Dr. Atara I. NTEKIM

Basic Information

Olopade 

Name: Dr. Atara I. NTEKIM

Faculty: CLINICAL SCIENCES

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 Department:Radiation Oncology

Designation: Senior Lecturer

Brief Biography:

Resume

CURRICULUM VITAE.

1 (a)  Name:                                                    Atara Isaiah Ntekim

  (c) Department:                                           Radiation Oncology

 (d)  Faculty:                                                   Clinical Sciences

 

11 (a) First Academic Appointment             Lecturer 1 (January, 2008).         

(b)  Present Post (with date)                        Snr Lecturer (October, 2015)

(c)  Date of Last Promotion:                         Not applicable

(d)  Date last considered:                             Not applicable

          

111.      University Education (with dates)

University of Calabar, Nigeria (1981 – 1987)

University of Nottingham, Nottingham United Kingdom (2013-2014).

 

1V.      Academic Qualifications (with dates and granting bodies)

MBBCh Calabar (June, 1987)

MRes Advanced Genomic and Proteomic Sciences, Nottingham (December, 2014

 

V.         Professional Qualifications and Diplomas (with dates)

 

FWACS (February, 2005)

FMCR (September, 2007)

Certificate in Brachytherapy – University of   Witwatersrand, Johannesburg South Africa (March, 2007)

V1       Scholarships, Fellowships and Prizes (with dates)

 

  • International Atomic Energy Agency (IAEA) fellowship for training in Brachytherapy Johannesburg Hospital, South Africa (January, 2007)
  • Novartis Institute for Biomedical Research (NIBR) Cambridge, Massachusetts, USA Fellowship for 3 months training in Clinical Trials (June , 2013)
  • University of Chicago, USA Fellowship for training in Clinical Trials Management (August 24, 2013).
  • TETfund Academic Staff Development grant for MRes program, University of Nottingham (September, 2013)

V11.    Honours Distinctions and Membership of Learned Societies

                       

  • Association of Radiologists of West Africa (ARAWA).
  • Psycho-Oncology Society of Nigeria.
  • African Organisation for Research and Training in Cancer (AORTIC).
  • International Network for Cancer Treatment and Research (INCTR).
  • European Society for Therapeutic Radiology and Oncology (ESTRO)
  • American Society of Clinical Oncology (ASCO)
  • American Association for Cancer Research (AACR)

VIII    Details of Teaching/Work Experience

 

Teaching of undergraduate students since 2008 as follows

            400 level students: Introduction to Radiation Oncology

            500 level students: Principles of Radiation Oncology

            600 level students: Brachytherapy techniques

 

1X       Research

(a)        Completed                             

  • Effect of aspirin on BIRC7/livin protein expression on colorectal cancer cells.
  • Optimal management of cervical cancer in HIV positive patients: A systematic review.

             

(b)       In progress

           

Title: Assessment of nutritional status among cancer patients in Ibadan.

This study was started in August, 2013. The study is to assess the proportion of cancer patients with poor nutritional status since poor nutrition negatively affects the outcome of cancer management. There is at present, no data in Nigeria with regards to nutritional status of our cancer patients and nutritional management of these patients are not commonly considered. The outcome of the study will generate interest in this aspect of cancer care which is vital to good clinical outcome. Recruitment of participants has commenced but has been slow due to industrial actions among health workers.

(c)        Dissertation and Thesis                                                                        

  • The role of radiotherapy in the management of laryngeal cancers in Ibadan, Nigeria. Submitted to The National Post Graduate College of Nigeria for the award of Fellowship in Radiation Oncology; 2007
  • Hormonal regulation of autophagy in prostate cancer. Submitted to the University of Nottingham, Nottingham, United Kingdom for the award of Master of Research (MRes) degree in Advanced Genomic and Proteomic Sciences (AGPS), 2014.

 

X         Publications

  • Books already published Nil
  • Chapters in Books already published

1.         Ntekim, A. (2011) Sexual Dysfunction among Cancer Survivors. In Azita  Goshtasebi (Editor) Sexual Dysfunctions - Special Issues : Zagreb In-Tech; ISBN: 978-953-307-859-5; (128 pages)  pages 39-60. Croatia (Contribution 100%). 

  • Ntekim, A. (2012) Cervical cancer in sub-Sahara Africa. In R. Rajkumar (Editor) Topics on Cervical Cancer with an Advocacy for Prevention, Zagreb In-Tech; ISBN 978-953-51-0183-3; (284 pages) pp 51- 74. Croatia (Contribution 100%).
  • Articles that have already appeared in Refereed Conference Proceedings

1.Effect of aspirin on BIRC7/livin protein expression on colorectal cancer cells: a putative report 2015 Proceedings of the American Association for Cancer Research Abstract Number: 1702

2.Mohammed Faruk, Sani Ibrahim, Surajo Mohammed Aminu, Adamu Abdullahi, Ahmed Adamu, Yawale Iliyasu, Mohammed Shehu Shehu, John Idoko, Abdullahi Jibril Randawa, Atara Ntekim, Saad Aliyu Ahmed, Abubakar Sani, Khalid Zahir Shah, Yahaya Ukwenya, Cheh Augustine Awasum, Kasimu Umar Adoke, Andrew Jonathan Nok. Assessment of chemotherapeutic responses to neoadjuvant FOLFOX and Aspirin on BIRC7 in colorectal adenocarcinoma cells induced in Albino rats. [abstracthttp://clincancerres.aacrjournals.org/content/23/1_Supplement/B27">http://clincancerres.aacrjournals.org/content/23/1_Supplement/B27

  • Leng, J. et al. Attitudes of breast cancer patients and oncology staff towards randomized clinical trials in southwest Nigeria. Clin. Oncol. 36, e18663–e18663 (2018).

