Papers by ADEMOLA POPOOLA
Cancer Epidemiology, Biomarkers & Prevention
Background: Vitamin C has long been recognized for its plethora of immune system and anti-inflamm... more Background: Vitamin C has long been recognized for its plethora of immune system and anti-inflammatory properties. Various cancers have been identified to have similarities in epigenetic inflammatory components. Because rates of prostate cancer have exhibited significant disparities in Black men with increased incidence and mortality, an examination of the intersection of diet, inflammation, and cancer and chronic disease diagnoses necessitates researchers to consider vitamin C. This study utilized data collected from the Prostate Cancer Transatlantic Consortium (CaPTC) Familial Cohort Study, an ongoing longitudinal cohort study initiated in 2017 which explores risk factors of prostate cancer among African Black men in Nigeria, Cameroon, and the United States (U.S.). Aim: The aim of this study was to examine the consumption habits of vitamin C-rich foods in African Black men and determine if dietary patterns influenced risk of cancer diagnosis. Methodology: Descriptive analyses comp...
The Lancet
Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as ind... more Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45•6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84•5 (95% CI 84•1-84•9), which varied between HIC (88•5 [89•0-88•0]), MIC (81•8 [82•5-81•1]), and LIC (66•8 [64•9-68•7]) settings. In the third phase, 1217 (74•6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51•4%) were from HIC, 538 (44•2%) from MIC, and 54 (4•4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3•6% (95% CI 3•0-4•1; p<0•0001) increase in SVR. This was consistent in HIC (4•8% [4•1-5•5]; p<0•0001), MIC (2•8 [2•0-3•7]; p<0•0001), and LIC (3•8 [1•3-6•7%]; p<0•0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.
British Journal of Surgery
Background There is a substantial gap in provision of adequate surgical care in many low- and mid... more Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality wa...
Cancer Research Communications
In this study, we used whole-exome sequencing of a cohort of 45 advanced-stage, treatment-naïve N... more In this study, we used whole-exome sequencing of a cohort of 45 advanced-stage, treatment-naïve Nigerian (NG) primary prostate cancer tumors and 11 unmatched nontumor tissues to compare genomic mutations with African American (AA) and European American (EA) The Cancer Genome Atlas (TCGA) prostate cancer. NG samples were collected from six sites in central and southwest Nigeria. After whole-exome sequencing, samples were processed using GATK best practices. BRCA1 (100%), BARD1 (45%), BRCA2 (27%), and PMS2(18%) had germline alterations in at least two NG nontumor samples. Across 111 germline variants, the AA cohort reflected a pattern [BRCA1 (68%), BARD1 (34%), BRCA2 (28%), and PMS2 (16%)] similar to NG samples. Of the most frequently mutated genes, BRCA1 showed a statistically (P ≤ 0.05) higher germline mutation frequency in men of African ancestry (MAA) and increasing variant frequency with increased African ancestry. Disaggregating gene-level mutation frequencies by variants reveal...
Cancer Research
Men of African ancestry (MAA) have the highest global incidence and mortality of prostate cancer ... more Men of African ancestry (MAA) have the highest global incidence and mortality of prostate cancer (PCa); however, the biology underlying this harsh disease presentation remains poorly understand, largely due to Africans and people within the African diaspora being under-represented in genomics research. MAA are younger at diagnosis, have higher tumor volume at diagnosis and have higher tumor aggression compared to European American men. Additionally, genomic profiling continues to show that PCa etiology and phenotype are influenced by higher amounts of African ancestry and that West African ancestry is associated with unique genomic alterations. Herein we utilize whole exome sequencing of a unique cohort of 45 advanced stage, treatment naïve Nigerian primary PCa tumors and 11 unmatched non-tumor tissue to compare genomic variants with African (AA) and European (EA) American TCGA PCa tumors. Nigerian samples were collected from 6 sites in central and southwest Nigeria. After whole exo...
