Papers by Emmanuel Ezeome
Developing World Bioethics, Apr 1, 2010
The ethics of conducting research in epidemic situations have yet to account fully for difference... more The ethics of conducting research in epidemic situations have yet to account fully for differences in the proportion and acuteness of epidemics, among other factors. While epidemics most often arise from infectious diseases, not all infectious diseases are of epidemic proportions, and not all epidemics occur acutely. These and other variations constrain the generalization of ethical decision-making and impose ethical demands on the individual researcher in a way not previously highlighted. This paper discusses a number of such constraints and impositions. It applies the ethical principles enunciated by Emmanuel et al. 1 to the controversial Pfizer study in Nigeria in order to highlight the particular ethical concerns of acute epidemic research, and suggest ways of meeting such challenges. The paper recommends that research during epidemics should be partly evaluated on its own merits in order to determine its ethical appropriateness to the specific situation. Snap decisions to conduct research during acute epidemics should be resisted. Community engagement, public notification and good information management are needed to promote the ethics of conducting research during acute epidemics. Individual consent is most at risk of being compromised, and every effort should be made to ensure that it is maintained and valid. Use of data safety management boards should be routine. Acute epidemics also present opportunities to enhance the social value of research and maximize its benefits to communities. Ethical research is possible in acute epidemics, if the potential challenges are thought of ahead of time and appropriate precautions taken.
Developing World Bioethics, Dec 1, 2009
Most writing on informed consent in Africa highlights different cultural and social attributes th... more Most writing on informed consent in Africa highlights different cultural and social attributes that influence informed consent practices, especially in research settings. This review presents a composite picture of informed consent in Nigeria using empirical studies and legal and regulatory prescriptions, as well as clinical experience. It shows that Nigeria, like most other nations in Africa, is a mixture of sociocultural entities, and, notwithstanding the multitude of factors affecting it, informed consent is evolving along a purely Western model. Empirical studies show that 70-95% of Nigerian patients report giving consent for their surgical treatments. Regulatory prescriptions and adjudicated cases in Nigeria follow the Western model of informed consent. However, adversarial legal proceedings, for a multiplicity of reasons, do not play significant roles in enforcing good medical practice in Nigeria. Gender prejudices are evident, but not a norm. Individual autonomy is recognized even when decisions are made within the family. Consent practices are influenced by the level of education, extended family system, urbanization, religious practices, and health care financing options available. All limitations notwithstanding, consent discussions improved with increasing level of education of the patients, suggesting that improved physician's knowledge and increasing awareness and education of patients can override other influences. Nigerian medical schools should restructure their teaching of medical ethics to improve the knowledge and practices of physicians. More research is needed on the preferences of the Nigerian people regarding informed consent so as to adequately train physicians and positively influence physicians' behaviors.
Journal of Cancer Epidemiology, 2016
Background. About 65% of cancer deaths globally occur in low to middle income countries (LMICs) w... more Background. About 65% of cancer deaths globally occur in low to middle income countries (LMICs) where prioritization and allocation of resources to cancer care are often quite poor. In the absence of governmental focus on this problem, public-private partnerships may be an avenue to provide effective cancer control. Methods.This manuscript highlights the establishment of a nongovernmental organization (NGO) to stimulate the development of partnerships between oncology professionals, private enterprise, and academic institutions, both locally and internationally. Examples of capacity building, grant support, establishment of collaborative networks, and the development of a facility to provide clinical care are highlighted. Results. Collaborations were established between oncology professionals at academic institutions in the US and Nigeria. Cancer control workshops were conducted in Nigeria with grant support from the Union for International Cancer Control (UICC). A monthly tumor board conference was established at LASUTH in Lagos, and further capacity building is underway with grant support from the United States NCI. An outpatient, privately funded oncology clinic in Lagos has been launched. Conclusion. In LMICs, effective partnership between public and private institutions can lead to tangible strides in cancer control. The use of creative healthcare financing models can also support positive change.
