Yahaya Ukwenya

The mobile phone as a tool in improving cancer care in Nigeria.

Objective: The use of mobile phone as a tool for improving cancer care in a low resource setting.

Spontaneous rupture of umbilical hernia in pregnancy: a case report.

A 28 year old woman presented with a spontaneous rupture of an umbilical hernia in her seventh month of pregnancy. She had four previous unsupervised normal deliveries. There was no history of trauma or application of herbal medicine on the hernia. The hernia sac ruptured at the inferior surface where it was attached to the ulcerated and damaged overlying skin. There was a gangrenous eviscerated small bowel. The patient was resuscitated and the gangrenous small bowel was resected and end to end anastomosis done. The hernia sac was excised and the 12 cm defect repaired. Six weeks later, she had spontaneous vaginal delivery of a live baby. We advocate that large umbilical hernias should be routinely repaired when seen in women of child bearing age.

Management and Outcomes of Male Breast Cancer in Zaria, Nigeria

Male breast cancer is an uncommon disease accounting for only 1% of all breast cancers. We present the evaluation, treatment and outcome of male patients seen with breast cancer in our institution. Male patients that had histological diagnosis of breast cancer from 2001 to 2010 were retrospectively evaluated. After evaluation patients were treated with modified radical mastectomy. Combination chemotherapy was given to patients with positive axillary lymph nodes. Radiotherapy and hormonal therapy were also employed. There were 57 male patients with breast cancer which accounted for 9% of all breast cancers seen during the study period. Their mean age was 59 ± 2.3 years. The mean tumor diameter was 13 ± 2.5 cm. Fifty three (93%) patients presented with advanced disease including 15 with distant metastasis. Four patients with stage II disease were treated with modified radical mastectomy, chemotherapy and tamoxifen. Of the 30 patients with sage III disease that had modified radical mastectomy, complete axillary clearance and tumor free margins were achieved in 25. Overall 21 (36.8%) patients were tumor free at one year. Overall 5-year survival was 22.8%. In conclusion, male patients with breast cancer present with advanced disease which is associated with poor outcome of treatment.

Adverse events and patient safety from the surgical perspective

Background: Surgeons practicing in emerging nations like Nigeria which are still struggling to cope with institutionalized approach to patient safety and quality health care have a critical role in ensuring the safety of their patients. This article aims to provide an overview of the surgeon′s role in the causation and prevention of surgical adverse events. Patients and Methods: The literature is reviewed using key terms: Surgical adverse events, postoperative morbidity and mortality, surgical safety and error management from Pubmed, Ajol, Google scholar, and Embase data bases. Results: An estimated 3-22% of surgical patients suffer adverse events, half of which may be preventable. Over three-quarters of adverse events are traceable to the operating theater from failures of surgical technique during routine operations. Preventable adverse events are symptomatic of both the surgeon and the health care system fallibility. Conclusion: Minimizing surgical adverse events require integrating safety into all the stages and the processes of surgical care. The surgeon′s antidote to adverse events is to deliver quality service and leadership throughout the period of patient care.

An analysis of dietary fiber and fecal fiber components including pH in rural Africans with colorectal cancer

Background/Aims Colorectal cancer (CRC) is now a major public health problem with heavy morbidity and mortality in rural Africans despite the lingering dietary fiber-rich foodstuffs consumption. Studies have shown that increased intake of dietary fiber which contribute to low fecal pH and also influences the activity of intestinal microbiota, is associated with a lowered risk for CRC. However, whether or not the apparent high dietary fiber consumption by Africans do not longer protects against CRC risk is unknown. This study evaluated dietary fiber intake, fecal fiber components and pH levels in CRC patients. Methods Thirty-five subjects (CRC=21, control=14), mean age 45 years were recruited for the study. A truncated food frequency questionnaire and modified Goering and Van Soest procedures were used. Results We found that all subjects consumed variety of dietary fiber-rich foodstuffs. There is slight preponderance in consumption of dietary fiber by the control group than the CRC patients. We also found a significant difference in the mean fecal neutral detergent fiber, acid detergent fiber, hemicellulose, cellulose and lignin contents from the CRC patients compared to the controls (P<0.05). The CRC patients had significantly more fecal pH level than the matched apparently healthy controls (P=0.017). Conclusions The identified differences in the fecal fiber components and stool pH levels between the 2 groups may relate to CRC incidence and mortality in rural Africans. There is crucial need for more hypothesis-driven research with adequate funding on the cumulative preventive role of dietary fiber-rich foodstuffs against colorectal cancer in rural Africans “today.”

