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Background / Aim: Incisional hernia is still relatively common in our practice. The aim of the studywas to identify risk factors associated with incisional hernia in our region. The setting is the ObafemiAwolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria during a period when prostheticmesh was not readily available. Patients and Methods: All the women who presented with incisionalhernia between 1996 and 2005 were prospectively studied using a standard form to obtaininformation on pre-hernia (index) operations and possible predisposing factors. They all had opensurgical repair and were followed up for 18-60 months. Results: Forty-four women were treatedduring study period. The index surgeries leading to the hernias were emergency caesarian section26/44 (59.1%), emergency exploratory laparotomy 6/44 (13.6%), and elective surgeries 12/44(27.3%). Major associated risk factors were the use of wrong suture materials for fascia repair, midlineincisions, wound sepsis, and overweight. Conclusion: For elective surgeries, reduction of weightshould be encouraged when appropriate, and transverse incisions are preferred. Absorbable sutures,especially chromic catgut, should be avoided in fascia closure. Antibiotics should be used forcomplicated obstetric cases.

The conservation of water is crucial to sustainable agricultural production during dry season when there is little or no rainfall to improve crop production. Thus, this study is aimed to evaluate the effects of different levels of water applications on the growth, yield and water use efficiency of okra under drip irrigation system during dry season. Sixteen drip irrigation plots (2 × 2 m²) were established following a 4 × 4 completely randomized block design with four replicates to determine the water consumptive use of okra. The growth, yield and water use efficiency of okra under four different irrigation management i.e. irrigation water applied at 100 FIT (full irrigation treatment), 80 FIT, 60 FIT and 40 FIT were measured. Results showed that highest growth parameters were observed under 100 FIT and the least under 40 FIT. The differences in plant height, number of leaves and leaf area in all the treatments blocks were not significant (p>0.05) for all the stages of development of okra. The yield obtained at 100 FIT, 80 FIT, 60 FIT and 40 FIT are 3.60 t ha-1, 3.54 t ha-1, 3.56 t ha-1 and 2.05 t ha-1 respectively. Using error bar there is significant effect of the treatment on the yield with 100 FIT, 80 FIT and 60 FIT having highest yields compare to 40 FIT. The irrigation water use efficiency (IWUE) ranged from 0.024-0.041 t ha-1 mm-1 while the crop water use efficiency (CWUE) ranged from 0.0088-0.0139 t ha-1 mm-1. Okra crop irrigated with drip irrigation at 60 FIT recorded the highest IWUE, CWUE and about 73% more yield than the 40 FIT, i.e. 0.041 t ha-1 mm-1, 0.0139 t ha-1 mm-1 and 3.56 t ha-1 mm-1 respectively. It can be concluded that okra crop irrigated at 60 FIT should be adopted in order to save 40% water to irrigate additional land. [ABSTRACT FROM AUTHOR]

There is a knowledge gap on the epidemiology of inflammatory bowel disease in Africa. To begin to address this issue we formed a case reporting network of practitioners with an interest in inflammatory bowel disease across sub-Saharan Africa. Here we report a series of 175 cases from 12 countries over 2 years., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation.)

Newly introduced Photovoltaic (PV) devices, featuring a built-in chip with an illuminating Light Emitting Diode (LED), have emerged in the commercial market. These devices are touted for their utility as both low- and high-side power switch drivers and for data acquisition coupling. However, comprehensive knowledge and experimentation regarding the limitations of these Photovoltaic Drivers in both switching and signal processing applications remain underexplored. This paper presents a detailed characterization of a Photovoltaic Driver, focusing on its performance under resistive and capacitive loads. Additionally, it delineates the device's constraints when employed in signal processing. Through the analysis of switching losses across various power switches (Silicon and Silicon Carbide) in both series and parallel driver configurations, this study assesses the driver's efficacy in operating Junction Field-Effect Transistors (JFETs). Findings suggest that Photovoltaic Drivers offer a low-cost, compact solution for specific applications, such as high-voltage, low-bandwidth measurements, and low-speed turn-on with fast turn-off power switching scenarios, including solid-state switches and hot-swap circuits. Moreover, they present a straightforward, cost-effective method for driving JFETs, simplifying the circuit design and eliminating the need for an additional negative power source.