(d)       Patents            Nil

(e) Articles that have already appeared in learned journals  (Red Not in Google scholar)

4.         Akinlade, B.I. Ntekim, A.I. Oyekunle, E.O. Campbell, O.B. (2010): Bladder and Rectal dose from high dose rate intracavitary brachytherapy with Cobalt-60 radionuclide source. The Central African Journal of Medicine Vol.56 No.1/4S, 25. Zimbabwe  (Contribution 30%). 

  • Ntekim A.I., Abdullahi, A., Campbell, O. B. Adenipekun, A. Ajekigbe, A. (2001): Docetaxel chemotherapy in the Management of advanced and metastatic breast cancer in Nigeria: a pilot study. West African Journal of Radiology Vol. 8 No.1, 25 -28. Nigeria (Contribution 50%). DOI:
  • 4314/wajr.v8i1.34210 (May 2006)

6.         Ntekim, A.I., Campbell, O.B. (2009): Primary Lymphoma of The Liver in a cervical cancer Survivor- A case Report. The Tropical Journal of Health Sciences Vol.16 No. 8, 44-46. Nigeria (Contribution 80%).

7.         Ntekim, A. I., Nufu, F.T, Campbell, O.B. (2009): Breast    cancer in Young females in Ibadan – Nigeria. African Health Sciences Vol.9 No.4, 242-246. Uganda (Contribution 70%).

8.         Ntekim, A. I., Abdulhahi, A., Ajekigbe, A., Campbell, O.B.

(2009): Burkitts Lymphoma - 50 Years after Discovery- Review Article. West African Journal of Radiology Vol. 16 No. 1, 55-60 Nigeria (Contribution 60%). 

9.          Ntekim, A. I., Ajekigbe, A. (2010): Hemorrhagic Cystitis in

 a Patient Receiving Docetaxel for Prostate Cancer.   Clinical Medicine Insights: Oncology Vol. 4, 11-13. New Zealand (Contribution 80%).

10.       Ntekim, A. I., Folasire, A.M. (2010):  CD4 Count and Anti

Retroviral Therapy for HIV Positive Patients with Cancer in Nigeria-A Pilot Study. Clinical Insights: Oncology Vol. 4, 61-66. New Zealand (Contribution 80%).

11.       Ntekim, A., Adenipekun, A., Akinlade, B., Campbell, O.B. (2010): High Dose Rate Brachytherapy in the Treatment of Cervical Cancer: Preliminary Experience with Cobalt 60 Radionuclide Source – A prospective Study. Clinical Medicine Insights: Oncology Vol. 4, 89-94. New Zealand (Contribution 50%).

12.       Elumelu, T.N., Adenipekun, A., Ntekim, A. (2013):  Pain

Associated with Secondary Lymphoedema among cancer patients. Journal of Palliative Care Vol.29 No.4, 253-257. Canada (Contribution 30%).

13.       Ntekim, A.I., Adenipekun, A.A., Akinlade, B.I., Elumelu-

Kupoluyi, T.N. (2014): High Dose Rate Brachytherapy in the Treatment of Uterine Cervical cancer using Cobalt- 60 Radionuclide Source: Three Years Treatment Outcome. West African Journal of Radiology Vol. 21 No.1, 21-5. Nigeria (Contribution 50%) [January, 2014http://www.ncbi.nlm.nih.gov/pubmed/26034498">Tandem-ring dwell time ratio in Nigeria: dose comparisons of two loading patterns in standard high-dose-rate brachytherapy planning for cervical cancer. J Contemp Brachytherapy. 2015 Apr;7(2):161-70

18.       de Brot S, Ntekim A, Cardenas R, James V, Allegrucci C, Heery DM, Bates DO, Ødum N, Persson JL, Mongan NP. Regulation of vascular endothelial growth factor in prostate cancer. Endocr Relat Cancer. 2015 Jun;22 (3):R107-23

19.       Ntekim A, Campbell O, Rothenbacher D. Optimal management of cervical cancer in HIV-positive patients: a systematic review. Cancer Medicine. 2015 September; 4(9):1381-1393

20.       Folasire A, Ntekim A, Omikunle A, Ali-Gombe M (2015): Association of Gleason Risk Groups with Metastatic Sites in Prostate Cancer. Afr. J. Biomed. Res. Vol.18, 189- 196

21.       Emmanuel Oyeyemi Oyekunle, Rachel Ibhade Obed, Bidemi Idayat Akinlade, Atara Ntekim. Comparison of doses to the rectum derived from treatment planning system with in-vivo dose values in vaginal vault brachytherapy using cylinder applicators. J Contemp Brachytherapy 2015; 7, 6: 485-491

22.       Obajimi MO, Adeniji-Sofoluwe AT, Oluwasola AO,

Adedokun BO, Mosuro OA, Adeoye AO, Ntekim A I. Soyemi T.O, Osofundiya O. O., O. S. Screening mammography in Ibadan: Our experience. Niger J Basic Clin Sci 2015; 12: (2)74-80. DOI: 10.4103/0331-8540.169297

Oladeji, A., Atalabi, O., Jimoh, M., Ntekim, I. & Elumelu, T. Delay in presentation of cancer patients for diagnosis and management: An institutional report. Int J Oncol 13, 10.5580/IJO.44745 (2016).

23        Atara Isaiah Ntekim, Oluyemisi Folake Folasire,  Ayorinde Mobolande Folasire Prevalence of Malnutrition among Cancer Patients in a Nigerian Institution Journal of Analytical Oncology 2017; 6: 117-124       

24 Adamu D. Bojude, Musa Ali-Gombe, Muhammed M. Manga, Atara I. Ntekim. Co-occurrence of Relapsed Pulmonary Tuberculosis and Breast Cancer Metastasis After Pregnancy and Lactation. Borno Medical Journal, July - December 2017, Volume 14, Issue 2. P237-240. 