Cytochrome P4501A1 genetic polymorphisms and breast cancer risk in Nigerian women
Breast Cancer Research and Treatment, Oct 28, 2005
In this case-control study based on 250 women with breast cancer and 250 age-matched controls, we... more In this case-control study based on 250 women with breast cancer and 250 age-matched controls, we sought to evaluate the role of four polymorphic variants in the CYP1A1 gene in breast cancer susceptibility in Nigerian women. Heterozygosity for the CYP1A1 M1 genotype (CYP1A1 M1 [T/C]) was associated with a 21% reduced risk of breast cancer (OR = 0.79, 95% CI 0.46-1.40) while homozygosity for the genotype (CYP1A1 M1 [C/C]) conferred a non-significant 9% reduced risk of breast cancer. These risk profiles were not significantly altered in subgroup analysis by menopausal status. While heterozygosity for the CYP1A1 M3 genotype (T/C) conferred a non-significant 24% reduced risk of breast cancer (OR = 0.76, 95% CI 0.47-1.22), homozygosity for the variant was associated a non-significant 1.95-fold increased risk of breast cancer (OR = 1.95, 95% CI 0.24-6.01). Subgroup analysis showed a non-significant 11% reduced risk in premenopausal heterozygous carriers (OR = 0.89, 95% CI 0.45-1.44) and a non-significant 6% increased risk of postmenopausal breast cancer for carriers of the CYP1A1 M3 (T/C) genotype. The CYP1A1 M2 (isoleucine to valine) polymorphism in exon 7 and CYP1A1 M4 (threonine to asparagine) variant in codon 461 of the CYP1A1 gene were found to be very rare in our study subjects. This study has shown that while the CYP1A1 M1 polymorphism conferred reduced risk of breast cancer, homozygosity for the CYP1A1 M3 (C/C) was associated with increased risk of breast cancer although these risks did not attain statistical significance.
Use of methylene blue dye for lymphatic basin mapping and sentinel lymph node biopsy in breast cancer patients in Enugu, Nigeria
Nigerian Journal of Clinical Practice, 2022
Journal of Clinical Oncology, Jun 1, 2022
Background: Modern management of breast cancer requires proper subtyping of the breast tumor to g... more Background: Modern management of breast cancer requires proper subtyping of the breast tumor to guide appropriate treatment and prognostication. However, there are barriers to availability of this resource in low-and middle-income countries (LMIC) which contributes to global inequalities in breast cancer management and outcomes. The non-availability is due to high cost, and lack of personnel and infrastructure required for immunohistochemistry (IHC), the current gold standard for subtyping. IHC results are affected by pre-analytic and analytic handling and are subjective. Alternative methods that are more objective, cost less and require less infrastructure and skilled personnel will improve access and reduce disparities. Methods: In the AFBRECANE Project, we compared the results of ER and PR subtyping of 1,000 breast cancer tumors from patients recruited from 5 clinical sites in Nigeria using IHC and Cepheid GeneXpert RNA STRAT4 biomarker assay at ACCME Lab in Nigeria and University of Maryland. Results: For ER, the sensitivities, specificities, and agreement between IHC and STRAT4 ranged from 50.0%, 71.4% and 59.4% to 77.1%, 80.0% and 78.5% while for PR, they ranged from 58.1%, 66.7% and 62.5% to 84.6%, 84.2% and 84.4%. Conclusions: The wide range of sensitivities, specificities, and agreement between IHC and STRAT4 in this study confirms the challenges of molecular subtyping of breast cancer in LMICs like Nigeria. Sustainable objective methods are sorely needed to improve diagnosis, treatment and prognostication, and reduce global disparities
Carcinoma of the breast in a sickle cell disease patient: case report
PubMed, Jul 1, 1996
Current developments in nutrition, Jun 1, 2019
Changing clinicopathological profile of intussusception in Nigeria--a 20-year review
PubMed, May 3, 2000
Background/aims: Intussuception was a common cause of intestinal obstruction at the University Co... more Background/aims: Intussuception was a common cause of intestinal obstruction at the University College Hospital, Ibadan. A peculiar type characterized by being ceco-colic, and found most commonly in adults, was the commonest variety found, but over the last few years this type of intussusception appears to have reduced in incidence. The aim of the study is to define the relative incidence of intussusception and the contribution of the various types of the overall incidence as seen at the University College Hospital, Ibadan, Nigeria. Methodology: Review of case notes and the surgical pathology records of all cases of Intussusception seen at the University College Hospital, Ibadan between 1975 and 1994 was done. Results: There was a 48.1% decline in the absolute number of cases seen during the period of the study, and this decline was more among adult cases than infantile intussusception. The mean age of presentation of infantile intussusception was 8 months, while it was 42 years for adults. The classical triad of vomiting, pain and bloody stool was seen in only 15% of cases. Morbidity and mortality rates were high at 18 and 8.5% respectively and this was related to delayed presentation. Conclusions: The incidence of intussusception has fallen in the community studied and this decline has affected the adult age group and the ceco-colic type of intussusception more. Late presentation is a feature of most cases and is related to the high mortality and morbidity rates seen.
