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The literature on the history of family medicine as an academic discipline locates its beginning with the establishment of two faculties linked to the Royal College of General Practice in 1958. However, the history of Community Oriented Primary Care documents, how the Kark’s moved from Pholela in KwaZulu-Natal, were involved with the establishment of the Natal Medical School in Durban. As part of this a Department of Social, Preventative and Family Medicine was established in 1956 with Dr Sidney Kark as its first Head of Department. The South African Academy of Family Practice and Primary Care established in 1980 explicitly orientated itself in relation to public healthcare (PHC). We need to re-claim the history of Community Oriented Primary Care as part of the history of family medicine and proudly trace our current ethos and values to the seminal work of the Kark’s.

Exertional or exercise-induced rhabdomyolysis (ER) is a condition in which excessive and unaccustomed physical activity results in skeletal muscle damage. The ER is a relatively uncommon condition but can have very serious consequences such as acute renal failure, severe electrolyte abnormalities, acid base disturbances and death if not recognised and managed appropriately. The risk factors for rhabdomyolysis exist in our local setting, hence, it is paramount that healthcare practitioners (GPs) in our settings be made aware of ER, its prevention and symptoms. Cases of ER are often reported in sports men or women. Here, we report a case of a 33-year-old healthy female, with clinical and serological presentation, which is typical of ER following the commencement of a regimen of exercise to lose weight.

The coronavirus disease 2019 (COVID-19) pandemic has had an enormous impact on the provision of human immunodeficiency virus (HIV) services amongst people living with HIV. Many people have adopted different health-seeking behaviour in alignment with the lockdown provisions during the COVID-19 pandemic. These lockdown regulations have had a huge impact on healthcare access for people on chronic medication. The disruption of antiretroviral therapy (ART) has a profound effect on HIV-associated morbidity and mortality. The impact on HIV programmes as a result of the interruption in ART could be bigger than the HIV pandemic alone.

The boomslang (Dipholidus typus) has a predominantly haemotoxic venom. Because of the consumptive nature of the coagulopathy, signs and symptoms are usually delayed by up to 72 h after the bite. Traditional laboratory coagulation assays have a long turnaround time, by which time the patient’s bleeding and clotting profile has changed. A 25-year-old male patient was bitten by a boomslang. Despite two normal laboratory coagulation assay results, a point-of-care rotational thromboelastometry showed low fibrinogen levels, leading to the administration of monovalent antivenom. This report highlights the value of point-of-care thromboelastometry in the care of patients with subclinical boomslang envenomation.

The effect of coronavirus disease 2019 (COVID-19) on the mood responses of individuals is an important indicator of how society is coping with the pandemic. Characterising mood responses in a South African sample could prepare clinicians for possible presentations of mental health concerns in general practice. This study described mood responses during COVID-19 Alert Level 1. The sample of 641 participants who completed the Brunel Mood State Scale during November 2020 was drawn from primary healthcare and family medicine clinics and practices in Cape Town. Their mood response profile was described and compared with pre-COVID-19 norms. The mood profile represented an inverse iceberg profile, with mean scores deviating significantly from pre-COVID-19 norms across all six mood dimensions measured. The inverse iceberg profile had been associated with a range of psychopathologies, suggesting an increased risk of psychological disorders. The current profile of mood responses could alert clinicians to the possibility of increased mental health needs of patients. Patient reports of prolonged anxiety and fatigue, particularly when combined with low mood and low vigour, could signal the need for intervention or referral for further mental health support.

Uterine balloon tamponade (UBT) should be attempted once emergency measures have been applied and medical treatment for post-partum haemorrhage (PPH) resulting from an atonic uterus has failed. Sinapi Biomedical (Pty) Ltd developed the Ellavi UBT, a free-flow pressure-controlled UBT unit. The device is affordable for use in lesser-resourced countries. A case series of Ellavi UBT used by medical officers in a rural regional hospital without specialist supervision was conducted. This case series was conducted in St Elizabeth’s Hospital in Lusikisiki, South Africa. The hospital serves as the regional hospital for the Ingquza Hill Subdistrict in the Eastern Cape Province. The Nelson Mandela Academic Hospital (NMAH) in Mthatha is the tertiary referral hospital. Workshops were conducted on the use of Ellavi UBT, and devices were made freely available to the hospital. The case series included 10 patients. Six patients delivered by caesarean section, and four had normal vertex deliveries. All patients had additional oxytocin infusions, and eight patients received misoprostol. Following the insertion and inflation of the Ellavi UBT, the PPH stopped in seven patients, was much reduced in one patient and reduced in one patient. In one case, the Ellavi UBT had no effect on the bleeding. All 10 patients were referred to the NMAH. All patients in the case series had good outcomes. The insertion of the Ellavi UBT and subsequent referral proved to be feasible in a rural regional hospital. All patients included in the case series arrived at the referral hospital and had a good outcome.