25 Adamu D. Bojude, Musa Ali-Gombe, Aminu U. Usman, Atara I. Ntekim. Stage IIB Carcinoma of The Uterine Cervix In A Patient With Bilateral Pelvic Kidneys: A Radiotherapeutic Challenge. Borno Medical Journal, July - December 2017, Volume 14, Issue 2. P225-228.

26        Anakwenze CP, Ntekim A, Trock B, Uwadiae IB, Page BR. Barriers to radiotherapy access at the University College Hospital in Ibadan, Nigeria. Clin Transl Radiat Oncol [Internethttp://dx.doi.org/10.1016/j.ctro.2017.05.003">http://dx.doi.org/10.1016/j.ctro.2017.05.003

27        Faruk M, Ibrahim S, Adamu A, Rafindadi AH, Ukwenya Y, Iliyasu Y, Adamu A, Aminu SM, Shehu MS, Ameh DA, Mohammed A, Ahmed SA, Idoko J, Ntekim A, Suleiman AM, Shah KZ, Adoke KU. (2017) An analysis of dietary fiber and fecal fibre components including pH in rural Africans with colorectal cancer.  Intest Research -0001;0013

28        Wilfred Ngwa, Emmanuel Ikhile, Atara Ntekim, Nwamaka Lasebikan,Adewumi Alabi’  Uchechukwu N. Shagaya,

29 Fatiregun Omolara,, Musa Ali-Gombe    Adamu Danladi Bojude, Mamsau Ngoma,  Twalib Ngoma, Madar Bhagwat,

, Omoruyi Credit Irabor, Jonathan Schoenfeld, Paul Nguyen,  Erno Sajo, Fran Laurie,

, Janaki Moni, Thomas J. Fitzgerald,  Potential Role of the Quality Assurance Review Center Platform in Global Radiation Oncology. Int J Radiat Oncol. 2017;99(4):956-962. doi:10.1016/j.ijrobp.2017.06.2461.

30 Jamil Jatto, Evaristus Oboh, Atara Ntekim (2017).   5-Fluorouracil Induced Cardiotoxicity in a Young Patient with Co­lon Cancer: An Unusual Finding  Journal of Oncology Research and Therapy 2017(3)  1-4

31.Aliyu, U. M., Folasire, A. M., & Ntekim, A. I. (2018). Treatment outcome of patients with nasopharyngeal carcinoma in Nigeria: An institutional experience. Precision Radiation Oncology, 1–4. http://doi.org/10.1002/pro6.44

32.     Dairo, M. D., Adamu, D. B., Onimode, Y. A., Ntekim, A. & Ayeni, O. Characteristics and Determinants of Patients Discontinuation of Breast Cancer Follow-Up Care at the Radiation Oncology Department , University College Hospital , Ibadan , Nigeria. Int. J. Breast Cancer 2018, 1–9 (2018).

(f)        Books, Chapters in Books and Articles already accepted for publication:            Nil

(g)       Technical Reports and Monographs: Nil                  

                                   

XI        Major Conferences Attended with Papers Read (in the last 5 years)

  • 6th African radiation Oncology Group (AFROG) Conference, Kampala, Uganda; 20-21 February, 2012. High dose rate brachytherapy in the treatment of uterine cervical cancer using Cobat-60 radionuclide source. Three years post treatment assessment.
  • American Society of Clinical Oncologists (ASCO) 2013 Conference Illinois Chicago USA 31 May-5 June, 2013
  • East Midland’s Proteomics Society Conference, University of Leicester, United Kingdom. 15 November, 2013
  • American Association for Cancer Research (AACR) New Horizons in Cancer Research 2015 Conference, Shangai China; November 12 -15, 2015. Effect of folinic acid, 5-FU and oxaliplatin based pre-operative chemotherapy on BIRC7/Livin expression in human colorectal cancer cells in Zaria Nigeria.

Signature----------------------------------------------          Date-------------------

    

Researches

A) COMPLETED

i) Effect of aspirin on BIRC7/livin protein expression on colorectal cancer cells.

ii) Optimal management of cervical cancer in HIV positive patients: A systematic review.

B) IN PROGRESS

Title: Assessment of nutritional status among cancer patients in Ibadan.

This study was started in August, 2013. The study is to assess the proportion of cancer patients with poor nutritional status since poor nutrition negatively affects the outcome of cancer management. There is at present, no data in Nigeria with regards to nutritional status of our cancer patients and nutritional management of these patients are not commonly considered. The outcome of the study will generate interest in this aspect of cancer care which is vital to good clinical outcome. Recruitment of participants has commenced but has been slow due to industrial actions among health workers.

C) DISSERTATION AND THESIS

i) The role of radiotherapy in the management of laryngeal cancers in Ibadan, Nigeria. Submitted to The National Post Graduate College of Nigeria for the award of Fellowship in Radiation Oncology; 2007.

ii) Hormonal regulation of autophagy in prostate cancer. Submitted to the University of Nottingham, Nottingham, United Kingdom for the award of Master of Research (MRes) degree in Advanced Genomic and Proteomic Sciences (AGPS), 2014.

Publications

Atara Ntekim (Radiation Oncology)

Publications and abstracts

1. Ntekim, A. I., Nufu, F.T, Campbell, O.B. (2009): Breast    cancer in Young females in Ibadan – Nigeria. African Health Sciences Vol.9 No.4, 242-246. Abstract: economic features of breast cancer in young females aged 40 years and below treated at the Radiotherapy Department of The University College Hospital, Ibadan Nigeria

Methods: Records of female patients treated for breast cancer from 2003 to 2006 were reviewed. Records of patients aged 40 years and below were sorted out for further review. Information not available in the records was collected during follow up visits from the patients.