Introduction: In Nigeria, mastectomy is the most common surgical treatment for breast cancer. Patients are often kept on admission for days until wound drains are removed. An early discharge programme was piloted in a Nigerian hospital in 2017 with very satisfactory outcomes. The impact of this evidence on clinical practice and surgical outcomes was evaluated over 5 years., Methods: From a prospectively maintained institutional database, the details of patients who underwent mastectomy between 2018 and 2022 were obtained. The duration of post-operative stay was obtained and analysed per year to determine the trend. Post-operative surgical complications such as seroma, haematoma, flap necrosis, and surgical site infection were analysed., Results: Overall, 147 patients (69%) had early discharge during the review period. Twenty-two patients (10.3%) were discharged within 24 h of surgery, 61 patients (28.6%) were discharged within 24-48 h, and 64 patients (30%) were discharged between 48 and 72 h. There was a steady increase in the adoption of the early discharge protocol over time with a 50% adoption rate in 2018 and 95% in 2022. The mean duration of hospital stay declined steadily from 3.9 days in 2018 to 2.2 days in 2022. Early discharge did not result in any compromise to post-operative outcomes., Conclusion: This study demonstrates the sustainability of early post-mastectomy discharge in a resource-limited setting with very satisfactory outcomes. It also provides a unique example of how locally generated evidence can guide local practice. We consider these findings generalisable in other Nigerian hospitals and low- and middle-income countries with similar contexts., Competing Interests: The authors have no conflict of interest to declare., (© 2024 S. Karger AG, Basel.)

Background: The majority of non-metastatic breast cancer patients in sub-Saharan Africa are recommended to have mastectomy. The impact of mastectomy on a predominantly young African patient population requires evaluation. The BREAST-Q is a validated patient-reported outcome measure of quality-of-life following breast surgery that has been translated into 30 languages-none in Africa. This study aimed to translate and assess the psychometric properties of the mastectomy module of the BREAST-Q for use in Nigeria., Methods: The BREAST-Q mastectomy module was translated from English to Yoruba and its psychometric properties assessed using best practice guidelines. Translation was performed in 4 steps: forward translation (x2), back translation, back translation review, and cognitive interviews with post-mastectomy patients. The translated BREAST-Q instrument was administered to post-mastectomy patients (n = 21) alongside the EORTC-QLQ BR23 to evaluate construct validity. Test-retest reliability was evaluated using intraclass correlation coefficients (ICC); surveys were re-administered 4 weeks apart., Results: The translation process identified English phrases not amenable to direct translation, including "emotionally healthy" and descriptions of pain ("nagging," "throbbing," "sharp"). Translations were amended to reflect local context and question intent. During cognitive interviews, patients provided suggestions to simplify complex phrases, e.g. "discomfort in your breast area.". Internal consistency within scales was over 0.70 for psychosocial wellbeing (α = 0.84-0.87), sexual wellbeing (α = 0.98-0.99), physical wellbeing in chest (α = 0.84-0.86), and satisfaction with care (α = 0.89-0.93). ICC for test-retest reliability was moderate (0.46-0.63)., Conclusions: The Yoruba version of the BREAST-Q mastectomy module presents a unique opportunity to adequately capture the experiences of Nigerian women post mastectomy. This instrument is being used in a pilot study of Nigerian patients to identify targets for intervention to improve the patient experience and compliance with breast cancer surgery., (© 2024. The Author(s).)

Background: Breast cancer outcomes are poor in Nigeria, partly due to late-stage diagnosis. To assess the impact of past and present interventions, a review of an institutional data base was performed to determine the trend with respect to stage at diagnosis over a decade., Methods: A retrospective analysis of an institutional data base was performed over a decade. The review period was divided into segments (2013-2015, 2016-2018 and 2019-2022). The latter period (2019-2022), corresponds to a time of more intense community interventions aimed at promoting early diagnosis and treatment around the locality of the teaching hospital. The stage at diagnosis within these periods were compared. The relationship between stage and sociodemographic variables (age, religion, marital status, menopausal status, and level of education) was assessed., Results: There were 910 patients, 144 within the first period (2013-2015), 318 in the second (2016-2018) and 454 in the third period (2019-2022). The majority presented with stage 3 disease (73.8%). There was a significant decline in the proportion of metastatic cases and a concomitant increase in early cases in the latter part of the review. The proportion of metastatic cases reduced from 23.6% (2013-2015), to 15.7% (2016-2018) and 9.3% (2019-2022) (p=0.001). Level of education was significantly associated with stage (p=0.001)., Conclusion: This study shows a trend towards downstaging of breast cancer in our locality. This trend corresponds to the period of more intense community interventions, justifying the need to further interrogate the direct impact of each of the interventions. This will provide a firm basis for sustaining or improving on current efforts to achieve more robust gains., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2023 by West African Journal of Medicine.)

