Surgery- Scholarly Publications

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    Open Access
    A 5‑Year Multidisciplinary Care Outcomes in Children with Wilms’ Tumour Managed at a Tertiary Centre: A Retrospective Observational Study
    (MedKnow, 2022) Alakaloko, FM; akinsete, AM; Seyi-Olajide, JO; Joseph, AO; Elebute, OO; Ladipo-Ajayi, AO; Odubanjo, MO; Olowoyeye, OA; Ademuyiwa, AO; Temiye, EO; Akinsulie, AA; Bode, CO
    Background: Over the last two decades, there has been significant improvement in the outcomes of children with Wilms' tumour (WT) in high income countries (HICs) with approximately 85% survival rate globally. This is partly attributable to a multi-disciplinary team approach to care and the evolution of more robust treatment measures. A previous review in our centre prior to multi-disciplinary team shows a survival rate of 31.48%, However, the survival rates from low- and middle-income countries are still low when compared to HICs due to delays in access to care at all levels, poor to non-existent health insurance coverage, limited workforce resources, weak health-care systems and infrastructure. The aim of this study is to determine the impact of a multi-disciplinary team approach on the treatment outcomes of children with WT. Methodology: This is a 5-year retrospective review of all patients managed with WT at the Lagos University Teaching Hospital, Lagos, Nigeria. Information was extracted from the patients' case notes, operation notes and ward admission records. The data were analysed with SPSS 25, and P < 0.05 was considered to be statistically significant. Results: Forty patients were included in the study; male to female ratio was 1.6:1. The disease occurred in the right kidney in 23 patients (57.5%) and on the left in 17 patients (42.5%). The average duration of symptoms before presentation was 3.6 months (range 1-7 months), majority of patients presented with abdominal masses and were assessed as per unit protocol with abdominal Computerized tomography scan, chest X-ray and abdominal ultrasound scan to assign the patient International Society of Paediatric oncology regimen. The predominant stage at surgery was Stage III 26 (65%), while Stage IV was 9 (22.5%). Morbidity after chemotherapy was 10 (25%). Twenty-five patients (63%) completed chemotherapy while 15 patients (37%) started chemotherapy but defaulted midway. The 5-year survival rate was 75%. Increasing age and male sex were associated with reduced odds of mortality; however, this was not statistically significant. Increased duration of treatment, being treated with chemotherapy alone, as well as advanced tumour stage and histology were associated with increased odds of mortality, however, this was not statistically significant. Conclusion: The development of an institutional WT treatment pathway involving a multidisciplinary team has resulted in improved outcomes. There is need for increased community awareness to improve the time to presentation.
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    Open Access
    The accuracy of ultrasonography in the diagnosis of breast pathology in symptomatic women
    (Nigerian Quarterly Journal of Hospital Medicine, 2012-10-01) Irurhe, N.K; Adekola, O.O; Awosanya, G.O.G; Adeyomoye, A.O; Olowoyeye, O.A; Awolola, N.A; Olajide, T.O
    Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of total cancer cases and 14% of cancer deaths worldwide. The developing countries are catching up with this trend. Breast ultrasound when properly performed and interpreted, is an indispensable tool in breast imaging. The early diagnosis and treatment of breast masses reduces the morbidity and mortality associated with delayed diagnosis of breast carcinoma. The use of breast ultrasound is gaining ground in recent time, this is due to current advances in ultrasound technology which permit greater spatial and contrast resolution and shortened scan time. Objective: To determine the sensitivity, specificity and positive predictive value of ultrasound in the detection of palpable breast masses and to correlate the findings of ultrasound with the findings of fine needle aspiration cytology, or histopathology. Methods: Breast ultrasound scanning was done in 100 patients with signs and symptoms of breast lesion referred from the Surgical out Patient Clinic to the Radiodiagnosis Department of Lagos University Teaching Hospital (LUTH). Histology reports were collected from either the case note or Morbid Anatomy department to correlate the findings with ultrasound diagnosis. Results: The mean age was 41.7 +/- 11.34 (18-59) years. Symptoms of breast lesion were highest in the age group 41-50 years 38 (38%), and least in 18-20 years 4 (4%). When the use of ultrasonography was compared with the histopathology report in the diagnosis of breast lesion in the studied population, the sensitivity was 100%, specificity (96.6%), accuracy (97%), posting predictive value (PPV) 81.3%, and negative predictive value (NPV) 100%. The accuracy, specificity and PPV however decreased with increasing age. Conclusion: Ultrasonography of the breast is useful in the diagnosis of breast lesions, because of the high sensitivity, specificity and diagnostic value it exhibited with histopathologic findings.