Despite the implementation of the Choice on Termination of Pregnancy (CTOP) Act, many women continue to procure illegal abortions in South Africa. A lack of knowledge of the CTOP Act and poor access to legal abortion in public health facilities is a big challenge. In the scope of the CTOP Act, the termination of pregnancy is a time-restricted health service, and women presented to a health care facility in the second trimester have encounter ore obstacles to access the services.

The ongoing coronavirus disease 2019 (COVID-19) pandemic presented a huge challenge to the health systems across the world. When the virus hit South Africa, and the state of national disaster was announced by the president, the healthcare system had to work on its COVID-19 response preparedness. Initially, a few hospitals were then designated facilities for managing COVID-19 patients. Kalafong Hospital, which was not amongst a list of designated facilities for COVID-19 was forced to evaluate its level of preparedness after an intern doctor tested positive. The objectives of this report are to illustrate the hospital’s response around the management of the index case to share our facility’s general response to the pandemic.

Transient gestation hypertension is a contributor to adverse pregnancy outcomes particularly when it progresses to pre-eclampsia (PE). This requires frequent monitoring. We illustrate the need for stringent monitoring of gestational hypertension, transient gestational hypertension (TGH) and PE without severe features and conducted a brief rapid review of the literature. Two cases are presented: Firstly, a 25-year-old primigravida at 30 gestational weeks who had an isolated TGH with high blood pressure (BP) of 141/87 mmHg, which was not investigated. Four weeks later, she presented with a BP of 202/128 mmHg, imminent eclampsia and intrauterine foetal death and had an uncomplicated induction of labour and delivered a 1400 g macerated male stillborn. Secondly, a 30-year-old primigravida at 30 gestational weeks who developed PE but her monitoring was compromised initially by inadequate healthcare capacity including unavailability of hospital bed-space for inpatient care and later by poor clinic attendance as a result of poor finances. At 32 gestational weeks, she presented with decreased foetal movement and was diagnosed as haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome and intrauterine foetal death. She was stabilised, had induction of labour and delivered a 1400 g male macerated stillborn. Thereafter, the need for her to go home to complete the cultural burial rites of her baby and the pressure from her workplace resulted in an inadequate postpartum follow-up care. In conclusion, transient gestational hypertension is associated with adverse maternal and foetal outcomes, including foetal demise. Unavailability of hospital bed-space and poor personal finances interfere with stringent monitoring of hypertensive disorders and can be associated with adverse pregnancy outcomes. Stringent laboratory monitoring in these cases is defined by the authors as testing at least blood levels of serum Creatinine, Haemoglobin concentration, Alanine transaminase and Platelet count (abbreviated as ‘CHAP’) weekly.

Background: Promoting evidence-based antibiotic prescribing through successful antimicrobial stewardship (AMS) programmes is critical to preserving the effectiveness of antibiotics for common infections in primary care. This requires a coordinated multidisciplinary effort. Such pharmacist–prescriber partnerships have been effective in high-income countries (HICs). Yet, evidence generated in such countries is not always applicable because of different social determinants of health. Methods: A multidisciplinary workshop was conducted with pharmacists and clinicians (doctors, nurses) on community-based antibiotic stewardship, the purpose of which was to explore how and where such partnerships might work in publicly funded primary care clinics in the greater Cape Metro region. Results: Participants perceived that promoting effective AMS was a priority for South African primary healthcare. However, it was clear that there are many hurdles to overcome working in settings that are relatively resource-poor. Prescribing guidelines needed to be harmonised. Participants felt that staff training on the principles of AMS should be mandatory. Research was urgently needed to better understand their community’s understanding of antibiotic use and AMS, and to champion outreach projects in the community. Conclusion: Important stakeholder perspectives in the community were highlighted to promote a multidisciplinary approach to AMS initiatives in primary care. These will need to be addressed to optimise antibiotic prescribing in the community.

In South Africa, large numbers of individuals with medical emergencies initially visit a general practitioner or family physician. In the case of maternity care, this may occasionally involve acute onset of severe hypertension during the antenatal period. Primary care providers (PCPs) are therefore faced with the conundrum of treating and stabilising high blood pressure or referring the patient to an appropriate hospital. Case reviews within groups of medical practitioners provide an opportunity for learning in the practical management of obstetric emergencies. The case history of a patient with severe hypertension was presented, and reflections on this patient encounter were highlighted. Amongst the challenges faced by generalists in their interactions with the public health sector are availability of standard clinical protocols, medicines, the need to work in partnership and the need to have ‘feedback’.