The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location., Competing Interests: Declaration of interests CA holds a patent for a laparoscopic instrument with the University of Nebraska, and serves in leadership positions and committees in the Society of Surgical Oncology, American College of Surgeons, Indian Association of Surgical Oncology, The Global Forum of Cancer Surgeons, Basavatarakam Indo-American Cancer Hospital and Research Institute, National Cancer Institute, National Comprehensive Cancer Network, and Accreditation Council for Graduate Medical Education. SC's current affiliation is Janssen (Boston, MA, USA) where he began work in June, 2022. MT received grants and contracts from Chugai, Takeda, Pfizer, Taiho, Japan Breast Cancer Research Group, Kyoto Breast Cancer Research Network, Eisai, Eli Lilly and Company, Daiichi Sankyo, AstraZeneca, Astellas, Shimadzu, Yakult, Nippon Kayaku, AFI Technology, Luxonus, Shionogi, GL Sciences, and Sanwa Shurui; payments or honoraria from Chugai, Takeda, Pfizer, Kyowa–Kirin, Taiho, Eisai, Daiichi Sankyo, AstraZeneca, Eli Lilly and Company, MSD, Exact Science, Novartis, Shimadzu, Yakult, Nippon Kayaku, Devicore Medical Japan, and Sysmex; participates in the data safety monitoring board or advisory board of Daiichi Sankyo, Eli Lilly and Company, BMS, Athenex Oncology, Bertis, Terumo, and Kansai Medical Net; and serves as an Associate Editor for British Journal of Cancer, Scientific Reports, Breast Cancer Research and Treatment, Cancer Science, Frontiers in Oncology, Asian Journal of Surgery, and Asian Journal of Breast Surgery. LN received honoraria for speaking and educational events from Duke University, University of Chicago, Dana-Farber Cancer Institute, Mayo Clinic Jacksonville, BioAscend, MJH Healthcare Holdings, Society of Surgical Oncology, and American Cancer Society; serves on the Johns Hopkins Data Safety Monitoring Board for KALPAS Study and Duke University Cancer Center SPORE External Advisory Board; holds leadership roles in the Board of Directors, American Association for Cancer Research (unpaid/non-salaried), Board of Directors, SHARE Cancer Patient Support Organization (unpaid/non-salaried), and the Susan G Komen Scientific Advisory Board (unpaid/non-salaried). HM-S received payment or honoraria from Merck and Bristol Myers Squibb. AFR served as a co-lead of the implementation group of WHO's Global Breast Cancer Initiative, and has stock units as an employee of Hologic. ITR received honoraria from AstraZeneca and MSD. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This study presents a novel method to estimate the aggregate pollution index (API) within the residential communities around a limestone mining and cement producing environment. The ranges for the air quality index (AQI), pollution load index in the topsoil (PLI t ), pollution load index in the subsoil (PLI s ), heavy metal pollution index in the water (HPI), and radiological external hazard index (H ex ) were 5.99 to 57.97, 1.65E-07 to 3.6E-04, 1.7E-08 to 3.5E-04, 52.17 to 1053.13, and 0.0694 Bq.kg -1 to 0.550, respectively. The AQI, PLI t , PLI s , HPI, and H ex revealed nonuniform patterns of variations across the communities, though there was a significant correlation between the PLI t and the PLI s , and between the HPI and the H ex ; and a moderate correlation between the HPI and the AQI, between the HPI and the PLI t , and between the HPI and the PLI s . The measured quality indicators (MQI), and the calculated pollution indices (CPI) were subjected to the multivariate analysis. The principal components (PC) split the ten communities the same way in the CPI and the MQI. The API, using the PC, ranged from 3 to 9. The Afami, Balogun, and Akinbo communities had the highest API, while the Ewekoro and Itori communities had the lowest. The CPI was 41% of the MQI, with respect to the within-cluster variance, indicating that the CPI-based clustering was more reliable. Both the CPI and the MQI attributed a unique pollution signature to the Ewekoro community, while the remaining nine communities shared a common pollution status with the Ibese community., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