Results: A total of 763 cases were evaluated out of which 221 (28.96 %) were 40 years and below. Stage 1 disease was diagnosed in 5 (2%) of the patients while 29 (13%) had stage 11 disease. Stages 111 and 1V were diagnosed in 102 (46%) and 85(39%) of the patients respectively. Invasive ductal carcinoma was the predominant histological type diagnosed in

210(95%) of the cases. Only 5(2%) of the patients had positive family history of breast cancer and 189 (85%) were income earners, out of these, 132(70%) had monthly income less than 12,500.00 Nigerian Naira (~100USD). The number of young patients who were married was 166 (75%) but 6 (4%) of the married ones had no children while the rest had at least one child. Sexual dysfunction in form of loss of libido was recorded in 77 (46%) of the married patients. All the patients had primary school education while 188 (85%) had secondary school education or above. The only source of financial support received by all the patients towards their treatment was from relatives.

Conclusion: This study shows that we have a higher proportion of young females with breast cancer in our environment than in developed countries. Most of them present late and majority of the patients have very low income. Physicians should pay serious attention to breast lumps in young females and free health care services for these patients can promote early access to treatment.

2. Ntekim, A. I., Ajekigbe, A. (2010): Hemorrhagic Cystitis in a Patient Receiving Docetaxel for Prostate Cancer.   Clinical Medicine Insights: Oncology Vol. 4, 11-13. Abstract: A case is reported in which docetaxel was used to treat a patient with hormone refractory metastatic prostate cancer. The treatment was terminated at the third course of docetaxel following the development of hemorrhagic cystitis. This reaction was unexpected, as it is not a known reaction to docetaxel. Hemorrhagic cystitis has been associated with cyclophosphamide, where the metabolite acrolein has been implicated. The mechanism of this reaction from docetaxel is not yet known.

3. Ntekim, A. I., Folasire, A.M. (2010):  CD4 Count and Anti-Retroviral Therapy for HIV Positive Patients with Cancer in Nigeria-A Pilot Study. Clinical Insights: Oncology Vol. 4, 61-66:                                             Abstract: Background: Highly Active Anti Retroviral Treatment (HAART) improves the outcome of HIV positive patients treated for cancer. In our center HAART is only commenced in HIV positive patients with malignancy if the CD4 T lymphocyte count is less than 200 cells/ul. Presently, the outcome of treatment in these patients is poor.

Objective: To evaluate the influence of CD4 T- cell count and HAART on treatment outcome of HIV positive patients with cancer managed at the oncology service of The University College Hospital, Ibadan- South West Nigeria.                                         

Patients and methods: Twenty two adult HIV positive patients with malignancies who presented for treatment at our hospital from 2007 to 2009 were closely monitored by the investigators. Relevant clinical data collected included age, sex, HIV status, type of malignancy, CD4 counts, history of ART, ECOG performance status, prescribed oncology treatment with regularity of treatment and to follow up conditions.

Results: Twenty two patients aged between 26 and 67 years were evaluated. The performance status of all patients was at least ECOG 2. Three ART naive patients with initial CD4 counts 450 cells/ul and above were able to complete oncology treatment without HAART with good malignant disease control. Five other patients on HAART before the diagnosis of malignancy with CD4 counts 350 cells/ul and above were also able to complete their treatments on schedule with good outcome. Eight HAART naive patients with initial CD4 counts less than 370 cells/ul had inconsistent treatments with poor outcome.                                                                                                       

Conclusion: Based on these observations, we propose that HAART should be commenced on all HIV positive patients diagnosed with malignancy with an initial CD4 count less than 450 cells/ul in our environment. Further studies in low resource settings with appropriate ample sizes are however needed to validate these findings.4.

4. Ntekim, A., Adenipekun, A., Akinlade, B., Campbell, O.B. (2010): High Dose Rate Brachytherapy in the Treatment of Cervical Cancer: Preliminary Experience with Cobalt 60 Radionuclide Source – A prospective Study. Clinical Medicine Insights: Oncology Vol. 4, 89-94.                                                                                                                 

Abstract: Iridium-192 is widely used for high-dose rate brachytherapy. Co-60 source with similar geometric and dosimetric properties are now available. It has a longer half life but higher energy than Iridium-192. If Co-60 source can produce similar results, it will be more economical for low resource settings.

Objective: To evaluate the acute gastrointestinal and genitourinary toxicity associated with Co-60 source in the brachytherapy of cervical cancer.

Methods: Seventy patients with cervical cancer received 45 Gy in 22 fractions of pelvic external beam radiotherapy and 19.5 Gy

in 3 fractions of HDR with Co-60 source using tandem and ring applicators with 6 courses of cisplatin 50 mg/m2 and 5 fluorouracil 1000 mg/m2 every three weeks. every 3 weeks. Toxicity was scored using NCI-CTC version 4.0.

Results: The median total BED (Gy10) for tumor was 86.2 (84.4–88.8) while that for rectum (BED Gy3) was 124.4 (120–133). Two patients (3%) had grade 3 gastrointestinal toxicity while all others had grade 2 toxicity and this is comparable with previous results.

Conclusion: Co-60 as HDR brachytherapy source is tolerable and is economical for low resource settings.

5. Elumelu, T.N., Adenipekun, A., Ntekim, A. (2013):  Pain Associated with Secondary Lymphoedema among cancer patients. Journal of Palliative Care Vol.29 No.4, 253-257. Abstract:  Lymphedema in cancer patients can cause a range of discomforts, including pain — although the presence of such pain is not often recognized by the caregivers of those who suffer from lymphedema. We used The Numeric Rating Scale (NRS) — a tool for measuring the amount of pain that patients to measure level of pain in cancer patients with lymphedema. Most of the cancer patients in our study population, all of whom had secondary lymphedema stage 11, experienced distressing pain. Such patients require thorough pain evaluation and classification, and effective management. Strong opioids, like liquid morphine, are highly desirable in our setting as they will facilitate better management of these patients

6. Ntekim, A.I., Adenipekun, A.A., Akinlade, B.I., Elumelu-Kupoluyi, T.N. (2014): High Dose Rate Brachytherapy in the Treatment of Uterine Cervical cancer using Cobalt- 60 Radionuclide Source: Three Years Treatment Outcome. West African Journal of Radiology Vol. 21 No.1, 21-5.                                                                                     