Medical practitioners are confronted daily with decisions about patients’ capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end-oflife decision-making capacity of a 72-year-old female with treatment-resistant schizophrenia and terminal cancer is discussed, as are the role of the treating clinician and the importance of health-related values. There is a recommendation that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient’s wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient’s capacity will change the treatment approach. Clinicians should attend to any possible underlying issues, instead of focusing strictly on capacity. Compared to the general populations people with serious mental illness (SMI) have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services. Conversations about end-of-life care can occur without fear that a person’s psychiatric symptoms or related vulnerabilities will undermine the process. More research about palliative care and advance care planning for people with SMI is needed. This is even more urgent in light of the coronavirus disease-2019 (COVID-19) pandemic, and South African health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with SMI.&nbsp

Background Critical appraisal is an important skill for clinicians of the future which medical students often have limited opportunities to develop. This study aimed to evaluate whether a national journal club session could improve medical students’ confidence with critical appraisal. Methods 98 medical students attended a critical appraisal lecture and supervised journal article discussions. Junior doctor mentors supported students to submit discussion points as a letter-to-the-editor. An online cross-sectional survey was administered before and after the conference. Results 74 students responded, reporting increased confidence with critically appraising research articles (median score 2 vs 4, p

This paper examines how some linguistic and extra-linguistic features of scientific letters published in well-reputed journals in the field of astrophysics (types and length of titles, as well as the relationship between title length and authorship patterns and collaboration practices) have changed over time. Our main results may be summarized as follows: 1) simple and nominal titles significantly outweigh compound, question and verbal titles, although the latter are on the rise; 2) the colon is the most frequently used punctuation mark; 3) the frequency of appearance of colons, full stops and commas increases over time; 4) there is a steady upward trend in longer titles, number of authors and countries; 5) Although over time authors contribute fewer words and countries involved in the research provide more words to the writing of scientific letter titles, authorship variations seem to be more relevant in relationship to the evolution of title length, i.e. title length is more author-driven than country-driven. A final diachronic cross-journal analysis confirms the co-existence of two different collaboration scenarios as already disclosed in a previous synchronic study on the same topic.

José María Dusmet (1869-1960) was a renowned Spanish entomologist. He specialized in big Hymenoptera, developing his tasks at the National Museum of Natural Sciences in Madrid, despite the fact he never occupied an official position. In 1925, Modesto Quilis (1904-1938), a student from Valencia, wrote Dusmet in order to obtain advice on how to make progress in entomological studies. From that moment and for more than a decade, Dusmet gave Quilis guidance to the practice of professional entomology in a diversity of aspects, e.g., acquisition of specimens and bibliography, contacts with other colleagues in Spain and other countries, or questions on taxonomy and nomenclature. He also introduced his young disciple in a certain kind of scientific ethos, based on a chivalric sense of the relationship between natural history practitioners. Some years went by and Quilis obtained an official job as entomologist specialized in microhymenoptera and pest control. His promising career was cut short by his premature death. Exchange letters between both naturalists have been consulted at the Archive of the National Museum of Natural History. This correspondence highlights the details of a sort of teaching-in-distance, pervaded by friendship and mutual admiration., José María Dusmet (1869-1960) fue un reconocido entomólogo español, especialista en macrohimenópteros, que desarrolló su labor vinculado al Museo Nacional de Ciencias Naturales aun sin ocupar oficialmente puesto alguno. En 1925 un joven universitario de Valencia, Modesto Quilis (1904-1938), contactó con él para solicitarle consejo para progresar en su afición por los insectos. A partir de ese momento, y durante más de diez años, Dusmet fue iniciando a Quilis en la práctica entomológica profesional. Así, le asesoraba en la adquisición de ejemplares y bibliografía, al tiempo que le facilitaba contactos entre especialistas nacionales y extranjeros y le resolvía dudas de nomenclatura y taxonomía. Además, le inició en un cierto ethos caballeresco de la práctica naturalista. Con el tiempo, Quilis logró una inserción profesional como entomólogo especialista en microhimenópteros y control biológico de las plagas del campo, iniciando una prometedora carrera que frustró su temprana muerte. Las cartas que ambos intercambiaron, conservadas en el Museo Nacional de Ciencias Naturales, ponen de relieve los detalles de un magisterio en la distancia intensamente cargado de admiración mutua y cultivo de la amistad.

