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.

Pattern of Blood Pressure Indices among the Residents of a Rural Community in South East Nigeria.

Cardiovascular diseases (CVDs) are the main causes of death in industrialized countries, and are significant causes of morbidity and mortality in sub-Saharan Africa. Hypertension is the most common cardiovascular disease in Nigerians, and the risk of CVD associated with hypertension is independent of other risk factors. Despite the high level of awareness of its presence in the developed countries, the level of control is still poor. CVDs tend to be commoner in urban settlements, and it has been hypothesized that rural sub-Saharan Africa is at an early stage of epidemiological transition from communicable to non-communicable diseases (NCD) because of the gradual adoption of unhealthy lifestyles. This study aimed at describing the pattern of blood pressure indices among the hypertensive residents of a rural community in South East Nigeria. A total of 858 individuals comprising 247 males and 611 females took part in the study. 46.4% of the subjects had hypertension. Hypertension was commoner in the males (50.2% vs. 44.8%) (χ(2)(1) = 1.484; P = 0.223). The males were significantly older and heavier than the females while the females had higher mean values of BMI and WC. The prevalence of hypertension is becoming alarmingly high in the rural communities of sub-Saharan Africa.

Prevalence of cardiovascular risk factors in the middle-aged and elderly population of a nigerian rural community.

Cardiovascular diseases (CVDs) causes of worldwide preventable morbidity and mortality. CVDs are a leading cause of mortality and morbidity in developing countries, and rates are expected to rise over the next few decades. The prevalence of CVD risk factors is dramatically increasing in low-and middle-income African countries, particularly in urban areas. We carried out a cross-sectional population-based survey in Imezi-Owa, a rural community in South East Nigeria to estimate the prevalence of major cardiovascular risk factors in both men and women aged 40-70 years. A total of 858 individuals made up of 247 (28.8%) males and 611 (71.2%) females were recruited. The mean age of the subjects was 59.8 ± 9.9 years. The prevalence of the different cardiovascular risk factors among the 858 subjects was as follows: hypertension 398 (46.4%) subjects, generalized obesity as determined by BMI 257 (30%) subjects, abdominal obesity 266 (31%) subjects, dysglycaemia 38 (4.4%) subjects and hypercholesterolaemia 32 (3.7%) subjects. Prevalence of hypertension and dysglycaemia was higher in men while the others were higher in women. Only hypertension (P = .117) and hypercholesterolaemia (P = .183) did not reveal any significant association with gender. Prevalence of CVD risk factors was highest in subjects aged 65 to 70 years.

Dilated alcoholic cardiomyopathy and incidental lymphoma occuring in a 56 year old man who was being managed for hypertensive heart disease in Enugu Nigeria--a rare finding.

We present a case of dilated alcoholic cardiomyopathy occurring in a 56-year-old Nigerian male. He admitted to taking alcoholic beverage, approximately 2-3 bottles of different brands of beer per day for about 30 years, but stopped three years ago on medical advice. He had a history of progressively worsening dyspnoea and encephalopathy, from decreasing ejection fraction. This resulted in a poor blood supply to the vital centers of the brain. Autopsy confirmed a dilated cardiomyopathy with an incidental fairly advanced B cell lymphoma involving the liver and spleen. The latter was thought to be a coincidental finding.

The prevalence pattern of external male genital defects among secondary school students in Enugu State of Nigeria.

BACKGROUND: Enugu State typifies a Third World environment where most deliveries occur outside the hospital setting. In such circumstances, hospital-based data about congenital defects are unreliable and call for special methods of approach. OBJECTIVE: To determine the prevalence and pattern of male external genital defects in Igbo male secondary school students in Nigeria. METHOD: Samples of male students aged 10 years and above seen in randomly selected secondary schools in Enugu State, of South-East Nigeria were guided through a protocol involving, self administered questionnaires, personal interviews and physical examinations for evidence and types of anomalies present in their external genitalia. The participating schools were selected by stratified random sampling; first by local government Areas (LGA) and then by schools. Consents for the study were obtained from Local Government Authorities, Heads of the schools and Parents' Teachers Associations, (PTA) Executives. RESULTS: Altogether, four urban and thirteen rural schools were studied, and a total of 6225 male students participated. Overall, 416 (6.8%) were identified with various types of external genital anomalies, with the prevalence observed being within, the ranges of population prevalence reported in the literature. The commonest types of anomalies encountered were crypto- orchidism with / or without scrotal hypoplasia 268 (4.30%), inguino- scrotal 56 (0.90%), and hydrocoeles 52 (0.83%). As many as 183 (44%) of those with congenital genital defects were not aware that they had them. CONCLUSION: External male genital defects among Igbos appear to be within the prevalence rate reported in the literature. However the ignorance rate of such defects is high within the Igbo society.

