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Diseases of urban and rural Blacks in South Africa are reviewed. In rural Blacks the major problems are infection and malnutrition. Other important disorders include cancer of the oesophagus, liver and cervix, and rheumatic heart disease and cardiomyopathy. The diseases in urban Blacks are those of a population in transition. Characterised by all gradations of socioeconomic development, from the relatively primitive to the completely westernised, these people exhibit a correspondingly wide and varied range of disease embracing the afflictions of rural dwellers and the new diseases of the city. Whereas the prevalence of some of the former, such as infection and malnutrition, is declining, they still constitute a considerable problem in urban Blacks. More important is the increasingly serious impact of the new disorders, which may be divided into two groups: (a) a large range and variety of alcohol-related disorders with serious effects at the social, economic, psychological and physical levels; and (b) most, if not all, of the diseases encountered in western populations. Some of these, such as obesity and hypertension, have not only attained epidemic proportions among urban Blacks, but their prevalence may actually have exceeded that among Whites. Other conditions, such as coronary heart disease, gout, gallstones and colonic cancer, which emerged later, are relatively uncommon or rare. A plea is made for much greater epidemiological research. This is necessary in order to obtain reliable knowledge of the prevalence of disease, to determine the best ways of applying present knowledge with existing and future resources, and to obtain knowledge regarding both old and new diseases of which the pathogenesis is still obscure.
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PMID:Diseases in urban and rural Black populations. 85 Aug 43

With improvements in life expectancy and as more and more people have access to modern medicine, non-communicable diseases are emerging as a health problem in both urban and rural communities in Myanmar. Of all non-communicable diseases, cardiovascular diseases (CVD) are known to be the major health problem. Since many studies that have been conducted in both developed and developing countries have shown a difference between rural and urban communities with regard to cardiovascular diseases, our study had the objective of finding out the prevalence of ischemic heart disease, hypertensive heart disease and rheumatic heart disease in a rural and urban community. The risk of obesity and smoking in the occurrence of CVD was also studied. A cross-sectional survey was conducted in three urban townships of Yangon City (Sanchaung, Latha and Pabedan) and one rural township of Hmawbi. The results showed that CVD were a health problem in both the urban and rural communities. Coronary heart disease was seen to be more prevalent in the urban townships than in the rural Hmawbi Township, but hypertension (HT) and rheumatic heart diseases (RHD) were more prevalent in the rural township of Hmawbi. Obesity which has been blamed as the major risk factor for CHD and HT in the developed countries was not found to be a risk factor in the study townships, but smoking was.
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PMID:Prevalence of cardiovascular diseases in rural area of Hmawbi and urban Yangon city. 134 45

Congestive heart failure (CHF) is a major cause of mortality and morbidity, and has a prognosis similar to that of several malignancies. There are increasing trends in both prevalence and incidence rates of CHF which points towards CHF becoming a major community health problem. Early detection of CHF is dependent upon criteria to define the initial stages of a condition which progresses slowly over many years. In western countries the dominant causes of CHF are hypertension and coronary heart disease, which account for more than 75% of the cases. Other precursors are diabetes and rheumatic heart disease. Independent risk factors for CHF are hypertension, smoking, obesity, and psychological stress. Early detection of CHF through identification of early symptoms such as dyspnea on exertion, treatment of known heart diseases, and treatment of risk factors may prevent its progress. Epidemiological data indicate that primary preventive efforts should be directed against hypertension, smoking and obesity. A multiple risk factor interventional approach seems to yield the best result since these risk factors act synergistically.
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PMID:Epidemiology and prognosis of heart failure. 179 25