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    Open Access
    An African, multi-centre evaluation of patient care and clinical outcomes for patients with COVID-19 infection admitted to high-care or intensive care units
    (2020) Biccard, BM; Miller, M; Michell, WL; Thomson, D; Ademuyiwa, A; Aniteye, E; Dhufera, HT; Elfagieh, M; Elfiky, M; Elhadi, M; Fredericks, D; Gebre, M; Bayih, AG; Hardy, A; Joubert, I; et, al
    Background: There is little data on critically ill COVID-19 patients in under-resourced environments, and none from Africa. The objectives of this study were to determine resources, patient comorbidities and critical care interventions associated with mortality in critically ill COVID-19 African patients. Methods: African multicentre, prospective observational cohort study of adult patients referred to intensive care or high-care units with suspected or known COVID-19 infection. Patient follow up was until hospital discharge, censored at 30 days. The study recruited from March to September 2020. Findings: 1243 patients from 38 hospitals in six countries participated. The hospitals had a median of 2 (interquartile range (IQR) 1-4) intensivists, with a nurse to patient ratio of 1:2 (IQR 1:3 to 1:1). Pulse oximetry was available to all patients in 29/35 (82·9%) sites, and 21/35 (60%) of sites could provide dialysis or proning. The 30-day mortality following critical care admission was 54·7% (95% confidence interval (CI) 51·9-57·6). Factors independently associated with mortality were an increasing age (odds ratio (OR) 1·04, 95% CI 1·02-1·05, p<0·001), a quick SOFA score of 3 (OR 3·61, 95% CI 1·41-9·24, p=0·01), increasing respiratory support defined as the need for continuous positive airway pressure (OR 5·86, 95% CI 1·47-23·35, p=0·01), invasive mechanical ventilation (OR 16·42, 95% CI 4·52-59·65, p<0·001), three organ systems requiring support at admission (OR 5·52, 95% CI 1·13-27·01, p=0·04), cardiorespiratory arrest within 24 hours prior to admission (OR 4·43, 95% CI 1·01-19·54, p=0·05) and vasopressor requirements (OR 2·73, 95% CI 1·71-4·36, p<0·001). Human immunodeficiency virus was not associated with mortality (OR 1·84, 95% CI 0·99-3·40, p=0·05). Interpretation: Mortality in critically ill COVID-19 African patients is higher than any other region, with an excess mortality of 18 and 29 deaths per 100 patients compared to other regions. Mortality is associated with limited critical care resources and severity of organ dysfunction at admission.
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    Open Access
    The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications.
    (Elservier :The Royal College of Anaesthetists, The College of Anaesthetists of Ireland, and The Hong Kong College of Anaesthesiologists., 2018-12) Kluyts, H.L.; le Manach, Y.; Munlemvo, D.M.; Madzimbamuto, F.; Basenero, A.; Coulibaly, Y.; Omigbodun, A.O.; Bankole, O.B.; Ojewola, R.W.; Osinowo, A.O. et al.
    Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.
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    Open Access
    Assessment of Parents’ Satisfaction with Paediatric Surgery Services at a Tertiary Hospital in South West Nigeria: A Quality Control Check
    (2017) Ademuyiwa, AO; Mosaku, SK; Ogbolu, RE; Oshodi, YO; Bode, CO
    Background: Patient satisfaction is an important link in the chain of patient-physician interaction, patient care experience and patient health outcome. Patient satisfaction is relevant in the evaluation of quality of services received in health institutions based in low and middle income countries, and can provide important feedback for service improvement in such resource-poor settings. Aim: This study aimed to examine the patient’s level of satisfaction with pediatric surgery services in a Teaching Hospital. Subjects and Methods: Setting: Paediatric Surgery Unit of the Lagos University Teaching Hospital. Prospective questionnaire based survey. Consenting literate parents of paediatric post-op patients were serially recruited from the pediatric surgery unit of the Lagos University Teaching Hospital. The consent of the Institution’s Research Ethics’ Committee was sought and obtained. Using a general sociodemographic questionnaire and the patient satisfaction with services scale, patient experiences were obtained. Results were expressed as simple percentages and presented in tables. Results: One hundred and thirty-four post-op cases participated in this study. These participants were parents of children with varied surgical conditions such as: hernia (24.6%, 33/134), hydrocoele (8.2%, 11/134), among other conditions. Majority of the cases were follow-up cases (75.4%, 101/134), compared to 24.6% being new cases. Most respondents (parents/guardians) rated the ‘assistance from the records officer’ as good/ very good/excellent (82.1%, 110/134), while 14.9% (20/134) rated it as fair/poor. Respondents were quite satisfied with the ‘amount of information given about the health problem’ with 82.9% (111/134) rating it as good/very good/excellent and 8.2% (11/134) as fair/poor. The ‘suitability of the treatment plan to needs was considered good/very good/excellent by 61.9% and fair/poor by 9.0%. However, the ‘overall quality of care’ was rated as fair/poor in 12.0%, and good/very good/excellent by 88.0% of respondents. Conclusion: In conclusion, the study serves as a useful feedback tool which provides important information on certain aspects of patient satisfaction, it identifies aspects which respondents find less satisfying and as such need improvement.
