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Item Relationship between Thyroid autoantibodies, imbalance of some essential Trace elements in the pathology of simple nontoxic Goitre(IISTE, 2016) Mbachu, N. A.; Afolabi, A. O.; Anetor, J. I.Autoimmunity and certain micronutrients have been implicated in the pathogenesis of thyroid disorders such as simple nontoxic goitre (SNTG). Alterations in certain trace elements and autoimmune parameters may arise from an indeterminate autoimmune mechanism. We sought to evaluate the association and interactions between trace elements and autoantibodies in simple nontoxic goitre. All consenting participants based on clinical and thyroid function tests were recruited for this case-control study. Subjects comprised of 37 patients and 44 controls, from the Surgery Outpatient and Endocrinology Clinics of the University College Hospital and the Lagos University Teaching Hospital, respectively. Anthropometric indices were measured, serum trace element were determined using atomic absorption spectrophotometer (AAS), thyroid autoantibodies and thyroid function tests were performed in serum using Enzyme linked immunosorbent assay (ELISA). Thyroperoxidase and thyroglobulin antibodies were significantly elevated in SNTG compared with controls, suggesting immune alteration. The free triiodothyronine (FT3) and free thyroxine (FT4) were significantly increased in SNTG (3.72±0.02 and 14.9±0.21 pmol/L) compared with controls (3.63±0.12. pmol/L and 13.12±0.12 pmol/L). The level of TSH was significantly increased in SNTG compared with controls. Antithyroglobulin level was positive in 14.0% (130.93±35.02 kiu/L) SNTG. Significantly reduced levels of Cu (11.92±0.32, µmol/L), Fe (20.13±0.52µmol/L) and Se (0.53±0.01µmol/L) relative to the controls (16.12±0.22, 28.73±0.23 and 3.82±0.03µmol/l) were found in SNTG. Simple nontoxic goitre appear to be associated with imbalance in certain essential trace elements and presence of autoantibodies which probably are among the key mechanisms involved in the pathology of thyroid disorders. Early detection of these abnormalities may be useful in the better understanding and improved management of thyroid disorders.Item The Thyroid and Parathyroid Glands(Dept. of Surgery, University of Ghana Medical School, 2015) Afolabi, A. O.; Ugwu, B. T.Item Penetrating abdominal injuries in children(Eleventh House Publishing Limited, 2002) Idowu, O. E.; Ogunsanya, W. F. O.; Afolabi, A. O.; Olapade-Olaopa, E. O.Traumatic injuries are leading causes of morbidity and mortality in children. The ubiquity of various types of weaponry (which is culturally and geographically dependent) has created an epidemic of violence that is spreading into all walks of life, and affecting all ages. The abdomen is the third most commonly injured region in children; 20% of the abdominal injuries are of the penetrating variety, the small intestine being the most commonly injured organ. In this article two illustrative cases of penetrating abdominal injury (PAI), causes, mechanism and pathophysiology of PAI, resuscitation and evaluation are presented. Treatment options with particular reference to the four commonly injured viscera and experience are also discussed.Item Pediatric intussusception in Ibadan, South Western Nigeria(Wolters Kluwer - Medknow, 2008) Ogundoyin, O. O.; Afolabi, A. O.; Lawal, T. A.Background: Intussusception is the most common cause of acquired intestinal obstruction in children presenting commonly as a surgical emergency between the fifth and ninth months of life. Method: A retrospective review of cases seen over eight years in our hospital was done to study the pattern of presentation and factors influencing management in our environment. Results: Thirty four patients were managed with age ranging from one week to six years. Thirty patients (88.2%) were infants. Majority were boys (58.8%) and the most common symptoms were vomiting (94.1%), passage of red currant jelly stool (91.2%), excessive crying (58.8%) and fever (52.9%). All the patients had exploratory laparotomy done with half of them undergoing simple reduction of the intussusception. There were three mortalities, two of which presented very late after two weeks of onset of illness with septicemia. There was no recurrence. Conclusion: Late presentation is a major cause of morbidity and mortality in developing countries. Early presentation, aggressive resuscitation and non- operative treatment will help in reducing the high mortality associated with late presentation.Item Pattern and outcome of childhood intestinal obstruction at a Tertiary Hospital in Nigeria(Faculty of Medicine, Makerere University, 2009) Ogundoyin, O. O.; Afolabi, A. O.; Ogunlana, D. I.; Lawal, T. A.; Yifieyeh, A. C.Background: Intestinal obstruction is a common cause of pediatric surgical emergency with a high morbidity and mortality in Africa. Methods: A retrospective review of cases managed from January 1996 to December 2005 at a teaching hospital in Southwestern, Nigeria was done to examine the pattern of causes of intestinal obstruction