This study presents the assessment of the air, soil, and water quality within the residential communities around two passive limestone mining/cement factories. The associations between the pollutants were tested across the media, within each medium, between the layers, and between two groups of the communities. The mean values for the PM 1.0 , PM 2.5 , and PM 10 were 65.8 µgm -3 , 50.1, and 73.7, respectively, in the air; for the Mn, Fe, Cu, Zn, Cr, K-40, U-238, and Th-232 were 0.433 g/kg, 8.950, 0.005, 0.054, 0.104, 161.57 Bq. kg -1 , 61.10, and 15.85, respectively, in the topsoil; 0.365 g/kg, 8.259, 0.004, 0.029, 0.057, 71.84 Bq. kg -1 , 16.37, 4.66, respectively, in the subsoil; and for the Mn, Fe, and Zn were 0.190, 1.499, and 0.256 mg/l, respectively, in the water. The PM 10 , Fe, and K-40 were the most abundant pollutants. The Co and Mn, Zn and Cu, Fe and Cu, the absorbed dose rate (ADR) and K-40, and ADR and U-238 correlated significantly. Though the Ibese group was more polluted than the Ewekoro group, the generally low levels of the pollutions were confirmatory of the earlier suspicions of the mining/production activities. The 2nd lithological layer at 0.5 to 1.9 m depths or the 3rd lithological layer at 1.1 to 7.69 m depths for the Ibese group and the 1st layer at the surface or the 2nd layer at 0.5 m depth for the Ewekoro group are protective layers for the groundwater that must not be exploited, given the three classes of groundwater vulnerability indices observed in the area., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Breast cancer-related lymphedema (BCRL) is common and has significant impact on quality of life. Very little is known about BCRL in sub-Saharan Africa. Generally, BCRL has been mostly evaluated post treatment, with very limited data on the prevalence of pre-treatment BCRL at baseline. This study presents the prevalence and clinical associations of lymphedema among newly diagnosed, treatment-naive breast cancer patients in a Nigerian cohort using bioimpedance estimations., Methods: Consecutively consenting, newly diagnosed, treatment-naive breast cancer patients were assessed for upper limb lymphedema using bioimpedance measurements of the extracellular fluid and the single-frequency bioelectrical impedance analysis value at 5 kHz. Patients were classified as having lymphedema if there was >10% difference in arm measurements or if the ratios of the arm measurements were >3 SD above a normative mean generated from representative controls. Regression analysis was performed to determine clinical variables associated with lymphedema., Results: There were 154 breast cancer patients with a median age of 47 (40.0-56.8) years and a body mass index of 27 (23.5-30.9) kg/m 2 . The majority (70%) had stage III disease. All measurements were significantly higher in cases than controls. Using various definitions, the prevalence of lymphedema was between 11.7% and 14.3%. Various clinical variables relating to clinical stage were significantly associated with lymphedema., Conclusion: The predominance of locally advanced disease in the Nigerian setting is associated with high pre-treatment lymphedema rates. This may set the stage for higher rates in the post-operative setting. Management of lymphedema should be incorporated into the treatment planning., Competing Interests: The authors have no relevant financial or non-financial conflicts of interest., (© the authors; licensee ecancermedicalscience.)

