Papers by OLUDOLAPO O AFUWAPE
Objective: This study describes our experience with a low cost handmade polydioxanone (PDS) extra... more Objective: This study describes our experience with a low cost handmade polydioxanone (PDS) extracorporeal knot to reduce the cost of laparoscopic appendectomy in a surgical practice. Methodology: This retrospective study was conducted from January 2018 to December 2019 in a general surgical unit of the University College Hospital Ibadan. The files of 20 patients with complete data for whom extracorporeal handmade PDS'0' knots were used for appendiceal stump closure during laparoscopic appendectomy were retrieved. Results: The mean age was 28.4 ± 13.2 years. There were nine male and eleven female patients. All the operations were performed by the same surgical team. The mesoappendix was coagulated with bipolar cautery and cut with scissors. The appendix base was double ligated with two extracorporeal knots and divided. The mean duration of surgery was 59.2 ± 31.2minutes. The median length of hospital stay was 2days. The mean duration of follow up was 2.80 ± 0.50 months. One patient developed superficial port site infection. Conclusion: The handmade extracorporeal knot used in this retrospective study for securing appendicular stump was found to be safe and cheaper than pre-tied extracorporeal loop. This will reduce dependency upon preformed endoloops making the procedure cheaper. There was no incidence of failed application of the handmade extracorporeal knot.
East and Central African Journal of Surgery, Dec 31, 2020
Medical journal of Zambia, 2017
Background: Laparoscopic surgery is the gold standard in developed countries. Challenges in devel... more Background: Laparoscopic surgery is the gold standard in developed countries. Challenges in developing countries apart from the cost of instrumentation include a low acceptance level among patients. The consequent low volume of surgical cases debars cost reduction for surgery. Objective: The aim of this study is to determine the knowledge level and perception of laparoscopic surgery in patients attending the surgical outpatient for the first time in a teaching hospital in Nigeria. We also determined probable factors which affect this. Design of the study: This was a prospective study carried out on consenting new patients at the surgical outpatient clinic of the surgical outpatient clinic of a Nigerian Teaching Hospital. The questionnaire was administered to consenting patients through a face-to-face interview by nonmedical personnel who had been instructed by the investigators. Data collection was on clinic days within the period. Results: A total of 370 persons were recruited in this study with a male: female ratio of 1:1.79. The age distribution was between 14years and 81 years with a mean age of 44.19. 62.6% had no knowledge of laparoscopic surgery. 108(29.3%) and 260(70.7%) had positive and negative perception respectively. Only 44% of the patients with positive perception acquired information from appropriate hospital personnel. The longer the duration of perceived knowledge by the patients the higher the tendency to have the wrong perception. The level of education was a significant contributory factor to appropriate perception of laparoscopic surgery. Conclusion: There is a need for public health education in the region to drive this relatively new frontier of surgery to improve our practice and encourage indigenous innovations.
Oncotarget, Jun 22, 2021
Breast cancer (BC) in Nigeria is characterized by disproportionately aggressive molecular subtype... more 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.
PubMed, Apr 4, 2007
Aim: An audit of gunshot injuries was conducted at the University College Hospital to determine t... more Aim: An audit of gunshot injuries was conducted at the University College Hospital to determine the pattern of injuries. Materials and methods: All records of patients who presented with gunshot injuries to the accident and emergency department of the University College Hospital for one year were retrieved. Data obtained from the records included demographic data (age and sex), anatomical regions involved, the type of missile classification, the circumstances surrounding the incident and the patient's vital signs at presentation. The severity of injury was computed using the injury severity score. Results: Eighty out of ninety patients' records were seen. There were 15 females (18.75%) and 65 (81.25%) males with mean ages of 25.60 years and 35.42 years respectively . The most common cause of gunshot injuries was armed robbery attack (71.3%) while the extremities (upper limbs and lower limbs) were the most common areas of injury (61.3%). Armed robbery was the most frequent cause of injuries. Conclusion: Low velocity missiles are predominant. The lower limb is the most commonly injured area. Armed robbery is the most common cause of such injuries. Most gunshot injuries are physiologically stable at presentation. Suicidal intent is still rare.
