machila E, Schwaninger S, Mtaja A, Mulendele E, Kavindele D, Spector J, Tadmor B, Gutierrez MM, Van Dam J, Colin L, Long A, Fishman MC, Mayosi BM, Zühlke LJ. Prevalence of rheumatic heart disease in Zambian school children. BMC Cardiovasc Disord 2018; 18:135. [PMID: 29969998 PMCID: PMC6029054 DOI: 10.1186/s12872-018-0871-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 06/24/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The large global burden of rheumatic heart disease (RHD) has come to light in recent years following robust epidemiologic studies. As an operational research component of a broad program aimed at primary and secondary prevention of RHD, we sought to determine the current prevalence of RHD in the country's capital, Lusaka, using a modern imaging-based screening methodology. In addition, we wished to evaluate the practicality of training local radiographers in echocardiography screening methods. METHODS Echocardiography was conducted on a random sample of students in 15 schools utilizing a previously validated, abbreviated screening protocol. Through a task-shifting scheme, and in the spirit of capacity-building to enhance local diagnostic and research skills, general radiographers based at Lusaka University Teaching Hospital (UTH) were newly trained to use portable echocardiography devices. Students deemed as screen-positive were referred for comprehensive echocardiography and clinical examination at UTH. Cardiac abnormalities were classified according to standard World Heart Federation criteria. RESULTS Of 1102 students that were consented and screened, 53 students were referred for confirmatory echocardiography. Three students had definite RHD, 10 had borderline RHD, 29 were normal, and 11 students were lost to follow-up. The rates of definite, borderline, and total RHD were 2.7 per 1000, 9.1 per 1000, and 11.8 per 1000, respectively. Anterior mitral valve leaflet thickening and chordal thickening were the most common morphological defects. The pairwise kappa test showed fair agreement between the local radiographers and an echocardiographer quality assurance specialist. CONCLUSION The prevalence of asymptomatic RHD in urban communities in Zambia is within the range of results reported in other sub-Saharan African countries using the WHF criteria. Task-shifting local radiographers to conduct echocardiography was feasible. The results of this study will be used to inform ongoing efforts in Zambia to control and eventually eliminate RHD. TRIAL REGISTRATION The study was registered on clinicaltrials.gov ( #NCT02661763 ).
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Affiliation(s)
- John Musuku
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Mark E Engel
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Patrick Musonda
- School of Public Health University of Zambia, Lusaka, Zambia
| | - Joyce Chipili Lungu
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Elizabeth Machila
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Sherri Schwaninger
- Global Health, Novartis Institutes for BioMedical Research, Cambridge, MA, USA.
| | - Agnes Mtaja
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Evans Mulendele
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Dorothy Kavindele
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Jonathan Spector
- Global Health, Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Brigitta Tadmor
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Marcelo M Gutierrez
- Global Health, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Joris Van Dam
- Global Drug Development, Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Laurence Colin
- Global Drug Development, Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Aidan Long
- Department of Allergy and Clinical Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Mark C Fishman
- Harvard Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
| | - Bongani M Mayosi
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Liesl J Zühlke
- Department of Paediatrics, Red Cross War Memorials Children's Hospital, Cape Town, South Africa
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Deffur A, Wilkinson RJ, Mayosi BM, Mulder NM. ANIMA: Association network integration for multiscale analysis. Wellcome Open Res 2018; 3:27. [DOI: 10.12688/wellcomeopenres.14073.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 11/20/2022] Open
Abstract
Contextual functional interpretation of -omics data derived from clinical samples is a classical and difficult problem in computational systems biology. The measurement of thousands of data points on single samples has become routine but relating ‘big data’ datasets to the complexities of human pathobiology is an area of ongoing research. Complicating this is the fact that many publicly available datasets use bulk transcriptomics data from complex tissues like blood. The most prevalent analytic approaches derive molecular ‘signatures’ of disease states or apply modular analysis frameworks to the data. Here we describe ANIMA (association network integration for multiscale analysis), a network-based data integration method using clinical phenotype and microarray data as inputs. ANIMA is implemented in R and Neo4j and runs in Docker containers. In short, the build algorithm iterates over one or more transcriptomics datasets to generate a large, multipartite association network by executing multiple independent analytic steps (differential expression, deconvolution, modular analysis based on co-expression, pathway analysis) and integrating the results. Once the network is built, it can be queried directly using Cypher (a graph query language), or by custom functions that communicate with the graph database via language-specific APIs. We developed a web application using Shiny, which provides fully interactive, multiscale views of the data. Using our approach, we show that we can reconstruct multiple features of disease states at various scales of organization, from transcript abundance patterns of individual genes through co-expression patterns of groups of genes to patterns of cellular behaviour in whole blood samples, both in single experiments as well in meta-analyses of multiple datasets.
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Long A, Lungu JC, Machila E, Schwaninger S, Spector J, Tadmor B, Fishman M, Mayosi BM, Musuku J. A programme to increase appropriate usage of benzathine penicillin for management of streptococcal pharyngitis and rheumatic heart disease in Zambia. Cardiovasc J Afr 2018; 28:242-247. [PMID: 28906539 PMCID: PMC5642026 DOI: 10.5830/cvja-2017-002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/17/2016] [Indexed: 01/08/2023] Open
Abstract
Rheumatic heart disease is highly prevalent and associated with substantial morbidity and mortality in many resourcepoor areas of the world, including sub-Saharan Africa.Primary and secondary prophylaxis with penicillin has beenshown to significantly improve outcomes and is recognisedto be the standard of care, with intra-muscular benzathine penicillin G recommended as the preferred agent by many technical experts. However, ensuring compliance with therapyhas proven to be challenging. As part of a public–privatepartnership initiative in Zambia, we conducted an educationaland access-to-medicine programme aimed at increasing appropriate use of benzathine penicillin for the preventionand management of rheumatic heart disease, according tonational guidelines. The programme was informed early onby identification of potential barriers to the administration ofinjectable penicillin, which included concern by health workers about allergic events. We describe this programme andreport initial signs of success, as indicated by increased useof benzathine penicillin. We propose that a similar approach may have benefits in rheumatic heart disease programmes in other endemic regions.
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Affiliation(s)
- Aidan Long
- Massachusetts General Hospital, Boston, USA.
| | | | | | | | | | | | - Mark Fishman
- Harvard Stem Cell and Regenerative Biology Department, Harvard University, Cambridge, USA
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - John Musuku
- University Teaching Hospital, Lusaka, Zambia
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Isiguzo GC, Zunza M, Chirehwa M, Mayosi BM, Thabane L. Quality of pilot trial abstracts in heart failure is suboptimal: a systematic survey. Pilot Feasibility Stud 2018; 4:107. [PMID: 29862038 PMCID: PMC5977467 DOI: 10.1186/s40814-018-0302-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/23/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pilot trials are miniature researches carried out with the sole aim of acting as the precursor for larger more definitive studies. Abstracts are used to summarize and introduce the findings to the reading audience. There is substantive empirical evidence showing that abstracts, despite their important roles, are not informative enough, lacking the necessary details. This systematic survey was designed to assess the quality of reporting of heart failure pilot trial abstracts. The quality of reporting was defined as the completeness of reporting based on adherence to the CONSORT extension for reporting of pilot trial abstracts. We also identified factors associated with reporting quality. METHODS We searched MEDLINE (PubMed), Cochrane Controlled Trials Register, Scopus, and African-wide information databases for abstracts from heart failure pilot trials in humans published from 1 January 1990 to 30 November 2016. These were assessed to determine the extent of adherence to CONSORT extension checklist for reporting of abstracts of pilot trials. We screened identified studies for inclusion based on title and abstract. Data were independently extracted by two reviewers using the checklist. We used regression analysis to assess the association between completeness of reporting (measured as the number of items in the CONSORT extension checklist for reporting of abstracts in pilot trials contained in each abstract) and factors influencing the quality of the reports. RESULTS Two hundred and twenty-eight (228) articles were retrieved, of which 92 met the inclusion criteria. The mean CONSORT extension score was 8.3/16 (standard deviation 1.7); the least reported items were the source of funding (1% [1/92]), trial registration (13% [12/92]), randomization sequence (13% [12/92]), number randomized to each arm (16% [15/92]), and number analyzed in each arm (16% [15/92]). Multivariable regression analysis showed that pharmacological intervention pilot trials [incidence rate ratio (IRR) = 0.88; 95% confidence interval (CI), 0.81-0.97] were significantly associated with better reporting. Other factors such as structured abstract (IRR = 1.10; 95% CI, 0.99-1.23) and CONSORT endorsement (IRR = 1.10; 95% CI, 0.99-1.23) only showed minimal relationship with better reporting quality. CONCLUSION The quality of reporting of abstracts of heart failure pilot trials was suboptimal. Pharmacological intervention was significantly associated with better reporting. These findings are consistent with previous research on reporting of trials.