There is conflicting evidence on the role of lipid biomarkers in breast cancer (BC), and no study to our knowledge has examined this association among African women. We estimated odds ratios (ORs) and 95% confidence intervals (95% CI) for the association of lipid biomarkers-total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides-with odds of BC overall and by subtype (Luminal A, Luminal B, HER2-enriched and triple-negative or TNBC) for 296 newly diagnosed BC cases and 116 healthy controls in Nigeria. Each unit standard deviation (SD) increase in triglycerides was associated with 39% increased odds of BC in fully adjusted models (aOR: 1.39; 95% CI: 1.03, 1.86). Among post-menopausal women, higher total cholesterol (aOR: 1.65; 95% CI: 1.06, 2.57), LDL cholesterol (aOR: 1.59; 95% CI: 1.04, 2.41), and triglycerides (aOR: 1.91; 95% CI: 1.21, 3.01) were associated with increased odds of BC. Additionally, each unit SD increase in LDL was associated with 64% increased odds of Luminal B BC (aOR 1.64; 95% CI: 1.06, 2.55). Clinically low HDL was associated with 2.7 times increased odds of TNBC (aOR 2.67; 95% CI: 1.10, 6.49). Among post-menopausal women, higher LDL cholesterol and triglycerides were significantly associated with increased odds of Luminal B BC and HER2 BC, respectively. In conclusion, low HDL and high LDL are associated with increased odds of TN and Luminal B BC, respectively, among African women. Future prospective studies can definitively characterize this association and inform clinical approaches targeting HDL as a BC prevention strategy., (© 2022. The Author(s).)

Background: Metabolic syndrome (MetS) is characterized by a cluster of biological irregularities. The purpose of this analysis was to examine the association of MetS with BC among Nigerian women, and for the first time evaluate this association by molecular subtype., Materials and Methods: MetS was defined as having at least 3 out of 5 of: high blood pressure (≥ 130/85 mm Hg), reduced HDL (< 50 mg/dL), elevated triglyceride (> 150 mg/dL), high waist circumference (≥ 80 cm), and prior diagnosis of diabetes or elevated fasting glucose level (≥ 100 mg/dL). Among 296 newly diagnosed BC cases and 259 healthy controls, multivariable logistic regression models were utilized to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the association between MetS and BC overall. Multinomial logistic regression models were used to evaluate each molecular subtype (Luminal A, Luminal B, HER2-enriched and triple-negative or TNBC)., Results: After adjusting for age, socio-demographic and reproductive risk factors, there was a positive association between MetS and BC (aOR: 1.84, 95% CI: 1.07, 3.16). In stratified analyses, MetS was associated with BC regardless of BMI status; however, the estimate was significant only among normal weight women (aOR: 3.85; 95% CI: 1.25, 11.90). MetS was significantly associated with TNBC subtype (aOR: 4.37, 95% CI: 1.67, 11.44); associations for other molecular subtypes were not statistically significant., Conclusion: MetS appears to be a robust risk factor for BC, particularly for TNBC. Public health and clinical interventions can provide substantial benefits in reducing the burden of MetS and preventing BC among Nigerian women., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The iBreastExam electronically palpates the breast to identify possible abnormalities. We assessed the iBreastExam performance compared with clinical breast examination for breast lesion detection in high risk and symptomatic Nigerian women., Methods: This prospective study was done at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) in Nigeria. Participants were Nigerian women aged 40 years or older who were symptomatic and presented with breast cancer symptoms or those at high risk with a first-degree relative who had a history of breast cancer. Participants underwent four breast examinations: clinical breast examination (by an experienced surgeon), the iBreastExam (performed by recent nursing school graduates, who finished nursing school within the previous year), ultrasound, and mammography. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the iBreastExam and clinical breast examination for detecting any breast lesion and suspicious breast lesions were calculated, using mammography and ultrasound as the reference standard., Findings: Between June 19 and Dec 5, 2019, 424 Nigerian women were enrolled (151 [36%] at high risk of breast cancer and 273 [64%] symptomatic women). The median age of participants was 46 years (IQR 42-52). 419 (99%) women had a breast imaging-reporting and data system (BI-RADS) assessment and were included in the analysis. For any breast finding, the iBreastExam showed significantly better sensitivity than clinical breast examination (63%, 95% CI 57-69 vs 31%, 25-37; p<0·0001), and clinical breast examination showed significantly better specificity (94%, 90-97 vs 59%, 52-66; p<0·0001). For suspicious breast findings, the iBreastExam showed similar sensitivity to clinical breast examination (86%, 95% CI 70-95 vs 83%, 67-94; p=0·65), and clinical breast examination showed significantly better specificity (50%, 45-55 vs 86%, 83-90; p<0·0001). The iBreastExam and clinical breast examination showed similar NPVs for any breast finding (56%, 49-63 vs 52%, 46-57; p=0·080) and suspicious findings (98%, 94-99 vs 98%, 96-99; p=0·42), whereas the PPV was significantly higher for clinical breast examination in any breast finding (87%, 77-93 vs 66%, 59-72; p<0·0001) and suspicious findings (37%, 26-48 vs 14%, 10-19; p=0·0020). Of 15 biopsy-confirmed cancers, clinical breast examination and the iBreastExam detected an ipsilateral breast abnormality in 13 (87%) women and missed the same two cancers (both <2 cm)., Interpretation: The iBreastExam by nurses showed a high sensitivity and NPV, but lower specificity than surgeon's clinical breast examination for identifying suspicious breast lesions. In locations with few experienced practitioners, the iBreastExam might provide a high sensitivity breast evaluation tool. Further research into improved specificity with device updates and cost feasibility in low-resource settings is warranted., Funding: Prevent Cancer Foundation Global Community Grant Award with additional support from the P30 Cancer Center Support Grant (P30 CA008748)., Competing Interests: Declaration of interests VLM reports consultant fees from Bayer Healthcare and Koios Medical, and a research grant from Pfizer, outside of the submitted work. OO and ADO report research grants from Pfizer, outside of the submitted work. All other authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The introduction of energy devices has significantly expanded the scope of surgical expedition. The LigaSure™ vessel sealing system is a bipolar electrosurgical device, recently introduced to our practice. Its impact on peri-operative outcomes in a variety of major operations was evaluated in this study., Methods: A retrospective review of operations performed following the adoption of the LigaSure™ vessel sealing device was carried out. Five categories of operations were evaluated (Thyroidectomies, Gastrectomies, Colectomies, Pancreaticoduodenectomies, and Anterior/Abdomino-perineal resection [A/APR of the rectum). Peri-operative outcomes (duration of operation, intra-operative blood loss, blood transfusion rates) were compared with a cohort of similar operations performed using conventional techniques. Data analysis and comparisons were done on a subgroup basis., Results: A total of 117 operations were performed using the LigaSure™ device with thyroidectomies being the most common (66/117-56.4%). Compared to cases done using conventional techniques of suture and knot with electrocautery (120 cases), the use of LigaSure™ was associated with a significant reduction in operation time in all categories of operations. Intraoperative blood loss was also lower in all categories of cases, but this was only statistically significant following A/APR and Thyroidectomies. Generally, there was a trend towards a reduction in blood transfusion rates., Conclusions: The use of energy devices for surgical operations is feasible in a resource-limited setting. It has the potential of improving outcomes., (© 2022. The Author(s).)

