Assessing cardiac safety among clients receiving methadone as part of opioid agonist maintenance therapy (OAMT) in Durban, South Africa.

Methadone is a recommended medication for opioid agonist maintenance therapy (OAMT). However, methadone can have cardiac side effects. There is limited South African cardiac safety data on methadone.To describe baseline and 12-month electrocardiographic (ECG) features and cardiac symptomology in people receiving OAMT in Durban, South Africa.Twelve-lead ECGs were conducted at baseline and 12 months. Clinical interviews were used to assess cardiac symptomatology. Baseline ECG parameters (PR interval, QRS interval, QT and QTc duration, heart rate) were analyzed using descriptive statistics. Baseline and 12-month ECG characteristics were compared using paired T-tests in retained participants. The association between QTc and methadone dose was assessed using Spearman's Rho at 12 months.Fifty-three clients (51 men, 2 women [median age 29.0]) were initiated on OAMT. Normal baseline ECG variants included 4 (7.5%) with sinus bradycardia and 3 (5.7%) with ST segment elevation. Mean baseline ECG intervals were PR interval: 156 ± 23 ms, QRS duration: 87 ± 9 ms, QT interval: 404 ± 22 ms and QTc interval: 406.9 ± 21.9 ms. At 12 months, 39 participants returned for reassessment (mean methadone dose: 37 ± 8 mg in women; 27 ± 10 mg in men). QTc intervals among male participants increased (406.4 ± 22 to 417 ± 24; p = 0.026 [-19.6; -1.4]). No significant correlation (r = 0.22; p = 0.185) between methadone dose and QTc interval at 12 months, nor reports of adverse cardiac symptomatology, were detected.Methadone at the doses provided, caused mild and clinically insignificant QTc interval prolongation in men at 12 months. We provide additional cardiac safety data for the use of methadone for OAMT among people with opioid use disorder.

Diphtheritic myocarditis: a case report, with toxinmediated complications and multi-organ involvement.

The re-emergence of diphtheria in South Africa in recent years warns of incomplete vaccination coverage. Recent outbreaks have been associated with a high mortality rate, due to late presentation, limited access to antitoxin and the occurrence of serious systemic complications. Death due to diphtheria is most commonly associated with diphtheritic myocarditis, which presents with heart failure, cardiogenic shock and conduction abnormalities. This case highlights the key clinical features and systemic complications, and examines the reasons for the return of diphtheria in our community.

A 10-year retrospective analysis of the clinical profile and outcomes of infective endocarditis at a tertiary hospital in KwaZulu-Natal, South Africa.

OBJECTIVE: To examine the clinical profile and treatment outcomes of infective endocarditis (IE) at a tertiary hospital in KwaZulu-Natal. METHODS: A 10-year retrospective analysis was conducted on cases of definite IE (modified Duke criteria). RESULTS: Ninety-seven subjects (HIV infected, n = 12) satisfied the study criteria (mean age 29.7 ± 15.6 years, M:F 1.4:1). Underlying rheumatic heart disease was present in 84.5% and severe dyspnoea in 67.0% of cases. Staphylococcus aureus was the commonest pathogen isolated (18.6%). Heart failure was present in 61.9% and vegetations were identified in 85 (87.6%) subjects, resulting in 41 (42.3%) embolic events. The clinical profile and outcomes were similar in the HIV-positive and -negative patients. Surgery was performed in 73 subjects (surgical mortality rate 9.5%, total mortality rate 26.4%). Multivariate analysis identified acute-onset IE [odds ratio (OR) 251.46, 95% confidence interval (CI) 1.18-5343.63, p = 0.043], vegetation size > 15 mm (OR 222.60, 95% CI 1.04-4730.34, p = 0.043) and medical management only (OR 20.89, 95% CI 2.12-200.06, p = 0.037) as predictors for increased in-hospital mortality. CONCLUSION: IE affects young people with underlying rheumatic heart disease and is associated with high morbi-mortality attributable to advanced disease at presentation and to haemodynamic failure resulting from valve destruction due to acute onset of aggressive infection.

The spectrum of rheumatic mitral valve regurgitation presenting to Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, over a 10-year period.

BACKGROUND: Recent evidence suggests that there is a change in the profile of rheumatic mitral regurgitation (MR) in South Africa to a pattern of chronic fibrotic valvular disease. OBJECTIVE: This study describes the clinical profile of patients with rheumatic MR in the province of KwaZulu-Natal (KZN). METHODS: A retrospective chart review was performed on patients seven years and older with moderate to severe rheumatic MR referred to Inkosi Albert Luthuli Central Hospital from 2006 to 2015. RESULTS: There were 320 patients meeting the study criteria (mean age 22.2 ± 15.8 years, male:female 1:2). Severe dyspnoea was present in 45.9% of patients, heart failure in 117 (36.6%) and atrial fibrillation in 13.8%. Three patients were diagnosed with active carditis at initial presentation and a further 31 had evidence of carditis during follow up. Of the 216 patients who underwent surgery, over one-third (37%) had prolapse of the anterior mitral leaflet, which was due to chordal elongation (n = 63, 29.2%) and/or ruptured chordae (n = 41, 19%). There were 32 deaths (10%) and of these, 27 (8.4%) patients died prior to surgery. CONCLUSIONS: Rheumatic MR in KZN predominantly affects the young, with concomitant carditis resulting in high morbidity and mortality rates.

High prevalence of cardiovascular risk factors in Durban South African Indians: The Phoenix Lifestyle Project.

BACKGROUND: Previous studies show a high prevalence of cardiovascular (CV) risk factors in South African (SA) Asian Indians, with the emergence of premature coronary artery disease in young Indian subjects. OBJECTIVE: To determine the prevalence of CV risk factors in this population. METHODS: This was a cross-sectional study of randomly selected adults aged 15 - 64 years from the suburb of Phoenix in Durban, KwaZulu-Natal Province, SA. All participants had demographic, anthropometric and biochemical measurements using the modified World Health Organization (WHO) STEPwise survey methods. Hypertension, obesity, lipid abnormalities and diabetes mellitus (DM) were diagnosed using WHO criteria. Age-standardised frequencies for glycaemic indices were calculated according to the WHO standard world population distribution. RESULTS: Of the 1 428 subjects who responded (response rate 72.1%), complete data for analysis were available on 1 378 (1 001 women). The mean age was 45.5 (standard deviation 13) years. There were high prevalences of hypertension (47.5%), DM (20.1%), total body obesity (raised body mass index) (32.4%) and increased waist circumference (73.1%). The 'thin-fat' Asian phenotype (isolated abdominal obesity) was found in only 4.8% of participants. High prevalences of total body obesity (32.1%), increased waist circumference (31.3%) and insulin resistance (28.2%) were documented in the youngest age group. Over half of the males and 14.6% of females were current smokers. Diabetic dyslipidaemia was found in 61 subjects (4.4%). In multivariate analysis, age, triglycerides and waist circumference measurement were significant independent risk factors associated with DM and, together with fasting glucose, also predicted hypertension. CONCLUSION: Compared with Asian Indian subjects with similar environmental exposure in previous studies, the magnitude of change in risk factor prevalence over the past two decades has been of epidemic proportions.