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Affiliation(s)
- Godsent C. Isiguzo
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Cardiology Unit, Department of Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Moleen Zunza
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Maxwell Chirehwa
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Bongani M. Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
- Biostatistics Unit/FSORC, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare-Hamilton, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H325, Hamilton, ON L8N 4A6 Canada
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Barth D, Mayosi BM, Badri M, Whitelaw A, Engel ME. Invasive and non-invasive group A β-haemolytic streptococcal infections in patients attending public sector facilities in South Africa: 2003–2015. S Afr J Infect Dis 2018. [DOI: 10.4102/sajid.v33i1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The burden of disease caused by group A streptococcus (GAS) in Africa is largely unknown. The aim of this study was to determine the incidence of invasive (iGAS) and non-invasive GAS (non-iGAS) infections in patients attending the public health sector of South Africa.Methods: iGAS and non-iGAS infection was defined as GAS isolated in culture from sterile and non-sterile sites respectively. Using annual census data, we calculated incidence rates (IR) of iGAS and non-iGAS infection by reviewing cases from the National Health Laboratory Service (NHLS) database derived from the 9 provinces of South Africa between 2003 and 2015.Results: About 50% of the samples were collected in the Eastern Cape province which had data for all the years under observation; missing data from the other eight provinces precluded analysis of annual incidence. A multi-modal distribution of 5 256 GAS cases was observed in the Eastern Cape province. iGAS cases (n = 428) showed an annual mean IR of 0.48 (Range: 0.15–1.12) cases per 105 per year (py) with a marginal decrease from 2003 to 2015 (Rate Difference (RD), 0.23/105 py; 95% CI: 0.02–0.44/105 py). The mean annual IR for non-iGAS infection (n = 4828) was 5.48 (Range: 0.19–11.55) cases/105py; IR showed a decrease (RD, 11.36/105 py; 95% CI: 10.53–12.19/105 py). The Mann-Kendall test and the Theil-Sen estimator showed a decreasing trend in the incidence of non-iGAS infection (p = 0.002) over the study period.Conclusions: The incidence of non-iGAS infection in the Eastern Cape province of South Africa declined from 2003 to 2015. The trends from the Eastern Cape and incomplete data from other provinces indicate the need for a detailed prospective evaluation of GAS infection in South Africa to verify this trend and provide information for planning appropriate interventions.
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Prendergast EA, Perkins S, Engel ME, Cupido B, Francis V, Joachim A, Al Kebsi M, Bode-Thomas F, Damasceno A, Abul Fadl A, El Sayed A, Gitura B, Kennedy N, Ibrahim A, Mucumbitsi J, Adeoye AM, Musuku J, Okello E, Olunuga T, Sheta S, Mayosi BM, Zühlke LJ. Participation in research improves overall patient management: insights from the Global Rheumatic Heart Disease registry (REMEDY). Cardiovasc J Afr 2018; 29:98-105. [PMID: 29570206 PMCID: PMC6008904 DOI: 10.5830/cvja-2017-054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/19/2017] [Indexed: 12/28/2022] Open
Abstract
Background Rheumatic heart disease (RHD) is a major public health problem in low– and middle–income countries (LMICs), with a paucity of high–quality trial data to improve patient outcomes. Investigators felt that involvement in a recent large, observational RHD study impacted positively on their practice, but this was poorly defined. Aim The purpose of this study was to document the experience of investigators and research team members from LMICs who participated in a prospective, multi–centre study, the global Rheumatic Heart Disease Registry (REMEDY), conducted in 25 centres in 14 countries from 2010 to 2012. Methods We conducted an online survey of site personnel to identify and quantify their experiences. Telephone interviews were conducted with a subset of respondents to gather additional qualitative data. We asked about their experiences, positive and negative, and about any changes in RHD management practices resulting from their participation in REMEDY as a registry site. Results The majority of respondents in both the survey and telephone interviews indicated that participation as a registry site improved their management of RHD patients. Administrative changes included increased attention to follow–up appointments and details in patient records. Clinical changes included increased use of penicillin prophylaxis, and more frequent INR monitoring and contraceptive counselling. Conclusions Our study demonstrates that participation in clinical research on RHD can have a positive impact on patient management. Furthermore, REMEDY has led to increased patient awareness and improved healthcare workers’ knowledge and efficiency in caring for RHD patients.
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Affiliation(s)
- E A Prendergast
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - S Perkins
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - M E Engel
- Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - B Cupido
- Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - V Francis
- Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - A Joachim
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - M Al Kebsi
- Faculty of Medicine and Surgery, University of Sana'a, Al-Thawrah, Cardiac Centre, Sana'a, Yemen
| | - F Bode-Thomas
- Departments of Paediatrics, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - A Damasceno
- Department of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - A Abul Fadl
- Faculty of Medicine, Benha University, Cairo, Egypt
| | - A El Sayed
- Cardiothoracic Surgery Department, Al Shaab Teaching Hospital and Faculty of Medicine, Alzaiem Alazhari University, Khartoum, Sudan
| | - B Gitura
- Cardiology Unit, Department of Medicine, Kenyatta National Teaching and Referral Hospital, Nairobi, Kenya
| | - N Kennedy
- Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi; Centre for Medical Education, Queen's University, Belfast; Royal Belfast Hospital for Sick Children, Belfast, Ireland
| | - A Ibrahim
- Cardiothoracic Surgery Department, Al Shaab Teaching Hospital and Faculty of Medicine, Alzaiem Alazhari University, Khartoum, Sudan
| | - J Mucumbitsi
- Paediatric Cardiology Unit, Department of Paediatrics, King Faisal Hospital, Kigali, Rwanda
| | - A M Adeoye
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - J Musuku
- University Teaching Hospital, Department of Paediatrics and Child Health, University of Zambia, Lusaka, Zambia
| | - E Okello
- Uganda Heart Institute, Kampala, Uganda
| | - T Olunuga
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - S Sheta
- Department of Paediatrics, Division of Paediatric Cardiology, Faculty of Medicine, Cairo University Children's Hospital, Cairo, Egypt
| | - B M Mayosi
- Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Dean of Faculty of Health Sciences, University of Cape Town, South Africa
| | - L J Zühlke
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Abstract
Contextual functional interpretation of -omics data derived from clinical samples is a classical and difficult problem in computational systems biology. The measurement of thousands of data points on single samples has become routine but relating ‘big data’ datasets to the complexities of human pathobiology is an area of ongoing research. Complicating this is the fact that many publically available datasets use bulk transcriptomics data from complex tissues like blood. The most prevalent analytic approaches derive molecular ‘signatures’ of disease states or apply modular analysis frameworks to the data. Here we describe ANIMA (association network integration for multiscale analysis), a network-based data integration method using clinical phenotype and microarray data as inputs. ANIMA is implemented in R and Neo4j and runs in Docker containers. In short, the build algorithm iterates over one or more transcriptomics datasets to generate a large, multipartite association network by executing multiple independent analytic steps (differential expression, deconvolution, modular analysis based on co-expression, pathway analysis) and integrating the results. Once the network is built, it can be queried directly using Cypher, or via custom functions that communicate with the graph database via language-specific APIs. We developed a web application using Shiny, which provides fully interactive, multiscale views of the data. Using our approach, we show that we can reconstruct multiple features of disease states at various scales of organization, from transcript abundance patterns of individual genes through co-expression patterns of groups of genes to patterns of cellular behaviour in whole blood samples, both in single experiments as well as in a meta-analysis of multiple datasets.
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31
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Barth D, M Mayosi B, Badri M, Whitelaw A, E Engel M. Invasive and non-invasive group A β-haemolytic streptococcal infections in patients attending public sector facilities in South Africa: 2003–2015. S Afr J Infect Dis 2018. [DOI: 10.1080/23120053.2017.1376546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Dylan Barth
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Bongani M Mayosi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Motasim Badri
- College of Medicine, King Saudi Bin Abdulaziz University for Medical Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Andrew Whitelaw
- Department of Microbiology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Mark E Engel
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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Hyle EP, Mayosi BM, Middelkoop K, Mosepele M, Martey EB, Walensky RP, Bekker LG, Triant VA. The association between HIV and atherosclerotic cardiovascular disease in sub-Saharan Africa: a systematic review. BMC Public Health 2017; 17:954. [PMID: 29246206 PMCID: PMC5732372 DOI: 10.1186/s12889-017-4940-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/22/2017] [Indexed: 12/27/2022] Open
Abstract
Background Sub-Saharan Africa (SSA) has confronted decades of the HIV epidemic with substantial improvements in access to life-saving antiretroviral therapy (ART). Now, with improved survival, people living with HIV (PLWH) are at increased risk for non-communicable diseases (NCDs), including atherosclerotic cardiovascular disease (CVD). We assessed the existing literature regarding the association of CVD outcomes and HIV in SSA. Methods We used the PRISMA guidelines to perform a systematic review of the published literature regarding the association of CVD and HIV in SSA with a focus on CVD surrogate and clinical outcomes in PLWH. Results From January 2000 until March 2017, 31 articles were published regarding CVD outcomes among PLWH in SSA. Data from surrogate CVD outcomes (n = 13) suggest an increased risk of CVD events among PLWH in SSA. Although acute coronary syndrome is reported infrequently in SSA among PLWH, limited data from five studies suggest extensive thrombus and hypercoagulability as contributing factors. Additional studies suggest an increased risk of stroke among PLWH (n = 13); however, most data are from immunosuppressed ART-naïve PLWH and thus are potentially confounded by the possibility of central nervous system infections. Conclusions Given ongoing gaps in our current understanding of CVD and other NCDs in PLWH in SSA, it is imperative to ascertain the burden of CVD outcomes, and to examine strategies for intervention and best practices to enhance the health of this vulnerable population. Electronic supplementary material The online version of this article (10.1186/s12889-017-4940-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA, 02114-2696, USA. .,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Bongani M Mayosi
- Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Keren Middelkoop
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Mosepele Mosepele
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Botswana-Harvard AIDS Partnership, Gaborone, Botswana
| | - Emily B Martey
- Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA, 02114-2696, USA
| | - Rochelle P Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA, 02114-2696, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Virginia A Triant
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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33
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Isiguzo G, Zunza M, Chirehwa M, Mayosi BM, Thabane L. Quality of abstracts of pilot trials in heart failure: A protocol for a systematic survey. Contemp Clin Trials Commun 2017; 8:258-263. [PMID: 29696217 PMCID: PMC5898522 DOI: 10.1016/j.conctc.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/27/2017] [Accepted: 11/06/2017] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Pilot trials are initial small-scale studies done to inform the design of larger trials. Their findings like other studies are usually disseminated as peer-reviewed journal articles. Abstracts are used to introduce the contents to readers, and give a general idea about the full reports and sometimes are the only source of information available to readers. Despite their importance, the contents of abstracts of trial reports are usually not informative enough and lack the essential details. METHODS AND ANALYSIS This is a protocol for a planned systematic survey with a primary aim of analyzing the reporting quality measured as the completeness of the reporting of pilot trial abstracts in heart failure. The secondary aim will be to explore factors associated with better reporting quality.Abstracts of heart failure pilot trials in humans (journal and conference abstracts) published in the English language from 1 January 1990 to 30 November 2016 will be assessed to determine the reporting quality, based on the CONSORT 2010 statement extension to randomized pilot and feasibility trials. All non-pilot/feasibility trials and non-human pilot trials will be excluded. We will search Medline (PUBMED), Cochrane controlled trials register, Scopus and African wide information databases for pilot trials in heart failure. Title and abstracts of identified studies will be screened for inclusion and data extracted independently by two reviewers in duplicate without using the full text. Reported and unreported items on the abstracts will be presented as frequencies and percentages, a descriptive analysis will be used to interpret the reporting quality and regression analysis used for characteristics associated with greater statistical reporting at 95% confidence interval. REVIEW REGISTRATION NUMBER PROSPERO CRD42016049911.