Background: The association between obesity and breast cancer (BC) has been extensively studied among US, European and Asian study populations, with often conflicting evidence. However, despite the increasing prevalence of obesity and associated conditions in Africa, the continent with the highest age-standardized BC mortality rate globally, few studies have evaluated this association, and none has examined in relation to molecular subtypes among African women. The current analysis examines the association between body composition, defined by body mass index (BMI), height, and weight, and BC by molecular subtype among African women., Methods: We estimated odds ratios (ORs) and 95% confidence intervals (95% CI) for the association between measures of body composition and BC and molecular subtypes among 419 histologically confirmed cases of BC and 286 healthy controls from the Mechanisms for Established and Novel Risk Factors for Breast Cancer in Women of Nigerian Descent (MEND) case-control study., Results: Higher BMI (aOR: 0.79; 95% CI: 0.67, 0.95) and weight (aOR: 0.83; 95% CI: 0.69, 0.98) were associated with reduced odds of BC in adjusted models, while height was associated with non-statistically significant increased odds of BC (aOR: 1.07, 95% CI: 0.90, 1.28). In pre/peri-menopausal, but not post-menopausal women, both higher BMI and weight were significantly associated with reduced odds of BC. Further, higher BMI was associated with reduced odds of Luminal A, Luminal B, and HER2-enriched BC among pre/peri-menopausal women, and reduced odds of triple-negative BC among post-menopausal women., Conclusions: Higher BMI and weight were associated with reduced odds of BC overall and by molecular subtype among West African women. Larger studies of women of African descent are needed to definitively characterize these associations and inform cancer prevention strategies., (© 2021. The Author(s).)