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    Open Access
    Association of high-sensitivity C-reactive protein and odds of breast cancer by molecular subtype: analysis of the MEND study
    (Oncotarget, 2021-06-22) Gupta, A; Oyekunle, T; Salako, O; Daramola, A; Alatise, O; Ogun, G; Adeniyi, A; Deyeaux, A; Saraiya, V; Hall, A; Ayandipo, O; Olajide, T; Olasehinde, O; Arowolo, O; Adisa, A; Afuwape, O; Olusanya, A; Adegoke, A; Tollefsbol, T.O; Arnett, D; Muehlbauer, M.J; Newgard, C.B; H3 Africa Research Network; Akinyemiju, T
    Breast cancer (BC) in Nigeria is characterized by disproportionately aggressive molecular subtypes. C-reactive protein (CRP) is associated with risk and aggressiveness for several types of cancer. We examined the association of high-sensitivity CRP (hsCRP) with odds of BC by molecular subtype among Nigerian women. Among 296 newly diagnosed BC cases and 259 healthy controls, multivariable logistic regression models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between hsCRP and odds of BC overall and by molecular subtype (luminal A, luminal B, HER2-enriched and triple-negative or TNBC). High hsCRP (> 3 mg/L) was observed in 57% of cases and 31% of controls and was associated with 4 times the odds of BC (aOR: 4.43; 95% CI: 2.56, 7.66) after adjusting for socio-demographic, reproductive, and clinical variables. This association persisted regardless of menopausal status and body mass index (BMI) category. High hsCRP was associated with increased odds of TNBC (aOR: 3.32; 95% CI: 1.07, 10.35), luminal A BC (aOR: 4.03; 95% CI: 1.29, 12.64), and HER2-enriched BC (aOR: 6.27; 95% CI: 1.69, 23.25). Future studies are necessary in this population to further evaluate a potential role for CRP as a predictive biomarker for BC.
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    Open Access
    Attitudes and acceptance of Nigerians towards vasectomy-a comparison of married men and women in Lagos
    (kenyan medical Association, 2013-03) Tijani, K.; Ojewola, W.
    Background: Nigeria with a growth rate of 28%, accounts for over two thirds of the West African population. It also has one of the highest maternal mortality rates in the world with contraceptive prevalence among married couples less than 10%. Despite its safety and efficacy vasectomy appears to be unpopular in our environment.. Objective: To assess the perception and acceptance of married men and women towards vasectomy and the influence of the spouse on the man’s decision to accept or reject vasectomy. Design: A cross sectional questionnaire based study. Setting: With an estimated population of 20 million, Lagos is the most cosmopolitan and urbanised city in Nigeria and accounts for 65% of all commercial activities in the country. Virtually all the tribes in Nigeria are represented in the city. Subjects: Literate pregnant women recruited from the antenatal clinics and literate new fathers. All subjects were recruited from three health facilities in the Lagos metropolis. Results: Twenty seven point five and twenty one percent of the men and women respectively had a good Knowledge of vasectomy while 49.1% and 19% of all men and women respectively with good knowledge would accept vasectomy (or agree for their spouses to have the procedure). Overall acceptance rates for men and women were 26 and 13.5% respectively while 92% of men who can opt for vasectomy will only do so if their spouses agree. Knowledge about vasectomy was the strongest single factor influencing the acceptance of vasectomy (p= 0.013) with stronger correlation among men than women (p=0.005 vrs p=.0.023). Conclusion: Knowledge and acceptance of vasectomy is significantly better in males than female Nigerians living in Lagos.