PubMed, May 25, 2023
Background: Progressive improvement in the accuracy of profiling of hormone receptors in breast c... more Background: Progressive improvement in the accuracy of profiling of hormone receptors in breast cancer provides the basis for targeted endocrine therapy, a major pillar of multimodal breast cancer treatment. However, the disparity in findings from comparatively smaller sample-sized studies in West Africa has led to somewhat conflicting conclusions and recommendations. Objectives: This study investigates the immunohistochemical (IHC) profile of breast cancer specimens for estrogen receptor (ER), progesterone receptor (PR), human epidermal receptor-2 (HER2)/neu, and Ki-67 in a tertiary hospital in Ibadan, Nigeria over 12 years. Materials and methods: We reviewed 998 IHC reports, documented clinicopathologic parameters, computed patterns of biomarkers, and stratified them based on the American Society of Clinical Oncology/College of American Pathologists recommendations. Descriptive analysis including frequency, mean, and median were generated from the data extracted. Results: Out of the 998 cases, 975 (97.7%) were females and 23 (2.3%) were males. The mean age was 48.84 ± 11.99 years. Open biopsies were the most common types of specimens (320, 41.6%): lumpectomy and incisional biopsy of ulcerated, fungating or unresectable tumours. In those cases, 246 (32.0%) were samples of breast-conserving or ablative surgical extirpation (mastectomy/wide local excision/quadrantectomy), and 203 (26.4%) were obtained by core needle biopsies. Invasive ductal carcinoma was the most common histopathological type (673, 94.5%). The majority of graded tumours were intermediate grade (444, 53.5%). Four hundred and sixty-nine (48.4%) were ER positive, 414 (42.8%) were PR positive, and 180 (19.4%) were HER2/neu positive. Three hundred and thirty-four (34.0%) were triple-negative. Eighty-nine cases had Ki-67 staining done, and of these 61 (68.5%) had positive nuclear staining. Conclusion: Steroid hormone receptors and HER-2/neu proportions in our cohort are likely to be more representative than the widely varied figures hitherto reported in the sub-region. We advocate routine IHC analysis of breast cancer samples as a guide to personalized endocrine therapy.
The Nigerian postgraduate medical journal, 2011
Laparoscopic surgery has become the preferred standard in developed countries. New procedures in ... more Laparoscopic surgery has become the preferred standard in developed countries. New procedures in laparoscopic surgery are continually being developed. Despite these innovations Nigeria and many other African are yet to fully embrace this surgical approach. Few therapeutic laparoscopic surgery procedures are performed annually in Nigerian teaching hospitals. Appropriate personnel and the initial high cost of acquiring state of the art equipments are some of the challenges in laparoscopic surgery in developing countries. A few centres have developed ways of solving these challenges. We discuss the envisaged problems with laparoscopic surgery in Nigeria and some other African countries and suggest solutions to these problems.
The Nigerian postgraduate medical journal, 2007
There is a dearth of information on emergency medical services in Nigeria. This study was conduct... more There is a dearth of information on emergency medical services in Nigeria. This study was conducted to determine the age, sex distribution and the pattern of patient presentation in the Accident and Emergency Department of a Nigeria teaching hospital. A retrospective study of all cases seen at the accident and emergency department of the University College Hospital in 2003 was carried out. The information extracted from the records includes age, sex, and diagnosis, department to which the patient was referred, the month of presentation and the outcome within the first twenty four hours of presentation. A total of 4674 patients attended the casualty, with a male: female ratio of 1.2:1. The third decade was the peak age distribution. There was a predominance of surgical cases (61%). In the treatment outcome, 52.1% were referred to other departments while there were ten (0.2%) mortalities. Trauma related cases constituted 45.1%. Road traffic accidents were the commonest cause of trauma. The largest proportion of patient were in the active third decade of life. Trauma is the commonest cause of presentation in the Accident and Emergency Department. A significant proportion of patients do not require admission. The doctor in the Accident and Emergency Department must be skilled in basic trauma care.
Open Forum Infectious Diseases
Background Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid ... more Background Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria. Methods Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures. Results A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 ...