Abstract: Background: The Iridium?192 radionuclide source is commonly used for high?dose?rate brachytherapy of uterine cervical cancer. The cobalt?60 radionuclide source, which is more economical, is now available with dosimetric properties similar to iridium?192. Objective: To evaluate late gastrointestinal and genitourinary complications, and also the survival pattern in cervical cancer patients treated with cobalt?60 high?dose?rate brachytherapy, three years after treatment. Materials and Methods: Seventy patients, who were treated with high?dose?rate brachytherapy using the cobalt?60 radionuclide source were followed up for three years. All the patients received 45 Gy of external beam radiotherapy in 22 daily fractions, with 19.5 Gy from high?dose?rate brachytherapy, in three fractions, over three weeks, using the cobalt?60 radio nuclide source. The patients also received concurrent cisplatin?based chemotherapy. Late complications were assessed every three months, using Radiation Therapy Oncology Group (RTOG) late toxicity criteria. The pattern of disease control was also assessed. Results: Late complications in the bowel were, six (9%) grade 1, four (6%) grade 2, one (1%) grade 3, and one (1%) grade 4. The late complications affecting the bladder were 5 (7%) grade 1 and 1 (1%) grade 4. Twenty?eight patients (40%) were alive without disease, seven (10%) were alive with disease, seven (10%) died of persistent disease, four (6%) died of metastatic disease, while 24 (34%) were lost to follow?up. Conclusion: The late complications were similar to those reported for Iridium?192 as a source of high?dose brachytherapy. Cobalt?60 high?dose?rate brachytherapy is tolerable, effective, and economical for low resource settings.

7. Akinlade, B.I., Elumelu-Kupoluyi, T.N., Ntekim, I.A., Adenipekun, A.A., Oyekunle, E.O., Campbell, O.B., Folasire, A.M. (2014): Normalized Therapy Dose (EQD2) from management of locally advanced cervical cancer: comparison with ABS recommendation. Cancer Biology Vol.4 No.2, 16-21.                                                

Abstract: Optimal radiotherapy dose fractionation regime (DFR) for definitive management of cervical cancer isnot well known. However, several investigators have demonstrated that the biologically equivalent dose in 2-Gy fractions(EQD2) required to achieve local control probability of more than 90% for advanced disease is about 87Gy to the high risk tumour volume. Patients with locally advanced cervical cancer (LACC) have been managed at the University College Hospital, Ibadan Nigeria with combination of external beam radiation and high dose rate (HDR) intracavitary brachytherapy using different DFR. This study is aimed at calculating EQD2 received by 250 patients with LACC managed with different DFR between 2008 and 2010. Patients’ data were extracted from case files and mathematical method was used to calculate EQD2. Results obtained were compared with EQD2 values (80–90Gy) recommended by the American Brachytherapy Society (ABS) for LACC. Out of eleven different DFR employed at the centre, only five resulted in EQD2 values (81.00Gy, 87.60 Gy, 81.30 Gy, 88.80 Gy and 83.10 Gy) that are within ABS recommendation; five fell below (65.60 Gy, 70.30 Gy, 75.60 Gy, 78.40 Gy and 77.80 Gy) and one is higher (99. 80 Gy). It means out of 250 patients managed during this period, only 45% received recommended dose required to cure macroscopic disease. This study shows that to improve therapeutic ratio, total EQD2 for DFR (of choice) must be calculated before treatment. With the on-going follow-up, further study is aimed at assessment of late complications, 5- year survival and rate of recurrence in these patients.

8. Elumelu T, Folasire A, Ntekim A, Oboh O. (2014). Salivary Gland Tumors in Nigerian Patients – a 10 year review. Journal of Cancer Biology & Research; 2(3):1054-1020.

Abstract: Objective: This study was carried out to examine the pattern and treatment outcomes of salivary gland tumors in Nigerian patients attending Radiotherapy clinic at the University College Hospital, Ibadan. Methodology: Retrospective review of clinical records of patients with salivary gland tumors seen in the Department of Radiotherapy UCH Ibadan, from 2001-2010 was done. Information collected included bio data, tumor site histology, degree of differentiation, and survival among others. Results: 108 cases of histologically diagnosed salivary gland tumors were recorded in the department in a 10 year period. The commonest recorded presenting complaint was facial swelling seen in all the 108 patients. Mucoepidermoid was the most common histological type in 40 (37.0%) of the cases. Social habits such as tobacco smoking and alcohol consumption did not have any strong association with development of these tumors. The stage at presentation, histology and grading were found to be of prognostic significance. Conclusion: This study shows that salivary gland tumors are not common in our environment; almost 50% of the patients presenting with locally advanced, fungating disease, usually inoperable and treatment intent is more of palliation. A high index of suspicion by the primary physician is required to improve early detection and treatment. There is a need for establishment of multidisciplinary tumor board for ease of referral and management of these patients for better control

9. Aminu S, Ibrahim S, Adamu A, Ilyasu Y, Shehu MS, Ntekim AI et al. Molecular Phylogenetic Analysis of Human Endogenous Retroviruses with Associated Malignancies. Journal of Cancer Biology and Research. 2015; 3(2):1060-1074