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    Open Access
    An audit of parental satisfaction of Paediatric day case surgery at the Lagos University Teaching Hospital
    (JOURNAL OF CLINICAL SCIENCES, 2014-07) Elebute, OA; Ademuyiwa, AO; Seyi-Olajide, JO; Bode, CO
    Background: In the recent past, there has been a gradual increase in the volume of patients treated on a day case basis in our centre. However, no study has been conducted to audit pediatric day-case surgery practice at the Lagos University Teaching Hospital. Objectives: To determine the level of parental satisfaction with pediatric day-case surgery at the Lagos University Teaching Hospital. Patients and Methods: A total of 101 parents or the patient’s caretakers whose wards had day case surgery were administered a self‑completed questionnaire on the first postoperative day visit at the surgical outpatient clinic. The questions assessed parental satisfaction with the following: (a) Communication with doctors (surgeons and anesthesiologists), (b) Physical conditions of the theatre environment, (c) Staff’s care, (d) Need to care for the child at home, and (e) Postoperative complication. Result: There were 101 respondents with an age range of 22‑56 years (mean 35.05 ± 6.85). Eighty‑seven (86%) of the respondents were satisfied with the amount of information they obtained from their doctors before the operation; 43 (42.6%) were satisfied with the waiting time, whereas 47 (46.5%) were satisfied with the fasting time. However, 26 (25.7%) of the respondents were dissatisfied with the waiting room environment and 87 parents (87.1%) were dissatisfied with the nursing care. Conclusion: Most parents are satisfied with pediatric day-case surgery care. Some adjustments, however, need to be made on reducing the waiting and fasting time of the patients and improving both the waiting room environment and the nursing care in order to increase its acceptance.
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    Open Access
    Awareness and practice of breast screening and its impact on early detection and presentation among breast cancer patients attending a clinic in Lagos, Nigeria
    (Nigerian journal of clinical practice, 2014) Olajide, T.O; Ugburo, A.O; Habeebu, M.O; Lawal, A.O; Afolayan, M.O; Mofikoya, M.O
    Background: Breast cancer is the most common malignancy among females in Nigeria. The concept of breast screening (BS) is that it would result in presentation at earlier stages. We evaluated the impact of BS on early detection and presentation of breast cancer and determined the aspects BS need improvement. Patients and methods: All patients with a diagnosis of malignant breast lump attending clinics at a tertiary hospital in Nigeria were recruited into the study over a 2-year period. Self-administered questionnaires were given to patients. Data collected were demographics, knowledge about BS, practice of BS, the motivation to practice BS and the source of information on BS. Results: Of 218 patients seen, 147 (67.4%) patients presented at the surgical outpatient clinic and 71 (32.6%) at the radiotherapy clinic, with age 48.01 ± 0.80 years. A total of 156 (71.6%) were aware of BS, while 62 (28.4%) were not aware. A logistic regression analysis showed that only the level of formal education predicted awareness of BS, P = 0.001 Nagelkerke's R2 = 0.126. Awareness of BS was mainly from electronic media 87 (55.7%). There was no significant difference in the ages of those aware and practicing BS 48.03 ± 1.05 years, and those not practicing BS 46.32 ± 1.94 years, P = 0.446. There was no significant difference in presentation for those practicing BS 7.41 ± 1.30 months, and those not practicing BS 11.38 ± 2.91 months, P = 0.175, with 64% practicing BS presenting late, while 77% not practicing BS presenting late, χ2 = 2.432, P = 0.488. A logistic regression analysis did not show any demographic or clinical parameters as predictive P = 0.225 Nagelkerke's R2 = 0.126. Conclusion: The high level of awareness and practice of BS was not translated into the presentation with early breast cancer.
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    Open Access
    Bilateral subcapsular orchiectomy versus bilateral total orchiectomy: Comparison of the quality of life post-orchiectomy
    (Walters Kluwer/Medknow, 2018-01) Orakwe, D.; Tijani, K.; Jeje, E.; Ojewola, W.