African Journal of Urology, 2021
Background Fournier’s gangrene is an acute soft tissue necrotizing infection involving the perine... more Background Fournier’s gangrene is an acute soft tissue necrotizing infection involving the perineum and the external genitalia which can result in a major loss of the scrotal wall with exposure of the testicles. Reconstruction of such major defect is quite challenging; the use of pedicled gracilis muscle flap helps to create an aesthetically acceptable scrotum with minimal donor site morbidity. Case presentation We described the case of a 60-year-old man with a large scrotal loss from Fournier’s gangrene following bladder outlet obstruction and perineal abscess. He had multiple debridement and reconstruction with pedicled left gracilis muscle flap with a good aesthetic and functional post-operative outcome. The major challenge encountered was the loss of the skin graft as a result of the retraction of the muscle flap due to too early ambulation; this can thus be avoided by adequate pre-operative counseling and enforcing bed rest. Conclusions The use of gracilis muscle flap in the re...
Saudi Journal of Kidney Diseases and Transplantation, 2018
Kidney transplantation is the gold standard for end-stage renal disease. All over the world there... more Kidney transplantation is the gold standard for end-stage renal disease. All over the world there are several challenges preventing sufficient organ donation to meet the growing needs of patients on the waiting list. One major challenge which is common to most countries is the shortage of organs from willing living donors. Many countries, especially, the developed countries, have devised several models of expanding their donor pools to meet the growing needs of patients on the waiting list. Nigeria, a developing country has very low kidney transplantation rate even though some progress have been made in making the procedure feasible in about a dozen hospitals in Nigeria. One very major challenge has been the shortage of donor organ supply. This paper intends to proffer suggestions on how to expand the organ donor pool in Nigeria.
Prostate cancer is a significant public health problem affecting men globally. In 2018, it was th... more Prostate cancer is a significant public health problem affecting men globally. In 2018, it was the second most commonly diagnosed cancer among men world-wide and disproportionately impact men of African ancestry. Some of the modifiable risk factors for prostate cancer include knowledge and attitudes about the disease, the belief system of individuals and their diet. Moreover, physical activity, alcohol and tobacco consumption have also been suggested as behavioral factors that contribute to prostate cancer disparities. This study compares modifiable risk factors implicated in prostate cancer among men living in Africa and African immigrants living in the United States to identifying behavioral factors that can be targeted for intervention. A cross-sectional study design was employed among Black men in Nigeria, Cameroon and African immigrants in United States using the Global Prostate Cancer Measure for Black men. Findings indicate that Nigerian and Cameroonian men residing in the Un...
Surgical endoscopy, Jan 5, 2018
Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high-... more Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but...
JCO Global Oncology
PURPOSE To describe a newly established international registry recruiting diverse patients with a... more PURPOSE To describe a newly established international registry recruiting diverse patients with advanced prostate cancer across academic and community practices to address unmet needs in this population. PATIENTS AND METHODS Initiated in 2017, IRONMAN (International Registry for Men with Advanced Prostate Cancer) is a prospective cohort of patients with advanced prostate cancer. The study will enroll 5,000 patients with metastatic hormone-sensitive prostate cancer (mHSPC) or castration-resistant prostate cancer (CRPC), recruited from Australia, the Bahamas, Barbados, Brazil, Canada, Ireland, Jamaica, Kenya, Nigeria, Norway, South Africa, Spain, Sweden, Switzerland, the United Kingdom, and the United States. The study is collecting datatypes to study variation in care and treatment of advanced prostate cancer across countries and across academic, community-based, and government practices with a focus on clinical outcomes, patient-reported outcomes, epidemiologic data, biologic subtyp...
Poster Presentations - Proffered Abstracts, 2020
Prostate cancer (CaP) has been identified as the most common cancer among men globally with highe... more Prostate cancer (CaP) has been identified as the most common cancer among men globally with higher prevalence, incidence and mortality rates in black men. This study aims to assess the risk factors for CaP among West African men residing in Nigeria, Cameroun and the United States. A validated CaPTC familial cohort study questionnaire was used to collect data on the respondents’ characteristics, alcohol consumption pattern, smoking pattern, knowledge of CaP, physical activity level and cancer status. Anthropometric measurements were taken using standard procedures. Data was summarised using descriptive statistics and penalized maximum likelihood logistic regression analysis via Firth method was used to determine association between CaP status and independent variables. The results show that 2.21% reported to have been diagnosed of CaP out of which 90.91% resides in Nigeria. Median age of the respondents is 47 years, 62.21% had poor knowledge of CaP, and 17.11% had central obesity. M...