Ibhade OR, Oyeyemi OE, Idayat AB, Atara I N. (2015) Tandem-ring dwell time ratio in Nigeria: dose comparisons of two loading patterns in standard high-dose-rate  brachytherapy planning for cervical cancer. J Contemp Brachytherapy.;7(2):161-70. Abstract: Purpose: In high-dose-rate (HDR) brachytherapy (BT), the source dwell times and dwell positions are essential treatment planning parameters. An optimal choice of these factors is fundamental to obtain the desired target coverage with the lowest achievable dose to the organs at risk (OARs). This study evaluates relevant dose parameters in cervix brachytherapy in order to assess existing tandem-ring dwell time ratio used at the first HDR BT center in Nigeria, and compare it with an alternative source loading pattern. Material and methods: At the Radiotherapy Department, University College Hospital (UCH), Ibadan, Nigeria, a total of 370 standard treatment plans in two alternative sets were generated with HDR basic 2.6 software for one hundred and eighty five cervical cancer patients. The initial 185 individual plans were created for clinical treatment using the tandem-ring dwell time ratio of 1 : 1. Modifying the initial applicator loading ratio, the second set of plans with related dose data were also obtained for study purposes only. Total reference air kerma (TRAK), total time index (TTI), ICRU volume, treatment time, point B dose, ICRU bladder dose, and rectal points dose were evaluated for both sets of plans. Results: The means of all evaluated dose parameters decreased when the existing tandem-ring dwell time ratio (1 : 1) was modified to other dwell weightings (1 : 1 – 3 : 1). These reductions were 13.43% (ICRU volume), 9.83% (rectal dose), 6.68% (point B dose), 6.08% (treatment time), 5.90% (TRAK), 5.88% (TTI), and 1.08% (bladder dose). Correspondingly, coefficients of variation changed by –7.98%, –5.02%, –5.23%, –4.20%, –3.93%, 8.65%, and 3.96% from the existing pattern to the alternative one. Conclusion: Tandem-ring dwell time ratio has significant influence on dosimetric parameters. This study has indicated the need to modify the existing planning approach at UCH.

10. de Brot S, Ntekim A, Cardenas R, James V, Allegrucci C, Heery DM, Bates DO, Ødum N, Persson JL, Mongan NP (2015). Regulation of vascular endothelial growth factor in prostate cancer. Endocr Relat Cancer. 2015.                                                               Abstract: Prostate cancer (PCa) is the most common malignancy affecting men in the western world. Although radical prostatectomy and radiation therapy can successfully treat PCa in the majority of patients, up to w30% will experience local recurrence or metastatic disease. Prostate carcinogenesis and progression is typically an androgen-dependent process. For this reason, therapies for recurrent PCa target androgen biosynthesis and androgen receptor function. Such androgen deprivation therapies (ADT) are effective initially, but the duration of response is typically %24 months. Although ADT and taxane-based chemotherapy have delivered survival benefits, metastatic PCa remains incurable. Therefore, it is essential to establish the cellular and molecular mechanisms that enable localized PCas to invade and disseminate. It has long been accepted that metastases require angiogenesis. In the present review, we examine the essential role for angiogenesis in PCa metastases, and we focus in particular on the current understanding of the regulation of vascular endothelial growth factor (VEGF) in localized and metastatic PCa. We highlight recent advances in understanding the role of VEGF in regulating the interaction of cancer cells with tumor-associated immune cells during the metastatic process of PCa. We summarize the established mechanisms of transcriptional and post-transcriptional regulation of VEGF in PCa cells and outline the molecular insights obtained from preclinical animal models of PCa. Finally, we summarize the current state of anti-angiogenesis therapies for PCa and consider how existing therapies impact VEGF signaling.

11. Ntekim A, Campbell O, Rothenbacher D. (2015): Optimal management of cervical cancer in HIV-positive patients: a systematic review. Cancer Medicine.; 4(9):1381-1393 Abstract: The clinical management of cervical cancer in HIV-positive patients has challenges mainly due to the concerns on immune status. At present, their mode of management is similar to HIV-seronegative patients involving the use of chemotherapy and radiotherapy concurrently as indicated. HIV infection, cancer, radiotherapy, and chemotherapy lower immunity through reduction in CD4 cell counts. At present there are no treatment guidelines for HIV-positive patients. This study was done to systematically review the literature on cervical cancer management in HIV-positive patients and treatment outcomes. A systematic literature search was done in the major databases to identify studies on the management of HIV-positive patients with cervical cancer. Identified studies were assessed for eligibility and inclusion in the review following the guidelines of The Cochrane Handbook for Systematic Reviews and CRD’s (Centre for Reviews and Dissemination) guidance for undertaking reviews in health care. Eight eligible studies were identified from the literature. Three of them were prospective while five were retrospective studies. Notably, the average age at diagnosis of cervical cancer in HIV-positive patients was a decade lower than in seronegative patients. There was no difference in distribution of stages of disease at presentation between HIV-positive and negative patients. Mild acute toxicity (Grades 1 and 2) was higher in HIV-positive patients than in HIV-negative patients in hematopoietic system. In the grades 3 and 4 reactions, anemia was reported in 4% versus 2% while gastrointestinal reactions were reported in 5% versus 2% respectively. In general, patients who were started early on HAART had higher rates of treatment completion. The study supports the suggestion that HAART should be commenced early at cervical cancer diagnosis in HIV-positive patients diagnosed with cervical cancer to ensure less toxicity and better treatment compliance.

12. Folasire A, Ntekim A, Omikunle A, Ali-Gombe M (2015): Association of Gleason Risk Groups with Metastatic Sites in Prostate Cancer. Afr. J. Biomed. Res. Vol.18, 189- 196 Abstract: Prostate cancer is the second most common non cutaneous male malignancy worldwide. Gleason composite score is used for risk classification. The most common site of metastasis in prostate cancer is the bone among others. The site and number of metastasis affect overall survival. The ability to predict the metastatic site at diagnosis can assist in predicting the prognosis. To assess the pattern of bone and visceral organ metastases in prostate cancer and evaluate if the initial Gleason grade at diagnosis can predict metastatic sites in prostate cancer. Records of patients with metastatic prostate cancer seen in an institution in Nigeria were analysed. Imaging examination reports used were Technitium99m bone scan for skeletal metastasis, ultrasonography, chest x-ray and cranial CT scan for evidence of visceral metastasis. The association of the initial Gleason grade and site of metastasis was determined using Chi square test for significance. Eighty two patient’s records were analysed. The proportion of patients with low risk Gleason grade (?6) at diagnosis was 27(32%), Intermediate risk grade (Gleason=7) was 25 (30%) while high risk Gleason grade (8-10) was 30 (38%). Spinal metastasis was 77(94%), pelvis 55(67%) femur 36 (44%) and tibia 1 (1%) while 55(67%) patients had multiple bones affected. Twenty seven patients 33% had visceral metastasis with liver 15(18%) lungs 9 (11%) and brain 3 (4%). There was no significant association between the initial Gleason risk grade with the site of metastasis (x2 3 =2.411, p=0.491). The spine was the most common site of metastases from prostate cancer in this series. The Gleason risk grade at diagnosis was not predictive of metastatic site.