    Objective: Bilateral subcapsular orchiectomy (BSO) is said to be more aesthetic and psychologically satisfying when compared to bilateral total orchiectomy (BTO). This study compared the quality of life (QoL) of men with advanced prostate cancer who had BTO to those who had BSO, with an emphasis on their perception of self or identity as a man. Subjects and Methods: Sixty‑one patients with advanced prostate cancer opting for bilateral orchiectomy were recruited. Pre‑orchiectomy and at 1 month and 3 months post‑orchiectomy, the Functional Assessment of Cancer Therapy for Prostate cancer (FACT‑P) questionnaires were administered and scored. Results: Thirty (49.18%) patients had BTO (BTO group), while 31 (50.82%) patients had BSO (BSO group) for advanced prostate cancer. On comparison of the two groups, there were no statistically significant differences in FACT‑P scores at 1 month and 3 months. The subscale scores also showed no significant statistical difference except for the physical well‑being score at 3 months post‑orchiectomy, which was lower in the BSO group (P = 0.041). The average scores of Item P5 (I am able to feel like a man) which were used to assess the sex‑role identity declined on an average over 3 months with no statistically significant difference on comparison of the two groups. Conclusion: The QoL scores (FACT‑P and FACT‑G) assessed over 3 months post‑orchiectomy did not differ on comparison of the BTO group and the BSO group. Performing a BSO in our region did not result in any psychological benefit when compared to performing a BTO.
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    Open Access
    Bilateral Subcapsular Orchiectomy versus Bilateral Total Orchiectomy: Comparison of the Quality of Life Post‑Orchiectomy
    (Wolters Cluwer - MedKnow: National Postgraduate Medical College of Nigeria, 2018-01) Orakwe, D.E.; Tijani, K.H.; Jeje, E.A.; Ogunjimi, M.A.; Ojewola, R.W.
    Objective: Bilateral subcapsular orchiectomy (BSO) is said to be more aesthetic and psychologically satisfying when compared to bilateral total orchiectomy (BTO). This study compared the quality of life (QoL) of men with advanced prostate cancer who had BTO to those who had BSO, with an emphasis on their perception of self or identity as a man. Subjects and Methods: Sixty-one patients with advanced prostate cancer opting for bilateral orchiectomy were recruited. Pre-orchiectomy and at 1 month and 3 months post-orchiectomy, the Functional Assessment of Cancer Therapy for Prostate cancer (FACT-P) questionnaires were administered and scored. Results: Thirty (49.18%) patients had BTO (BTO group), while 31 (50.82%) patients had BSO (BSO group) for advanced prostate cancer. On comparison of the two groups, there were no statistically significant differences in FACT-P scores at 1 month and 3 months. The subscale scores also showed no significant statistical difference except for the physical well-being score at 3 months post-orchiectomy, which was lower in the BSO group (P = 0.041). The average scores of Item P5 (I am able to feel like a man) which were used to assess the sex-role identity declined on an average over 3 months with no statistically significant difference on comparison of the two groups. Conclusion: The QoL scores (FACT-P and FACT-G) assessed over 3 months post-orchiectomy did not differ on comparison of the BTO group and the BSO group. Performing a BSO in our region did not result in any psychological benefit when compared to performing a BTO.
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    Open Access
    Bilious vomiting in Tracheo-esophageal fistula with oesophageal atresia, Situs Inversus incompletus and gastro-biliary fistula. A diagnostic conundrum.
    (Elsevier Ltd, 2020-04) Ladipo-Ajayi, OA; Olayade, OO; Ademuyiwa, A; Ifezue, U; Uchime, K
    The diagnosis of oesophageal atresia with or without fistula has traditionally been premised on the clinical finding of excessive salivation, regurgitation of feeds with attendant respiratory compromise in affected neonates. In addition, inability to pass an appropriate sized oesophageal tube into the stomach is confirmatory. OA/TOF is documented to be associated with other congenital abnormalities in up to 50% of cases. These often affect the outcome of treatment. A presentation of OA/TOF with bilious vomiting is rare and requires a high index of suspicion and appropriately selected investigations to cinch the diagnosis. Thus bilious vomiting in a neonate does not rule out the diagnosis of OA/TOF and it is important to ensure a thorough examination and investigation in every surgical neonate.
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    Open Access
    Carcinoma of the penis: experience from the Lagos University Teaching Hospital Lagos, Nigeria
    (Lagos University Medical Society, 2011-01) Ajekigbe, A.; Anunuobi, C.; Tijani, K.