In this study we compare the titles of scientific letters and those of research papers published in the field of astrophysics in order to identify the possible differences and/or similarities between both genres in terms of several linguistic and extra-linguistic variables (length, lexical density, number of prepositions, number of compound groups, number of authors and number of countries mentioned in the paper bylines). We also carry out a cross-genre and cross-journal analysis of the referred six variables. Our main findings may be summarized as follows: (1) When compared to research paper titles, scientific letter titles are usually shorter, they have a lower lexical density, they include a higher number of prepositions per number of words and a lower number of compound groups per number of words, although they have more up to 4-word compound groups, i.e. the simplest ones. As a consequence, scientific letter titles include less information, which is also less condensed, than research paper titles. (2) The predominance of compound adjectives over compound nouns in the titles of both genres highlights the scientificity of astrophysical discourse. (3) In general terms, our data show a positive correlation between title length and the number of countries mentioned in the bylines for both genres. The positive correlation between title length and number of authors is only met in the case of research papers. In light of these findings, it may be concluded that scientific letters are a clear example of a timeliness and more “immediate” science, whereas research papers are connected to a more timeless and “elaborate” science. It may also be concluded that two different collaboration scenarios are intertwining on the basis of three separate geographic and linguistic publication contexts (Mainland Europe, The United Kingdom and The United States of North America).

Background: Since 2007, the postgraduate training of family physicians for South African district hospitals has been formalised. This training differs from European and North American programmes as up to 30% of the skills needed rely on district hospital surgical, obstetrics and anaesthetics procedures, particularly in rural areas, as outlined in the national unit standards. The aim of this study was to evaluate the appropriateness and sufficiency of learning opportunities for these skills in a rural district hospital. Methods: A descriptive, cross-sectional study was undertaken of the number and type of procedures performed in theatre for a 1-year period and compared with the required procedural skills stipulated in the national unit standards. Descriptive statistical analyses were used to analyse categorical data. Results: Three thousand seven hundred and forty-one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by Caesarean section. There were adequate opportunities for teaching most core skills. Conclusions: Sufficient and appropriate learning opportunities exist for postgraduate family medicine training in all the core skills performed in a theatre according to the national unit standards. Keywords: Post Graduate Training, Family Medicine, Procedural Skills, Rural, District hospitals

Background: Deep vein thrombosis (DVT) is 10 times more prevalent in HIV and AIDS patients than in the general population and is more common in patients with severe immune suppression (CD4 < 200 cells/mL). Opportunistic infections render HIV and AIDS patients susceptible to a hypercoaguable state, including lower protein S levels. Aim and setting: To present the profile of HIV and AIDS patients who developed DVT in the primary care wards of Dr. George Mukhari Academic Hospital (DGMAH), Garankuwa. Methods: Cross-sectional study of clinical records of admitted HIV and AIDS patients without DVT to the primary care wards, DGMAH, from 01 February 2010 to 31 January 2011. Results: Two hundred and twenty-nine patients were admitted and 17 (7.4%) developed DVT. Of those that developed DVT, eight (47%) had infection with tuberculosis (TB), four (24%) had pneumonia and four (24%) had gastroenteritis. The risk of developing DVT was 8/94 (8.5%) in those with TB, 4/53 (7.5%) in those with gastroenteritis and 4/75 (5.3%) in those with pneumonia. The mean duration of stay was 14.1 days in those with DVT versus 4.0 days in those without. Conclusion: HIV (and AIDS) is a hypercoaguable state and the risk of DVT is relatively high in patients with opportunistic infections. HIV and AIDS patients who are admitted to hospital with opportunistic infections may benefit from anti-thrombotic prophylaxis and further studies are needed to evaluate this.

Sarcoidosis is a multisystem granulomatous disease of unknown aetiology characterized by increased inflammation, and results from gene–environment interactions. Proteinase‐activated receptor‐1 mediates the interplay between coagulation and inflammation. The rs2227744G > A promoter single nucleotide polymorphism has been linked to inflammation, cardiovascular disease and chronic obstructive pulmonary disease exacerbations. Using a case‐control study (184 cases with sarcoidosis and 368 controls), we show that the rs2227744A allele significantly associates with protection from sarcoidosis (P = 0.003, OR = 0.68 (0.52–0.88)).

A sputum eosinophilia is observed in 10–40% of COPD subjects. The blood eosinophil count is a biomarker of sputum eosinophilia, but whether it is associated with bronchial submucosal eosinophils is unclear. In 20 COPD subjects and 21 controls we assessed the number of bronchial submucosal eosinophils and reticular basement membrane thickening and found these were positively correlated with the blood eosinophil percentage. In COPD, blood eosinophils are a good biomarker of bronchial eosinophilia and remodelling.