in children and the management outcome. Results: One hundred and thirty cases were seen over the study period with an age range of 2 hours to 14 years. Majority (61.24%) were infants, while 18.46% were neonates. Fifty-five cases (42.31%) were due to congenital causes while the rest were of acquired causes. The major causes of intestinal obstruction in the study were intussusception (29.23%), anorectal malformations (22.31%), obstructed inguinoscrotal hernia (16.92%) and Hirschsprungís disease (13.85%). Surgical site infection and sepsis were the commonest complications observed with an overall complication rate of 60.78%. The mortality rate was 3.08% and most (75%) occurred in neonates. Conclusion: While mortality as an outcome of management is low, the morbidity was very high in this study.Item Intussusception and Volvulus secondary to jejunal Adenocarcinoma in an adult Nigerian male; a case report(Wolters Kluwer - Medknow, 2010) Okolo, C. A.; Afolabi, A. O.; Sababi, S. M.A 31 year-old Nigerian man with jejuno-jejunal intussusception with the lead point being an adenocarcinoma complicated by small intestinal volvulus is presented. The subtle clinical features of an underlying small bowel malignancy were masked by the overwhelming clinical and radiological features of intussusception. This rare case is reported to remind clinicians to have an increased index of suspicion of malignancy in patients who present with the usual features of chronic anemia, weight loss and loss of appetite with an intra-abdominal mass. The presentation of acute intestinal obstruction, with mesenteric vein thrombosis probably due to intussusception or volvulus should not however lower the suspicion. Histological evaluation of surgical biopsies is of immense importance.Item Interaction of some selected Trace elements with Thyroid hormones in patients with Goiter in Ibadan, Nigeria(Sciencedomain International, 2014) Adedapo, K. S.; Sonuga, A. A.; Afolabi, A. O.; Amosu, A.Trace elements influence hormones at different levels of action, including hormone secretion, activity and binding to target tissue. Thyroid hormones also influence the metabolism of some essential trace elements. There is paucity of knowledge on the interaction of some trace elements in goiter development in the study environment. This study was carried out to determine the levels of selenium, copper, and zinc and their correlation with free triiodothyronine (fT3), free thyroxine (fT4), and Thyroid Stimulating Hormone (TSH) in patients with goiter in Ibadan. Sixty randomly selected participants who agreed to participate by signing the consent form following due explanation of the purpose of the study, were recruited. They comprised of 30 female patients (19 hyperthyroid and 11 euthyroid) attending the Nuclear Medicine and Surgery clinics of the University College Hospital, Ibadan, and 30 apparently healthy women as controls. Serum zinc, copper and selenium were determined by atomic absorption spectrophotometery and fT3, fT4 and TSH by ELISA. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) soft version 20.0 and data were expressed as mean and Standard Error of Mean (SEM). Results showed that hyperthyroid goiter patients had significantly lower levels of Selenium (0.9±0.027 vs. 4.00±0.02 µg/dl), Zinc (70.56±1.46 vs. 73.88±2.05 µg/dl) and Copper (85.23±5.09 vs. 123.11±1.80 µg/dl) compared with the controls (p<0.05). For euthyroid goiter, a significant positive correlation was found between FT3 with copper and selenium (p<0.05, r=0.46), (p<0.05, r=0.80) respectively; and positive correlation (p<0.05, r=0.46) between Zinc and TSH in the hyperthyroid group. Diets and/or supplementations rich in Selenium, Copper and Zinc may reduce the development of certain goiters.Item Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria(ecancermedicalscience, 2020) Ayandipo, O. O.; Ogun, G. O.; Adepoju, O. J.; Fatunla, E. O.; Afolabi, A. O.; Osuala, P. C.; Ogundiran, T. O.Introduction: Oncologic surgical extirpation, the mainstay of loco-regional disease control in breast cancer, is aimed at achieving negative margins and lymph node clearance. Even though axillary lymph nodal metastasis is a critical index of prognostication, establishing the impact of lymph node ratio (LNR) and adequate surgical margins on disease specific survivorship would be key to achieving longer survival. This study examines the prognostic role of pN (lymph nodes positive for malignancy), LNR and resection margin on breast cancer survival in a tertiary hospital in Ibadan, Nigeria. Methods: We conducted a longitudinal cohort study of 225 patients with breast carcinoma, documented clinico-pathologic parameters and 5-year follow up outcomes – distant metastasis and survival. