Associated Factors of Leaked Repair Following Omentopexy for Perforated Peptic Ulcer Disease; a Cross-sectional Study.

Introduction: Previous studies have reported numerous clinico-pathologic risk factors associated with increased risk of leaked repair following omental patch for perforated peptic ulcer disease (PPUD). This study aimed to analyze the risk factors associated with leaked repair of omental patch and document the management and outcome of established cases of leaked repair in a resource-poor setting. Methods: This is a multicenter cross-sectional study of leaked repair after omental patch of PPUD between January 2016 to December 2022. Following primary repair of PPUD with omental pedicle reinforcement, associated factors of leaked repair were evaluated using univariate and multivariate analyses. Results: Overall, 360 cases were evaluated (62.8% male). Leaked repair rate was 11.7% (42 cases). Those without immunosuppression were 3 times less likely to have leaked repair (aOR= 0.34; 95% CI: 0.16 - 0.72; p = 0.003) while those with sepsis were 4 times more likely to have leaked repair (aOR=4.16; 95% CI: 1.06 - 12.36; p = 0.018). Patients with delayed presentation (>48 hours) were 2.5 times more likely to have leaked repair than those who presented in 0 - 24 hours (aOR=2.51; 95% CI: 3.62 - 10.57; p = 0.044). Those with Perforation diameter 2.1-3.0 cm were 8 times (aOR=7.98; 95% CI: 2.63-24.21; p<0.0001), and those with perforation diameter > 3.0cm were 33 times (aOR=33.04; 95% CI: 10.98-100.25; p<0.0001) more likely to have leaked repair than those with perforation diameter of 0-1.0 cm. Similarly, in those with no perioperative shock, leaked repair was 4 times less likely to develop than those with perioperative shock (aOR= 0.42; 95% CI: 0.41-0.92; p = 0.041). There was significant statistical difference in morbidity (p = 0.003) and mortality (p < 0.0001) rates for cases of leaked repairs and successful repairs. Conclusion: Leaked repair following omentopexy for peptic ulcer perforation was significantly associated with large perforation diameter, delayed presentation, sepsis, immunosuppressive therapy, and perioperative shock.

Emergency laparotomy for peritonitis in the elderly: A Multicentre observational study of outcomes in Sub-Saharan Africa.

Background: Globally, interest in surgical diseases in the elderly was rekindled recently mainly due to a surge in the aging population and their increased susceptibility to infections. In sub-Saharan Africa, infective diseases are major causes of high morbidity and mortality especially in elderly cohorts, hence this study was set to evaluate current status of this scourge in the elderly in our environment. Aim: To document the aetiologic factors and analyze the impact of selected clinical and perioperative indices on mortality and morbidity rates of peritonitis in the elderly. Methods: This was a multicenter prospective study involving elderly patients aged 65years and above managed between October 2015 and September 2021 in Southeast Nigeria. Results: Of the 236 elderly patients examined, approximately two-third (150, 63.6%) were aged 65-74years. The rest were aged ≥ 75years. There were 142(60.2%) males and 94(39.8%) females. Perforated peptic ulcer (89,37.7%) was the most common cause of peritonitis followed by ruptured appendix (59, 25.0%), then typhoid perforation (44,18.6%). However, typhoid perforation was the deadliest with a crude mortality rate of 40.9%. Overall, morbidity and mortality rates were 33.8% and 28.5% respectively. The main independent predictors of mortality were peritonitis arising from typhoid perforation (p = 0.036), late presentation (p = 0.004), district location of hospital (p = 0.011) and intestinal resection (p = 0.003). Conclusion: Generalized peritonitis is a cause of significant morbidity and mortality in the elderly patients in our environment. Perforated peptic ulcer was the most common cause, but typhoid perforation remains the deadliest. Late presentation, district hospital setting and bowel resection were associated with elevated mortality.

Re-examining the environmental Kuznets curve (EKC) for India via the multiple threshold NARDL procedure.

Irrespective of the vast array of empirical evaluations pertaining to the environmental Kuznets curve (EKC) hypothesis, both for India and other countries, previous studies, amid divergent submissions, inadvertently failed to highlight the relevant threshold that ensures significant reductions in environmental decay. Additionally, the implications of environmental-control technology on environmental quality are also lacking mostly in the context of Indian economy. Thus, this study enlists environmental-control technology and other relevant factors over the period 1980-2018 and employs the novel multiple threshold nonlinear ARDL technique, a model rarely applied in previous studies for updated empirical narratives. Accordingly, the empirical evidence rectifies that the variables converged to long-run equilibrium. Furthermore, from the tercile partial deviations, it is established that at the middle threshold (GDP2W2), pollution shrinks more significantly amid rising income, thereby validating the EKC hypothesis for India. Likewise, environmental-control technologies provided only a short-term insignificant carbon neutrality pathway, whereas they provided long-term insignificant emission increasing effects. This implies that the depth of such technology in India is inadequate to invoke cleaner environments at all times. Likewise, energy consumption and urbanization processes are significant environmental polluters, while trade openness provides insignificant long- and short-term carbon emission effects. Against this background, economic growth within the middle threshold promises a more sustainable environment amid rising national income at all times. Moreover, given its short-term outcomes, strengthening the depth of environmental-control technology is imperative to ensure a long-lasting clean environment in India.