Fractionated neem leaf extract is safe and increases CD4+ cell levels in HIV/AIDS patients.

The safety and effect of an acetone-water neem leaf extract (IRAB) on CD4 cells was investigated in 60 HIV/AIDS patients as part of an ongoing study to determine the influence of neem on immunity and viral load in HIV/AIDS. Patients were confirmed as HIV I or II positive, as having CD4 cell count, less than 300 cells/microL, and as antiretrovirally naïve. They were given oral IRAB (1.0 g daily for 12 weeks). Clinical and laboratory tests were carried out at baseline and at 4 weekly intervals. Thus, the patients served as their own controls. Sixty patients completed treatment. Fifty (83.33%) were completely compliant with respect to laboratory tests. Increase in mean CD4 cells, 266 cells/microL (159%), for the 50 patients was significant (P < 0.001) between baseline and week 12. Erythrocyte sedimentation rate (64 mm/hr at baseline) was 16 mm/hr at week 12, whereas total number of incidences of HIV/AIDS-related pathologies decreased from 120 at baseline to 5. Mean bodyweight, hemoglobin concentration, and lymphocyte differential count increased significantly by 12% (P < 0.05), 24% (P < 0.0001), and 20% (P < 0.0001), respectively. There were no adverse effects and no abnormalities in kidney and liver function parameters. The results support the safety of IRAB in HIV/AIDS, and its significant influence on CD4 cells may be useful in the formulation of multidrug combination therapies for HIV/AIDS. However, its antiretroviral activity is being evaluated in our laboratory.

Fixed drug eruption in Nigeria.

Fixed drug eruption (FDE) causes cosmetic embarrassment in Nigerian patients, particularly when the characteristic hyperpigmented patches affect the face and lips. Drugs that have been implicated in the etiology of FDE, and the sites of lesions, may vary from country to country. Antimalarials, such as Fansidar, Fancimef, Maloxine, Amalar, and Metakelfin, were the most common offending agents, accounting for 38% of FDEs, followed by trimethoprim + sulfamethoxazole (co-trimoxazole) (28%), dipyrones (10%), Butazolidin (6%), thiacetazone (6%), metronidazole (4%), paracetamol (3%), and naproxen (3%). Lesions induced by the combination of sulfadoxine and pyrimethamine (in antimalarials) mainly involved the face and lips. In most cases, patients took these sulfa-containing antimalarials in combination with numerous other drugs, particularly analgesics. Unlike chloroquine-induced pruritus, which affects most Africans, the association between antimalarials and FDE has not been well documented in our region. Co-trimoxazole was associated more often than antimalarials with FDEs involving the mucocutaneous junctions of the genitalia and lips. Males with genital lesions on the glans penis represented 11 (48%) of those with co-trimoxazole hypersensitivity. The trunk and limbs were affected mainly by pyrazoles and Butazolidin, respectively; however, solitary lesions on the trunk were usually due to co-trimoxazole, whereas solitary lesions on the limbs were associated with Butazolidin.

The Incidence of External Male Genital Defects in Enugu State of Nigeria: an Estimate Based on the Prevalence among Secondary School Students

Background: Enugu State typifies a Third World environment where most deliveries occur outside the hospital setting. In such circumstances; therefore; hospital-based data about congenital defects are unreliable and call for special methods of approach. Objective: To assess the place of school prevalence survey results in estimating the population incidence of anomalies of the male external genitalia.Method: From February 2; 2002 to August 1; 2004 a sample of male students aged 10 years and above seen in randomly selected secondary schools in Enugu State of Southeast Nigeria were guided through a protocol involving; self-administered questionnaires; physical examinations for evidence and types of anomalies present in their external genitalia and personal interviews. The participant schools were selected by stratified random sampling; first by Local Government Area (LGA) and then by school. Consents for the study were obtained from Local Government authorities; Heads of the schools; and Parents' Teachers Associations; (P T A) Executives. Results: Altogether; four urban and thirteen rural schools were studied over the 18 month-period of the investigation and a total of 6226 male students participated. Overall; 416 (6.8) were identified with various types of external genital anomalies; with the prevalence rates observed being within the ranges of population prevalence reported in the literature. The commonest types of anomalies encountered were crypto-orchidism with / or without scrotal hypoplasia 268 (4.30); inguino-(scrotal) hernias 56 (0.90); and hydrocoeles 52 (0.83); in descending order. As many as 183 (44) of those with congenital genital defects were not aware they had them. When compared with urban schools; rural schools were characterized by a higher frequency [8.4 vs. 2.8respectively; x2 = 58.35; P 0.0001] and a lower level of awareness about anomalies of the external male genitalia [P

