Obstetrics. & Gynecology
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Item An assessment of ovarian cancer histologic types across the African Diaspora(2021) George, S. H. L.; Omotoso, A.; Pinto, A.; Mustapha, A.; Sanchez-Covarrubias, A. P.; Umar, U. A.; Umar, A. B.; Oluwasola, T. A. O.; Okolo, C. A.; Anthony, U. U.; Ukekw, F. I.; Bakari, M. A.; Dahiru, A. M. C.; Abdullahi, H. I.; Abimiku, B. A.; Abdurrahman, A.; Usman, A.; Ahmed, S. A.; Usman, H. A.; Kabir, A.; Eleje, G. U.; Chiemeka, M. E.; Nzeribe, E.; Nweke, I.; Kadas, S. A.; Suleiman, D. E.; Ekanem, E.; Uche, U. M.; Paul, J.; Agwu, U. M.; Edegbe, F. O.; Anorlu, R. I.; Banjo, A.; Ajenifuja, K. O.; Fawole, A. A.; Kazeem, I. O. O.; Magaji, F.; Silas, O.; Athanasius, B. P.; Tamunomie, N. K.; Abudu, E. B. K.; Ango, I. G.; Abdullahi K.; Lawal, I.; Kabir, S. A.; Ekanem, V.; Ezeanochie, M.; Yahaya, U. R.; Castillo, M. N.; Bahall, V.; Chatrani, V.; Brambury, I.; Bowe, S.; Halliday, D.; Bruney, G.; Butler, R.; Ragin, C.; Odedina, F.; Chamala, S.; Schlumbrecht, M.; Audu, B.Objective: Ovarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. Methods: Patients diagnosed with ovarian cancer (all histologies) between June 2016- December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student’s t-test with significance set at p<0.05. Results: Nigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sexcord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7± 12.8 years) relative to USB (58.9 ± 15.0) and CBB (59.0± 13.0,p<0.001). Black women [CBB (25.2 ± 15.0), Nigerians (29.5 ± 15.1), and USB (33.9 ± 17.9)] were diagnosed with GCT younger than White women (35.4 ± 20.5, p=0.011). Black women [Nigerians (47.5 ± 15.9), USB (50.9 ± 18.3) and CBB (50.9 ± 18.3)] were also diagnosed with SCST younger than White women (55.6 ± 16.5, p<0.01). Conclusion: There is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation.Item Mutation analysis of p53 gene in cervical cancer and useful polymorphic variants in exons 3 and 4(2021) Gbadegesin, M. A.; Omotosho, O. E.; Oluwasola, T. A. O.; Okolo, C. A.; Oluwasola, A. O.; Soremekun, O.; Ogun, G. O.; Abideen O. O.; Oyeronke A. O.Background: Factors contributing to the pathogenesis and progression of cervical cancer include poor attitude to screening and health intervention, late presentation, among others. Mutations in p53 gene have been attributed to several cancer cases. The present study was designed to find relationships between the mutation patterns in p53 gene and cervical carcinoma staging. Such knowledge could contribute to early diagnosis of cervical cancer. Results: From the sequence analysis of p53 gene fragment isolated by polymerase chain reactions (PCR), nineteen (19) polymorphic variants were identified. Missense mutations occurred in 47% of the samples, 32% were silent mutations, 16% were frameshift mutations and 5% nonsense mutations. Socio-biological characteristics of the study participants revealed that 60% have husbands with multiple sexual partners and that only 23.3% of the participants have ever had the Papanicolaou (Pap) smear test prior to diagnosis, whilst 20% were unaware of the screening test. Conclusions: Increased severity of cervical carcinoma staging as revealed from the histopathological analysis was found to be associated with accumulation of higher levels of mutations in the p53 gene. Molecular analysis of p53 gene mutations may prove useful as a screening biomarker for cervical cancer.Item Bilateral ovarian serous cystadenocarcinoma in a teenager: a case report.(2017) Oluwasola, T. A. O.; Abdusalam, R. A.; Okolo, C. A.; Odukogbe, A. A.Background: Genital Chlamydial trachomatis infection, though often asymptomatic, is an established indirect causative agent of female infertility via its activities on the tubal physiology. Many risk factors are postulated for its acquisition and the main thrust of this study was to establish the organisms’ correlates among infertile women attending gynaecologic clinic in Ibadan. Methods: A systematic sampling technique was used on each selected day to recruit women who met the inclusion criteria into the study using a sampling frame of 2. Interviewer-administered questionnaires were used to obtain attributes considered as risk factors for acquiring genital Chlamydia trachomatis infection from 150 consenting infertile women between January and November 2015. These attributes included sexual history, social status, alcohol intake and past history of sexually transmitted infections (STIs). Blood samples and endocervical swabs were subsequently taken for detection of C. trachomatis infection using polymerase chain reaction (PCR). Data analysis was done using SPSS version 20.0. Results: The mean age of the respondents was 34.1±5.6 years and 7.30% were positive for C. trachomatis. Chlamydia trachomatis infection was significantly associated with past history of gonorrhoea, history of multiple sexual partners, husband that has other sexual partners and lifetime sexual partners greater than one. Conclusions: The prevalence of asymptomatic C. trachomatis among infertile women indicated the pathogen as a potential aetiologic agent of female infertility and supported the asymptomatic nature of the infection. The risk factors found to be associated with the organisms’ infection lend out further support to the sexual transmissibility of C. trachomatis.Item An overview of the genetics of cervical cancer.