A three-decade examination of the prevalence, incidence, secular trends, and prognosis of cardiac failure in the Framingham Study provides insights into its epidemiology. Annual incidence of CHF is observed to increase from 3 to 1000 at ages 35-64, to 10 per 1000 at ages 65-94. There is a slight male predominance, owing to a higher rate of coronary disease, which conferred a fourfold risk of cardiac failure. Most cardiac failure is on the basis of long-standing hypertension or CHD. Silent infarctions were as predisposing for CHF as symptomatic MIs surviving 1 year. Hypertension is a major predisposing factor that at least triples the CHF risk, the systolic component being more predictive than the diastolic component. Correctable predisposing risk factors for CHF include: elevated blood pressure, impaired glucose tolerance, elevated cholesterol, low HDL-cholesterol, obesity, and a high hematocrit. Risk factors reflecting deteriorating cardiac function also were highly predictive, including: an enlarged heart, poor vital capacity, sinus tachycardia, and ECG-LVH. Commonly encountered ECG abnormalities such as intraventricular block, nonspecific repolarization abnormality, and ECG-LVH are all associated with a substantial risk of CHF. ECG-LVH carries a higher risk than x-ray enlargement. Sudden death was a common feature with CHF, occurring at 5 times the general population rate, even excluding those with overt CHD. Using the standard cardiovascular risk factors (age, systolic blood pressure, cholesterol, glucose, cigarettes, and ECG-LVH) jointly, it is possible to identify one tenth of the population from which 40% of CHF events evolve, in the absence of interim CHD or RHD.
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PMID:Epidemiology and risk profile of cardiac failure. 315 46

Ninety-eight subjects with a diagnosis of primary rheumocarditis made at a pediatric clinic in childhood were examined for the central hemodynamics by tetrapolar chest rheography. Based on a clinical and instrumental study rheumatic heart disease was diagnosed in 3 subjects; in 37 subjects, no heart pathology was recognized; myocarditic cardiosclerosis was diagnosed in 22, obesity in 20, and neurocirculatory dystonia of the cardial type in 16 subjects. The data obtained point to the overdiagnosis of rheumatic fever.
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PMID:[Status of central hemodynamics in persons with a history of diagnosed primary rheumocarditis in childhood]. 407 27

During the last 4 years 2040 patients with myocardial infarction were admitted to the C.C.U. of the National Institute of Cardiology. Thirty five patient under 40 years of age were studied. Three had Rheumatic heart disease and in 32 the etiology of the myocardial infarction was probably coronary atherosclerosis. The 32 cases under 40 years of age were compared to a group of patients with myocardial infarction older than 40 years of age. A great predominance of myocardial infarction was found in young males which were heavy smokers. There were no significant differences with the presence of obesity and arterial hypertension. In the younger group, myocardial infarction were more frequent in those with intellectual activity and in taxi drivers. The early hospital course was better in the young group they did not have cardiac failure, cardiogenic shock and none died. However, in the long term follow up the younger group had more P.V.C. and ventricular tachycardia. The cardiography of the younger showed an important predominance of lesions in the left coronary artery. It is concluded that in young people, myocardial infarctions seems to occur primarily in smokers with stress in their Kind of living. These patients seem to have less complications in the early and long term courses. However, more cardiac rhythm disorders are present.
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PMID:[Myocardial infarction in patients below the age of 40 (author's transl)]. 711 66

During the past 2.5 years, 50 Ross operations have been performed at Rigshospitalet in Copenhagen in a broad range of patients with aortic valve disease including children and adults from 6 weeks to 71 years of age. Many patients had complicating conditions including endocarditis (n = 13, eight native, five prosthetic valve), prosthetic valve dysfunction (n = 4), subvalvular obstruction (n = 3) treated by septal myectomy (n = 1) or modified Konno operation (n = 2), ascending aortic aneurysm (n = 2), ventricular septum defect (n = 1), mitral valve disease (n = 6), rheumatic heart disease (n = 4), coronary artery disease (n = 1), and extreme obesity (n = 1). All operations were performed as free-standing total aortic root replacements. The results have been encouraging with low mortality (2%) and no major morbidity. One patient has been reoperated because of autograft insufficiency due to left coronary cusp prolapse and two additional patients have grade 2 autograft insufficiency and are being followed closely. Two patients have developed early pulmonary homograft stenosis, which has required pulmonary homograft replacement. Despite these problems, we are enthusiastic about this operation and believe it may emerge as operation of choice for most patients under 60-65 years of age with aortic valve disease and for patients with prosthetic or advanced native aortic valve endocarditis. With increasing frequency, our choice has been to proceed with a Ross operation, and currently, our only absolute contraindication is Marfan's syndrome. Based on reported recurrent disease in patients with rheumatic valve disease, the autograft should be used with caution for this indication.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Expanding indications for the Ross operation. 758 41