13. Emmanuel Oyeyemi Oyekunle, Rachel Ibhade Obed, Bidemi Idayat Akinlade, Atara Ntekim (2015). Comparison of doses to the rectum derived from treatment planning system with in-vivo dose values in vaginal vault brachytherapy using cylinder applicators. J Contemp Brachytherapy 2015; 7, 6: 485-491.                                        Abstract: quality assurance (QA). This study compares calculated doses to the rectum with measured dose values as a means of QA in vaginal vault brachytherapy using cylinder applicators. Material and methods: At the Department of Radiotherapy, University College Hospital (UCH), Ibadan, Nigeria, intracavitary brachytherapy (ICBT) was delivered by a GyneSource high-dose-rate (HDR) unit with 60Co. Standard 2D treatment plans were created with HDR basic 2.6 software for prescription doses 5-7 Gy at points 5 mm away from the posterior surface of vaginal cylinder applicators (20, 25, and 30 mm diameters). The LiF:Mg, Ti thermoluminescent dosimeter rods (1 x 6 mm) were irradiated to a dose of 7 Gy on Theratron 60Co machine for calibration purpose prior to clinical use. Measurements in each of 34 insertions involving fourteen patients were performed with 5 TLD-100 rods placed along a re-usable rectal marker positioned in the rectum. The dosimeters were read in Harshaw 3500 TLD reader and compared with doses derived from the treatment planning system (TPS) at 1 cm away from the dose prescription points. Results: The mean calculated and measured doses ranged from 2.1-3.8 Gy and 1.2-5.6 Gy with averages of 3.0 ± 0.5 Gy and 3.1 ± 1.1 Gy, respectively, for treatment lengths 2-8 cm along the cylinder-applicators. The mean values correspond

to 48.9% and 50.8% of the prescribed doses, respectively. The deviations of the mean in-vivo doses from the TPS values ranged from –1.9 to 2.1 Gy with a p-value of 0.427.

Conclusions: This study was part of efforts to verify rectal dose obtained from the TPS during vaginal vault brachytherapy. There was no significant difference in the dose to the rectum from the two methods of measurements

14. Surajo Mohammed Aminu, Sani Ibrahim, Ahmed Adamu,Yawale Iliyasu, Mohammed Sani Shehu, John Idoko, Atara Ntekim, Khalid Zahir Shah and Mohammed Faruk (2015). Molecular Phylogenetic Analysis of Human Endogenous Retroviruses with Associated Malignancies. Journal of Cancer Biology & Research 3(2): 1060-1054 Abstract: Human Endogenous Retroviruses (HERVs) are remnants of ancient retroviral infections with similarities to exogenous retroviruses and make up 8% of the entire human genome. HERVs are found to play a role in carcinogenesis. We sought to analyze 37HERVs in relation to 16 types of cancers using phylogenetic analysis. HERVs nucleotide sequences were aligned and corrected manually. A neighbor-joining method was used to create a phylogenetic tree using CLUSTAL X2 version 2.1.0.0 algorithm. Two thousand (2000) replications were employed for bootstrap probabilities in creating the tree. The results obtained were systematically analyzed as they relate to different types of cancer. The phylogenetic analysis shows three main branches of HERVs. The first main branch was made up of HERV-H, HER-F, HERV-S71-related, ERV9, MSRV, HERV-K1.1, HERV-E, HERV-R, HERV-I, RTLVH, HERV-S and HRES-1. The second main branch was composed of HERV-T, HERV-P, HERV-FRD, HERV-KHTDV, and HERV-W. The third main branch contains majorly HERV-Ks family, HERV-L, HERV-P-T47D and XMRV. The HERV-Ks family is the most homologous among all the HERVs and also ubiquitous in terms of cancer tissues expression. The youngest sub-class of the HERV-Ks - HERV-K 133, and HERV-KHML 1.1, together with the widely debated XMRV were nested in the same group and present about 60% similarity. HERV-F and HERV-H present 70% similarity. HERV-S-71-Related, ERV9 and MSRV showed 100% similarity. Testing for HERVs, which phylogenetically present high sequence homology with each other, may help further research in the use of HERVs as an agent of immunotherapeutic target in cancer management.

15. Obajimi MO, Adeniji-Sofoluwe AT, Oluwasola AO,Adedokun BO, Mosuro OA, Adeoye AO, Ntekim A I. Soyemi T.O, Osofundiya O. O., O. S. (2015): Screening mammography in Ibadan: Our experience. Niger J Basic Clin Sci; 12: (2)74-80.                             Abstract: Background: Early detection is an essential step in decreasing the mortality and morbidity of breast cancer. Mammography is a proven effective tool for early breast cancer detection. It has high sensitivity and specificity and remains the gold standard for breast cancer screening. This study aims at describing the findings at screening mammography in women in Ibadan, South?West Nigeria. Materials and Methods: A prospective descriptive single centre study of 568 asymptomatic women who had screening mammography over a 5 year period (2006–2011) in the Department of Radiology, University College Hospital, Ibadan, Nigeria. Two views; the cranio?caudal and the medio?lateral oblique views were obtained. Mammographic findings were reported using the American College of Radiology Breast Imaging Reporting and Data System (BI?RADS) lexicon and assigned a final BI?RADS category according to overall findings. Data was analysed using Statistical Package for the Social Science SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago USA: SPSS Inc. Results: A total of 568 women participated in the study with age range from 22 to 82 years (mean 47.8 years). About a third (35.6%) of the women were post?menopausal; and a positive family history of breast cancer was reported in 28 (6.2%) women. The most frequent mammographic breast pattern was BI?RADS I (fatty replaced) in 181 (36.5%) women. Two hundred and twenty women had final BI?RADS category of two (benign), with 49% being fibroadenomas. Over 70% of 164 women called back for diagnostic work up absconded for various socioeconomic and religious factors. Nine women with suspicious breast masses were detected and had treatment constituted immediately. Conclusion: Mammography is just gaining ground in Nigeria; future increased patronage by women is anticipated with intense advocacy and widespread breast cancer awareness