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Affiliation(s)
- Godsent Isiguzo
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Cardiology Unit, Department of Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Moleen Zunza
- Biostatistics Unit, Centre for Evidence-based Health Care, Department of Medicine, University of Stellenbosch, Cape Town, South Africa
| | - Maxwell Chirehwa
- Biostatistics Unit, Centre for Evidence-based Health Care, Department of Medicine, University of Stellenbosch, Cape Town, South Africa
| | - Bongani M. Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare-Hamilton, ON, Canada
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Zühlke L, Mayosi BM. The life and the legacy of Hamilton Naki: Experimental heart transplant surgeon and teacher. J Heart Lung Transplant 2017; 36:1309-1310. [PMID: 29173393 DOI: 10.1016/j.healun.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Liesl Zühlke
- Children's Heart Disease Research Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
| | - Bongani M Mayosi
- Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
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35
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Wiyeh AB, Ochodo EA, Wiysonge CS, Kakia A, Awotedu AA, Ristic A, Mayosi BM. A systematic review of the efficacy and safety of intrapericardial fibrinolysis in patients with pericardial effusion. Int J Cardiol 2017; 250:223-228. [PMID: 29107356 DOI: 10.1016/j.ijcard.2017.10.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/13/2017] [Indexed: 11/30/2022]
Abstract
Pericardial effusion is the abnormal accumulation of fluid in the pericardial space. The complications of pericardial effusion can either be acute (e.g., cardiac tamponade) or chronic (e.g., constrictive pericarditis). We have conducted a systematic review of the scientific literature to evaluate the efficacy and safety of intrapericardial fibrinolysis in preventing complications of pericardial effusion. We searched for both published and unpublished studies. 29 studies, with a total of 109 patients were included in this review; 17 case reports, 11 case series, and one randomised controlled trial (RCT). All included studies had a high risk of bias. The most common causes of pericardial effusion were Staphylococcus aureus (12 studies with 23 cases) and Mycobacterium tuberculosis (2 studies with 19 cases). The most common fibrinolytic agents used were streptokinase (15 studies) and urokinase (5 studies). Intrapericardial fibrinolysis prevented complications in 94 (86.2%) patients. Non-fatal procedure-related complications were reported 21 (19.2%) patients. No patient died following intrapericardial fibrinolysis. There is very low certainty of the efficiency and safety of intrapericardial fibrinolysis in preventing the complications of pericardial effusion. High quality RCTs are required to address this question.
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Affiliation(s)
- Alison B Wiyeh
- Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University, Cape Town, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Eleanor A Ochodo
- Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Aloysious Kakia
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha, South Africa
| | - Abolade A Awotedu
- Department of Medicine, Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Arsen Ristic
- Department of Cardiology, Clinical Centre of Serbia and Belgrade University School of Medicine, Belgrade, Serbia.
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
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36
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Shenje J, Lai RP, Ross IL, Mayosi BM, Wilkinson RJ, Ntsekhe M, Wilkinson KA. Effect of prednisolone on inflammatory markers in pericardial tuberculosis: A pilot study. Int J Cardiol Heart Vasc 2017; 18:104-108. [PMID: 29750184 PMCID: PMC5941241 DOI: 10.1016/j.ijcha.2017.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/27/2017] [Accepted: 10/22/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pericardial disorders are a common cause of heart disease, and the most common cause of pericarditis in developing countries is tuberculous (TB) pericarditis. It has been shown that prednisolone added to standard anti-TB therapy leads to a lower rate of constrictive pericarditis. We conducted a pilot study to evaluate the effect of adjunctive prednisolone treatment on the concentration of inflammatory markers in pericardial tuberculosis, in order to inform immunological mechanisms at the disease site. METHODS Pericardial fluid, plasma and saliva samples were collected from fourteen patients with pericardial tuberculosis, at multiple time points. Inflammatory markers were measured using multiplex luminex analysis and ELISA. RESULTS In samples from 14 patients we confirmed a strongly compartmentalized immune response at the disease site and found that prednisolone significantly reduced IL-6 concentrations in plasma by 8 hours of treatment, IL-1beta concentrations in saliva, as well as IL-8 concentrations in both pericardial fluid and saliva by 24 hours. CONCLUSION Monitoring the early effect of adjunctive immunotherapy in plasma or saliva is a possibility in pericarditis.
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Affiliation(s)
- Justin Shenje
- The Cardiac Clinic, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory 7925, South Africa
| | - Rachel P. Lai
- The Francis Crick Institute, NW1 2AT London, United Kingdom
| | - Ian L. Ross
- The Cardiac Clinic, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory 7925, South Africa
| | - Bongani M. Mayosi
- The Cardiac Clinic, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory 7925, South Africa
| | - Robert J. Wilkinson
- The Cardiac Clinic, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory 7925, South Africa,The Francis Crick Institute, NW1 2AT London, United Kingdom,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa,Imperial College London, W2 1PG, United Kingdom
| | - Mpiko Ntsekhe
- The Cardiac Clinic, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory 7925, South Africa
| | - Katalin A. Wilkinson
- The Cardiac Clinic, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory 7925, South Africa,The Francis Crick Institute, NW1 2AT London, United Kingdom,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa,Corresponding author at: Institute of Infectious Disease and Molecular Medicine, Room N2.09.B3 Wernher Beit North Building, Observatory 7925, South Africa.
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Munung NS, Mayosi BM, de Vries J. Equity in international health research collaborations in Africa: Perceptions and expectations of African researchers. PLoS One 2017; 12:e0186237. [PMID: 29036174 PMCID: PMC5643046 DOI: 10.1371/journal.pone.0186237] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 09/27/2017] [Indexed: 02/03/2023] Open
Abstract
Introduction and method Africa is currently host to a number of international genomics research and biobanking consortia, each with a mandate to advance genomics research and biobanking in Africa. Whilst most of these consortia promise to transform the way international health research is done in Africa, few have articulated exactly how they propose to go about this. In this paper, we report on a qualitative interviewing study in which we involved 17 genomics researchers in Africa. We describe their perceptions and expectations of international genomics research and biobanking initiatives in Africa. Results All interviewees were of the view that externally funded genomics research and biobanking initiatives in Africa, have played a critical role in building capacity for genomics research and biobanking in Africa and in providing an opportunity for researchers in Africa to collaborate and network with other researchers. Whilst the opportunity to collaborate was seen as a benefit, some interviewees stressed the importance of recognizing that these collaborations carry mutual benefits for all partners, including their collaborators in HICs. They also voiced two major concerns of being part of these collaborative initiatives: the possibility of exploitation of African researchers and the non-sustainability of research capacity building efforts. As a way of minimising exploitation, researchers in Africa recommended that genuine efforts be made to create transparent and equitable international health research partnerships. They suggested that this could be achieved through,: having rules of engagement, enabling African researchers to contribute to the design and conduct of international health projects in Africa, and mutual and respectful exchange of experience and capacity between research collaborators. These were identified as hallmarks to equitable international health research collaborations in Africa. Conclusion Genomics research and biobanking initiatives in Africa such as H3Africa have gone some way in defining aspects of fair and equitable research collaborations in Africa. However, they will need to strive at achieving equitable health research collaborations if they truly aim at setting a gold standard for how international health research should be conducted in Africa.