Does trade openness influence the performance of small and medium enterprises in Nigeria? A re-evaluation of the evidence.

The theoretical premises of open trade predict that open economies would benefit more from trade than those in autarky. Empirical findings for Nigeria are mixed both for macro-based studies and those devoted to sectoral investigations. In this paper, we re-evaluate the evidence on trade openness's impact on the performance of small- and medium-scale enterprises (SMEs) in Nigeria. Existing studies in this area suffer from a twin restriction; one in scope, the other in methodology. We thus employ a two-pronged analytical framework on time series data spanning 1981 to 2019. First, the autoregressive distributed lag (ARDL) methodology is used to investigate the short-run and long-run effects of trade openness on SMEs' performance. Second, the Toda-Yamamoto causality test provides additional evidence on the direction of causality among the policy variables. Our findings show that trade openness exerts a positive but insignificant impact on the performance of SMEs. Causality test results indicate that variations in exchange rate, infrastructure, labour force and foreign direct investment influence the performance of SMEs. The paper recommends the creation of enabling environments that guarantee formidable enterprise performance amidst open trade. Specifically, there is need, among other things, for significant improvements in infrastructure levels as well as stability in the exchange rate.

Mortality audit in general surgery unit and lessons learned at a Nigerian tertiary hospital: a single centre observational study.

Introduction: mortality among surgical admissions is a global phenomenon, but the rates, pattern and factors that predict such deaths vary from region to region and even in one region, it varies among institutions. The aim was to document the pattern and factors that influence mortality in the general surgery unit of our institution. Methods: this was a seven-year retrospective, case-control study. All general surgery admissions managed at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria from January 2013 to December 2019 were included. Data were retrieved from case files of those managed during the period. Pattern and factors associated with increased mortality were analyzed and presented in tabular and descriptive forms. Results: of 4,898 general surgery admissions, 481 deaths were recorded, giving a crude mortality rate of 9.8%. Though highest number of deaths occurred in those in the 16-45 years age range, crude mortality rate was highest in elderly patients (>65 years). Generalized peritonitis was the most common cause of death, representing 38.9% of all deaths followed by cancers (22.9%), then abdominal injuries (16.8%). Of the 110 deaths from cancers, breast cancer (40, 36.4%) was the most important cause followed by colorectal cancers (29, 26.4%). Overall, 78.2% of the deaths occurred in emergency cases. In the logistic regression analysis, the following were significantly associated with mortality: advanced age, comorbidities, emergency presentation, high ASA scores (III-V) and delayed presentation. Conclusion: significant mortality occurs in our general surgery unit and is higher in older patients, and in those with generalized peritonitis, abdominal trauma and cancers.

Food and healthcare accessibility during COVID-19 pandemic.

The pervasive effects of the novel coronavirus (COVID-19) have put the world to test. Its effects permeate all facets of life including healthcare services and food supplies. However, most empirical studies failed to investigate its effects on the prices of food and healthcare services, which by all standards, are essential commodities. On this background, this study evaluates the impact of COVID-19 reported cases and lockdown stringency measures on the food and healthcare prices in the six (6) worst-affected countries. For empirical purposes, daily prices of food and healthcare services between 22nd January and 31st December 2020 were regressed against daily cases of COVID-19 and lockdown stringency measures within the dynamic autoregressive distributed lag procedure. Empirical evidences reveal that prices of healthcare and food are cointegrated with COVID-19 cases and lockdown measures in all the selected countries except Italy. Equally, healthcare and food prices reinforced itself in the long-run in the US, the UK and France. Furthermore, COVID-19 cases lead to significant increases in food and healthcare prices in the US, whereas, food and healthcare prices in France and UK declined significantly as COVID-19 cases mount. Conversely, food and healthcare prices declined significantly in the US and soar in France and the UK in reactions to COVID-19 new cases. Likewise, government stringency measures and containment health measures contributed significantly to healthcare and food price hike in the US and France respectively. Meanwhile, healthcare and food prices in the other selected countries remained unaffected even as the pandemic ravages. Following this empirical discoveries, relevant policy guidelines have been communicated.