PubMed, Nov 1, 2018
Background: Cataract, glaucoma, and conjunctivitis are common causes of ocular morbidity in Niger... more Background: Cataract, glaucoma, and conjunctivitis are common causes of ocular morbidity in Nigeria. A major obstacle in reducing the burden of ocular morbidity in rural areas is access to eye care services. Up to 80% of the population in developing countries use traditional medications for their primary healthcare needs because they are accessible, available, and affordable. The aim of this study is to evaluate the content and cost of commercialized traditional medications used in the treatment of common eye conditions in Nigeria. Patients and methods: All the registered traditional healers (THs) at an International Trade Fair in Enugu who treated eye problems were identified. Data on their location and scope of their practice were collected by the researchers. Proxy patients consulted THs in the trade fair with simulated cataract, glaucoma, and bacterial conjunctivitis, and treatment was sought. Medication for the treatment of the simulated disorders was paid for and procured. The mode of administration and the cost of the drugs were recorded by proxy patients. Each medication was labeled with a code and sent to the laboratories of the National Agency for Drug Administration and Control for analysis. Data were entered into a database on Microsoft Access and transferred to STATA V12.1 (StataCorp) for analysis. Results: Cataract was treated by 87.5% of all the traditional eye healers interviewed. A total of 32 samples were collected and analyzed. These comprised mainly oral (53.1%) and topical traditional medications (43.8%). The pH of the topical samples ranged from 3.5 to 10, while the mean microbiological load per topical solution was 3.3 × 104 cfu/mL ± 0.96. The cost of treatment of cataract ranged from 4 to 70 USD. Conclusion: The content of the majority of the samples of traditional eye medications in this study had high extremes of pH and/or had a high microbial content. The practice of THs should be regulated.
PubMed, Sep 1, 2008
Objective: To compare the outcomes of modified radical mastectomy wounds managed by closed wound ... more Objective: To compare the outcomes of modified radical mastectomy wounds managed by closed wound drainage with suction and without suction. Method: A prospective randomised trial was conducted at the University College Hospital in Ibadan, and the University of Nigeria Teaching Hospital in Enugu. Fifty women who required modified radical mastectomy for breast cancer were randomised to have closed wound drainage with suction (26 patients) and closed wound drainage without suction (24 patients). Results: There was no significant difference in the intraoperative and postoperative variables. Suction drainage drained less volume of fluid and stayed for a shorter time in the wound, but the differences were not significant. There was no difference in the length of hospital stay, time to stitch removal, and number of dressing changes. More haematomas and wound infections occurred in the simple drain group while more seromas occurred in the suction drain group, but these were not significant. The suction drain was more difficult to manage and the cost was 15 times higher than the simple drainage system. Conclusion: Closed simple drains are not inferior to suction drains in mastectomy wounds and, considering the cost saving and simplicity of postoperative care, they are preferable to suction drains.