Abstract B27: Assessment of chemotherapeutic responses to neoadjuvant FOLFOX and Aspirin on BIRC7 in colorectal adenocarcinoma cells induced in Albino rats

Chemotherapeutic resistance is a problem in the management of malignant tumors especially colorectal adenocarcinoma. Overexpression of Baculoviral IAP repeat-containing protein-7 (BIRC7) was previously reported by this study group to limit the cytotoxic efficacy of neoadjuvant folinic acid, 5-fluorouracil and oxaliplatin (FOLFOX) chemotherapy regimen on human colorectal cancer cells in-vivo. And a significant inhibitory effect of Aspirin on the BIRC7 protein in p53 mutant SW480 colon cancer cells in-vitro was also found. Our aim now is to access the efficacy of the addition of Aspirin to neoadjuvant FOLFOX-chemotherapy on colorectal cancer cells in-vivo using the N-methyl-N-nitrosourea (NMU) carcinogen-induced model on albino rats per rectum. A total of 180 male Albino rats whose weight falls between 110-150g will be used. They will be grouped into 18 sets of 10 rats each and a three staged study will be performed. Namely, assessment of health parameters before the cancer induction, assessments on confirmation of cancer induction and assessments after chemotherapeutic intervention. The chemotherapeutic intervention will be further subdivided into mono, bi or tri therapy in various combinations with and without the addition of the Aspirin. The addition of Aspirin to the chemotherapy regimen will be further divided into concurrent and sequential addition. NMU will be administered at a dose of 2 mg/kg intra rectally every other day until the development of colorectal cancer which, will be confirmed by barium enema and histological analysis. Aspirin will be administered at a dose of 25 mg/kg or 12.5 mg/kg. Folinic acid will be administered at a dose of 7 mg/kg or 3.5 mg/kg intraperitoneally (i.p). Oxaliplatin will be dministered at a dose of 3 mg/kg or 1.5 mg/kg i.p. And 5-FU will be administered at a dose of 50 mg/kg or 25 mg/kg i.p. The animals9 hemogram and other pertinent investigations will be done ultimately including culling for histological assessment of tumors. The tumors will be processed for HE May 16-19, 2016; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(1_Suppl):Abstract nr B27.

Abstract 4918: Is Livin a protagonist of mucinous adenocarcinoma histology in colorectal cancer

The mechanism of cancer resistance to chemotherapy regimen remains uncertain. Colorectal mucinous adenocarcinoma is one of the distinct histological subtypes of the disease implicated in chemotherapeutic resistance associated with nodal and peritoneal metastases and worse disease-free survival as an index of poor prognosis. One of the important acquired capabilities used by the cancer cells to resist anticancer therapies is evasion of apoptosis possibly via inhibitor of apoptosis proteins for which Livin is one. This protein contains baculoviral IAP repeat domains in addition to a RING finger, a protein-protein motif important for binding and inhibition of active caspases that interfere with intrinsic and/or extrinsic pathway and the ensuing blockade of apoptosis. Thus, understanding the molecular events on how cancer cells of mucinous histology evade apoptotic death may provide a novel paradigm for a molecular targeted therapy in the management of colorectal mucinous adenocarcinoma. In this study, the expression pattern and prognostic value of IAP family protein, Livin, in colorectal cancer patients with mucinous histology pre and post-chemotherapy regimen was investigated. Tissue sections from advanced stage colorectal cancer patients who were treated or untreated with neo-adjuvant FOLFOX chemotherapy before curative resection were included in this study. The tissue sections were grouped according to colorectal adenocarcinomas showing mucinous histology and non-mucinous component. Histological study including Haematoxylin and Eosin, and immunohistochemistry for Anti-Livin and DNA mismatched repair proteins were carried out. Immunofluorescence study was performed to clarify the expression pattern of the protein using Anti-Livin antibody. Protein expression quantification study was also used. Results show significant cytoplasmic localisation and expression of Livin protein in the colorectal cancer cells. The Livin protein expression was found to be increased by more than a one-fold post-chemotherapy treatment when compared with pre-chemotherapy treated patients with mucinous histology of colorectal cancer. Younger patients were found to have a greater probability of colorectal mucinous adenocarcinoma diagnosis and worse prognosis. Our findings show that Livin-induced inhibition of apoptosis activity can be a target for novel approaches to treatment and prevention of chemotherapy associated drug resistance in mucinous histology colorectal cancer since Livin overexpression has been associated with metastases and worse disease-free survival. More study is needed Citation Format: Mohammed Faruk, Abdulmumini Hassan Rafindadi, Sani Ibrahim, Surajo Mohammed Aminu, Surajo Mohammed Aminu, Ahmed Adamu, Ahmed Adamu, Yawale Iliyasu, Adamu Abdullahi, Mohammed Sani Shehu, Abdullahi Mohammed, John Idoko, Abdullahi Jibril Randawa, Abdullahi Jibril Randawa, Atara Ntekim, Saad Aliyu Ahmed, Aishatu Suleiman Maude, Almustapha Aliyu Liman, Abubakar Sani, Khalid Zahir Shah, Yahaya Ukwenya, Yahaya Ukwenya, Cheh Augustine Awasum, Kasimu Umar Adoke, James Olowu Enemari, James Olowu Enemari, James Olowu Enemari, Andrew Jonathan Nok. Is Livin a protagonist of mucinous adenocarcinoma histology in colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4918. doi:10.1158/1538-7445.AM2017-4918