Nigerian Postgraduate Medical Journal
MATERIALS AND METHODS- Archival formalin fixed paraffin embedded gastric Adenocarcinoma tumour ti... more MATERIALS AND METHODS- Archival formalin fixed paraffin embedded gastric Adenocarcinoma tumour tissue from the Department of Pathology, University College Hospital, Ibadan were studied for HER 2 protein status using immunohistochemistry. RESULTS- HER 2 protein receptor status was determined in 36 cases using immunohistochemistry. The male: female ratio was 1.4:1. The age range of the patients was 30 to 86 years, with peak age-groups being in the 6th and 7th decade of life. Mean age of the patients was 57.6 years while the median age was 56years. Four cases were positive for the HER 2 receptor protein representing about 11% of the cases. Two cases had staining score of 2+ while another 2 cases had score of 3+. The four positive cases were intestinal variants of gastric adenocarcinomas based on Laurens classification. Three were well differentiated tumours and one was moderately differentiated. CONCLUSION- HER 2 protein overexpression by immunohistochemistry can be demonstrated in black Africans with gastric carcinoma. More detailed and multicentre studies will be needed to draw firm conclusions in this regard.
Nigerian Postgraduate Medical Journal
There is a dearth of information on emergency medical services in Nigeria. This study was conduct... more There is a dearth of information on emergency medical services in Nigeria. This study was conducted to determine the age, sex distribution and the pattern of patient presentation in the Accident and Emergency Department of a Nigeria teaching hospital. A retrospective study of all cases seen at the accident and emergency department of the University College Hospital in 2003 was carried out. The information extracted from the records includes age, sex, and diagnosis, department to which the patient was referred, the month of presentation and the outcome within the first twenty four hours of presentation. A total of 4674 patients attended the casualty, with a male: female ratio of 1.2:1. The third decade was the peak age distribution. There was a predominance of surgical cases (61%). In the treatment outcome, 52.1% were referred to other departments while there were ten (0.2%) mortalities. Trauma related cases constituted 45.1%. Road traffic accidents were the commonest cause of trauma. The largest proportion of patient were in the active third decade of life. Trauma is the commonest cause of presentation in the Accident and Emergency Department. A significant proportion of patients do not require admission. The doctor in the Accident and Emergency Department must be skilled in basic trauma care.
East African Medical Journal, 2018
Alexandria Journal of Medicine
ABSTRACT Introduction: Dyspepsia is a symptom complex with varied underlying etiologies. The unde... more ABSTRACT Introduction: Dyspepsia is a symptom complex with varied underlying etiologies. The underlying etiology determines the precise treatment and prognosis though Helicobacter pylori infection plays a central role. The aim of this study was to describe the spectrum and pattern of distribution of findings in patients with dyspepsia undergoing oesophago-gastro-duodenoscopy at the University College Hospital, Ibadan. Methods: A retrospective analysis of computerized database patients with dyspepsia who underwent oesophago-gastro–duodenoscopy from 2015 to 2019. Results: A total of 1,373 procedures were done and dyspepsia was the indication in 736 (53.2%) comprising 317 (43.1%) male and 405 (55%) female (P< .001). The age ranged from 18 to 100 with a mean of 50 ± 15 years. The age group 40–59 years had the highest representation (P = .00). The esophageal mucosa was normal in 592 (80.4%) while 45 (6.1%) and 36 (4.9%) patients had esophagitis and esophageal candidiasis, respectively. In the stomach, 230 (31%) patients had normal mucosa while 433 (57.5%) and 40 (5.4%) patients had gastritis and gastric ulcers, respectively. Antrum was the most commonly involved site by the gastritis and ulcers in 236 (55.8%) and 24 (60%) patients, respectively. The mean age of those with non-ulcer dyspepsia was 49.8 ± 15 while that of those with organic dyspepsia was 55.7 ± 13.7 years (P= .01). Furthermore, there was a significant correlation between the age group and organic dyspepsia (P = .00). The first part of the duodenum was normal in 594 (80.7%) while bulbar duodenitis was seen in 106 (14.4%). Conclusion: In our practice, OGD in patients with dyspepsia is either normal or yielded few abnormalities. The most common abnormalities were gastritis, duodenitis, esophagitis and gastric ulcers. Gastritis and ulcers were antral predominant and gastric ulcers were more common than duodenal ulcers. There was a significant relationship between increasing age and organic dyspepsia.