PubMed, Sep 1, 2010
Objective: To assess the delays and define the causes of delay in presentation and treatment of b... more Objective: To assess the delays and define the causes of delay in presentation and treatment of breast cancer patients in Enugu, Nigeria. Design: A cross-sectional survey of breast cancer patients using a semi structured questionnaire. Setting: Surgical Oncology unit, University of Nigeria Teaching Hospital Enugu, (UNTH-E), Nigeria. Subjects: 164 consecutively presenting breast cancer patients seen between June 1999 and May 2005. Results: Most of the patients (82.3%) reported for initial evaluation at a modern health facility while 17.5% reported first to alternative practitioners. Forty six patients (26.4%) presented within a month of noticing the symptoms while 72 (45.3%) delayed more than 3 months. In contrast, 18 (17%) were seen at the site of definitive treatment within one month of seeking help at the initial hospital while 73.4% had a delay of more than 3 months after the initial hospital contact. Institutional or physician induced delays were present in 46.2% of the cases while patient related delays were present in 79.2% of cases. Only use of alternative practitioners for initial treatment was significantly related to delays of more than three months before presentation (p = 0.017). Conclusion: For breast cancer prevention programs in Nigeria to succeed, they must in addition to breast awareness and screening programs, address the institutional bottlenecks, the dearth of knowledge among primary care physicians and improve referrals from alternative practitioners and prayer houses.
BMC Complementary and Alternative Medicine, Sep 12, 2007
Background: The use of Complementary and Alternative Medicine (CAM) by cancer patients is very co... more Background: The use of Complementary and Alternative Medicine (CAM) by cancer patients is very common and varies between populations. The referenced English literature has no local study from Africa on this subject. This study was conducted to define the prevalence, pattern of use, and factors influencing the use of CAM by cancer patients at the University of Nigeria Teaching Hospital Enugu (UNTH-E), Nigeria Method: Face-to-face interviews using semi-structured questionnaire were used to determine the use of CAM by cancer patients. All consenting cancer patients were interviewed as they presented at the core surgical units of the UNTH-E, from June 2003 to September 2005. Results: 160 patients were interviewed; 68 (42.5%) were males and 94 (57.5%) were females. Ages ranged from 13-86 years. Breast, urogenital system, gastrointestinal system, and soft tissue cancers predominated. One hundred and four patients (65.0%) have used CAM at some time during their current cancer illness; 56 (35.0%) patients have not used any form of CAM. There were more females than males among the non-CAM users. The use of CAM was not affected by age, marital status, level of education, religious affiliation, or socioeconomic status. The most frequently used CAMs were herbs (51.9%), faith/prayer healing (49.4%), aloe vera (23.1%), Forever Living Products (16.3%), medicinal tea (14.4%), and Blackstone (12.5%). Over 23% of those who used CAM were satisfied, but 68.3% were disappointed. Most users (67.3%) did not see any benefit from the CAM, but 25% could describe some specific benefits. More than 21% of users reported various unwanted effects. While 86.5% of CAM users will use orthodox medicine instead of CAM in the future, 9.6% will use the two together to help each other. Most users (79.8%) will not repeat CAM or recommend its use for cancer. The majority of patients (55.8%) did not mention their use of CAM to their doctors-mostly because the doctor did not ask. Conclusion: CAM use is common among cancer patients in Nigeria. Most users do not obtain the expected benefits, and adverse events are not uncommon. Every clinician in the field of oncology should ask his/her patients about the use of CAM; this knowledge will enable them to better counsel the patients.
PubMed, Sep 1, 2010
Mesenchymal tumours of the gastrointestinal tract (GIT) are uncommon. Recent progress in the unde... more Mesenchymal tumours of the gastrointestinal tract (GIT) are uncommon. Recent progress in the understanding of the biology and origin of these tumours has led to their reclassification. A new subclass designated Gastrointestinal Stromal Tumours (GIST) is diagnosed based on the presence of a mutational over expression of c-kit protein that is thought to be critical in the pathogenesis of these tumours. This new class oftumours may form the majority of gastrointestinal mesenchymal tumours. Even though the diagnosis of GIST is mainly based on positive staining with CD117, a minority of tumours with histological characteristics of GIST are CD117 negative and are classified as CD117 negative GIST. In this first review of mesenchymal GIT tumours from Nigeria, we present 11 cases ofmesenchymal tumours of the gastrointestinal tract seen within a six-year period at our centre. Immunohistochemistry was performed on 7 of them in which histological appearances suggested GIST. Only two cases had all the criteria defined in the consensus conference on the diagnosis of GIST. Our findings, albeit in a very small sample, contrasts with what obtains in developed countries in the proportion of GIT mesenchymal tumours that are truly GIST. This raises a question to be answered on the true nature and proportion of gastrointestinal strumal tumours among GIT tumours in Nigerian patients.