Transforming growth factor-β1(TGF-β1) is a multifunctional cytokine that has an important role in the regulation of cell growth, differentiation, and repair in a variety of tissues.1 In addition to its role in the cell cycle and apoptosis, TGF-β1 induces the synthesis of extracellular matrix (ECM) and is upregulated by angiotensin II.1 2 Dilated cardiomyopathy is characterised by myocyte loss, hypertrophy of residual myocytes, increased interstitial fibrosis, and abnormalities of the cytoskeleton.3 Cytotoxic lymphocytes and macrophages are also present in the myocardium in increased numbers which may provide a source of TGF-β1.4 Therefore in this study we have investigated whether patients with chronic heart failure caused by idiopathic dilated cardiomyopathy have increased plasma concentrations of TGF-β1, and whether this is associated with increased macrophage gene expression for TGF-β1compared to those with normal left ventricular function. Patients with ischaemic or hypertensive heart disease were excluded because of the potential confounding effects on TGF-β1 concentrations of atherosclerosis and pressure overload with left ventricular hypertrophy. Twenty patients who presented with symptoms and signs of chronic heart failure with no obvious cause and with the clinical diagnosis of dilated cardiomyopathy (by the World Health Organization criteria) were studied. All patients had right and …

OBJECTIVE—To investigate the contribution of apoptosis in the development of the skeletal myopathy in chronic heart failure. DESIGN—The electrophoretic pattern of myosin heavy chains (MHC), fibre cross sectional area, number of in situ nick end labelling (TUNEL) positive apoptotic myocyte nuclei, and the tissue levels of caspase-3, Bcl-2, and ubiquitin were determined in biopsies taken from the vastus lateralis muscle. The study involved nine patients with severe chronic heart failure caused by ischaemic heart disease and hibernating myocardium and five controls. RESULTS—In chronic heart failure patients the vastus lateralis showed a significant increase of MHC2a and MHC2b and a greater degree of fibre atrophy, as demonstrated by the decreased cross sectional area. There was also an increased number of TUNEL positive apoptotic myocyte nuclei. Tissue concentrations of Bcl-2 were decreased, while those of caspase-3 and ubiquitin were increased. Peak oxygen consumption (VO2) was negatively correlated with the number of TUNEL positive nuclei and the fibre cross sectional area. There was a correlation between the number of apoptotic nuclei and the fibre cross sectional area, but no correlation between myosin heavy chains and number of apoptotic nuclei. CONCLUSIONS—Myocyte apoptosis occurs in the skeletal muscle of patients with chronic heart failure, and its magnitude is associated with the severity of exercise capacity limitation and the degree of muscle atrophy. Muscle atrophy contributes to the limitation of exercise capacity, together with the increased synthesis of fast, more fatiguable myosin heavy chains. Keywords: apoptosis; chronic heart failure; exercise capacity; myosin heavy chains

Diabetes mellitus is a well recognised risk factor for cardiovascular disease and diabetic individuals with acute coronary syndrome (ACS) have a two- to fourfold increased risk of adverse cardiovascular events compared to non-diabetic individuals.1 It is becoming increasingly clear that impaired glucose metabolism and the pre-diabetic state are also associated with adverse clinical outcomes. A retrospective study of 197 patients by Norhammar et al 2 showed that among non-diabetic patients with acute myocardial infarction, those with higher admission blood glucose had higher rates of death, rehospitalisation for heart failure, and rehospitalisation for non-fatal reinfarction. In this study, admission plasma glucose was an independent predictor of non-fatal reinfarction, hospitalisation for heart failure, and a major adverse cardiovascular event (MACE).2 Another study by Norhammar et al revealed that 35% of patients admitted to the coronary care unit with a myocardial infarction and no prior diagnosis of diabetes may have an abnormal glucose tolerance test at discharge.3 The American Diabetes Association (ADA) recently redefined the cut off point for normal fasting blood glucose concentrations from 110 mg/dl to 100 mg/dl, meaning that a value of 100 mg/dl or above would lead to a diagnosis of impaired fasting glucose, which is included in the term pre-diabetes.4 The impact of the new guideline is immense. Health and human services estimate that …

Information of the segmented left ventricular (LV) area supplied by every coronary artery is potentially useful for strategy and practice of percutaneous coronary intervention, coronary artery bypass surgery, or percutaneous transluminal septal myocardial ablation (PTSMA).1,2 Myocardial contrast echocardiography (MCE) with intracoronary contrast injection has been used to evaluate the segmented LV area supplied by a coronary artery but it is invasive and evaluation of myocardial enhancement by ultrasound contrast material may depend upon the skill of the investigator.1 With a prototype high speed cone beam computed tomography (CT) apparatus employing 256 detector rows (Athena, Sony-Toshiba), an entire heart can be imaged within a single gantry rotation.3,4 Using this technique, combined with selective intracoronary injection of contrast, we determined the segmented LV area supplied by every coronary artery selectively. Two domestic pigs (20 kg each) were anaesthetised with isoflurane, and catheters positioned in the left anterior descending branch (LAD) of the coronary artery in pig 1 and the left circumflex branch (LCx) in pig 2, via the femoral arteries. The heart rate of pigs ranged between 70–80 beats per minute. Scan conditions for the 256 slice cone beam CT were: 120 kV, 200 mA, 1.0 second exposure, 1.0 second gantry rotation time, 0.5 mm slice thickness, and 256×0.5 mm slice collimation. For comparison, those for the 16 slice multislice CT scanner routinely used at our institute (SOMATOM Sensation 16, Siemens) were: …