Abstract A19: Dietary-fiber and fecal fiber contents including pH in rural Africans with colorectal cancer

Studies have shown improved/increased intake of dietary fiber and low fecal pH are associated with a lowered risk for colorectal cancer. This study aimed to compare dietary fiber intake, fecal neutral detergent fiber (NDF) content, acid detergent fiber (ADF), cellulose, hemicellulose, lignin and fecal pH level of colorectal cancer patients and matched apparently healthy control group in rural Africans in Zaria, Nigeria. Twenty-one subjects of mean age 44.7 years who are diagnosed with colorectal cancer by histology and 14 apparently healthy matched control groups with mean age 45.2 years were recruited for this study. A predefined semi structured food frequency questionnaire (FFQ) was used to access the dietary fiber intake by the subjects. The fecal NDF content was analyzed by extracting 1 g of fecal sample with a mixture of ethanol/ether and refluxed with decalin and sodium sulphite. The extract was suctioned and washed with acetone to yield the total NDF. The NDF was refluxed with an acid detergent solution and dried overnight to yield the ADF. The differences in the NDF and ADF gave the total hemicelluloses. The differences in the weight of the ADF post-treatment with permanganate solution yielded the total lignin. The differences in weight of the permanganate residue post-treatment with 72% Sulphuric acid gave the cellulose content. A pH meter calibrated with buffers of pH 4 and 7 was used to measure the fecal pH of all the subjects. Results from the FFQ show all subjects consumed variety of dietary fiber food in significant amount. However, there was a significant difference in the fecal NDF, ADF, hemicellulose, lignin and cellulose contents from the colorectal cancer patients when compared with the control group (p Citation Format: Mohammed Faruk, Sani Ibrahim, Ahmed Adamu, Abdulmumini Hassan Rafindadi, Yahaya Ukwenya, Yawale Iliyasu, Abdullahi Adamu, Mohammed Sani Shehu, Danladi Amodu Ameh, Sirajo Mohammed Aminu, Saad Aliyu Ahmed, John Idoko, Atara Ntekim, Aishatu Maude Suleiman, Khalid Zahir Shah, Kasimu Umar Adoke. Dietary-fiber and fecal fiber contents including pH in rural Africans with colorectal cancer [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr A19.

Surgical site infection following colorectal cancer surgery: Observations from Zaria, Northern Nigeria

Background: Management of colorectal cancer (CRC) in Nigeria is associated with such challenges as operating on locally advanced tumors. We performed a prospective observational study to assess the prevalence of surgical site infection (SSI) following CRC resection in a low resource setting. Materials and Methods: Consecutive patients, who had standard oncologic resection for CRC at Ahmadu Bello University Teaching Hospital, Zaria over a 5-year period from 2008 to 2012, were enrolled into the study. From 2010, patients with locally advanced rectal cancers were given neoadjuvant chemoradiation with concurrent 45 Gy external beam radiation over 5 weeks and fortnightly FOLFOX 4 regimen to downstage tumor followed 6 weeks later by surgery. Surgical resections were performed through open laparotomy. The outcome of interest was the development of SSI within 30 days of surgery. Patient and surgical variables were evaluated for association with SSI. Results: Of 188 patients seen with CRC, 78 (41.5%) had surgical resection and 75 were analyzed for SSI. The prevalence of SSI was 13.7% following transabdominal colectomy, 50% following abdominoperineal resection and 25.3% following overall CRC resection (P Conclusion: We observed that the prevalence of SSI in our setting is high and is possibly due to the difficulties of surgical resection of tumors most of which were locally advanced at the time of surgery among other factors.

Colorectal cancer in pregnancy: a rapid progressive disease

Colorectal cancer during pregnancy is uncommon and most patients present in late pregnancy. This report describes unusual presentations of colorectal cancer in relation to pregnancy in three patients. The first patient is a 30-year-old primipara that developed lower abdominal pain and constipation two weeks after an emergency cesarean section. She had no change in bowel habit, rectal bleeding, or weight loss. Within two weeks after delivery she developed progressive massive ascitis. She was found to have a hard mass in the rectum. Colonoscopy and biopsy was diagnostic of adenocarcinoma of the rectum. Patient died three days later from respiratory difficulty. (Published: 11 January 2010) Citation: Libyan J Med 2010, 5: 4632 - DOI: 10.4176/090806