Annals of Global Health
Background: Nigeria reports the highest age-standardized mortality rate for breast cancer (BC) am... more Background: Nigeria reports the highest age-standardized mortality rate for breast cancer (BC) among African countries and disproportionately high rates of high-grade cancer. Histological grade is a strong predictor of mortality, and evidence suggests that educational attainment influences cancer outcomes. Objective: We characterize the association between educational trends across the lifecourse and BC grade at diagnosis. Methods: Data on 224 BC patients enrolled in the Mechanisms for Established and Novel Risk Factors for Breast Cancer in Nigerian Women (MEND) study was analyzed. Participant and parental (mother and father) education was categorized as low (primary school or less) or high (secondary school or greater). Accordingly, the educational trend across the life-course was determined for each participant relative to each parent: stable high, increasing, decreasing, or stable low. BC grade was classified as high (grade 3) or low (grades 1-2). Findings: About 34% of participants, 71% of fathers, and 85% of mothers had low education. Approximately one-third of participants were diagnosed with high-grade BC. Participants with low-grade BC were more likely to have highly educated fathers (p = 0.04). After adjusting for age, comorbidities, marital status and mammogram screening, participants with highly educated fathers were 60% less likely to have high-grade BC
Journal of Clinical Sciences, 2019
Background: Benzodiazepines, narcotics, and propofol in different combinations are administered t... more Background: Benzodiazepines, narcotics, and propofol in different combinations are administered to provide sedation and analgesia during colonoscopy. The study aimed to compare the efficacy and safety of midazolam-pentazocine with the propofol-fentanyl combination for sedation and analgesia during colonoscopy. Patients and Methods: This prospective randomized, double-blind study was conducted in 62 adults aged 18–82 years scheduled for colonoscopy. Patients were assigned into two groups, Group A (n = 31) received midazolam 2.5–5.0 mg with pentazocine 15–30 mg, whereas Group B (n = 31) received propofol 0.5 mg/kg with fentanyl 0.5ug/kg before the procedure. Efficacy was measured by the depth of sedation using Ramsay sedation score (RSS), pain score, and recovery from sedation, whereas safety was evaluated with heart rate, blood pressure (BP), and oxygen saturation. Results: There was no statistically significant difference between the two groups with respect to demographic and clinical data. The patients in Group B were more sedated with a mean RSS of 4.1 ± 0.79 compared with 2.07 ± 0.74 in Group A (P = 0.001). The mean pain score during the procedure was lower in Group B 3.19 ± 1.9 compared with 4.8 ± 1.9 in Group A (P = 0.001). The recovery time was faster in Group B compared with Group A, 24 versus 46 min, respectively (P = 0.001). The systolic BP at 5 and 10 min was lower in Group B (P = 0.024 and P = 0.001), respectively, as well as the diastolic BP at 5 and 10 min (P = 0.042 and P = 0.04), respectively. Hypotension was observed in six patients in Group B compared to two patients in Group A. There was no difference in the heart rates in both groups. Two patients in both groups had desaturation <90%, and oxygen was administered to maintain the oxygenation. No patient developed apnea that would have warranted endotracheal intubation. Conclusion: Propofol-fentanyl combination provided better sedation, less painful procedure, and shorter recovery time with minimal cardiorespiratory complication.
Journal of Clinical Sciences, 2018
Background: Appendicitis is one of the most common indications for nonelective abdominal surgery.... more Background: Appendicitis is one of the most common indications for nonelective abdominal surgery. This is true in both developed and developing countries. The aim of this study was to describe the pattern of presentation and outcome of management in a large hospital in the developing world. Methods: All patients of the general surgery divisions who had appendicectomy for clinical preoperative diagnosis of acute appendicitis between July 2007 and June 2016 were included in the study. Patients who had incidental appendicectomy were excluded from the study. Data were collected retrospectively using a data collection instrument designed for the study. Results: The total number of appendicectomy operations performed within the stipulated period was 1081. Male:female ratio was 1.37:1. The age range was from 12 years to 80 years. The most common symptom and sign remain the right lower quadrant pain and right iliac fossa tenderness, respectively. The duration of symptoms before presentation ranged from 10 h to 96 h. Approximately 20% or a fifth of the patients had ruptured appendix. Tumor associated appendicitis constituted 2.2%. The negative appendicectomy rate was 9.5%. About 47% of the patients were discharged <72 h after surgery. There were five mortalities in all. Conclusion: The diagnosis of acute appendicitis in the developing world may still be done with acceptable levels of accuracy based on in-depth medical history and clinical examination.