Diabetes is not only a predisposing factor for cardiovascular disease but once diabetic patients develop coronary artery disease (CAD) they have significantly worse outcomes compared to non-diabetic patients.1,2 Diabetes is an independent risk factor for a worse outcome after presentation with acute coronary syndrome (ACS).2 Prior studies have demonstrated that diabetic patients without previous myocardial infarction have as high a risk as non-diabetic patients with previous myocardial infarction.3 Based on this and other studies, diabetes is considered a CAD equivalent or, in other words, patients with diabetes should be treated as already having vascular disease. Elevated cardiac enzymes, both creatine kinase myocardial band (CK-MB) and troponin, have been demonstrated to be important prognostic determinants of patients with ACS and to identify high risk patients.4 The prognostic implications of elevated biomarkers in diabetic patients who are already considered to be at high risk have not been systematically studied. The primary objective was to analyse the prognostic implication of elevated biomarkers in patients with and without diabetes in predicting six month mortality. We studied 1951 consecutive patients who were admitted to the University of Michigan Medical Center from 27 December 1998 to 16 October 2002 with a diagnosis of ACS. The protocol was approved by the institutional review board at the University of Michigan and informed consent obtained from all patients. …

Sirolimus eluting stents are associated with very low restenosis rates when deployed for single de novo native coronary lesions.1 These and other drug eluting stents are changing the face of interventional cardiology practice.2 A number of fundamental practical questions arise with the use of these novel stents, including the effects on in-stent restenosis (ISR) of overlapping stents, tandem stents, and deploying drug eluting and bare metal stents in the same vessel, as well as the ongoing issue of higher ISR rates in patients with diabetes.1 While rabbit iliac and porcine coronary models of ISR are often used for stent evaluation, these models are expensive and subject to a number of well documented limitations.3 A simple, more cost effective model of ISR would therefore be of major utility. Such a model is described here. All studies were approved by the University of New South Wales ethics committee. Male Sprague-Dawley rats (350–450 mg) were anaesthetised using ketamine and xylazine in the standard manner. A midline incision was made, and access to the left common carotid artery achieved using standard surgical techniques. The vessel was then isolated from the surrounding tissues, and an arteriotomy performed. A 2.0 × 7 mm BiodivYsio human coronary stent (Abbott Vascular, Illinois, USA) was then advanced into the vessel after topical application of 3–5 drops of glyceryl trinitrate (100 μg/ml). No fluoroscopic guidance was used. At a pre-marked point corresponding to the lower thoracic aorta, the stent was deployed using a single inflation at 16 atmospheres for 10 seconds. The stent balloon was then withdrawn, and post-deployment dilatation performed using a 3.0 × 15 mm coronary angioplasty balloon (Boston …

Este estudo investiga a recorrência de nominalizações deverbais em resumo de cartas científicas em língua portuguesa, do arquivo da cientista Bertha Lutz, com intuito de estimar os graus de produtividade das nominalizações e observar suas funções de índice. A pesquisa situa-se entre a Linguística e a Ciência da Informação e objetiva contribuir para o refinamento da indexação. Estabeleceu-se a hipótese de que as nominalizações em -ção prevalecem, em cartas científicas, e exercem funções de índices relevantes. Consideram-se como referencial teórico a análise de gêneros na Sociolinguística, a teoria lexical e a indexação na Ciência da Informação. Os resumos foram processados pelo software RankWords2. 0 e produzida uma lista de frequência de palavras. A aplicação das leis de Zipf e Ponto T confirmou sua viabilidade na indexação dos resumos. Finalmente, observa-se a recorrência de nominalizações relevantes, na região de concentração de palavras-chave, e ressalta-se que os dados obtidos corroboram a hipótese estabelecida. The study investigates the recurrence of deverbal nominalization in the abstracts of scientific letters in Portuguese language from the files of the scientist Bertha Lutz. The study aims to estimate the degree of productivity of nominalizations and to observe their index role. The study is situated between the Linguistics and Information Science and intends to contribute to the indexing refinement. The hypothesis is that the nominalizations in -ção prevail in the lexicon of scientific letters as relevant index. The theoretical framework used was the genre analysis, academic discourse and lexical theory, in the Sociolinguistics, and indexing within Information Science. The abstracts were processed by RankWords 2.0 software. A list of word frequency was obtained. It was confirmed the adequacy of Zipf’s Laws and Goffman Transition Point. The results point out to the recurrence of nominalizations in -ção with high semantic content in Goffman T Region and confirm the established hypothesis