    BACKGROUND: Carcinoma of penis is rare in countries where neonatal mate circumcision is the tradition and in Nigeria it is a common practice amongst almost all the tribes. OBJECTIVE: This is to document the prevalence, age distribution, site and histologic types of penile carcinoma at the Lagos University Teaching Hospital Idi-Araba over a 20 year period. METHODS: Cases of the penile carcinoma recorded in the surgical pathology register of the Department of Morbid Anatomy, the Cancer Registry and the Medical Records Department of the Lagos University Teaching Hospital over a twenty year period were reviewed. Information extracted included the age, site of lesion, and histopathologic type. The histopathology slides were reexamined to confirm the diagnosis and to grade the lesion. The data was analyzed using simple statistical methods. RESULTS: There were 7 cases of carcinoma of the penis accounting for 1.9% of malignant lesions of the male genital tracts in LUTH, 3 (42.85%) of which were on the shaft of the penis. The ages of the patients ranged from 42-79 years with a mean of 52.2 years, majority (42.92) of the cases were inthe 5th decade. All the cases were well differentiated squamous cell carcinomas. CONCLUSION: Carcinoma of the penis is rare in Lagos, Nigeria. This may be attributed to the common practice of neonatal male circumcision in Nigeria.
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    Open Access
    Case report: Neonatal pancreatitis, chromosomal abnormality andduodenal stenosis in a newborn. A new syndrome?
    (Elsevier Ltd, 2020) Ladipo-Ajayi, O; Ihediwa, G; Akinjo, AO; Awolola, NO; Elebute, OA; Ademuyiwa, AO
    Introduction: Pancreatitis is a dire clinical diagnosis with variable presentation in the paediatric population. Moreover, neonatal pancreatitis has been rarely reported in the English literature. Presentation of case: A newborn, product of a poorly supervised, pre-term gestation with pre-natally diagnosed intestinal obstruction, and post-natal clinical features of jaundice, vomiting, abdominal distension, aphonation and suspected chromosomal abnormalities. There was maternal hepatitis which was untreated. Diagnosed as duodenal atresia, the baby was investigated, resuscitated and had surgery. Intra-operative findings were of an omental bubble, duodenal stenosis with annular pancreas, coagulative necrosis of the pancreas and multiple intra peritoneal cheesy deposits. Following an unfortunate demise, autopsy confirmed pancreatitis and multiple congenital abnormalities. Discussion: Paediatric caregivers should be aware of the possibility of neonatal pancreatitis in jaundiced newborns with intestinal obstruction especially with a background of maternal viraemia. Conclusion: A constellation of unusual presentations as highlighted could be a pointer to an emerging syndrome. All paediatric caregivers should entertain a high index of suspicion of pancreatitis in such a case, investigate and expedite appropriate interventions to prevent mortality.
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    Open Access
    Challenges in the Management of Benign Prostatic Enlargement in Nigeria
    (Official Journal of Lagos University Medical Society (LUMS), 2016-10) Jeje, E.A.; Ojewola, R.W.; Nwofor, A.M.E.; Ogunjimi, M.A.; Alabi, T.O.
    The burden of benign prostatic enlargement (BPE) caused by benign prostatic hyperplasia (BPH) is very high in Nigeria and management of patients with this benign urologic condition constitutes the bulk of work done by urologists. This article aims to highlight some of the challenges facing the specialist urologists in the management of patients with BPE in Nigeria. The challenges are many and varied. They include factors relating to the patients themselves, infrastructural problems, and healthcare financing issues as well as problems with the healthcare givers. Factors related to the system include heath facilities, inadequate manpower, unchecked proliferation and popularity of alternative medicine as well as limited availability of minimally invasive surgical treatments. Patients' related factors contribute significantly to these challenges and include the prevailing poverty, poor health-seeking attitude, low literacy level and ignorance on the prostatic diseases amongst the Nigerian patients. The problems with healthcare givers include lack of local guidelines for the management of BPH and lack of professional development by the General Practitioners who manage most of the patients in Nigeria. Recommendations include embarking on mass literacy campaign and health education about prostatic diseases, development and standardization of laboratory practice in the nation, improvement in the coverage of and inclusion of BPH in the National Health Insurance Scheme (NHIS) in Nigeria. It was also recommended that the Nigerian Association of Urological Surgeons (NAUS) develop a guideline on the management of BPE/BPH.
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    Open Access
    Choice of Future Location of Surgical Practice: A Survey of Surgical Trainees in Nigeria and Implications for Timely Access to Surgical Care
    (World Journal of Surgery, 2019-06-20) Seyi-olajide, J. O.; Ameh, E. A.; Olajide, T. O.; Awofeso, O.