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with patients’ survival. The receiver operating characteristic curve was plotted to deter mine the proportion of metastatic lymph nodes which predicted survival. The survival analysis was done using Kaplan–Meier method. Results: Sixty (26.7%) patients of the patients had positive resection margins, with the most common immuno-histochemical type being Lumina A. 110 (49%) patients had more than 10 axillary lymph nodes harvested. The mean age was 48.6 + 11.8 years. Tumour size (p = 0.018), histological type (p = 0.015), grade (p = 0.006), resection margin (p = 0.023), number of harvested nodes (p < 0.01), number of metastatic nodes (p < 0.001) and loco-regional recurrence (p < 0.01) are associated with survival. The overall 5-year survival was 65.3%. Conclusion: Unfavourable survival outcomes following breast cancer treatment is multifactorial, including the challenges faced in the multimodal treatment protocol received by our patients.Item Tranexamic acid for acute gastrointestinal bleeding (the HALT-IT trial): statistical analysis plan for an international, randomised, double-blind, placebo-controlled trial(Springer Nature, 2019) Brenner, A.; Afolabi, A.; Ahmad, S. M.; Arribas, M.; Chaudhri, R.; Coats, T.; Cuzick, J.; Gilmore, I.; Hawkey, C.; Jairath, V.; Javaid, K.; Kayani, A.; Mutti, M.; Nadeem, M. A.; Shakur-Still, H.; Stanworth, S.; Veitch, A.; Roberts, I.Background: Acute gastrointestinal (GI) bleeding is an important cause of mortality worldwide. Bleeding can occur from the upper or lower GI tract, with upper GI bleeding accounting for most cases. The main causes include peptic ulcer/erosive mucosal disease, oesophageal varices and malignancy. The case fatality rate is around 10% for upper GI bleeding and 3% for lower GI bleeding. Rebleeding affects 5–40% of patients and is associated with a four-fold increased risk of death. Tranexamic acid (TXA) decreases bleeding and the need for blood transfusion in surgery and reduces death due to bleeding in patients with trauma and postpartum haemorrhage. It reduces bleeding by inhibiting the breakdown of fibrin clots by plasmin. Due to the methodological weaknesses and small size of the existing trials, the effectiveness and safety of TXA in GI bleeding is uncertain. The Haemorrhage ALleviation with Tranexamic acid – Intestinal system (HALT-IT) trial aims to provide reliable evidence about the effects of TXA in acute upper and lower GI bleeding. Methods: The HALT-IT trial is an international, randomised, double-blind, placebo-controlled trial of tranexamic acid in 12,000 adults (increased from 8000) with acute upper or lower GI bleeding. Eligible patients are randomly allocated to receive TXA (1-g loading dose followed by 3-g maintenance dose over 24 h) or matching placebo. The main analysis will compare those randomised to TXA with those randomised to placebo on an intention-to-treat basis, presenting the results as effect estimates (relative risks) and confidence intervals. The primary outcome is death due to bleeding within 5 days of randomisation and secondary outcomes are: rebleeding; all-cause and cause-specific mortality; thromboembolic events; complications; endoscopic, radiological and surgical interventions; blood transfusion requirements; disability (defined by a measure of patient’s self-care capacity); and number of days spent in intensive care or high-dependency units. Subgroup analyses for the primary outcome will consider time to treatment, location of bleeding, cause of bleed and clinical Rockall score. Discussion: We present the statistical analysis of the HALT-IT trial. This plan was published before the treatment allocation was unblinded.Item Experience with managing retrosternal goitres in ibadan, Nigeria(Wolters Kluwer - Medknow, 2016) Ayandipo, O. O.; Afolabi, A. O.; Afuwape, O. O.; Bolaji, B. E.; Salami, M. A.Background: There is no general consensus on the definition of retrosternal goitre however thyroidectomy remains the gold standard of treatment with or without a sternotomy Aim: To review the outcome of surgical management of retrosternal goitres. Methodology: Retrospective review of records of patients who had thyroidectomy for retrosternal goitre over a 15-year period. Results: Out of a total of 45 patients, 34(76%) were females and 11(24%) were males with a male/female ratio of 3:1; while their age ranged between 28 and 72years with a mean of 57+15SD. All the patients were euthyroid and a quarter did not have symptoms apart from a neck mass. In all, 15% of the patients had recurrent goitre. CT scan of neck and chest was done in 31 (72%) patients; while 44 (98%) patients had cervical retrosternal goitres, 1(2%) patient had ectopic retrosternal goitre. A cervical incision was sufficient in 28 (62%) patients while 17 (38%) patients required additional sternotomy. Total thyroidectomy was done in all the patients. There were post-operative complications in 19 (42%) patients. Histopathology showed that 3(6.6%) patients had papillary thyroid carcinoma while 42(93.4%) had benign pathology findings. Conclusion: Surgical removal is the treatment of choice. Most retrosternal goitres can be resected through a collar stud incision; however the possibility of a need for a sternotomy should always be planned. The simultaneous occurrence of cervical and ectopic retrosternal goitre should always be ruled out with a CT scan.