(2018) Gbadegesin, M. A.; Soremekun, O.; Oluwasola, T. A. O.; Okolo, C. A.; Oluwasola, A. O.Cervical cancer is the fourth most common cancer in women, and the seventh of all human cancers. It is the most rampant cancer of the female genital tract in the developing world and manifests in two common histological subtypes: squamous cell carcinoma which is derived from squamous cells of the cervix and cervical adenocarcinoma which arose from the glandular cells. Most cases of deaths from cervical cancer occur in the less developed countries of the world where there are ineffective screening systems. Factors that increase the risk for developing cervical cancer include infection by Human Papilloma Virus (HPV) as the main direct factor and other indirect factors such as smoking, dietary habits, age, race, socioeconomic status, sexual history, use of oral contraceptives, high parity and the human immunodeficiency virus infection. Identifying the genetic alterations that predispose to or associate with cervical cancer will help in the screening of patients at risk of the cancer thereby allowing early diagnosis and prompt management with better outcomes. In this review we describe the role of HPV DNA integration into the host cellular genome, the effects of viral E6 and E7 proteins, and the loss of heterozygosity as genetic factors in cervical cancer.Item Primary Ovarian Pregnancy Mimicking Abdominal Pregnancy(Wolters Kluwer Medknow Publications, 2015) Ogunbode, O. O.; Aremu, O. O.; Okolo, C. A.The objectives of this study were to emphasise that ectopic pregnancy (EP) can occasionally occur in rare sites such as the ovary, and to show that it may be difficult making the diagnosis clinically and radiologically. It also highlighted the benefit of early surgical intervention in reducing mortality and morbidity from this condition. The case was a 31‑year‑old nulliparous woman who presented with amenorrhoea of 20 weeks and a 2‑month history of lower abdominal pain. Radiological studies suggested abdominal pregnancy coexisting with uterine fibroids for which she had an exploratory laparotomy, which revealed a primary right ovarian pregnancy necessitating the performance of right ovariectomy. Locating the sites of EP may still pose a diagnostic challenge. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be confirmed at surgery.Item Knowledge of the human papilloma virus vaccines, and opinions of gynaecologists on its implementation in Nigeria(2013-06) Morhason-Bello, I. O.; Adesina, O. A.; Adedokun, B. O.; Awolude, O.; Okolo, C. A.; Aimakhu, C. O.; Akinwunmi, B. O.; Oladokun, A.; Adewole, I. F.The objective of this study was to determine the knowledge and perception of Nigerian Obstetricians and Gynaecologists towards human papilloma virus vaccine use in Nigeria. A cross sectional study was conducted amongst participants that attended the 42nd Society of Gynaecology and Obstetrics of Nigeria. The findings revealed that 44.5% knew the correct HPV vaccine schedule. Regarding implementation in Nigeria, 87.4% suggested its incorporation into the national immunization program and about a third agreed that it should be a precondition for school enrolment. Regression analysis showed that senior residents were more likely to have adequate knowledge of the vaccine compared to junior residents (AOR 7.181 95% CI OR=1.792 – 28.782). We conclude that the knowledge of eligibility and schedule is poor. It is recommended that adequate information should be provided to this group of health workers because of their strategic position in its implementation in NigeriaItem A review of vulvar and vaginal cancers in Ibadan, Nigeria(2013) Okolo, C. A.; Odubanjo, M. O.; Awolude, O. A.; Akang, E. E. U.The objectives of this study are to give an update on the previous studies on vulvar and vaginal cancers from the University College Hospital (UCH), Ibadan, Nigeria, to elucidate any changes in pattern, and to enumerate some of the factors affecting the management of these cancers at the UCH today. All the cases of cancer of the vulva and vagina seen at the UCH between January 1981 and