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Charles Shey Wiysonge

Publications and source records attributed to Charles Shey Wiysonge.

8 recordsLinked to original sources
PubMed2006

Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry.

BACKGROUND: The incidence of tuberculous pericarditis has increased in Africa as a result of the human immunodeficiency virus (HIV) epidemic. However, the effect of HIV co-infection on clinical features and prognosis in tuberculous pericarditis is not well characterised. We have used baseline data of the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry to assess the impact of HIV co-infection on clinical presentation, diagnostic evaluation, and treatment of patients with suspected tuberculous pericarditis in sub-Saharan Africa. METHODS: Consecutive adult patients in 15 hospitals in three countries in sub-Saharan Africa were recruited on commencement of treatment for tuberculous pericarditis, following informed consent. We recorded demographic, clinical, diagnostic and therapeutic information at baseline, and have used the chi-square test and analysis of variance to assess probabilities of significant differences (in these variables) between groups defined by HIV status. RESULTS: A total of 185 patients were enrolled from 01 March 2004 to 31 October 2004, 147 (79.5%) of whom had effusive, 28 (15.1%) effusive-constrictive, and 10 (5.4%) constrictive or acute dry pericarditis. Seventy-four (40%) had clinical features of HIV infection. Patients with clinical HIV disease were more likely to present with dyspnoea (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.4 to 7.4, P = 0.005) and electrocardiographic features of myopericarditis (OR 2.8, 95% CI 1.1 to 6.9, P = 0.03). In addition to electrocardiographic features of myopericarditis, a positive HIV serological status was associated with greater cardiomegaly (OR 3.89, 95% CI 1.34 to 11.32, P = 0.01) and haemodynamic instability (OR 9.68, 95% CI 2.09 to 44.80, P = 0.0008). However, stage of pericardial disease at diagnosis and use of diagnostic tests were not related to clinical HIV status. Similar results were obtained for serological HIV status. Most patients were treated on clinical grounds, with microbiological evidence of tuberculosis obtained in only 13 (7.0%) patients. Adjunctive corticosteroids were used in 109 (58.9%) patients, with patients having clinical HIV disease less likely to be put on them (OR 0.37, 95% CI 0.20 to 0.68). Seven patients were on antiretroviral drugs. CONCLUSION: Patients with suspected tuberculous pericarditis and HIV infection in Africa have greater evidence of myopericarditis, dyspnoea, and haemodynamic instability. These findings, if confirmed in other studies, may suggest more intensive management of the cardiac disease is warranted in patients with HIV-associated pericardial disease.

Adolescent↗
PubMed2006

How strong is the evidence for use of beta-blockers as first-line therapy for hypertension? Systematic review and meta-analysis.

OBJECTIVE: To quantify the effect of first-line antihypertensive treatment with beta-blockers on mortality, morbidity and withdrawal rates, compared with the other main classes of antihypertensive agents. METHODS: We identified eligible trials by searching the Cochrane Controlled Trials Register, Medline, Embase, reference lists of previous reviews, and contacting researchers. We extracted data independently in duplicate and conducted meta-analysis by analysing trial participants in groups to which they were randomized, regardless of subsequent treatment actually received. RESULTS: Thirteen trials with 91,561 participants, meeting inclusion criteria, compared beta-blockers to placebo (four trials; n = 23,613), diuretics (five trials; n = 18,241), calcium-channel blockers (CCBs) (four trials; n = 44,825), and renin-angiotensin system (RAS) inhibitors, namely angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (three trials; n = 10,828). Compared to placebo, beta-blockers reduced the risk of stroke (relative risk 0.80; 95% confidence interval 0.66-0.96) with a marginal fall in total cardiovascular events (0.88, 0.79-0.97), but did not affect all-cause mortality (0.99, 0.88-1.11), coronary heart disease (0.93, 0.81-1.07) or cardiovascular mortality (0.93, 0.80-1.09). The effect on stroke was less than that of CCBs (1.24, 1.11-1.40) and RAS inhibitors (1.30, 1.11-1.53), and that on total cardiovascular events less than that of CCBs (1.18, 1.08-1.29). In addition, patients on beta-blockers were more likely to discontinue treatment than those on diuretics (1.80; 1.33-2.42) or RAS inhibitors (1.41; 1.29-1.54). CONCLUSION: Beta-blockers are inferior to CCBs and to RAS inhibitors for reducing several important hard end points. Compared with diuretics, they had similar outcomes, but were less well tolerated. Hence beta-blockers are generally suboptimal first-line antihypertensive drugs.

Adrenergic beta-Antagonists↗
PubMed2004

Coverage and costs of childhood immunizations in Cameroon.

OBJECTIVE: To quantify the association between household-level and provider-level determinants and childhood immunization rates in Cameroon while also calculating the cost of childhood immunizations. METHODS: This study uses multilevel regression analysis to calculate these relationships. The 1998 Cameroon Demographic and Health Survey and the 2000 Multiple Indicator Cluster Survey are the main sources of household-level data. These surveys are supplemented by data from a 2002 survey of health facilities conducted in three provinces. At the national level, immunization financing data were collected from the Ministry of Health and donors that support the national Expanded Programme on Immunization. FINDINGS: The 1998 survey found that nationally 37% of children were fully immunized; the 2000 survey found that nationally 34% were fully immunized. These results are strongly correlated with both the mother's level of education and the household's economic status. Multilevel logistic regression shows that maternal education level is a stronger predictor of positive immunization status than is relative economic status. Children of mothers with secondary education or higher education were 3 times more likely to be fully vaccinated than children whose mothers had not completed primary education. At the health-facility level, both having art immunization plan and regular supervisory visits from someone at the health-district level are strongly positively associated with immunization rates. The cost of routine vaccinations for each fully immunized child is 12.73 U.S. dollars when donors' contributions are included but not the costs of immunization campaigns. CONCLUSION: Studies conducted in the 1980s and 1990s found that costs per fully immunized child varied from 2.19 U.S. dollars to 26.59 U.S. dollars (not adjusted for inflation) in a range of low-income and middle-income countries. The relatively low rates of immunization coverage in Cameroon, and the strong influence of the household's socioeconomic status--particularly the mother's level of education--on immunization rates suggest that the effectiveness of the Cameroon programme could be increased by promoting immunization and directing such programmes towards households with limited resources.

Cameroon↗