Despite aggressive control of modifiable risk factors, recurrent acute coronary syndromes are still common, and the underlying mechanisms largely elusive. Glycoprotein (Gp) Ia/IIa is one of several collagen receptors involved in platelet adhesion.1 A C807T gene variant of GpIa is related to Gp Ia/IIa receptor density on the platelet surface,2 with the density proportionate to the number of T alleles.2 Previous case-control studies in white subjects have associated this variant with acute ischaemic heart disease.3 As it is not known whether the 807T allele may also predict recurrent acute coronary syndromes, this was investigated in 117 survivors of a first acute coronary event; patients were followed for up to five years. Between 1996 and 1998 we enrolled 195 patients below the age of 65 years; these patients were discharged from our coronary care unit with a diagnosis of acute myocardial infarction (MI), according to World Health Organization criteria, (MI, n = 141) or severe Braunwald class IIIB unstable angina (UA, n = 54) at first presentation of disease. After informed consent for genetic analyses, a final number of 117 patients (79 MI, 38 UA) accepted follow up assessment which took place at six months, two years, and five years. Clinical evaluation was blinded to the results of genotyping. Major cardiovascular risk factors, angiographic extent of disease, and left ventricular ejection fraction (LVEF) were assessed at enrolment. Antiplatelet drugs during follow up consisted of aspirin or ticlopidine if aspirin was contraindicated. Following percutaneous coronary interventions, aspirin and ticlopidine were both prescribed for four weeks. Gp IIb/IIIa inhibitors were not administered. The primary end point was the composite of fatal and …

Dilated cardiomyopathy (DCM), characterised by a severe dysfunction of the heart muscle, often results from a myocarditis, which could be caused by a variety of organisms or mediated by autoimmune responses to the exposure of cardiac specific antigen, such as myosin, after cardiomyocyte damage. DCM of humans can be experimentally reproduced in susceptible mouse strains by immunisation with purified cardiac myosin.1 Moreover, chlamydia infection may mediate heart disease through an antigenic mimicry between the chlamydia outer membrane protein and muscle specific α myosin of the heart.2 The aim of this study was to investigate the prevalence of Chlamydia pneumoniae infection by measuring the serum IgG and IgA antibodies against C pneumoniae in patients with DCM. Twenty six consecutive patients with DCM, aged 56.9 (15.5) years, diagnosed according to the World Health Organization/International Society and Federation of Cardiology criteria,3 were enrolled. Twenty eight healthy subjects, mean (SD) age 57.4 (13.7) years, matched for age and sex, were used as the controls; they were chosen from the subjects undergoing coronary angiography during the same period and not showing any significant coronary stenosis, valvar disease or other cardiovascular diseases. None of the patients had a clinical history of specific heart muscle disease that may have caused left ventricular …

The efficacy of the timely administration of thrombolytic treatment in the clinical management of acute myocardial infarction (MI) is well established. Large scale clinical trials have conclusively shown that the earlier the administration of such treatment, the greater the morbidity and mortality advantage.1 The demonstration of this time dependent relation has prompted research into factors that contribute to the delay interval between symptom onset and hospital presentation. The failure of sociodemographic and clinical factors to be consistently related to pre-hospital delay2 has recently focused attention on how patients make sense of their symptoms and determine whether they need urgent medical help. Building on a recent study which found that patient delay was associated with a discrepancy between symptom experience and prior symptom expectation of MI,3 we extended the scope of this research by also investigating whether delay was related to having a family member present or to behaviours such as self medication before calling for help. We evaluated a consecutive sample comprising 47 participants with a confirmed diagnosis of acute MI (38 men and nine women with a mean (SD) age of 62 (13.4) years). Thirty eight per cent of the sample had a family history of MI and 15% of participants had experienced a previous MI. Patients were required to recall both the symptoms experienced as part of their …

The adhesion of leucocytes to vascular endothelium is fundamental to the pathogenesis of atherosclerosis and the acute coronary syndromes. The CD11b/CD18 receptor is particularly important in this process. This molecule is expressed on both neutrophils and monocytes. In common with other integrin receptors it consists of α and β subunits (CD11b and CD18, respectively), which allow binding of leucocytes to the endothelial surface.1 The aims of our study were: (1) to compare the expression of CD11b and CD18 on peripheral neutrophils and monocytes in patients with an acute coronary syndrome, patients with stable coronary artery disease, and healthy controls; and (2) to assess any functional change in neutrophil adhesion in the acute coronary syndrome. Twenty two consecutive patients with an acute coronary syndrome were studied. None had received thrombolytics or glycoprotein IIb/IIIa inhibitors and none had undergone coronary revascularisation. All were on maintenance aspirin (n = 19) or had received > 12 hours of such treatment in hospital (n = 3). Twelve patients with stable coronary artery disease were also studied. All had a > 50% stenosis of at least one major coronary artery, had stable cardiac symptoms over the past six months, and were taking maintenance aspirin. The third group consisted of 12 healthy volunteers with no cardiac history or symptoms. These subjects were asked to take aspirin for three days before blood sampling. None of the patients or volunteers studied had …