British Journal of Surgery, 2019
Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practi... more Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle...
Babcock University Medical Journal (BUMJ)
Background: Leiomyoma is a benign smooth muscle mesenchymal tumor, usually of uterine origin but ... more Background: Leiomyoma is a benign smooth muscle mesenchymal tumor, usually of uterine origin but may rarelydevelop in the vaginal walls. Case presentation: A case of 40-year-old para 5+0 woman with anterior vaginal wall leiomyoma is reported. Thepresentation mimics that of uterovaginal prolapse and hence presents a diagnostic challenge. The unusualappearance of the protrusion, failure to reduce at any time even while lying down, and complete absence of urinarysymptoms raised the suspicion of a rare case. The diagnosis was made through examination under anesthesia,cystoscopy, and biopsy. Histological examination of the biopsy specimen confirmed vaginal wall leiomyoma. Thepatient had complete excision of the mass without any complications. Discussion and Conclusion: Vaginal wall leiomyoma is a rare benign vaginal lesion that can easily bemisdiagnosed. Diagnosis involves critical clinical evaluation, especially during pelvic examinations. Any vaginalprotrusion should be approached with...
Annals of Tropical Pathology, 2021
Introduction: Histopathology Request Forms (HRFs) serve as interphase between clinicians and path... more Introduction: Histopathology Request Forms (HRFs) serve as interphase between clinicians and pathologists in making diagnosis of tissue pathology. Inadequacies of the completion of HRFs have been a source of major frictions between the two groups of physicians. Various reports have highlighted this inadequacy. The need for adequate information on the HRF to be standardized cannot be overemphasized. Aim: The paper aims to evaluate the histopathology request forms from institutions in Nigeria and to propose an improved prostate disease-specific histopathology request form. Methodology: Histopathological request forms from some major Nigerian health institutions were analyzed for adequacy based on required information for a standardized histological reportage. A request form specific for suspected prostate diseases was designed from the review of literature. Results: Histopathology request forms (HRFs) from sixteen Nigerian health institutions were received from all the geopolitical zo...
Diagnostic Histopathology, 2021
Eosinophilic solid and cystic renal cell carcinoma (ESC RCC) is a recently described distinct and... more Eosinophilic solid and cystic renal cell carcinoma (ESC RCC) is a recently described distinct and unique renal neoplasm that was originally described in female patients with tuberous sclerosis complex but now shown to occur mostly in a sporadic form with a female predominance. They result from somatic loss of TSC1 or TSC2 tumour suppressor genes. These tumours typically show a solid and cystic architecture, and the neoplastic cells are characterized by abundant granular eosinophilic cytoplasm with most showing a characteristic basophilic cytoplasmic stippling. The incidence is currently unknown because majority of cases were misdiagnosed or labelled as the more aggressive ‘unclassified renal cell carcinoma' or ‘unclassified renal neoplasm with oncocytic or eosinophilic morphology'. We report a case of a twenty-three year old female with a solitary right renal mass. We review the literature and highlight the clinical and morphological features that distinguish this entity fro...
