Browsing by Author "Zuhlke, Liesl"

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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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    Epidemiology, health systems and stakeholders in rheumatic heart disease in Africa : a systematic review protocol
    (BMJ Publishing Group, 2016) Moloi, Annesinah Hlengiwe; Watkins, David; Engel, Mark E.; Mall, Sumaya; Zuhlke, Liesl
    ntroduction: Rheumatic heart disease (RHD) is a chronic disease affecting the heart valves, secondary to group A streptococcal infection (GAS) and subsequent acute rheumatic fever (ARF). However, RHD cure and preventative measures are inextricably linked with socioeconomic development, as the disease mainly affects children and young adults living in poverty. In order to address RHD, public health officials and health policymakers require up-to-date knowledge on the epidemiology of GAS, ARF and RHD, as well as the existing enablers and gaps in delivery of evidence- based care for these conditions. We propose to conduct a systematic review to assess the literature comprehensively, synthesising all existing quantitative and qualitative data relating to RHD in Africa. Methods and analysis: We plan to conduct a comprehensiveliteraturesearchusinganumberof databases and reference lists of relevant articles published from January 1995 to December 2015. Two evaluators will independently review and extract data from each article. Additionally, we will assess overall study quality and risk of bias, using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Programme criteria for quantitative and qualitative studies, respectively. We will meta-analyse estimates of prevalence, incidence, case fatality and mortality for each of the conditions separately for each country. Qualitative meta-analysis will be conducted for facilitators and barriers in RHD health access. Lastly, we will create a list of key stakeholders. This protocol is registered in the PROSPERO International Prospective Register of systematic reviews, registration number CRD42016032852
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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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    Standard echocardiography versus handheld echocardiography for the detection of subclinical rheumatic heart disease : protocol for a systematic review
    (BMJ Publishing Group, 2018-02) Telford, Lisa H.; Abdullahi, Leila H.; Ochodo, Eleanor A.; Zuhlke, Liesl; Engel, Mark E.
    Introduction Rheumatic heart disease (RHD) is a preventable and treatable chronic condition which persists in many developing countries largely affecting impoverished populations. Handheld echocardiography presents an opportunity to address the need for more cost-effective methods of diagnosing RHD in developing countries, where the disease continues to carry high rates of morbidity and mortality. Preliminary studies have demonstrated moderate sensitivity as well as high specificity and diagnostic odds for detecting RHD in asymptomatic patients. We describe a protocol for a systematic review on the diagnostic performance of handheld echocardiography compared to standard echocardiography using the 2012 World Heart Federation criteria for diagnosing subclinical RHD. Methods and analysis Electronic databases including PubMed, Scopus, Web of Science and EBSCOhost as well as reference lists and citations of relevant articles will be searched from 2012 to date using a predefined strategy incorporating a combination of Medical Subject Heading terms and keywords. The methodological validity and quality of studies deemed eligible for inclusion will be assessed against review specific Quality Assessment of Diagnostic Accuracy Studies 2 criteria and information on metrics of diagnostic accuracy and demographics extracted. Forest plots of sensitivity and specificity as well as scatter plots in receiver operating characteristic (ROC) space will be used to investigate heterogeneity. If possible, a meta-analysis will be conducted to produce summary results of sensitivity and specificity using the Hierarchical Summary ROC method. In addition, a sensitivity analysis will be conducted to investigate the effect of studies with a high risk of bias.