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Affiliation(s)
| | - Bongani M. Mayosi
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Groote Schuur Hospital, Cape Town, South Africa
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Wang H, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Adedeji IA, Adedoyin RA, Adetifa IMO, Adetokunboh O, Afshin A, Aggarwal R, Agrawal A, Agrawal S, Ahmad Kiadaliri A, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Aiyar S, Akanda AS, Akinyemiju TF, Akseer N, Al Lami FH, Alabed S, Alahdab F, Al-Aly Z, Alam K, Alam N, Alasfoor D, Aldridge RW, Alene KA, Al-Eyadhy A, Alhabib S, Ali R, Alizadeh-Navaei R, Aljunid SM, Alkaabi JM, Alkerwi A, Alla F, Allam SD, Allebeck P, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Ameh EA, Amini E, Ammar W, Amoako YA, Anber N, Andrei CL, Androudi S, Ansari H, Ansha MG, Antonio CAT, Anwari P, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Asghar RJ, Assadi R, Assaye AM, Atey TM, Atre SR, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Babalola TK, Bacha U, Badawi A, Balakrishnan K, Balalla S, Barac A, Barber RM, Barboza MA, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Béjot Y, Bekele BB, Bell ML, Bello AK, Bennett DA, Bennett JR, Bensenor IM, Benson J, Berhane A, Berhe DF, Bernabé E, Beuran M, Beyene AS, Bhala N, Bhansali A, Bhaumik S, Bhutta ZA, Bicer BK, Bidgoli HH, Bikbov B, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Bjerregaard P, Blosser CD, Boneya DJ, Boufous S, Bourne RRA, Brazinova A, Breitborde NJK, Brenner H, Brugha TS, Bukhman G, Bulto LNB, Bumgarner BR, Burch M, Butt ZA, Cahill LE, Cahuana-Hurtado L, Campos-Nonato IR, Car J, Car M, Cárdenas R, Carpenter DO, Carrero JJ, Carter A, Castañeda-Orjuela CA, Castro FF, Castro RE, Catalá-López F, Chen H, Chiang PPC, Chibalabala M, Chisumpa VH, Chitheer AA, Choi JYJ, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Cohen AJ, Colquhoun SM, Coresh J, Criqui MH, Cromwell EA, Crump JA, Dandona L, Dandona R, Dargan PI, das Neves J, Davey G, Davitoiu DV, Davletov K, de Courten B, De Leo D, Degenhardt L, Deiparine S, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dey S, Dharmaratne SD, Dherani MK, Diaz-Torné C, Ding EL, Dixit P, Djalalinia S, Do HP, Doku DT, Donnelly CA, dos Santos KPB, Douwes-Schultz D, Driscoll TR, Duan L, Dubey M, Duncan BB, Dwivedi LK, Ebrahimi H, El Bcheraoui C, Ellingsen CL, Enayati A, Endries AY, Ermakov SP, Eshetie S, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Fanuel FBB, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Feyissa TR, Filip I, Fischer F, Foigt N, Foreman KJ, Frank T, Franklin RC, Fraser M, Friedman J, Frostad JJ, Fullman N, Fürst T, Furtado JM, Futran ND, Gakidou E, Gambashidze K, Gamkrelidze A, Gankpé FG, Garcia-Basteiro AL, Gebregergs GB, Gebrehiwot TT, Gebrekidan KG, Gebremichael MW, Gelaye AA, Geleijnse JM, Gemechu BL, Gemechu KS, Genova-Maleras R, Gesesew HA, Gething PW, Gibney KB, Gill PS, Gillum RF, Giref AZ, Girma BW, Giussani G, Goenka S, Gomez B, Gona PN, Gopalani SV, Goulart AC, Graetz N, Gugnani HC, Gupta PC, Gupta R, Gupta R, Gupta T, Gupta V, Haagsma JA, Hafezi-Nejad N, Hakuzimana A, Halasa YA, Hamadeh RR, Hambisa MT, Hamidi S, Hammami M, Hancock J, Handal AJ, Hankey GJ, Hao Y, Harb HL, Hareri HA, Harikrishnan S, Haro JM, Hassanvand MS, Havmoeller R, Hay RJ, Hay SI, He F, Heredia-Pi IB, Herteliu C, Hilawe EH, Hoek HW, Horita N, Hosgood HD, Hostiuc S, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Huang H, Iburg KM, Igumbor EU, Ileanu BV, Inoue M, Irenso AA, Irvine CMS, Islam SMS, Islam N, Jacobsen KH, Jaenisch T, Jahanmehr N, Jakovljevic MB, Javanbakht M, Jayatilleke AU, Jeemon P, Jensen PN, Jha V, Jin Y, John D, John O, Johnson SC, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimi SM, Karthikeyan G, Kasaeian A, Kassaw NA, Kassebaum NJ, Kastor A, Katikireddi SV, Kaul A, Kawakami N, Kazanjan K, Keiyoro PN, Kelbore SG, Kemp AH, Kengne AP, Keren A, Kereselidze M, Kesavachandran CN, Ketema EB, Khader YS, Khalil IA, Khan EA, Khan G, Khang YH, Khera S, Khoja ATA, Khosravi MH, Kibret GD, Kieling C, Kim YJ, Kim CI, Kim D, Kim P, Kim S, Kimokoti RW, Kinfu Y, Kishawi S, Kissoon N, Kivimaki M, Knudsen AK, Kokubo Y, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krohn KJ, Kuate Defo B, Kuipers EJ, Kulikoff XR, Kulkarni VS, Kumar GA, Kumar P, Kumsa FA, Kutz M, Lachat C, Lagat AK, Lager ACJ, Lal DK, Lalloo R, Lambert N, Lan Q, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Lavados PM, Laxmaiah A, Lee PH, Leigh J, Leung J, Leung R, Levi M, Li Y, Liao Y, Liben ML, Lim SS, Linn S, Lipshultz SE, Liu S, Lodha R, Logroscino G, Lorch SA, Lorkowski S, Lotufo PA, Lozano R, Lunevicius R, Lyons RA, Ma S, Macarayan ER, Machado IE, Mackay MT, Magdy Abd El Razek M, Magis-Rodriguez C, Mahdavi M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mantovani LG, Manyazewal T, Mapoma CC, Marczak LB, Marks GB, Martin EA, Martinez-Raga J, Martins-Melo FR, Massano J, Maulik PK, Mayosi BM, Mazidi M, McAlinden C, McGarvey ST, McGrath JJ, McKee M, Mehata S, Mehndiratta MM, Mehta KM, Meier T, Mekonnen TC, Meles KG, Memiah P, Memish ZA, Mendoza W, Mengesha MM, Mengistie MA, Mengistu DT, Menon GR, Menota BG, Mensah GA, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Mikesell J, Miller TR, Mills EJ, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mohammad KA, Mohammadi A, Mohammed KE, Mohammed S, Mohan MBV, Mohanty SK, Mokdad AH, Mollenkopf SK, Molokhia M, Monasta L, Montañez Hernandez JC, Montico M, Mooney MD, Moore AR, Moradi-Lakeh M, Moraga P, Morawska L, Mori R, Morrison SD, Mruts KB, Mueller UO, Mullany E, Muller K, Murthy GVS, Murthy S, Musa KI, Nachega JB, Nagata C, Nagel G, Naghavi M, Naidoo KS, Nanda L, Nangia V, Nascimento BR, Natarajan G, Negoi I, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Ningrum DNA, Nisar MI, Nomura M, Nong VM, Norheim OF, Norrving B, Noubiap JJN, Nyakarahuka L, O'Donnell MJ, Obermeyer CM, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olusanya BO, Olusanya JO, Oren E, Ortiz A, Osgood-Zimmerman A, Ota E, Owolabi MO, Oyekale AS, PA M, Pacella RE, Pakhale S, Pana A, Panda BK, Panda-Jonas S, Park EK, Parsaeian M, Patel T, Patten SB, Patton GC, Paudel D, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Pervaiz A, Pesudovs K, Peterson CB, Petri WA, Petzold M, Phillips MR, Piel FB, Pigott DM, Pishgar F, Plass D, Polinder S, Popova S, Postma MJ, Poulton RG, Pourmalek F, Prasad N, Purwar M, Qorbani M, Quintanilla BPA, Rabiee RHS, Radfar A, Rafay A, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman MHU, Rahman SU, Rahman M, Rai RK, Rajsic S, Ram U, Rana SM, Ranabhat CL, Rao PV, Rawaf S, Ray SE, Rego MAS, Rehm J, Reiner RC, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Rivas JC, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy A, Rubagotti E, Ruhago GM, Saadat S, Sabde YD, Sachdev PS, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Sahathevan R, Sahebkar A, Sahraian MA, Salama J, Salamati P, Salomon JA, Salvi SS, Samy AM, Sanabria JR, Sanchez-Niño MD, Santos IS, Santric Milicevic MM, Sarmiento-Suarez R, Sartorius B, Satpathy M, Sawhney M, Saxena S, Saylan MI, Schmidt MI, Schneider IJC, Schulhofer-Wohl S, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Seid AM, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Sharma J, Sharma R, She J, Shen J, Shetty BP, Shi P, Shibuya K, Shifa GT, Shigematsu M, Shiri R, Shiue I, Shrime MG, Sigfusdottir ID, Silberberg DH, Silpakit N, Silva DAS, Silva JP, Silveira DGA, Sindi S, Singh JA, Singh PK, Singh A, Singh V, Sinha DN, Skarbek KAK, Skiadaresi E, Sligar A, Smith DL, Sobaih BHA, Sobngwi E, Soneji S, Soriano JB, Sreeramareddy CT, Srinivasan V, Stathopoulou V, Steel N, Stein DJ, Steiner C, Stöckl H, Stokes MA, Strong M, Sufiyan MB, Suliankatchi RA, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tadakamadla SK, Tadese F, Tandon N, Tanne D, Tarajia M, Tavakkoli M, Taveira N, Tehrani-Banihashemi A, Tekelab T, Tekle DY, Temsah MH, Terkawi AS, Tesema CL, Tesssema B, Theis A, Thomas N, Thompson AH, Thomson AJ, Thrift AG, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tortajada M, Tran BX, Truelsen T, Trujillo U, Tsilimparis N, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uthman OA, Uzochukwu BSC, van Boven JFM, Varakin YY, Varughese S, Vasankari T, Vasconcelos AMN, Velasquez IM, Venketasubramanian N, Vidavalur R, Violante FS, Vishnu A, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Waid JL, Wakayo T, Wang YP, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Wesana J, Wijeratne T, Wilkinson JD, Wiysonge CS, Woldeyes BG, Wolfe CDA, Workicho A, Workie SB, Xavier D, Xu G, Yaghoubi M, Yakob B, Yalew AZ, Yan LL, Yano Y, Yaseri M, Ye P, Yimam HH, Yip P, Yirsaw BD, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zeeb H, Zenebe ZM, Zerfu TA, Zhang AL, Zhang X, Zodpey S, Zuhlke LJ, Lopez AD, Murray CJL. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1084-1150. [PMID: 28919115 PMCID: PMC5605514 DOI: 10.1016/s0140-6736(17)31833-0] [Citation(s) in RCA: 488] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/21/2017] [Accepted: 06/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. INTERPRETATION Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. FUNDING Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
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Abstract