    Background There is inequity and maldistribution of the surgical workforce in Nigeria. Most specialists practice in second- and third-level hospitals often located in urban or semi-urban areas. A knowledge of the proposed choice of practice location of surgical trainees and the factors that influence the choice could provide insight into future surgical coverage and help in planning and policy-making. Methods This is a cross-sectional survey of surgical trainees attending the mandatory integrated revision and update course of the West African College of Surgeons. Anonymous structured questionnaires were self-administered to 200 trainees, of which 143 completed the questionnaires. Results The response rate was 71.5%. One hundred and six (74.1%) trainees preferred to work in a tertiary hospital on completion of training, 13 (9.1%) were in a Private Hospital, and 16 (11.2%) were undecided. Nearly all tertiary hospitals are in urban or semi-urban towns. The commonest factors influencing choice of practice location were proximity to family 19 (13.3%), proximity to hometown 11 (7.6%), availability of working facilities 10 (6.9%), income 7 (4.9%) and underserved areas 7 (4.9%). Of 122 (85.3%) trainees who agreed to work for some period each year (ranging from 1 week to 6 months) in a rural setting, 42 (29.3%) would do it without additional financial incentive. Conclusion The choice of most surgical trainees not to work in a rural setting as specialists would exacerbate the ongoing surgical workforce maldistribution and inequity in Nigeria. However, the willingness of 85.3% to provide periodic rural surgical coverage could be leveraged in planning of initiatives to address the maldistribution.
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    Open Access
    Clinical and proctosigmoidoscopic findings in patients with anorectal sepsis in a private health facility in Lagos, Nigeria
    (Nigerian Quarterly Journal of Hospital Medicine, 2012) Jeje, E.A; Mofikoya, B.O; Osunkoya, S.A; Olajide, T.O; Osinowo, A.O
    Background: Anorectal sepsis is a distressing condition which is sometimes inadequatelytreated. Objectives: To determine the clinical and prostosigmoidoscopic findings in patients with anorectal sepsis seen by the authors over a 5 year period as well as identifying the commonly performed procedures. Method: A review of all the records of patients seen by the authors over a 5 year period was carried out. The demographic pattern was determined including the age, sex, mode of presentation, and associated co-morbidities. The detailed perianal and protosigmoidoscopic findings were also noted Results: 45 males and 10 females were seen during the study period. The mean age incidence was 43.4 years. The commonest mode of presentation was perianal discharge and pain in over 85% of the patients seen. The low anal fistula was the commonest pathology on proctosigmoidoscopy while abscesses and external haemorrhoids were the other commonly occurring lesions found . Fistulotomy was the most commonly perfomed procedure while diabetes was the most common comorbidity. Conclusion: Anorectal sepsis most commonly affects males in the fifth decade of life. Thorough evaluation and adequate operative treatment appear to result in satisfactory early outcome.
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    Open Access
    Clinico-pathological Correlation of Digital Rectal Examination Findings Amongst Nigerian Men with Prostatic Diseases: A Prospective Study of 236 Cases
    (Walters Kluwer/Medknow, 2013-01) Ojewola, W.; Jeje, E.; Tijani, K.; Anunuobi, C.
    Aims and Objective: This study aims at correlating different digital rectal examination (DRE) abnormalities with histopathological results in patients with prostatic diseases. Materials and Methods: A prospective study of 236 patients who underwent prostate needle biopsy (PNB). Inclusion criteria were presence of abnormal DRE findings or elevated prostate specific antigen above 4 ng/ml or both. They all had 10‑core extended transrectal biopsy and specimens were sent for histopathological examination. Correlations were made between DRE findings and histopathology results. Two separate multivariate logistic regression models were created; the first evaluated the relationship of predictors (DRE findings) to the likelihood of detecting cancer and the second explored predictors of high‑grade cancer on PNB. Results: Two hundred and thirty‑six patients were enrolled with a mean age of 66.9 years and range of 43‑90 years. Histopathology results were malignant in 102 (43.2%) and benign in 134 (56.8%). Ninety‑one (38.6%) and 145 (61.4%) had normal DRE and abnormal DRE findings with cancer detection rates of 23.1% and 55.8% respectively. Nodular prostate is the most common abnormality in 63.4% patients with abnormal DRE. Each sign of DRE had different predictive value with enhanced positive predictive value when combinations of abnormalities are present. Abnormal DRE is an independent predictor of high‑grade tumor. Mean Gleason scores were 4.7 and 7.1 in patients with normal and abnormal DRE respectively. Conclusion: DRE is a useful and important tool in assessing patients with suspected prostate diseases who need prostate biopsy. An abnormal DRE correlated well with prostate cancer and independently predicted high‑grade disease in these men
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    Open Access
    Clinico‑pathological Correlation of Digital Rectal Examination Findings Amongst Nigerian Men with Prostatic Diseases: A Prospective Study of 236 Cases
    (Wolters Clover, MedKnow, 2013-01) Ojewola, R.W.; Jeje, E.A.; Tijani, K.H.; Ogunjimi, M.A.; Anunobi, C.C.