Cancer is now a formidable health care burden in sub-Saharan Africa (SSA) due to lifestyle westernization and longer life expectancy. The exponential increase in cancer incidence coupled with high mortality rate is not comparable with that seen in westernized countries. To address global cancer disparity, globalization of cancer clinical trials to involve sub-Saharan Africa can serve as a platform where innovative targeted therapies can be made available to patients in the environ. In the 2019 African Organization for Research and Training in Cancer (AORTIC) conference held at Maputo, Mozambique, a group of clinical trialists spanning across multiple continents highlighted the opportunities in Africa for the conduct of cancer clinical trials. The secondary purpose of the meeting was to address the belief that Africa was incapable of conducting interventional cancer trials but showed the in-continent strengths, such as available capacities, trained local clinical trialists with clinical trial experiences, clinical trial consortia, local capabilities, mapping out logistics, ethical consideration, political will, real-time benefits of clinical trials to clinical practice, and future directions for trials., Competing Interests: Colin PillaiEmployment: Roche, CP+ Associates GmbHLeadership: Clinical Research Management LTD (ACE Research), Nairobi, KenyaStock and Other Ownership Interests: Novartis, Alcon, RocheConsulting or Advisory Role: Johnson & Johnson/Janssen Ifeoma OkoyeStock and Other Ownership Interests: Safety Molecular Pathology Laboratory J. Joshua SmithConsulting or Advisory Role: Guardant Health Diane Reidy-LagunesHonoraria: NovartisConsulting or Advisory Role: Lexicon, Advanced Accelerator ApplicationsResearch Funding: Novartis, Ipsen, Merck Grace MacaulayEmployment: MedImmune, Cepheid/DanaherStock and Other Ownership Interests: MedImmuneNo other potential conflicts of interest were reported.

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 life-course 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 (aOR 0.41; 95% CI 0.20 to 0.84) compared to those with less-educated fathers. Stable high life-course education relative to father was also associated with a significantly lower likelihood of having high-grade BC (aOR 0.36; 95% CI 0.15 to 0.87) compared to stable low life-course education. No significant associations were observed for the participant's education, mother's education, or life-course education relative to mother., Conclusions: Early-life socioeconomic status (SES) may influence BC grade. This deserves further study to inform policies that may be useful in reducing high-grade BC in Nigeria., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2021 The Author(s).)

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., Competing Interests: CONFLICTS OF INTEREST The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results., (Copyright: © 2021 Gupta et al.)

High-quality data are needed to guide interventions aimed at improving breast cancer outcomes in sub-Saharan Africa. We present data from an institutional breast cancer database to create a framework for cancer policy and development in Nigeria. An institutional database was queried for consecutive patients diagnosed with breast cancer between January 2010 and December 2018. Sociodemographic, diagnostic, histopathologic, treatment and outcome variables were analyzed. Of 607 patients, there were 597 females with a mean age of 49.8 ± 12.2 years. Most patients presented with a palpable mass (97%) and advanced disease (80.2% ≥ Stage III). Immunohistochemistry was performed on 21.6% (131/607) of specimens. Forty percent were estrogen receptor positive, 32.8% were positive for HER-2 and 43.5% were triple negative. Surgery was performed on 49.9% (303/607) of patients, while 72% received chemotherapy and 7.9% had radiotherapy. At a median follow-up period of 20.5 months, the overall survival was 43.6% (95% CI -37.7 to 49.5). Among patients with resectable disease, 18.8% (57/303) experienced a recurrence. Survival was significantly better for early-stage disease (I and II) compared to late-stage disease (III or IV) (78.6% vs 33.3%, P < .001). Receipt of adjuvant radiotherapy after systemic chemotherapy was associated with improved survival in patients with locally advanced disease (68.5%, CI -46.3 to 86 vs 51%, CI 38.6 to 61.9, P < .001). This large cohort highlights the dual burden of advanced disease and inadequate access to comprehensive breast cancer care in Nigeria. There is a significant potential for improving outcomes by promoting early diagnosis and facilitating access to multimodality treatment., (© 2021 UICC.)