BACKGROUND Tuberculous pericarditis can impair the heart's function and cause death; long term, it can cause the membrane to fibrose and constrict causing heart failure. In addition to antituberculous chemotherapy, treatments include corticosteroids, drainage, and surgery. OBJECTIVES To assess the effects of treatments for tuberculous pericarditis. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register (27 March 2017); the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library (2017, Issue 2); MEDLINE (1966 to 27 March 2017); Embase (1974 to 27 March 2017); and LILACS (1982 to 27 March 2017). In addition we searched the metaRegister of Controlled Trials (mRCT) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal using 'tuberculosis' and 'pericard*' as search terms on 27 March 2017. We searched ClinicalTrials.gov and contacted researchers in the field of tuberculous pericarditis. This is a new version of the original 2002 review. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs. DATA COLLECTION AND ANALYSIS Two review authors independently screened search outputs, evaluated study eligibility, assessed risk of bias, and extracted data; and we resolved any discrepancies by discussion and consensus. One trial assessed the effects of both corticosteroid and Mycobacterium indicus pranii treatment in a two-by-two factorial design; we excluded data from the group that received both interventions. We conducted fixed-effect meta-analysis and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS Seven trials met the inclusion criteria; all were from sub-Saharan Africa and included 1959 participants, with 1051/1959 (54%) HIV-positive. All trials evaluated corticosteroids and one each evaluated colchicine, M. indicus pranii immunotherapy, and open surgical drainage. Four trials (1841 participants) were at low risk of bias, and three trials (118 participants) were at high risk of bias.In people who are not infected with HIV, corticosteroids may reduce deaths from all causes (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.59 to 1.09; 660 participants, 4 trials, low certainty evidence) and the need for repeat pericardiocentesis (RR 0.85, 95% CI 0.70 to 1.04; 492 participants, 2 trials, low certainty evidence). Corticosteroids probably reduce deaths from pericarditis (RR 0.39, 95% CI 0.19 to 0.80; 660 participants, 4 trials, moderate certainty evidence). However, we do not know whether or not corticosteroids have an effect on constriction or cancer among HIV-negative people (very low certainty evidence).In people living with HIV, only 19.9% (203/1959) were on antiretroviral drugs. Corticosteroids may reduce constriction (RR 0.55, 0.26 to 1.16; 575 participants, 3 trials, low certainty evidence). It is uncertain whether corticosteroids have an effect on all-cause death or cancer (very low certainty evidence); and may have little or no effect on repeat pericardiocentesis (RR 1.02, 0.89 to 1.18; 517 participants, 2 trials, low certainty evidence).For colchicine among people living with HIV, we found one small trial (33 participants) which had insufficient data to make any conclusions about any effects on death or constrictive pericarditis.Irrespective of HIV status, due to very low certainty evidence from one trial, it is uncertain whether adding M. indicus pranii immunotherapy to antituberculous drugs has an effect on any outcome.Open surgical drainage for effusion may reduce repeat pericardiocentesis In HIV-negative people (RR 0.23, 95% CI 0.07 to 0.76; 122 participants, 1 trial, low certainty evidence) but may make little or no difference to other outcomes. We did not find an eligible trial that assessed the effects of open surgical drainage in people living with HIV.The review authors found no eligible trials that examined the length of antituberculous treatment needed nor the effects of other adjunctive treatments for tuberculous pericarditis. AUTHORS' CONCLUSIONS For HIV-negative patients, corticosteroids may reduce death. For HIV-positive patients not on antiretroviral drugs, corticosteroids may reduce constriction. For HIV-positive patients with good antiretroviral drug viral suppression, clinicians may consider the results from HIV-negative patients more relevant.Further research may help evaluate percutaneous drainage of the pericardium under local anaesthesia, the timing of pericardiectomy in tuberculous constrictive pericarditis, and new antibiotic regimens.
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Affiliation(s)
- Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Mpiko Ntsekhe
- Groote Schuur HospitalDivision of CardiologyObservatory 7925Cape TownSouth Africa
| | - Lehana Thabane
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics50 Charlton Ave ERoom H325, St. Joseph's HealthcareHamiltonONCanadaL8N 4A6
| | - Jimmy Volmink
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Dumisani Majombozi
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Freedom Gumedze
- University of Cape TownDepartment of Statistical SciencesCape TownSouth Africa
| | - Shaheen Pandie
- University of Cape TownDepartment of MedicineCape TownSouth Africa
| | - Bongani M Mayosi
- University of Cape TownDepartment of MedicineCape TownSouth Africa
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Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, Forouzanfar MH, Longenecker CT, Mayosi BM, Mensah GA, Nascimento BR, Ribeiro ALP, Sable CA, Steer AC, Naghavi M, Mokdad AH, Murray CJL, Vos T, Carapetis JR, Roth GA. Global, Regional, and National Burden of Rheumatic Heart Disease, 1990-2015. N Engl J Med 2017; 377:713-722. [PMID: 28834488 DOI: 10.1056/nejmoa1603693] [Citation(s) in RCA: 651] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rheumatic heart disease remains an important preventable cause of cardiovascular death and disability, particularly in low-income and middle-income countries. We estimated global, regional, and national trends in the prevalence of and mortality due to rheumatic heart disease as part of the 2015 Global Burden of Disease study. METHODS We systematically reviewed data on fatal and nonfatal rheumatic heart disease for the period from 1990 through 2015. Two Global Burden of Disease analytic tools, the Cause of Death Ensemble model and DisMod-MR 2.1, were used to produce estimates of mortality and prevalence, including estimates of uncertainty. RESULTS We estimated that there were 319,400 (95% uncertainty interval, 297,300 to 337,300) deaths due to rheumatic heart disease in 2015. Global age-standardized mortality due to rheumatic heart disease decreased by 47.8% (95% uncertainty interval, 44.7 to 50.9) from 1990 to 2015, but large differences were observed across regions. In 2015, the highest age-standardized mortality due to and prevalence of rheumatic heart disease were observed in Oceania, South Asia, and central sub-Saharan Africa. We estimated that in 2015 there were 33.4 million (95% uncertainty interval, 29.7 million to 43.1 million) cases of rheumatic heart disease and 10.5 million (95% uncertainty interval, 9.6 million to 11.5 million) disability-adjusted life-years due to rheumatic heart disease globally. CONCLUSIONS We estimated the global disease prevalence of and mortality due to rheumatic heart disease over a 25-year period. The health-related burden of rheumatic heart disease has declined worldwide, but high rates of disease persist in some of the poorest regions in the world. (Funded by the Bill and Melinda Gates Foundation and the Medtronic Foundation.).
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Affiliation(s)
- David A Watkins
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Catherine O Johnson
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Samantha M Colquhoun
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Ganesan Karthikeyan
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Andrea Beaton
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Gene Bukhman
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Mohammed H Forouzanfar
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Christopher T Longenecker
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Bongani M Mayosi
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - George A Mensah
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Bruno R Nascimento
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Antonio L P Ribeiro
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Craig A Sable
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Andrew C Steer
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Mohsen Naghavi
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Ali H Mokdad
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Christopher J L Murray
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Theo Vos
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Jonathan R Carapetis
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Gregory A Roth
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
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Affiliation(s)
- Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Hazel A Bradley
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Jimmy Volmink
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Bongani M Mayosi
- Department of Medicine, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
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Smedema JP, van Geuns RJ, Truter R, Mayosi BM, Crijns HJGM. Contrast-enhanced cardiac Magnetic Resonance: distinction between cardiac sarcoidosis and infarction scar. Sarcoidosis Vasc Diffuse Lung Dis 2017; 34:307-314. [PMID: 32476863 DOI: 10.36141/svdld.v34i4.5715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 01/09/2017] [Indexed: 11/02/2022]
Abstract
Objectives: To review the value of delayed contrast-enhanced cardiac magnetic resonance (CECMR) in differentiating patients with cardiac sarcoidosis (CS) from those with coronary artery disease and recent myocardial infarctions. Background: Late gadolinium enhancement (LGE) accurately delineates myocardial necrosis or fibrosis. The pattern of LGE in ischemic and non-ischemic myocardial disease is different, and might be helpful in distinguishing CS from ischemic disease. Methods: The CECMR studies of 30 patients with CS were compared to those performed in 30 consecutive infarct patients, who had been managed with primary coronary interventions, and 10 healthy controls. Two experienced blinded observers classified patients by assessing the distribution of LGE. Results: LV LGE was present in 29/30 CS (mean 3.8 segments, range 0-12), all infarct (mean 4.3 segments, range 0-9), and none of the patients in the control group. The amount of LV LGE did not differ significantly between CS and infarct patients (19 ± 11% and 19 ± 12%, P= 0.8). The CS group exhibited a predominantly patchy, 3 layer LGE (P = 0.01), whereas confluent transmural LGE (P = 0.04) with a vascular distribution (P < 0.001) was prevalent in the infarct group. Significantly more RV LGE (P = 0.01) and dilation (P = 0.02) were found in the CS group. The two observers classified patients correctly as CS in 72% and 83% of cases, as ischemic in nature in 77% and 80% of cases, and as normal in 90% and 100% respectively. Conclusions: Gadolinium CMR was helpful in differentiating patients with CS from patients with ischemic heart disease and previous myocardial infarctions. In a subgroup of ischemic patients the pattern of LGE was atypical, and suggestive of non-ischemic etiology. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 307-314).