    Aims and Objective: This study aims at correlating different digital rectal examination (DRE) abnormalities with histopathological results in patients with prostatic diseases. Materials and Methods: A prospective study of 236 patients who underwent prostate needle biopsy (PNB). Inclusion criteria were presence of abnormal DRE findings or elevated prostate specific antigen above 4 ng/ml or both. They all had 10‑core extended transrectal biopsy and specimens were sent for histopathological examination. Correlations were made between DRE findings and histopathology results. Two separate multivariate logistic regression models were created; the first evaluated the relationship of predictors (DRE findings) to the likelihood of detecting cancer and the second explored predictors of high‑grade cancer on PNB. Results: Two hundred and thirty‑six patients were enrolled with a mean age of 66.9 years and range of 43‑90 years. Histopathology results were malignant in 102 (43.2%) and benign in 134 (56.8%). Ninety‑one (38.6%) and 145 (61.4%) had normal DRE and abnormal DRE findings with cancer detection rates of 23.1% and 55.8% respectively. Nodular prostate is the most common abnormality in 63.4% patients with abnormal DRE. Each sign of DRE had different predictive value with enhanced positive predictive value when combinations of abnormalities are present. Abnormal DRE is an independent predictor of high‑grade tumor. Mean Gleason scores were 4.7 and 7.1 in patients with normal and abnormal DRE respectively. Conclusion: DRE is a useful and important tool in assessing patients with suspected prostate diseases who need prostate biopsy. An abnormal DRE correlated well with prostate cancer and independently predicted high‑grade disease in these men.
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    Open Access
    Collaborative Molecular Epidemiology Study of Metabolic Dysregulation, DNA Methylation, and Breast Cancer Risk Among Nigerian Women: MEND Study Objectives and Design
    (J Glob Oncol, 2019-06-05) Akinyemiju, T; Daramola, A; Alatise, O.; Adeniyi, A; Ogun, G.; Ayandipo, O.; Olajide, T. O.; Olasehinde, O.; Arowolo, O.; Adisa, A.
    Purpose: To elucidate the role of metabolic dysregulation and associated DNA methylation changes on breast cancer risk and aggressive subtypes among Nigerian women. We describe the design and methods of a collaborative molecular epidemiology study of breast cancer in Nigerian hospitals. Methods: The Mechanisms for Novel and Established Risk Factors for Breast Cancer in Women of Nigerian Descent (MEND) study was designed as a matched case-control study of 350 patients, age 18 to 75 years, with newly diagnosed, treatment-naïve breast cancer and 350 age-matched healthy controls from surrounding geographic areas. Patients with breast cancer seen for initial diagnosis at four large tertiary hospitals in southwest Nigeria and one affiliated private hospital were recruited. Healthy female controls were selected from a cohort of 4,000 healthy women recruited as part of the Human Heredity and Health (H3) in Africa Chronic Kidney Disease Case-Control Study in Nigeria. Tumor and adjacent normal tissue, and blood and saliva samples were collected for molecular and epigenetic assays. Results: Although recruitment is ongoing, a total of 416 patients have been recruited to date, with tumor and blood samples obtained from at least 310 patients. Data on age-matched (± 6 months) controls have also been obtained and harmonized. Lipid assays for 350 pathologically verified cases and 350 age-matched controls is underway, and pathologic characterization of tumors (including immunohistochemistry for subtyping) is ongoing. Data on DNA methylation for tumors and adjacent normal tissue are expected by the end of the study period. Conclusion: The MEND study will provide a unique, high-quality source of data to evaluate the contribution of metabolic dysregulation such as obesity, diabetes, hypertension, and metabolic syndrome to the biology of breast cancer among Nigerian women and foster collaborative studies relevant for women of African descent globally