The non-invasive detection of coronary artery disease is a prime goal for future developments in clinical cardiology. In addition to the documentation of significant stenoses, the detection of vulnerable plaques is of major importance for risk stratification and early treatment, in order to prevent plaque ruptures.1 Recently, a new generation of fast spiral computed tomography scanners has been introduced using a multi-slice technique (MSCT). This new technology allows for an almost motion free visualisation of the coronary arteries.2 3 We report on non-invasive differentiation of coronary plaque morphology by MSCT in patients with lesions in the proximal left anterior descending artery (LAD). The results were compared with the findings of intracoronary ultrasound (ICUS). The study protocol was approved by the local ethical committee and the patients gave informed consent before inclusion in the study. All patients had chronic stable angina caused by a severe lesion in the LAD and were assigned for percutaneous transluminal coronary angioplasty (PTCA). A major inclusion criterion in the study was the presence of a clearly identifiable plaque in the proximal LAD. One plaque was selected for analysis in each patient. MSCT of the …

Scientific letters, of great importance in the history of science and scientific instrumentation, have particular relevance in those sectors of the earth sciences in which structured observation networks are distributed across the territory, such as seismology, meteorology, geomagnetism and astronomy.

The β-1 adrenoceptor (AR), and to a lesser extent the β-2 AR, mediate the effect of circulating catecholamines on the pumping efficiency of the heart through positive inotropic, chronotropic, and lusitropic effects. These responses are required to meet the demands for increased tissue blood flow, not only during exercise, but also in pathophysiological states such as heart failure. Yet, cardiac responsiveness to β-1 AR activation or blockade, especially in heart failure, displays significant variation between individuals.1 The discovery of two common polymorphisms within the β-1 AR gene supports the notion that part of this may be genetic in origin. These variants, 389R>G and 49S>G, affect the encoded amino acid sequence (switching arginine to glycine and serine to glycine, respectively) and have notable effects on β-1 AR signalling both in cell lines and in intact human myocardial tissue.2,3 In vivo, the failing myocardium with its down regulated β-1 AR function may be particularly affected by these polymorphisms. Here we confirm a previous report that heart failure patients awaiting transplant do have significantly different exercise capacities depending on their genotype status for the 389R>G β-1 AR polymorphism. To identify sufficient numbers of patients with severe left ventricular (LV) dysfunction, we retrospectively approached 167 living patients entered into the cardiac transplant programme …

Thirty seven years have passed since the first description of Kawasaki disease (KD) and some women with coronary artery lesions caused by KD are now of childbearing age1,2 The incidence of giant aneurysms leading to ischaemic heart disease among women is about one third that among men. There is little information on managing pregnancy and delivery in patients with coronary artery disease.3,4 We analysed the clinical course of pregnancy and delivery in this population and determined the nature of problems. We encountered 13 pregnancies and deliveries in 10 patients who had coronary artery lesions caused by KD from 1993 to 2004 in our follow up clinic. Their ages at delivery ranged from 18–34 years (median 28 years) (table 1). All patients underwent cardiac catheterisation including selective coronary angiography and left ventriculography before pregnancy. The interval between the latest coronary angiogram and delivery ranged from eight weeks to eight years. All patients underwent a treadmill test and exercise stress radioimmunological myocardial imaging before pregnancy. View this table: Table 1 Coronary artery lesions on coronary angiograms and medication, mode of delivery, and anaesthesia Nine patients had a normal left ventricular …

Although American College of Cardiology/American Heart Association/European Society of Cardiology clinical practice guidelines1 recommend oral anticoagulation for patients aged 75 years or older with non-valvar atrial fibrillation (NVAF) and without contraindication to this treatment, underutilisation has often been reported.2 Moreover, this population has been underrepresented in clinical trials—the only one that included a high proportion of elderly patients3 had equivocal results: a reduction of embolic events, but an increase in severe bleeding, especially intracranial, that offset the benefit obtained. We planned a prospective observational cohort study with the following objectives: to describe cardioembolic risk factors and contraindications to anticoagulants in our population of elderly patients; to manage oral anticoagulation prescription in this group by trying to follow the guidelines; and to evaluate whether oral anticoagulation in our outpatient cardiology clinic is effective and safe to lessen thromboembolic events in elderly patients with NVAF. We have previously reported the usefulness of a prospective protocol in this setting to increase oral anticoagulation prescription.4 This work describes basal and follow up data of the subgroup of patients aged 75 years and older. This protocol received the usual ethical approval for observational studies in our institution, and all patients gave informed consent. Patient selection criteria and methods have been described.4 From 1 February 2000 to 1 …