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Affiliation(s)
- Jan-Peter Smedema
- Departments of Cardiology, Maastricht University Medical Centre, The Netherlands
| | - Robert-Jan van Geuns
- Department of Cardiology and Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Rene Truter
- Schnetler, Corbett and Associates, Panorama Medi-Clinic, Cape Town, South Africa
| | - Bongani M Mayosi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Harry J G M Crijns
- Departments of Cardiology, Maastricht University Medical Centre, The Netherlands
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Mayosi BM, Fish M, Shaboodien G, Mastantuono E, Kraus S, Wieland T, Kotta MC, Chin A, Laing N, Ntusi NB, Chong M, Horsfall C, Pimstone SN, Gentilini D, Parati G, Strom TM, Meitinger T, Pare G, Schwartz PJ, Crotti L. Identification of Cadherin 2 (
CDH2
) Mutations in Arrhythmogenic Right Ventricular Cardiomyopathy. ACTA ACUST UNITED AC 2017; 10:CIRCGENETICS.116.001605. [DOI: 10.1161/circgenetics.116.001605] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 02/22/2017] [Indexed: 11/16/2022]
Abstract
Background—
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically heterogeneous condition caused by mutations in genes encoding desmosomal proteins in up to 60% of cases. The 40% of genotype-negative cases point to the need of identifying novel genetic substrates by studying genotype-negative ARVC families.
Methods and Results—
Whole exome sequencing was performed on 2 cousins with ARVC. Validation of 13 heterozygous variants that survived internal quality and frequency filters was performed by Sanger sequencing. These variants were also genotyped in all family members to establish genotype–phenotype cosegregation. High-resolution melting analysis followed by Sanger sequencing was used to screen for mutations in cadherin 2 (
CDH2
) gene in unrelated genotype-negative patients with ARVC. In a 3-generation family, we identified by whole exome sequencing a novel mutation in
CDH2
(c.686A>C, p.Gln229Pro) that cosegregated with ARVC in affected family members. The
CDH2
c.686A>C variant was not present in >200 000 chromosomes available through public databases, which changes a conserved amino acid of cadherin 2 protein and is supported as the causal mutation by parametric linkage analysis. We subsequently screened 73 genotype-negative ARVC probands tested previously for mutations in known ARVC genes and found an additional likely pathogenic variant in
CDH2
(c.1219G>A, p.Asp407Asn).
CDH2
encodes cadherin 2 (also known as N-cadherin), a protein that plays a vital role in cell adhesion, making it a biologically plausible candidate gene in ARVC pathogenesis.
Conclusions—
These data implicate
CDH2
mutations as novel genetic causes of ARVC and contribute to a more complete identification of disease genes involved in cardiomyopathy.
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Sani MU, Davison BA, Cotter G, Damasceno A, Mayosi BM, Ogah OS, Mondo C, Dzudie A, Ojji DB, Kouam CK, Suliman A, Yonga G, Ba SA, Maru F, Alemayehu B, Edwards C, Sliwa K. Echocardiographic predictors of outcome in acute heart failure patients in sub-Saharan Africa: insights from THESUS-HF. Cardiovasc J Afr 2017; 28:60-67. [PMID: 28262911 PMCID: PMC5514351 DOI: 10.5830/cvja-2016-070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 07/10/2016] [Indexed: 01/19/2023] Open
Abstract
Background: The role of echocardiography in the risk stratification of acute heart failure (HF) is unknown. Some small studies and retrospective analyses have found little change in echocardiographic variables during admission for acute HF and some echocardiographic parameters were not found to be associated with outcomes. It is unknown which echocardiographic variables will predict outcomes in sub-Saharan African patients admitted with acute HF. Using echocardiograms, this study aimed to determine the predictors of death and re-admissions within 60 days and deaths up to 180 days in patients with acute heart failure. Methods: Out of the 1 006 patients in the THESUS-HF registry, 954 had had an echocardiogram performed within a few weeks of admission. Echocardiographic measurements were performed according to the American Society of Echocardiography guidelines. We examined the associations between each echocardiographic predictor and outcome using regression models. Results: Heart rate and left atrial size predicted death within 60 days or re-admission. Heart rate, left ventricular posterior wall thickness in diastole (PWTd), and presence of aortic stenosis were associated with the risk of death within 180 days. PTWd added to clinical variables in predicting 180-day mortality rates. Conclusions: Echocardiographic variables, especially those of left ventricular size and function, were not found to have additional predictive value in patients admitted for acute HF. Left atrial size, aortic stenosis, heart rate and measures of hypertrophy (LV PWTd) had some predictive value, suggesting the importance of early treatment of hypertension and severe valvular heart disease.
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Affiliation(s)
- Mahmoud U Sani
- Department of Medicine, Bayero University Kano; Aminu Kano Teaching Hospital, Kano, Nigeria.
| | - Beth A Davison
- Momentum Research, Inc, Durham, North Carolina, United States of America
| | - Gad Cotter
- Momentum Research, Inc, Durham, North Carolina, United States of America
| | | | - Bongani M Mayosi
- Department of Medicine, GF Jooste and Groote Schuur Hospitals, University of Cape Town, Cape Town, South Africa
| | - Okechukwu S Ogah
- Department of Medicine, University College Hospital, Ibadan and Ministry of Health, Abia State, Nigeria
| | | | - Anastase Dzudie
- Department of Internal Medicine, Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon
| | - Dike B Ojji
- Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Charles Kouam Kouam
- Department of Internal Medicine, Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon
| | - Ahmed Suliman
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Gerald Yonga
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | | | - Fikru Maru
- Addis Cardiac Hospital, Addis Ababa, Ethiopia
| | | | | | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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46
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Ntusi NA, Shaboodien G, Badri M, Gumedze F, Mayosi BM. Clinical features, spectrum of causal genetic mutations and outcome of hypertrophic cardiomyopathy in South Africans. Cardiovasc J Afr 2017; 27:152-158. [PMID: 27841901 PMCID: PMC5101433 DOI: 10.5830/cvja-2015-075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 09/15/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Little is known about the clinical characteristics, spectrum of causal genetic mutations and outcome of hypertrophic cardiomyopathy (HCM) in Africans. The objective of this study was to delineate the clinical and genetic features and outcome of HCM in African patients. METHODS Information on clinical presentation, electrocardiographic and echocardiographic findings, and outcome of cases with HCM was collected from the Cardiac Clinic at Groote Schuur Hospital over a mean duration of follow up of 9.1 ± 3.4 years. Genomic DNA was screened for mutations in 15 genes that cause HCM, i.e. cardiac myosin-binding protein C (MYBPC3), cardiac β-myosin heavy chain (MYH7), cardiac troponin T2 (TNNT2), cardiac troponin I (TNNI3), regulatory light chain of myosin (MYL2), essential light chain of myosin (MYL3), tropomyosin 1 (TPM1), phospholamban (PLN), α-actin (ACTC1), cysteine and glycine-rich protein 3 (CSRP3), AMP-activated protein kinase (PRKAG2), α-galactosidase (GLA), four-and-a-half LIM domains 1 (FHL1), lamin A/C (LMNA) and lysosome-associated membrane protein 2 (LAMP2). Survival and its predictors were analysed using the Kaplan-Meier and Cox proportional hazards regression methods, respectively. RESULTS Forty-three consecutive patients [mean age 38.5 ± 14.3 years; 25 (58.1%) male; and 13 (30.2%) black African] were prospectively enrolled in the study from January 1996 to December 2012. Clinical presentation was similar to that reported in other studies. The South African founder mutations that cause HCM were not found in the 42 probands. Ten of 35 index cases (28.6%) tested for mutations in 15 genes had disease-causing mutations in MYH7 (six cases or 60%) and MYBPC3 (four cases or 40%). No disease-causing mutation was found in the other 13 genes screened. The annual mortality rate was 2.9% per annum and overall survival was 74% at 10 years, which was similar to the general South African population. Cox's proportional hazards regression showed that survival was predicted by New York Heart Association (NYHA) functional class at last visit (p equals; 0.026), but not by the presence of a disease-causing mutation (p = 0.474). CONCLUSIONS Comprehensive genetic screening was associated with a 29% yield of causal genetic mutations in South African HCM cases, all in MYH7 and MBPC3 genes. A quarter of the patients had died after a decade of follow up, with NYHA functional class serving as a predictor of survival.