PubMed, Jun 1, 2010
Objective: To evaluate the challenges and outcome of management of large abdominal wall hernias i... more Objective: To evaluate the challenges and outcome of management of large abdominal wall hernias in a resource limited environment and highlight the options available to surgeons in similar conditions. Design: A review of prospectively collected data on large abdominal wall hernias managed between 2003 and 2009. Setting: University of Nigeria Teaching Hospital, Enugu, Nigeria and surrounding hospitals. Subjects: Patients with hernias more than 4 cm in their largest diameter, patients with closely sited multiple hernias or failed previous repairs and in whom the surgeon considers direct repair inappropriate. Outcome measures: Demographics of patients with large hernias, methods of hernia repair, recurrences, early and late complications following the repair. Results: There were 41 patients, comprising 28 females and 13 males with ages 14 - 73 years. Most (53.7%) were incisional hernias. Gynecological surgeries (66.7%) were the most common initiating surgeries. Fifteen of the patients (36.6%) have had failed previous repairs, 41.5% were obese, five patients presented with intestinal obstruction. Thirty nine of the hernias were repaired with prolene mesh, one with composite mesh and one by danning technique. Most of the patients had extra peritoneal mesh placement. Three patients needed ventilator support. After a mean follow up of 18.6 months, there was a single failed repair. Two post op deaths were related to respiratory distress. There were 12 wound infection and 8 superficial wound dehiscence, all of which except one resolved with dressing. One reoperation was done following mesh infection and extrusion. Conclusion: Large abdominal wall hernia repair in resource limited environments present several challenges with wound infection and respiratory distress being the most notable. Surgeons who embark on it in these environments must be prepared t o secure the proper tissue replacement materials and have adequate ventilation support.
Cancer Epidemiology, Aug 1, 2022
(C. Adebamowo). Declaration of Competing Interest CAA had the idea for the NIBBLE study, designed... more (C. Adebamowo). Declaration of Competing Interest CAA had the idea for the NIBBLE study, designed it, obtained funding, supervised implementation, and data management. SA contributed to the study design and data management. GB conducted all the statistical analyses, generated the first draft of the manuscript, which was revised by the co-authors, and finalized the manuscript. TY, MY, OO, OB, EE, IS, EM, IA, and BA enrolled participants, conducted biopsies, data collection, and ensured data quality. AF and BA conducted the laboratory diagnosis all authors contributed to drafting the manuscript, provided critical revisions, and approved the final draft.
Bilateral benign phyllodes tumour in a nulliparous woman: a case report and review of literature
PubMed, Mar 1, 2007
Cystosarcoma Phyllodes is an uncommon disease of the breast with variable clinical behaviour. Its... more Cystosarcoma Phyllodes is an uncommon disease of the breast with variable clinical behaviour. Its incidence is reported as 1% of all breast tumours. The occurrence of bilateral disease is very rare. In this communication, we present a case of metachronous bilateral benign cystosarcoma phyllodes presenting in a 24year old nulliparous lady. She had right breast mastectomy after two recurrences following local excision. The left breast lesion developed one year after the treatment of the right lesion, again she had to be treated with mastectomy after 2 recurrences. This case unlike most reported cases of bilateral Phyllodes tumour occurred in a nulliparous lady. The problems of diagnosis, clinical behaviour and management are discussed.