HIV/AIDS awareness and sexual practices among undergraduates in Enugu, Nigeria.

OBJECTIVE: To assess the knowledge of HIV/AIDS among Nigeria undergraduates and to determine how the knowledge has influenced their sexual behaviour. MATERIALS AND METHODS: A pre-tested self - administered questionnaire survey of a random sample of undergraduates of two University Campuses in Enugu, Nigeria. RESULTS: All the 505 respondents had heard of HIV/AIDS. The respondents exhibited a high knowledge of HIV/AIDS. For the 348 (68.9% ) respondents who had ever had sexual intercourse, the mean number of sexual partners, which they had before and after they became aware of HIV/AIDS did not differ significantly 93.2+ 1.7 versus 2.9+1.5; p = 0.3). However, there was a significant tendency towards a more consistent condom use after the respondents became aware of HIV/AIDS. On univariate logistic regression, being married (OR=2.8, <0.001), previous risky sexual behaviour (OR= 2.5, <0.0001) and being more than 20 years old (OR=1.4, p < 0.02) (but not respondents' level of knowledge of HIV/AIDS etc) were significant predictors of risky sexual behaviour after the respondents became aware of HIV/AIDS. On multivariate logistic regression - previous risky sexual behaviour (OR =2.5, <0.00001) and being married (OR = 2.1, p< 0.001) remained significant. CONCLUSION: High knowledge of HIV/AIDS has no correlation with subsequent sexual behaviour among Nigerian undergraduates.

An antimalarial extract from neem leaves is antiretroviral.

An acetone-water neem leaf extract with antimalarial activity was evaluated in vitro at 5 microg/ml for inhibition of adhesion of malaria parasite-infected erythrocytes and cancer cells to endothelial cells, and at 10 microg/ml for protection of lymphocytes against invasion by HIV. The extract was also evaluated in 10 patients with HIV/AIDS at 1000 mg daily for 30 d. The mean binding of infected erythrocytes and cancer cells per endothelial cell was 15 and 11 respectively in the absence of the extract, and 0 and 2 respectively in with the extract. In the absence and presence of the extract, 0% and 75%, respectively, of lymphocytes were protected. In the treated patients, haemoglobin concentration, mean CD4+ cell count and erythrocyte sedimentation rate, which were initially 9.8 g/dl, 126 cells/microl and 90 mm/h respectively, improved to 12.1 g/dl, 241 cells/microl and 49 mm/h. Mean bodyweight and platelet count, initially 57 kg and 328 x 10(3)/mm3 respectively, increased to 60 kg and 359 x 10(3)/mm3. No adverse effects were observed during the study. The extract showed antiretroviral activity with a mechanism of action that may involve inhibition of cytoadhesion. The results may help in the development of novel antiretroviral and antimalarial drugs.

Interference by malaria in the diagnosis of typhoid using Widal test alone.

A total of 270 febrile patients (130 males and 140 females) aged between 15 and 59 were screened using thick and thin blood film stains for malaria, bacteriologic culture and Widal test for enteric fevers. Sixty (22%) were positive for malaria while 38 (14%) were positive for enteric fevers out of which 16 (26.6%) concomitantly had malaria parasite. Cases without malaria parasite (MP) or enteric fever organism were 172 (63.7%) and classified as pyrexia of unknown origin (PUO). Forty-four were strictly malaria cases out of which 36 (82%) were due to Plasmodium falciparum, and all had antibody Widal titres > or = 160 to 0 antigen while 4 (9%) were due to Plasmodium malariae, 3 (6.8%) were due to P. ovale and 1 (2.3%) was due to P. vivax. Twenty (52.6%) of the 38 patients with enteric fever had typhoid, all had Widal titres > or = 160 to 0 antigen. In all, antibody reaction Widal titres to H antigen were < 20. There was no statistical significant difference [chi2 = 327.2, P > 0.05] between Widal titres of malaria and typhoid cases. Hence using Widal test alone, one cannot differentiate typhoid fever from malaria. In another 250 healthy adults, of equal sex distribution, used as controls 12 (4.8%) had malaria parasite and 4 (1.6%) had enteric fever organisms. While only 4 (1.6%) gave Widal titre of 80 to 0 antigen the rest had antibody titres of < 20 to O antigen. Malaria could interfere with serological diagnosis of typhoid and hence lead to over diagnosis of typhoid in Nigeria.