Journal of Medicine in the Tropics, 2016
Both tuberculosis (TB) and Crohn's disease can affect any part of the gastrointestinal tract,... more Both tuberculosis (TB) and Crohn's disease can affect any part of the gastrointestinal tract, but the terminal ileum and ileocecal region are mostly affected. Colonoscopic features of erythema, mucosal nodules, ulcers, strictures, and a deformed ileocecal valve occur in TB are nonspecific and can also occur in Crohn's disease. This is a case of a Nigerian with ileocecal TB, which mimicked Crohn's disease at colonoscopy. The patient is a 23-year-old man who presented to the clinic on account of recurrent abdominal pain and weight loss of 7 months duration. There was history of nonmucoid, nonbloody, and nonfoul smelling bowel motions. He had progressive weight loss was progressive with history of nausea, bloating, and anorexia but no vomiting. Colonoscopy revealed polypoid lesions in the cecum, deformed and polypoid ileocecal valve, and cobblestone appearance in the ileum. The histology of the ileal and colonic biopsies showed diffuse transmural infiltration by lymphocytic cells. Because of the extent of cecal and ileal involvement together with severe abdominal pain the patient was experiencing, he was taken for surgery where a right hemicolectomy with ileotransverse anastomosis was performed. The histology of the resected bowel then revealed features consistent with TB.
Prehospital and Disaster Medicine, 2012
A 20-year-old male was impaled through the chest, abdomen, and right upper thigh by three 1.5 cm ... more A 20-year-old male was impaled through the chest, abdomen, and right upper thigh by three 1.5 cm (0.59 in) diameter rods, each 2 m (6.56 ft) in length. The first rod entered below his right nipple, the second through the right hypochondrium, and the third through the right upper thigh. He was transported to the hospital with the rods in situ. This paper provides insight as to how these unusual injuries were managed in a limited-resource environment. Even in a developing country, the challenges posed by multiple impalement injuries can be managed successfully by rapid prehospital transfer, along with an adequate and coordinated hospital team effort.
Edorium Journal of Surgery, May 17, 2022
Methods: This was a retrospective study of adult patients undergoing emergency general surgery pr... more Methods: This was a retrospective study of adult patients undergoing emergency general surgery procedures. The main end-points were post-operative mortality and surgical site infection (SSI). The ability of the SAS to predict post-operative outcomes was determined using the receiver operating characteristics curve (ROC). Statistical significance was defined by a p value of <0.05. Results: The mean SAS was 5.6 ± 1.7 with majority of patients (61.4%, n = 70) being at medium risk (Apgar score 5-7) for post-operative complication. The most common post-operative complication was SSI (47.1%, n = 25) with a 30-day mortality of 9.6%. The ROC curve showed that the SAS is a poor predictor of post-operative complications (Area under the curve [AUC] = 0.408) and mortality (AUC = 0.394). However, there is a statistically significant association between mean SAS and occurrence of post-operative complications (p = 0.026). Conclusion: The SAS does not predict post-operative complications in adult patients undergoing emergency general surgery procedures.
This was a retrospective study of deaths in the ER of the University College Hospital Ibadan over... more This was a retrospective study of deaths in the ER of the University College Hospital Ibadan over a one year period from January to December 2005. The data extracted from the casualty records included the biodata, the vital signs at presentation, the Glasgow coma score (GCS), the diagnosis at presentation and the time interval between presentation and death. The injury severity for trauma patients at presentation was computed from the vital signs at presentation and the probability of survival was calculated. There were two hundred and five different diagnoses which were narrowed down to four major categories; trauma related, surgical, medical and obstetrics and gynecological emergencies. There were 5100(five thousand one hundred) visits to the ER in the University College Hospital Ibadan in the year under review. A total of 168 mortalities (3.3%) were recorded (97 males and 71 females) with mean ages of 49+/-37.8 years in the male and 42+/-30.7 years in the female. The distribution of the recorded cases was narrowed down to four major categories; trauma related, surgical, medical (internal medicine) and obstetrics and gynecological emergencies. (Fig 1).
Uploads
Papers by OLUDOLAPO O AFUWAPE