The first Ross operation in Copenhagen was performed in 1992, and from the beginning of the series, which now numbers 80 patients, the underlying philosophy has been based on our belief that the autograft/Ross operation possesses a number of important and unique advantages compared with other alternatives, particularly for patients with complicated aortic valve disease in which alternative treatments are not satisfactory. The series includes patients of 6 weeks to 71 years of age, many with complicating conditions (endocarditis, 24 patients [native valve, 15; prosthetic valve, 9; advanced 17; active, 15; healed, 9], prosthetic valve dysfunction, 4; small aortic root, 2; ascending aortic aneurysm, 5; ventricular septum defect, 2; mitral valve disease, 7; tricuspid valve disease, 2; rheumatic heart disease, 7; aortic annular dilatation, 2; coronary artery disease, 4; extreme obesity, 1; severely reduced left ventricular function, 7; and previous heart surgery, 28). Mortality is low: hospital mortality, 3 patients (3.75%); late mortality, 1 patient (1.25%). Three patients have required reoperation, however; 1 because of autograft insufficiency and 2 because of pulmonary homograft stenosis, but autograft function is good in 73 (< or = 1+) and acceptable (< or = 2+) in 3 patients, and seems to be stable at follow-up. All in all, the early results are encouraging. We are particularly enthusiastic about the Ross operation for patients with complicated aortic valve pathology such as endocarditis, the small aortic root, combined valvular and subvalvular stenosis, and we believe that the Ross operation may be the best operation for these patients.
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PMID:Changing indications for the Ross operation. 889 19

Coronary artery disease is the main cause of congestive heart failure (CHF) in all populations. Latin American countries (LAC) are undergoing the first phase of an epidemic of coronary artery disease that probably will lead to an increased incidence of CHF. The progressive implementation of successful interventions, such as early reperfusion and rehabilitation programs, should increase the survival of patients with acute myocardial infarction and the population at high risk of CHF. The increasing prevalence of risk factors, such as diabetes, hypertension, and obesity, and the ageing of the population may also contribute to a rising incidence of CHF in LAC. Moreover, infectious diseases such as Chagas disease and rheumatic heart disease, known causes of CHF, are still frequent in this population and additionally contribute to the incidence of CHF. If timely preventive interventions are not implemented, CHF could become one of the main contributors to the burden of morbidity, mortality, and health costs in LAC. Properly conducted clinical and epidemiologic studies are needed to identify, implement, and evaluate preventive strategies that are likely to succeed within the specific context of LAC.
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PMID:Congestive heart failure in Latin America: the next epidemic. 1499 83

New Caledonia is an archipelago in the South Pacific with a high prevalence of acute rheumatic fever and rheumatic heart disease. Conducted in 2006, this study aimed at characterizing clinical manifestations and microbial features of isolates obtained from invasive Streptococcus pyogenes disease. Clinical and demographic data were collected prospectively. Isolates were biotyped, T typed, emm sequenced, and tested for antibiotic susceptibility. Detection of the speA, speB, speC, and ssa genes was also carried out. The estimated annual incidence of invasive S. pyogenes disease in 2006 was high at 38 cases/100,000 inhabitants in New Caledonia. Invasive isolates were obtained from 90 patients with necrotizing fasciitis (41 cases), bacteremia with no identified focus (12 cases), myositis (10 cases), septic arthritis (9 cases), erysipelas (8 cases), postpartum infection (4 cases), myelitis and osteomyelitis (3 cases), severe pneumonia (2 cases), and endocarditis (1 case). The most frequent associated comorbidities were skin lesions (71%) and obesity (29%). Thirty-one different emm types were identified, and the following six accounted for 54% of the isolates: emm15 (15.5%), emm92 (12.2%), emm106 (8.9%), emm74 (6.7%), emm89 (5.6%), and emm109 (5.6%). The speA, speC, and ssa genes were expressed at different frequencies in the various emm types. The first epidemiological study of invasive S. pyogenes disease in New Caledonia highlights that emm type distribution is particular and should be taken into account in the development of an appropriate vaccine. These findings support the prevention of pyoderma and other cutaneous lesions in order to limit the development of both invasive disease and poststreptococcal sequelae in the South Pacific.
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PMID:Clinical and microbial characteristics of invasive Streptococcus pyogenes disease in New Caledonia, a region in Oceania with a high incidence of acute rheumatic fever. 1995 76


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