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Affiliation(s)
- Ntobeko A Ntusi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa and The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. ntobeko.ntusi@ gmail.com
| | - Gasnat Shaboodien
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa and The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Motasim Badri
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa and The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; King Saud Bin Abdulaziz University for Medical Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Freedom Gumedze
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Bongani M Mayosi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa and The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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47
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Abstract
BACKGROUND Beta-blockers refer to a mixed group of drugs with diverse pharmacodynamic and pharmacokinetic properties. They have shown long-term beneficial effects on mortality and cardiovascular disease (CVD) when used in people with heart failure or acute myocardial infarction. Beta-blockers were thought to have similar beneficial effects when used as first-line therapy for hypertension. However, the benefit of beta-blockers as first-line therapy for hypertension without compelling indications is controversial. This review is an update of a Cochrane Review initially published in 2007 and updated in 2012. OBJECTIVES To assess the effects of beta-blockers on morbidity and mortality endpoints in adults with hypertension. SEARCH METHODS The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to June 2016: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 6), MEDLINE (from 1946), Embase (from 1974), and ClinicalTrials.gov. We checked reference lists of relevant reviews, and reference lists of studies potentially eligible for inclusion in this review, and also searched the the World Health Organization International Clinical Trials Registry Platform on 06 July 2015. SELECTION CRITERIA Randomised controlled trials (RCTs) of at least one year of duration, which assessed the effects of beta-blockers compared to placebo or other drugs, as first-line therapy for hypertension, on mortality and morbidity in adults. DATA COLLECTION AND ANALYSIS We selected studies and extracted data in duplicate, resolving discrepancies by consensus. We expressed study results as risk ratios (RR) with 95% confidence intervals (CI) and conducted fixed-effect or random-effects meta-analyses, as appropriate. We also used GRADE to assess the certainty of the evidence. GRADE classifies the certainty of evidence as high (if we are confident that the true effect lies close to that of the estimate of effect), moderate (if the true effect is likely to be close to the estimate of effect), low (if the true effect may be substantially different from the estimate of effect), and very low (if we are very uncertain about the estimate of effect). MAIN RESULTS Thirteen RCTs met inclusion criteria. They compared beta-blockers to placebo (4 RCTs, 23,613 participants), diuretics (5 RCTs, 18,241 participants), calcium-channel blockers (CCBs: 4 RCTs, 44,825 participants), and renin-angiotensin system (RAS) inhibitors (3 RCTs, 10,828 participants). These RCTs were conducted between the 1970s and 2000s and most of them had a high risk of bias resulting from limitations in study design, conduct, and data analysis. There were 40,245 participants taking beta-blockers, three-quarters of them taking atenolol. We found no outcome trials involving the newer vasodilating beta-blockers (e.g. nebivolol).There was no difference in all-cause mortality between beta-blockers and placebo (RR 0.99, 95% CI 0.88 to 1.11), diuretics or RAS inhibitors, but it was higher for beta-blockers compared to CCBs (RR 1.07, 95% CI 1.00 to 1.14). The evidence on mortality was of moderate-certainty for all comparisons.Total CVD was lower for beta-blockers compared to placebo (RR 0.88, 95% CI 0.79 to 0.97; low-certainty evidence), a reflection of the decrease in stroke (RR 0.80, 95% CI 0.66 to 0.96; low-certainty evidence) since there was no difference in coronary heart disease (CHD: RR 0.93, 95% CI 0.81 to 1.07; moderate-certainty evidence). The effect of beta-blockers on CVD was worse than that of CCBs (RR 1.18, 95% CI 1.08 to 1.29; moderate-certainty evidence), but was not different from that of diuretics (moderate-certainty) or RAS inhibitors (low-certainty). In addition, there was an increase in stroke in beta-blockers compared to CCBs (RR 1.24, 95% CI 1.11 to 1.40; moderate-certainty evidence) and RAS inhibitors (RR 1.30, 95% CI 1.11 to 1.53; moderate-certainty evidence). However, there was little or no difference in CHD between beta-blockers and diuretics (low-certainty evidence), CCBs (moderate-certainty evidence) or RAS inhibitors (low-certainty evidence). In the single trial involving participants aged 65 years and older, atenolol was associated with an increased CHD incidence compared to diuretics (RR 1.63, 95% CI 1.15 to 2.32). Participants taking beta-blockers were more likely to discontinue treatment due to adverse events than participants taking RAS inhibitors (RR 1.41, 95% CI 1.29 to 1.54; moderate-certainty evidence), but there was little or no difference with placebo, diuretics or CCBs (low-certainty evidence). AUTHORS' CONCLUSIONS Most outcome RCTs on beta-blockers as initial therapy for hypertension have high risk of bias. Atenolol was the beta-blocker most used. Current evidence suggests that initiating treatment of hypertension with beta-blockers leads to modest CVD reductions and little or no effects on mortality. These beta-blocker effects are inferior to those of other antihypertensive drugs. Further research should be of high quality and should explore whether there are differences between different subtypes of beta-blockers or whether beta-blockers have differential effects on younger and older people.
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Affiliation(s)
- Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Hazel A Bradley
- University of the Western CapeSchool of Public HealthPrivate Bag X17BelvilleCape TownSouth Africa7535
| | - Jimmy Volmink
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Bongani M Mayosi
- J Floor, Old Groote Schuur HospitalDepartment of MedicineObservatory 7925Cape TownSouth Africa
| | - Lionel H Opie
- Medical SchoolHatter Cardiovascular Research InstituteAnzio RoadObservatoryCape TownSouth Africa7925
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48
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Calligaro GL, Zijenah LS, Peter JG, Theron G, Buser V, McNerney R, Bara W, Bandason T, Govender U, Tomasicchio M, Smith L, Mayosi BM, Dheda K. Effect of new tuberculosis diagnostic technologies on community-based intensified case finding: a multicentre randomised controlled trial. Lancet Infect Dis 2017; 17:441-450. [PMID: 28063795 DOI: 10.1016/s1473-3099(16)30384-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inadequate case detection results in high levels of undiagnosed tuberculosis in sub-Saharan Africa. Data for the effect of new diagnostic tools when used for community-based intensified case finding are not available, so we investigated whether the use of sputum Xpert-MTB/RIF and the Determine TB LAM urine test in two African communities could be effective. METHODS In a pragmatic, randomised, parallel-group trial with individual randomisation stratified by country, we compared sputum Xpert-MTB/RIF, and if HIV-infected, the Determine TB LAM urine test (novel diagnostic group), with laboratory-based sputum smear microscopy (routine diagnostic group) for intensified case finding in communities with high tuberculosis and HIV prevalence in Cape Town, South Africa, and Harare, Zimbabwe. Participants were randomly assigned (1:1) to these groups with computer-generated allocation lists, using culture as the reference standard. In Cape Town, participants were randomised and tested at an Xpert-equipped mobile van, while in Harare, participants were driven to a local clinic where the same diagnostic tests were done. The primary endpoint was the proportion of culture-positive tuberculosis cases initiating tuberculosis treatment in each study group at 60 days. This trial is registered at ClinicalTrials.gov, number NCT01990274. FINDINGS Between Oct 18, 2013, and March 31, 2015, 2261 individuals were screened and 875 (39%) of these met the criteria for diagnostic testing. 439 participants were randomly assigned to the novel group and 436 to the routine group. 74 (9%) of 875 participants had confirmed tuberculosis. If late culture-based treatment initiation was excluded, more patients with culture-positive tuberculosis were initiated on treatment in the novel group at 60 days (36 [86%] of 42 in the novel group vs 18 [56%] of 32 in the routine group). Thus the difference in the proportion initiating treatment between groups was 29% (95% CI 9-50, p=0·0047) and 53% more patients initiated therapy in the novel diagnostic group than in the routine diagnostic group. One culture-positive patient was treated based only on a positive LAM test. INTERPRETATION Compared with traditional tools, Xpert-MTB/RIF for community-based intensified case finding in HIV and tuberculosis-endemic settings increased the proportion of patients initiating treatment. By contrast, urine LAM testing was not found to be useful for intensive case finding in this setting. FUNDING European and Developing Countries Clinical Trials Partnership and South African Medical Research Council.
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Affiliation(s)
- Gregory L Calligaro
- Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe; Lung Infection and Immunity Unit, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Lynn S Zijenah
- Department of Immunology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Jonathan G Peter
- Institute of Infectious Diseases and Molecular Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe; Division of Clinical Immunology and Allergology, Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Grant Theron
- Lung Infection and Immunity Unit, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe; DST/NRF of Excellence for Biomedical Tuberculosis Research, and MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Virginia Buser
- Lung Infection and Immunity Unit, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Ruth McNerney
- Lung Infection and Immunity Unit, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Wilbert Bara
- Mabvuku Polyclinic, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical and Research Training Institute, Harare, Zimbabwe
| | - Ureshnie Govender
- Lung Infection and Immunity Unit, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Michele Tomasicchio
- Lung Infection and Immunity Unit, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Liezel Smith
- Lung Infection and Immunity Unit, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Keertan Dheda
- Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe; Institute of Infectious Diseases and Molecular Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe; Lung Infection and Immunity Unit, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe; Division of Clinical Immunology and Allergology, Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
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49
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Zühlke L, Karthikeyan G, Engel ME, Rangarajan S, Mackie P, Cupido-Katya Mauff B, Islam S, Daniels R, Francis V, Ogendo S, Gitura B, Mondo C, Okello E, Lwabi P, Al-Kebsi MM, Hugo-Hamman C, Sheta SS, Haileamlak A, Daniel W, Goshu DY, Abdissa SG, Desta AG, Shasho BA, Begna DM, ElSayed A, Ibrahim AS, Musuku J, Bode-Thomas F, Yilgwan CC, Amusa GA, Ige O, Okeahialam B, Sutton C, Misra R, Abul Fadl A, Kennedy N, Damasceno A, Sani MU, Ogah OS, Elhassan TOHM, Mocumbi AO, Adeoye AM, Mntla P, Ojji D, Mucumbitsi J, Teo K, Yusuf S, Mayosi BM. Clinical Outcomes in 3343 Children and Adults With Rheumatic Heart Disease From 14 Low- and Middle-Income Countries. Circulation 2016; 134:1456-1466. [DOI: 10.1161/circulationaha.116.024769] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 09/20/2016] [Indexed: 11/16/2022]
Abstract
Background:
There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease or information on their predictors. We report the 2-year follow-up of individuals with rheumatic heart disease from 14 low- and middle-income countries in Africa and Asia.