December 2008 were reviewed and re-classified according to the World Health Organization (WHO) histological classification of 2004. The results are as follows: Vaginal and vulvar cancers were the 4th (1.4%) and 5th (1.2%) most common of the 5913 gynecological cancers seen. The mean age was 49.7 years. Squamous cell carcinoma (SCC) was the most common histological type. Notably, vulvar cancer is more common than vaginal cancer in the US and the UK and this opposes our findings. We studied time periods before and after the year 2000, and found vaginal cancer to be more common before and vulvar cancer after the year 2000. We suggest that this may be related to the introduction of the FIGO guidelines in 2000. We conclude that it is important to strictly adhere to the FIGO guidelines in determining the primary site of origin of these cancers in patients with advanced local disease as this distinction has implications for clinical management. The objectives of this study are to give an update on the previous studies on vulvar and vaginal cancers from the University College Hospital (UCH), Ibadan, Nigeria, to elucidate any changes in pattern, and to enumerate some of the factors affecting the management of these cancers at the UCH today. All the cases of cancer of the vulva and vagina seen at the UCH between January 1981 and December 2008 were reviewed and re-classified according to the World Health Organization (WHO) histological classification of 2004. The results are as follows: Vaginal and vulvar cancers were the 4th (1.4%) and 5th (1.2%) most common of the 5913 gynecological cancers seen. The mean age was 49.7 years. Squamous cell carcinoma (SCC) was the most common histological type. Notably, vulvar cancer is more common than vaginal cancer in the US and the UK and this opposes our findings. We studied time periods before and after the year 2000, and found vaginal cancer to be more common before and vulvar cancer after the year 2000. We suggest that this may be related to the introduction of the FIGO guidelines in 2000. We conclude that it is important to strictly adhere to the FIGO guidelines in determining the primary site of origin of these cancers in patients with advanced local disease as this distinction has implications for clinical management.Item Knowledge of the human papilloma virus vaccines, and opinions of gynaecologists on its implementation in Nigeria(Women’s Health and Action Research Centre, 2013) Morhason-Bello, I. O.; Adesina, O. A.; Adedokun, B. O.; Awolude, O.; Okolo, C. A.; Aimakhu, C. O.; Akinwunmi, B. O.; Oladokun, A.; Adewole, I. F.The objective of this study was to determine the knowledge and perception of Nigerian Obstetricians and Gynaecologists towards human papilloma virus vaccine use in Nigeria. A cross sectional study was conducted amongst participants that attended the 42nd Society of Gynaecology and Obstetrics of Nigeria. The findings revealed that 44.5% knew the correct HPV vaccine schedule. Regarding implementation in Nigeria, 87.4% suggested its incorporation into the national immunization program and about a third agreed that it should be a precondition for school enrollment. Regression analysis showed that senior residents were more likely to have adequate knowledge of the vaccine compared to junior residents (AOR 7.181 95% CI OR=1.792 – 28.782). We conclude that the knowledge of eligibility and schedule is poor. It is recommended that adequate information should be provided to this group of health workers because of their strategic position in its implementation in Nigeria.Item Correlation of cervical cytology and visual inspection with acetic HIV-positive women(Informa Healthcare USA, Inc, 2008) Akinwuntan, A. I.; Adesina, O. A.; Okolo, C. A.; Oluwasola, O. A.; Oludokun, A.,; Ifemeje, A. A.; Adewole, I. F.The prevalence of squamous intraepithelial lesion is higher among human immunodeficiency virus (HIV)-positive women. These lesions when they occur in these patients are also more difficult to treat. A total of 205 consenting HIV-seropositive women were recruited. A cervical cytology (Pap smear) was taken, followed by visual inspection with freshly prepared 5% acetic acid and cervical biopsy taken from the squamocolumnar junction as the reference for diagnosis to avoid verification bias. The sensitivity of VIA was 76.0% (95% CI 52.0-91.0); specificity 83.0% (95% CI 77.0-88.0); positive predictive value 34.0% (95% CI 21.0-49.0). The sensitivity of cervical cytology (Pap smear) was 57.0% (95% CI 34.0-77.0), specificity of 95.0% (95% CI 90.0-97.0), and positive predictive value of 55.0% (95% CI 33.0-75.0). In HIV-seropositive women, the sensitivity of VIA is 76.0%, making it a useful screening test for preinvasive lesion of the cervix in low resource settings.