Availability and functionality of sphygmomanometers at health care institutions in Enugu, Nigeria.

OBJECTIVE: Our aim was to investigate the availability of functional blood pressure monitors at health care institutions in Enugu, Nigeria. METHODS: During repeated surveys of 15 (primary, secondary and tertiary) health care institutions in Enugu between 2007 and 2012, records were made of the availability and functional status of sphygmomanometers in the clinics and wards. We also assessed the degree of agreement between measurements by institutional staff and measurements by trained observers using the same or the standard sphygmomanometer. RESULTS: Apart from three institutions, there was inadequate availability of fully functional sphygmomanometers: 61 staff attending to outpatients were sharing 35 sphygmomanometers, 6 of which were faulty i.e. needing repairs. Wards invariably had only one or two functional sphygmomanometers, regardless of bed occupancy. Institutional staff ignored recommended guidelines for blood pressure measurement. The overall mean difference in blood pressure measurements between institutional staff and a trained observer (1.6 mmHg; 95% confidence interval, CI: -0.3 to 3.4; P=0.1) was greater and more significant than the mean difference between the two observers (0.1 mmHg; CI: -1.5 to 1.7; P=0.9) and the mean difference between institutional and standard sphygmomanometers (-0.2 mmHg; CI: -1.7 to 1.3; P=0.8). CONCLUSION: There has been a notable lack of reporting on the availability of blood pressure measuring devices in third world health care institutions. Our surveys have shown inadequate availability of functional sphygmomanometers in the institutions, but satisfactory agreement between measurements by institutional staff and trained observers. In view of recent guidelines and recommendations, there is need to supplement office readings with mercury devices with oscillometric home or automated office blood pressure recording.

Low-dose lisinopril in normotensive men with idiopathic oligospermia and infertility: a 5-year randomized, controlled, crossover pilot study.

The outcomes of drug treatment for male infertility remain conjectural, with controversial study results. Our pilot study employed a randomized, placebo-controlled, crossover methodology with intention-to-treat analysis. Thirty-three men with idiopathic oligospermia were randomized to start either daily oral lisinopril 2.5 mg (n = 17) or daily oral placebo (n = 16). Lisinopril was found to cause a normalization of seminal parameters in 53.6% of the participants. Although the mean ejaculate volume was unchanged (P ≥ 0.093), the total sperm cell count and the percentage of motile sperm cells increased (P ≤ 0.03 and P < 0.001, respectively), whereas the percentage of sperm cells with abnormal morphology decreased (P ≤ 0.04). The pregnancy rate was 48.5%, and there was no serious adverse drug event. It is concluded, albeit cautiously, that prolonged treatment with 2.5 mg/day of oral lisinopril may be well tolerated in normotensive men with idiopathic oligospermia, may improve sperm quantity and quality, and may enhance fertility in approximately half of those treated.

Ocular dynamics of systemic aqueous extracts of Xylopia aethiopica (African guinea pepper) seeds on visually active volunteers.

Xylopia aethiopica, African guinea pepper, is an angiosperm belonging to the family Annonecae, and used mainly as spice and in traditional medicine. The ocular dynamics of bolus consumption of 300 mg total dose was undertaken on visually active volunteers with a view to finding its ocular effects or complications. Results showed that the aqueous extract of X. aethiopica was neither a miotic nor a mydriatic, but lowered the intraocular pressure (17.48%), reduced the near point of convergence (31.1%) and increased the amplitude of accommodation (8.98%) which are positively correlated (r=0.95). On the other hand, the systemic extract had no effect on the visual acuity at far and near as well as the phoria status at the appropriate distances. The convergence excess resulted in esophoria and the increased amplitude of accommodation placed greater demand on accommodation mechanism without any discomfort. The nonspecific mechanism of action makes it a safer spice which can be exploited in the management of exophoria and raised intraocular pressure (glaucoma) in instances where the efficacy of the older conventional drugs is insufficient.