Saudi Journal of Kidney Diseases and Transplantation
Organ transplantation is the gold standard for treating end-stage organ diseases, many of whom ar... more Organ transplantation is the gold standard for treating end-stage organ diseases, many of whom are on waiting lists. The reasons for this include the nonavailability of suitable organs to be transplanted. In many nations, most of these challenges have been surmounted by the adoption of deceased donor program, which is not so in sub-Saharan countries such as Nigeria. This study is to audit the potentially transplantable organs available from potential deceased donors from a Nigerian tertiary hospital. This is a study of deaths in the intensive care unit (ICU) and the accident and emergency units of the University of Ilorin Teaching Hospital, Nigeria. Data included the biodata, social history, diagnosis or indications for admission, time of arrival and death, causes of death, associated comorbidities, potential organs available, social history, and availability of relations at the time of death. There were 104 deaths in the ICU and 10 patients in the accident and emergency unit. There were 66 males (57.9%) and 48 females (42.1%). Eighty patients were Muslims (70.2%) and 34 were Christians (19.8%). A total of 33 participants were unmarried (28.9%),whereas 81 (71.1%) were married. The tribes of the patients were Yoruba (105, 92.1%), Igbo (7, 6.1%), Hausa (1, 0.9%), and Nupe (1, 0.9%). The age range was 0.08-85 years. Twenty-two (19.3%) had primary and the remaining had at least secondary education. The causes of death were myriad, and there were relatives available at the times of all deaths. The Maastricht classification of the deaths were Class I - 1 (0.9%), Class II - 37 (32.2%), Class III - 9 (7.8%), Class IV - 20 (17.4%), and Class V - 47(40.9%). There were no transplantable organs in 42 (36.5%), one organ in eight (7%), two organs in two (7%), three organs in one (0.9%), four organs in 13 (11.3%), five organs in six (5.2%), six organs in 11 (9.6%), seven organs in 11 (9.6%), eight organs in five (13%), and nine organs in five (4.3%). Deceased donor sources of organs are worthy of being exploited to improve organ transplantation in Nigeria.
BJS Open
Background: End colostomy rates following colorectal resection vary across institutions in high-i... more Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6⋅9 per cent) from low-HDI, 254 (15⋅5 per cent) from middle-HDI and 1268 (77⋅6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57⋅5, 40⋅9 and 35⋅4 per cent; P < 0⋅001) and subsequent use of end colostomy (52⋅2, 24⋅8 and 18⋅9 per cent; P < 0⋅001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3⋅20, 95 per cent c.i. 1⋅35 to 7⋅57; P = 0⋅008) after risk adjustment for malignant disease (OR 2⋅34, 1⋅65 to 3⋅32; P < 0⋅001), emergency surgery (OR 4⋅08, 2⋅73 to 6⋅10; P < 0⋅001), time to operation at least 48 h (OR 1⋅99, 1⋅28 to 3⋅09; P = 0⋅002) and disease perforation (OR 4⋅00, 2⋅81 to 5⋅69; P < 0⋅001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.
Cancer Health Disparities, 2019
Prostate cancer (CaP) has been identified as the most common cancer among men globally with highe... more Prostate cancer (CaP) has been identified as the most common cancer among men globally with higher prevalence, incidence and mortality rates in Black men. This study aims to assess the risk factors for CaP among West African men residing in Nigeria, Cameroon and the United States. A validated Prostate Cancer Transatlantic Consortium (CaPTC) familial cohort study questionnaire was used to collect data on the respondents’ characteristics, alcohol consumption pattern, smoking pattern, knowledge of CaP, physical activity level and cancer status. Anthropometric measurements were taken using standard procedures. Data was summarised using descriptive statistics and penalized maximum likelihood logistic regression analysis via Firth method to determine the association between CaP status and independent variables. The results show that 2.21% of the respondents reported to have been diagnosed with CaP. The median age of the respondents was 47 years with 62.21% having poor knowledge of CaP, an...
… urology and nephrology, 2010
... Caudal block anesthesia for transrectal prostate biopsy SO Ikuerowo Æ AA Popoola Æ EO Olapade... more ... Caudal block anesthesia for transrectal prostate biopsy SO Ikuerowo Æ AA Popoola Æ EO Olapade-Olaopa Æ LI Okeke Æ OB Shittu Æ SA Adebayo Æ AA Sanusi ... Aana J 61(2):153157 10. Owen H, Cousins MJ (1989) Subarachnoid and extra-dural anesthesia. ...
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Papers by ADEMOLA POPOOLA