Compliance to correct dose of chloroquine in uncomplicated malaria correlates with improvement in the condition of rural Nigerian children.

Non-compliance to correct dosing is thought to be one of the main causes of treatment failure of chloroquine in the home management of childhood malaria. There are few studies of compliance to drugs used for tropical diseases. In order to study compliance in the rural setting, chloroquine syrup was packaged with a novel pictorial insert for compliance to correct dosing. Compliance was assessed in a field trial in September 1996-December 1997, involving 632 children with uncomplicated malaria in Udi local government area in Nigeria. Written informed consent was obtained from mothers/guardians before children were enrolled in the study. There were 3 arms to the trial: control villages (group I) received chloroquine syrup without further intervention, group II received a pictorial insert with chloroquine syrup, and group III received chloroquine syrup, the pictorial insert and verbal instructions. Each group was made up of 3 health centres. Compliance was assessed by volumetric measurement of the chloroquine syrup left in 30-mL bottles and by questionnaires administered to mothers/helpers of the children. Control villages recorded full compliance for 36.5 +/- 4.4% of the children, group II for 51.9 +/- 7.9% and group III for 73.3 +/- 4.2%. There was a significant correlation (P < 0.0001) between full compliance, improvement and time for improvement of the condition. This study is deemed important because it focuses on children, who bear the greatest burden of malaria. It is unique for introducing a pictorial insert that illiterate villagers, who may not understand the use of age or weight in drug dispensing, may utilize as a substitute.

Clinical pharmacokinetics of suramin in patients with onchocerciasis.

OBJECTIVE: Ten male patients with onchocerciasis received six weekly infusions of suramin according to the WHO-recommended regimen. RESULTS: In no case did the plasma concentration of suramin exceed 300 mg x l(-1), and serious toxicity was not observed. The apparent volume of distribution (median 20.6 l) was comparable to that reported for patients with prostatic carcinoma. Elimination from patients with onchocerciasis was relatively slow (median plasma clearance 6.2 ml x h(-1), median terminal elimination half-life 91.8 days). CONCLUSION: Microfilariae were eliminated in eight out of ten patients. Spontaneous nodule regression was noted in four patients.

Tropical splenomegaly syndrome in Nigerian adults.

Thirty-nine Tropical Splenomegaly Syndrome (TSS) patients. 19 males and 20 females, aged 13 to 69 years, with a mean age of 44.4 years, seen over a two-year period, January 1987 to December, 1988, at the consultant Medical Out-patient Clinics of the University of Nigeria Teaching Hospital, Enugu, Nigeria, were retrospectively studied. The aetiopathogenetic basis of the syndrome was briefly reviewed. The implications of the probable extent of this medical problem TSS in the tropics was emphasized. The spectrum of clinical presentation, haematological picture and results of other investigations were reviewed. An attempt was made to possibly distinguish TSS from such other similarly presenting conditions as Hodgkin's Lymphoma, Chronic granulocytic leukaemia and Chronic lymphocytic leukaemia, on clinical grounds and simple laboratory data that can be easily available to the tropical physician. The probable complications of TSS, the ease of treatment and the impressive results of therapy were highlighted. The place of the different antimalarial chemoprophylactic agents in the treatment of TSS was reviewed. Finally, the question of the appropriate duration of therapy for TSS was entertained.

Tropical splenomegaly syndrome in Nigerian adults

Thirty-nine tropical splenomegaly syndrome (TSS) patients were studied between january 1987 and december 1988 at the University of Nigeria Teaching Hospital; Enugu; Nigeria. The aetiopathogenetic basis of the syndrome was briefly reviewed. The implications of the probable extent of this medical problems TSS in the tropics was emphasized. The probable complications of TSS; the ease of treatment and the impressive results of therapy were highlighted. The place of the different antimalarial chemoprophyllatic agents in the treatment of TSS was reviewed. Finally; the question of the appropriate duration of therapy for TSS was entertained