Financial development and environmental sustainability in Nigeria: fresh insights from multiple threshold nonlinear ARDL model.

Previous studies failed to account for the effects of major, minor and moderate changes in financial development on environmental sustainability in Nigeria. To provide this necessary fresh evidence, the current study applied the recently proposed multiple threshold nonlinear autoregressive distributed lag model for the provision of such information. Quarterly data series from 2000Q1 to 2018Q4 obtained from various data hosts were used for empirical analysis. Evidence from the estimations proves that the MTNARDL models provide more robust outputs than the NARDL. Equally, results from this enhanced framework indicate that the effects of extremely large changes in financial development on environmental sustainability differ significantly from the effects of extremely small changes. Again, the finding reveals that the positive impacts of financial development on environmental sustainability fizzles out at the lower thresholds. Furthermore, stronger asymmetric effects between financial development and CO2 emissions exist in the long run, as compared with the short run. Therefore, to ensure environmental sustainability and sustainable development in Nigeria, policy makers should pay adequate attention to the long-run dynamics and ensure that financial development level does not degenerate to the lower thresholds where the positive impacts of financial developments fizzle out.

Outcome of open excisional breast biopsies in Abakaliki, South-East Nigeria.

INTRODUCTION: open excisional breast biopsy is a known modality for treatment of breast lumps especially in developing countries. Other sophisticated methods are available for management of breast lumps in more advanced nations. Our aim in this study was to review the outcome of open excision breast biopsies in our setting with a view to improving patient management. METHODS: this study was conducted at the National Obstetric Fistula Centre, Abakaliki, South East Nigeria among women who had excision breast biopsy between January 2015 and December 2016. Data was analysed using Statistical Package for Social Sciences (SPSS), version 21. RESULTS: a total of 107 case folders were reviewed in this study. The mean age of the women was 27 ± 10 years. Overlying breast incision was the preferred route in 78(72.9%), periareolar incision in 28(26.2%), and Gillard Thomas's method (infero-lateral submammary sulcus incision) used in one patient with bilateral multiple breast lumps (0.9%). The complications recorded in this study were haematoma in 3(2.8%), wound infection in 5(4.7%) and wound breakdown in 1(0.9%). Hypertrophic scar was found in 2(1.8%) patients at follow-up. Overall, most patients were satisfied with the aesthetic outcome of their surgery. CONCLUSION: open excision breast biopsy is a useful modality for management of breast diseases in our setting. Complication rates are minimal. Both overlying and periareolar breast incisions results in aesthetically satisfactory scar in our practice. Inferior-lateral sub mammary sulcus skin incision is useful when the lumps are multiple and located at different quadrants of the breast. Appropriate use of drain helps to reduce the incidence of haematoma.

Cytochrome P450 1B1 Val432Leu polymorphism and breast cancer risk in Nigerian women: a case control study.

BACKGROUND: Cytochrome P450 1B1 (CYP1B1) is active in the metabolism of estrogens to reactive catechols and of different procarcinogens. Several studies have investigated the relationship between genetic polymorphisms of CYP1B1 and breast cancer risk with inconsistent results. A G --> C transversion polymorphism in the heme-binding region in codon 432 of the gene results in amino acid change (Val --> Leu); the Leu allele display increased catalytic efficiency for 4-hydroxylation of estradiol in some experimental systems. METHODS: In this study, we utilized a polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) assay to assess the relationship between this polymorphism and breast cancer risk in a case control study including 250 women with breast cancer and 250 controls from four University Teaching Hospitals in Southern Nigeria. RESULTS: Heterozygosity for the CYP1B1 M1 genotype (CYP1B1 M1 [Val/Leu]) was associated with a significant 59% increased risk of breast cancer (OR = 1.59, 95% CI 1.01-2.58) while homozygosity for the genotype (CYP1B1 M1 [Leu/Leu]) conferred a non-significant 51% increased risk of breast cancer. These risk profiles were modified in subgroup analysis. In premenopausal women, harboring at least one CYP1B1 (Leu) allele conferred a significant two-fold increased risk of breast cancer (OR = 2.04, 95% CI 1.10-3.78). No significant association was observed in postmenopausal women (OR = 1.08, 95% CI 0.57-2.04). CONCLUSION: Our results suggest that the codon 432 polymorphism of the CYP1B1 gene is associated with increased risk of breast cancer and is particularly involved in breast cancer risk in premenopausal women of African descent.

Leptin receptor Gln223Arg polymorphism and breast cancer risk in Nigerian women: a case control study.