Methods:
Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for 2 years to assess mortality, congestive heart failure, stroke or transient ischemic attack, recurrent acute rheumatic fever, and infective endocarditis.
Results:
Vital status at 24 months was known for 2960 (88.5%) patients. Two-thirds were female. Although patients were young (median age, 28 years; interquartile range, 18–40), the 2-year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.80–3.11), congestive heart failure (HR, 2.16; 95% CI, 1.70–2.72), New York Heart Association functional class III/IV (HR, 1.67; 95% CI, 1.32–2.10), atrial fibrillation (HR, 1.40; 95% CI, 1.10–1.78), and older age (HR, 1.02; 95% CI, 1.01–1.02 per year increase) at enrollment. Postprimary education (HR, 0.67; 95% CI, 0.54–0.85) and female sex (HR, 0.65; 95% CI, 0.52–0.80) were associated with lower risk of death. Two hundred and four (6.9%) patients had new congestive heart failure (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or transient ischemic attack (8.45/1000 patient-years), 19 (0.6%) had recurrent acute rheumatic fever (3.49/1000 patient-years), and 20 (0.7%) had infective endocarditis (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/transient ischemic attack or systemic embolism. Patients from low- and lower-middle–income countries had significantly higher age- and sex-adjusted mortality than patients from upper-middle–income countries. Valve surgery was significantly more common in upper-middle–income than in lower-middle– or low-income countries.
Conclusions:
Patients with clinical rheumatic heart disease have high mortality and morbidity despite being young; those from low- and lower-middle–income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and the treatment of clinical rheumatic heart disease are required to improve outcomes.
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Affiliation(s)
- Liesl Zühlke
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Ganesan Karthikeyan
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Mark E. Engel
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Sumathy Rangarajan
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Pam Mackie
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Blanche Cupido-Katya Mauff
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Shofiqul Islam
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Rezeen Daniels
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Veronica Francis
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Stephen Ogendo
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Bernard Gitura
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Charles Mondo
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Emmy Okello
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Peter Lwabi
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Mohammed M. Al-Kebsi
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Christopher Hugo-Hamman
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Sahar S. Sheta
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Abraham Haileamlak
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Wandimu Daniel
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Dejuma Yadeta Goshu
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Senbeta G. Abdissa
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Araya G. Desta
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Bekele A. Shasho
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Dufera M. Begna
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Ahmed ElSayed
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Ahmed S. Ibrahim
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - John Musuku
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Fidelia Bode-Thomas
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Christopher C. Yilgwan
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Ganiyu A. Amusa
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Olukemi Ige
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Basil Okeahialam
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Christopher Sutton
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Rajeev Misra
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Azza Abul Fadl
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Neil Kennedy
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Albertino Damasceno
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Mahmoud U. Sani
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Okechukwu S. Ogah
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Taiwo OlunugaHuda H. M. Elhassan
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Ana Olga Mocumbi
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Abiodun M. Adeoye
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Phindile Mntla
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Dike Ojji
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Joseph Mucumbitsi
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Koon Teo
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Salim Yusuf
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Bongani M. Mayosi
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
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Lim SS, Allen K, Bhutta ZA, Dandona L, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Hay SI, Holmberg M, Kinfu Y, Kutz MJ, Larson HJ, Liang X, Lopez AD, Lozano R, McNellan CR, Mokdad AH, Mooney MD, Naghavi M, Olsen HE, Pigott DM, Salomon JA, Vos T, Wang H, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abraham B, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NME, Abyu GY, Achoki T, Adebiyi AO, Adedeji IA, Afanvi KA, Afshin A, Agarwal A, Agrawal A, Kiadaliri AA, Ahmadieh H, Ahmed KY, Akanda AS, Akinyemi RO, Akinyemiju TF, Akseer N, Al-Aly Z, Alam K, Alam U, Alasfoor D, AlBuhairan FS, Aldhahri SF, Aldridge RW, Alemu ZA, Ali R, Alkerwi A, Alkhateeb MAB, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Amini H, Ammar W, Amrock SM, Andersen HH, Anderson BO, Anderson GM, Antonio CAT, Anwari P, Ärnlöv J, Artaman A, Asayesh H, Asghar RJ, Atique S, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Barac A, Barber R, Barker-Collo SL, Bärnighausen T, Barrero LH, Barrientos-Gutierrez T, Basu S, Bayou TA, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Béjot Y, Bell ML, Bello AK, Bennett DA, Bensenor IM, Benzian H, Berhane A, Bernabé E, Bernal OA, Betsu BD, Beyene AS, Bhala N, Bhatt S, Biadgilign S, Bienhoff KA, Bikbov B, Binagwaho A, Bisanzio D, Bjertness E, Blore J, Bourne RRA, Brainin M, Brauer M, Brazinova A, Breitborde NJK, Broday DM, Brugha TS, Buchbinder R, Butt ZA, Cahill LE, Campos-Nonato IR, Campuzano JC, Carabin H, Cárdenas R, Carrero JJ, Carter A, Casey D, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cavalleri F, Cecílio P, Chang HY, Chang JC, Charlson FJ, Che X, Chen AZ, Chiang PPC, Chibalabala M, Chisumpa VH, Choi JYJ, Chowdhury R, Christensen H, Ciobanu LG, Cirillo M, Coates MM, Coggeshall M, Cohen AJ, Cooke GS, Cooper C, Cooper LT, Cowie BC, Crump JA, Damtew SA, Dandona R, Dargan PI, Neves JD, Davis AC, Davletov K, de Castro EF, De Leo D, Degenhardt L, Del Gobbo LC, Deribe K, Derrett S, Des Jarlais DC, Deshpande A, deVeber GA, Dey S, Dharmaratne SD, Dhillon PK, Ding EL, Dorsey ER, Doyle KE, Driscoll TR, Duan L, Dubey M, Duncan BB, Ebrahimi H, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Felicio MM, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Ferrari AJ, Fischer F, Fitchett JRA, Fitzmaurice C, Foigt N, Foreman K, Fowkes FGR, Franca EB, Franklin RC, Fraser M, Friedman J, Frostad J, Fürst T, Gabbe B, Garcia-Basteiro AL, Gebre T, Gebrehiwot TT, Gebremedhin AT, Gebru AA, Gessner BD, Gillum RF, Ginawi IAM, Giref AZ, Giroud M, Gishu MD, Giussani G, Godwin W, Gona P, Goodridge A, Gopalani SV, Gotay CC, Goto A, Gouda HN, Graetz N, Greenwell KF, Griswold M, Gugnani H, Guo Y, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Gyawali B, Haagsma JA, Haakenstad A, Hafezi-Nejad N, Haile D, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Hammami M, Hankey GJ, Harb HL, Haro JM, Hassanvand MS, Havmoeller R, Heredia-Pi IB, Hoek HW, Horino M, Horita N, Hosgood HD, Hoy DG, Htet AS, Hu G, Huang H, Iburg KM, Idrisov BT, Inoue M, Islami F, Jacobs TA, Jacobsen KH, Jahanmehr N, Jakovljevic MB, James P, Jansen HAFM, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jee SH, Jeemon P, Jha V, Jiang Y, Jibat T, Jin Y, Jonas JB, Kabir Z, Kalkonde Y, Kamal R, Kan H, Kandel A, Karch A, Karema CK, Karimkhani C, Karunapema P, Kasaeian A, Kassebaum NJ, Kaul A, Kawakami N, Kayibanda JF, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khan G, Khang YH, Khoja TAM, Khosravi A, Khubchandani J, Kieling C, Kim CI, Kim D, Kim S, Kim YJ, Kimokoti RW, Kissoon N, Kivipelto M, Knibbs LD, Kokubo Y, Kolte D, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Kravchenko M, Krueger H, Defo BK, Kuchenbecker RS, Kuipers EJ, Kulikoff XR, Kulkarni VS, Kumar GA, Kwan GF, Kyu HH, Lal A, Lal 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Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015. Lancet 2016; 388:1813-1850. [PMID: 27665228 PMCID: PMC5055583 DOI: 10.1016/s0140-6736(16)31467-2] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 08/13/2016] [Accepted: 08/16/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). METHODS We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. FINDINGS In 2015, the median health-related SDG index was 59·3 (95% uncertainty interval 56·8-61·8) and varied widely by country, ranging from 85·5 (84·2-86·5) in Iceland to 20·4 (15·4-24·9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r2=0·88) and the MDG index (r2=0·92), whereas the non-MDG index had a weaker relation with SDI (r2=0·79). Between 2000 and 2015, the health-related SDG index improved by a median of 7·9 (IQR 5·0-10·4), and gains on the MDG index (a median change of 10·0 [6·7-13·1]) exceeded that of the non-MDG index (a median change of 5·5 [2·1-8·9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. INTERPRETATION GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs. FUNDING Bill & Melinda Gates Foundation.
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