Introduction: There is a paucity of prospective data on the performance of the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening in sub-Saharan Africa. The aim of this exploratory analysis was to evaluate the feasibility and performance of FIT in Nigeria., Methods: This was a prospective, single-arm study. A convenience sample of asymptomatic, average-risk individuals between 40-75 years of age were enrolled at Obafemi Awolowo University Teaching Hospital. Study participants returned in 48 hours with a specimen for ova and parasite (O&P) and qualitative FIT (50ug/g) testing. Participants with a positive FIT had follow-up colonoscopy and those with intestinal parasites were provided treatment., Results: Between May-June 2019, 379 individuals enrolled with a median age of 51 years (IQR 46-58). In total, 87.6% (n = 332) returned for FIT testing. FIT positivity was 20.5% (95% CI = 16.3%-25.2%). Sixty-one (89.7%) of participants with a positive FIT had a follow-up colonoscopy (n = 61), of whom 9.8% (95%CI:3.7-20.2%) had an adenoma and 4.9% (95%CI:1.0-13.7%) had advanced adenomas. Presence of intestinal parasites was inversely related to FIT positivity (6.5% with vs. 21.1% without parasites, p = 0.05). Eighty-two percent of participants found the FIT easy to use and 100% would recommend the test to eligible family or friends if available., Conclusions: Asymptomatic, FIT-based CRC screening was feasible and well tolerated in this exploratory analysis. However, the high FIT positivity and low positive predictive value for advanced neoplasia raises concerns about its practicality and cost effectiveness in a low-resource setting such as Nigeria., Competing Interests: The authors have declared that no competing interests exist.

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.

Background: Early postmastectomy discharge with a drain in place is standard practice in most developed countries. Its feasibility has not been evaluated in low resource settings like Nigeria., Methods: Consenting patients undergoing mastectomy were discharged on the third postoperative day and assessed as outpatients for wound complications as well as their experience at home. Wound outcomes were compared with patients who had traditional long stay., Results: Forty-five of the 58 patients who had a mastectomy during the study period participated in the early discharge program (77.6%). Of these, four patients (8.9%) had drain malfunction, seroma occurred in eight patients (17.8%), eight patients (17.8%) had wound infection, and six patients (13.3%) had flap necrosis. There was no readmission. Compared with long stay patients, postoperative stay was significantly shorter (3 vs 11 days; P < 0.01) with significant cost savings, while complication rates were not statistically different. All the patients in the early discharge group were confident operating their drains and preferred early discharge. Being around relatives, reduced cost, and fear of the hospital environment were common reasons cited for their preference., Conclusion: Our results support the implementation of an early postmastectomy discharge program in a low resource setting., (© 2018 Wiley Periodicals, Inc.)

Background: The aim of this study is to describe the trends and variations in the global burden of colorectal cancer (CRC)., Methods: Data (2012-2030) relating to CRC was extracted from GLOBOCAN 2012 database and analyzed., Results: The results of our study demonstrate a rising global burden of colorectal cancer which persists until the year 2035 and likely beyond. The rise in the global burden is not uniform with significant variations influenced by geographic location, socio-economic status, age, and gender. Although the EURO region has the highest burden, Asia as a continent continues to bear the heaviest brunt of the disease. Although the burden of disease is higher in more developed regions, mortality is considerably higher in less developed regions and this gap widens over the next two decades. The disease predominantly affects the male gender across all regions of the world. Age has a complex relation with the burden of CRC and is affected by the cross-influences relating to socio-economic status., Conclusions: The results of our study demonstrate a rising global burden of CRC with some unique variations. Knowledge of this data can increase awareness and help strategic targeting of efforts and resources., (© 2017 Wiley Periodicals, Inc.)

Unlabelled: Background / Aim: Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in our region. The setting is the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria during a period when prosthetic mesh was not readily available., Patients and Methods: All the women who presented with incisional hernia between 1996 and 2005 were prospectively studied using a standard form to obtain information on pre-hernia (index) operations and possible predisposing factors. They all had open surgical repair and were followed up for 18-60 months., Results: Forty-four women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/44 (59.1%), emergency exploratory laparotomy 6/44 (13.6%), and elective surgeries 12/44 (27.3%). Major associated risk factors were the use of wrong suture materials for fascia repair, midline incisions, wound sepsis, and overweight., Conclusion: For elective surgeries, reduction of weight should be encouraged when appropriate, and transverse incisions are preferred. Absorbable sutures, especially chromic catgut, should be avoided in fascia closure. Antibiotics should be used for complicated obstetric cases.