Breast Journal, Sep 1, 2006
The recent upsurge in global obesity and the recognition of the role of metabolic syndrome and ot... more The recent upsurge in global obesity and the recognition of the role of metabolic syndrome and other correlates of obesity in the etiology of breast cancer and other chronic diseases has created the impetus for renewed interest in the role of anthropometric measures in breast cancer risk. This case-control study was designed to evaluate the role of anthropometric variables in breast cancer susceptibility in an indigenous sub-Saharan African population drawn from midwestern and southeastern Nigeria, a population grossly underreported in the global epidemiologic literature. Study participants were 250 women with breast cancer who were receiving treatment in the surgical outpatient clinics and surgical wards of four university teaching hospitals located in midwestern and southeastern Nigeria, while the controls were 250 age-matched women without breast cancer or other malignant diseases being treated for other surgical diseases in the same institutions between September 2002 and April 2004. Waist:hip ratio (WHR) was associated with a significant 2.5-fold increased risk of premenopausal breast cancer (odds ratio [OR] = 2.56, 95% confidence interval [CI] 1.48-4.41] and a 2-fold increased risk of postmenopausal breast cancer (OR = 2.00, 95% CI 1.04-2.53). Increasing height conferred a modestly nonsignificant increased risk of premenopausal breast cancer (OR = 1.59, 95% CI 0.98-2.58). The study showed that WHR is a significant predictor of breast cancer risk in Nigerian women and measures to sustain increased physical activity and ensure healthy dietary practices are recommended to reduce the burden of obesity in the population.
Research Square (Research Square), Feb 2, 2022
Background: Breast cancer risk is associated with body composition indices especially waist-hip r... more Background: Breast cancer risk is associated with body composition indices especially waist-hip ratio-≥0.85 (which de nes central adiposity), body mass index ≥30Kg/m2 (which de nes obesity), percentage body fat mass-≥25Kg/m2 (which de nes general adiposity), and physical inactivity (de ned as <600(MET-min/week or ≤7999 step counts/day). Physical inactivity promotes in ammatory microenvironment, oxidative stress and diminish antioxidant (superoxide dismutase) level, similar to adiposity but unlike physical activity. Therefore, a pedometer-based walking programme may improve body composition, physical activity and Superoxide dismutase levels in breast cancer survivors, thus preventing breast cancer recurrence. Methods: This study is a single-blind randomized controlled trial involving 80 participants from the Oncology Clinic, who were consecutively strati ed according to their baseline physical activity level (METmin/week), and step count/day obtained using a Fitbit Charge HR pedometer. The experimental group received an intervention programme to improve physical activity level by setting weekly targets of additional 1500 steps to the baseline value, while the control group did not change their physical activity tasks for the duration of the study. Data were collected with the short form of International Physical Activity Questionnaire at baseline and the 6 th week, and weekly from the Fitbit server/data centre, which receives transmitted data from the pedometer customised to each participant. Data were analysed using simple descriptive statistics, multiple regression analysis, and independent t-test at p<0.05, one-tailed test. Results: There was a signi cant increase in step counts/day (p=0.0002), physical activity level(METmin/week) (p=0.006), and Superoxide dismutase level(p=<.0001), with a decrease in waist-Hip Ratio (p=0.002), and percentage body fat mass (p=0.01), unlike the body mass index (p=0.09) in the intervention group compared to control. Conclusion: Physical activity, Superoxide dismutase level and body composition may be improved through a pedometer-based walking programme and possibly the prognosis of breast cancer recurrence. Trials Registration number: PACTR202001542824141. Recent Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN) estimate indicates that there were 115 950 new cases of cancer in 2018 out of which 26 310 (22.7%) were breast cancer cases with cancerrelated deaths reported at 70 327 [22]. A signi cant proportion of the increase in the incidence of breast cancer in Nigeria is due to increasing life expectancy, reduced risk of death from infectious diseases, increasing prevalence of smoking, obesity as well as changing dietary and lifestyle patterns, especially physical inactivity [20, 21]. Regular physical activity is directly related to physiological and psychological health bene ts [23, 24]. However, most breast cancer survivors experience cancer related fatigue [25] and are unlikely to achieve the minimum requirements of at least 150 minutes a week of moderate-intensity physical activity for health [26]. Thus, a high proportion of breast cancer survivors are sedentary/irregularly active [27, 28]. A sedentary lifestyle has been linked to weight gain [29, 30]. However, weight gain of up to 2-6 kg which is likely to alter body composition [31-33], is also a common problem among individuals receiving adjuvant chemotherapy (cyclophosphamide, methotrexate, and uorouracil) for breast cancer [34]. The consequent weight gain/obesity may affect upper and lower extremity muscle
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Papers by Emmanuel Ezeome