Browsing by Author "Lawrenson, John"

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    Direct and indirect effects of the COVID-19 pandemic on children with cardiovascular disease
    (South African Heart Association, 2020) Zuhlke, Liesl; Brown, Stephen; Cilliers, Antoinette; Hoosen, Ebrahim; Lawrenson, John; Ntsinjana, Hopewell
    ENGLISH ABSTRACT: Coronavirus 2 (SARS-CoV-2) the causative agent of what we now know as “Coronavirus Disease 2019” (COVID-19), is the most serious global health crisis of our generation, with a significant and far-reaching impact upon health, economy, social cohesion and emotional and mental wellbeing. Although children do not bear the brunt of direct mortality, they are significantly affected in terms of morbidity and interruption to access, continuity and complexity of care, as well as the indirect social and financial effects impacting on their health outcomes. In this review we present some of the most recent data relevant to children with congenital and acquired heart disease, and consider some of the cardiac presentations noted. We discuss the necessary protections to staff in the echo and cardiac catherisation laboratories and present some general recommendations to general paediatricians and communities to ensure the continued health of our patients. Finally, we encourage ongoing registries and biorepositories and support clinical trials to ensure that children also receive new technologies and therapeutics as these become available.
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    Prevention of infective endocarditis associated with dental interventions : South African Heart association position statement, endorsed by the South African Dental Association
    (South African Heart Association, 2017) Jankelow, David; Cupido, Blanche; Zuhlke, Liesl; Sliwa, Karen; Ntsekhe, Mpiko; Manga, Pravin; Doubell, Anton; Lawrenson, John; Essop, Mohammed Rafique
    ENGLISH ABSTRACT: Infective endocarditis (IE) is associated with significant morbidity and mortality. Prevention is therefore an important clinical entity. The maintenance of optimal oral health is likely to play the most important role in protecting those at risk for IE. Both patients and health care practitioners must be educated in this regard. Guidelines have recommended that antibiotic prophylaxis should be limited to individuals (undergoing certain high-risk dental procedures) with underlying cardiac conditions that are associated with the greatest risk of an adverse outcome from IE. These conditions include prosthetic valves, congenital heart disease and previous IE. In South Africa, and other developing countries, IE is often a disease of young patients with rheumatic heart disease (RHD) and carries a very poor prognosis. In contrast, IE in Europe/North America, where guidelines and indications for antibiotic prophylaxis have been reduced, has a different spectrum of factors. These patients are older with degenerative valve disease. IE may also occur as a result of invasive health care associated procedures or in the setting of prosthetic valves and implantable cardiac devices. Recently published international guidelines cannot be automatically applied to countries where RHD is common and oral hygiene is poor. We therefore recommend that patients with RHD should also receive antibiotic prophylaxis prior to the listed dental procedures. Antibiotic prophylaxis should be prescribed after stressing the role of good oral health and why the approach differs in South Africa. There should be close cooperation between the dental practitioner and clinician as to who should receive prophylaxis and who should not.
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    PROTEA, a Southern African multicenter congenital heart disease registry and biorepository: rationale, design, and initial results
    (Frontiers Media S.A., 2021-10) Aldersley, Thomas; Lawrenson, John; Human, Paul; Shaboodien, Gasnat; Cupido, Blanche; Comitis, George; De Decker, Rik; Fourie, Barend; Swanson, Lenise; Joachim, Alexia; Magadla, Phaphama; Ngoepe, Malebogo; Swanson, Liam; Revell, Alistair; Ramesar, Raj; Brooks, Andre; Saacks, Nicole; De Koning, Bianca; Sliwa, Karen; Anthony, John; Osman, Ayesha; Keavney, Bernard; Zühlke, Liesl
    Objectives: The PartneRships in cOngeniTal hEart disease (PROTEA) project aims to establish a densely phenotyped and genotyped Congenital Heart Disease (CHD) cohort for southern Africa. This will facilitate research into the epidemiology and genetic determinants of CHD in the region. This paper introduces the PROTEA project, characterizes its initial cohort, from the Western Cape Province of South Africa, and compares the proportion or “cohort-prevalences” of CHD-subtypes with international findings. Methods: PROTEA is a prospective multicenter CHD registry and biorepository. The initial cohort was recruited from seven hospitals in the Western Cape Province of South Africa from 1 April 2017 to 31 March 2019. All patients with structural CHD were eligible for inclusion. Descriptive data for the preliminary cohort are presented. In addition, cohort-prevalences (i.e., the proportion of patients within the cohort with a specific CHD-subtype) of 26 CHD-subtypes in PROTEA's pediatric cohort were compared with the cohort-prevalences of CHD-subtypes in two global birth-prevalence studies. Results: The study enrolled 1,473 participants over 2 years, median age was 1.9 (IQR 0.4–7.1) years. Predominant subtypes included ventricular septal defect (VSD) (339, 20%), atrial septal defect (ASD) (174, 11%), patent ductus arteriosus (185, 11%), atrioventricular septal defect (AVSD) (124, 7%), and tetralogy of Fallot (121, 7%). VSDs were 1.8 (95% CI, 1.6–2.0) times and ASDs 1.4 (95% CI, 1.2–1.6) times more common in global prevalence estimates than in PROTEA's pediatric cohort. AVSDs were 2.1 (95% CI, 1.7–2.5) times more common in PROTEA and pulmonary stenosis and double outlet right ventricle were also significantly more common compared to global estimates. Median maternal age at delivery was 28 (IQR 23–34) years. Eighty-two percent (347/425) of mothers used no pre-conception supplementation and 42% (105/250) used no first trimester supplements. Conclusions: The cohort-prevalence of certain mild CHD subtypes is lower than for international estimates and the cohort-prevalence of certain severe subtypes is higher. PROTEA is not a prevalence study, and these inconsistencies are unlikely the result of true differences in prevalence. However, these findings may indicate under-diagnosis of mild to moderate CHD and differences in CHD management and outcomes. This reemphasizes the need for robust CHD epidemiological research in the region.
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    Surprises of off-label drug use : where had all the Prostin gone?
    (2009) De Decker, Rik.; Gordon-Graham, Eugenie; Seller, Neil; Lawrenson, John