BACKGROUND: Leptin, a 16 kDa polypeptide hormone, implicated in various physiological processes, exerts its action through the leptin receptor, a member of the class I cytokine receptor family. Both leptin and leptin receptor have recently been implicated in processes leading to breast cancer initiation and progression in animal models and humans. An A to G transition mutation in codon 223 in exon 6 of the leptin receptor gene, resulting in glutamine to arginine substitution (Gln223Arg), lies within the first of two putative leptin-binding regions and may be associated with impaired signaling capacity of the leptin receptor. This study was designed to assess the role of this polymorphism in breast cancer susceptibility in Nigerian women. METHODS: We utilized a polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) assay to evaluate the association between the Gln223Arg polymorphism of the leptin receptor gene and breast risk in Nigeria in a case control study involving 209 women with breast cancer and 209 controls without the disease. Study participants were recruited from surgical outpatient clinics and surgical wards of four University Teaching Hospitals located in Midwestern and southeastern Nigeria between September 2002 and April 2004. RESULTS: Premenopausal women carrying at least one LEPR 223Arg allele were at a modestly increased risk of breast cancer after adjusting for confounders (OR = 1.8, 95% confidence interval [CI] 1.0-3.2, p = 0.07). There was no association with postmenopausal breast cancer risk (OR = 0.9, 95% CI 0.4-1.8, p = 0.68). CONCLUSION: Our results suggest that the LEPR Gln223Arg polymorphism in the extracellular domain of the LEPR receptor gene is associated with a modestly increased risk of premenopausal breast cancer in Nigerian women.

Anthropometry and breast cancer risk in Nigerian women.

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.

Case-control study of risk factors for breast cancer in Nigerian women.

This study evaluated the potential risk factors for breast cancer in Nigerian women using a case-control design of 250 women with breast cancer and their age-matched female controls. Both cases and controls were recruited from 4 University Teaching Hospitals in Midwestern and Southeastern Nigeria. Data on the clinical and epidemiological characteristics were collected using interviewer-administered structured questionnaires. The mean age of the cases and controls were 46.1 and 47.1 years, respectively. Fifty-seven percent of the cases were premenopausal while 43% were postmenopausal. The association of risk factors with breast cancer was assessed using conditional logistic regression. Positive family history of breast cancer in first- and second-degree relatives (Odds ratio [OR] = 8.07, 95% confidence interval [CI], 1.003, 64.95, p = 0.04), education of high school level and above (OR = 1.35, 95% CI 1.04, 1.74, p = 0.0205), age at first fullterm pregnancy (FFTP) greater than 20 years (OR = 1.32 95% CI 1.01, 1.71, p = 0.0413) and waist/hip ratio (WHR) (OR = 1.98, 95% CI 1.27, 3.10, p = 0.0026) were associated with increased risk of breast cancer in the final multiple conditional logistic regression model. The findings from this study have shown that sociodemographic characteristics, reproductive variables and anthropometric measures are significant predictors of breast cancer risk in Nigerian women.

Simple tandem repeat (TTTA)n polymorphism in CYP19 (aromatase) gene and breast cancer risk in Nigerian women.

BACKGROUND: Breast cancer is the most common cancer and the leading cause of cancer related deaths in women worldwide. The incidence of the disease is increasing globally and this increase is occurring at a faster rate in population groups that hirtherto enjoyed low incidence. This study was designed to evaluate the role of a simple tandem repeat polymorphism (STRP) in the aromatase (CYP19) gene in breast cancer susceptibility in Nigerian women, a population of indigenous sub-Saharan African ancestry. METHODS: A case-control study recruiting 250 women with breast cancer and 250 women without the disease from four University Teaching Hospitals in Southern Nigeria was carried out between September 2002 and April 2004. Participants were recruited from the surgical outpatient clinics and surgical wards of the Nigerian institutions. A polymerase chain reaction (PCR)-based assay was employed for genotyping and product sizes were detected with an ABI 3730 DNA Analyzer. RESULTS: Conditional logistic regression analysis revealed that harboring the putative high risk genotypes conferred a 29% increased risk of breast cancer when all women in the study were considered (Odds ratio [OR] = 1.29, 95% confidence interval [CI] 0.83-2.00), although this association was not statistically significant. Subgroup analysis based on menopausal status showed similar results among premenopausal women (OR = 1.35, 95% CI 0.76-2.41 and postmenopausal women (OR = 1.27, 95% CI 0.64-2.49). The data also demonstrated marked differences in the distribution of (TTTA)n repeats in Nigerian women compared with other populations. CONCLUSION: This study has shown that harboring 10 or more repeats of the microsatellite (TTTA)n repeats of the CYY19 gene is associated with a modest increased risk of breast cancer in Nigerian women.

Cytochrome P4501A1 genetic polymorphisms and breast cancer risk in Nigerian women.

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.