16. Atara Ntekim (2016). Cervical Cancer in Human Immunodeficiency Virus (HIV) Positive Patients, Gynecologic Cancers - Basic Sciences, Clinical and Therapeutic Perspectives, Dr. Samir Farghaly (Ed.), Zagreb ; InTech ISBN: 978-953-51-4278-2, pp277-294.                                                                                                                   Abstract: The clinical management of cervical cancer in human immunodeficiency virus (HIV) positive patients is associated with challenges mainly due to the state of their immunity. They are managed like their HIV seronegative counterparts with surgery or chemoradiotherapy. HIV, cervical cancer, radiotherapy and chemotherapy lower immunity through reduction in CD4 cell counts. A perspective on the management of HIV positive patients with cervical cancer is hereby provided. Available studies were reviewed and peculiar characteristics of HIV patients with cervical cancer were examined. Strategies for managing such patients were identified. HIV positive patients are younger and have more aggressive disease. They have more treatment related toxicities, poorer disease control with higher rates of incomplete and treatment delays than their HIV negative counterparts. Highly active anti-retroviral therapy (HAART) improves treatment outcome in such patients. HIV positive patients with cervical cancer should be commenced on HAART at diagnosis. There should be closer monitoring of CD4 cell counts and viral load while on oncology treatment towards early recognition of need for prophylaxes against opportunistic infections. The dosage of the treatment modalities should also be adjusted according to CD4 cells count status. Possible interactions between antiretroviral therapy (ART) with chemotherapy and radiotherapy should not be overlooked.

17. Oladeji, A., Atalabi, O., Jimoh, M., Ntekim, I. & Elumelu, T. (2016). Delay in presentation of cancer patients for diagnosis and management: An institutional report. Int J Oncol 13, 10.5580. Abstract: Introduction: Cancer is a public health problem world-wide affecting all categories of persons and there is rising incidence in developing countries. Most cancer patients in developing countries present late with associated high mortality. Identifying causes of late presentation can assist in designing programs to minimize such. Objectives: This study was undertaken to measure total delays for presentation and to identify factors responsible for late presentation in patients with cancer. In addition, common places where patients with cancer related symptoms first seek help were identified. Methods: This was a cross-sectional survey of consecutive patients with advance staged cancer at the Radiotherapy Department of University College Hospital, Ibadan, Nigeria. Participants were patients with advance cancer (stages III & IV) who were seen at the department between June 2014 and May 2015. Information relevant to the study were collected using semi structured questionnaire. Results: A total of Two hundred and eighteen respondents participated in the study. Out of this number, 51 (23.4%) and 167 (76.6%) sought medical care within 3 months and over 3 months respectively after the discovery of first symptom of their cancer. The respondents gave multiple and varied reasons for presenting late for proper medical care, top on the list are lack of awareness of cancer symptoms as recorded for 134(61%) of the respondents., seeking after alternative care (48.2%), fear of diagnosis (45%) and the challenges of distance to available centers of treatment. Most responders 126 (58%) visited general practitioners first for consultation following onset of symptoms. Conclusion: The outcome of this study shows that most of our cancer patients (77%) experience significant total delays from time of symptoms to diagnosis and treatment. Prominent among the factors responsible for late delay is lack of awareness of cancer symptoms. Most of the patients sought initial help from their General Practitioners /Private Health Centers.

18. Atara Isaiah Ntekim, Oluyemisi Folake Folasire,  Ayorinde Mobolande Folasire  (2017): Prevalence of Malnutrition among Cancer Patients in a Nigerian Institution Journal of Analytical Oncology; 6: 117-124                                                                      Abstract: Background: Cancer is a major health problem. Successful management includes adequate supportive care. Nutritional problems are common among cancer patients and these are not routinely addressed by oncologists during oncology care leading to suboptimal outcome even in developed countries. In Nigeria and other low and medium income countries, the situation is worse as nutritional screening and assessment of cancer patients are not routinely carried out.Objectives: To determine the proportion of cancer patients at risk of malnutrition and compare convergence of risk assessment using SGA and MUST tools. Methods: This was a prospective study carried out among cancer patients who presented for cancer care in the Department of Radiation Oncology, University College Hospital Ibadan, Nigeria. Nutritional assessment tools which included Malnutrition Universal Scoring Tool (MUST) and Subjective Global Assessment (SGA) were used to assess the nutritional status of the participants. Results: A total of 89 patients aged between 18 and 85 years participated in the study. The number of males were 13 (15%) while females were 76(85%). In our study 54 (60.8%) of our patients were at risk of malnutrition using the malnutrition universal scoring tool (MUST) scale while 53(60%) were malnourished using the subjective global assessment (SGA) scale. The reliability for the classifications using the MUST and SGA scales was positive (moderate) [Kappa = 0.584 (p<0.0005), 95% CI (0.410, 0.758)]. Conclusion: There is a high proportion of clinical malnutrition among cancer patients in the study population. According to this study, there was similarity between the classifications of nutritional risk, using the MUST and SGA tools.

19. Adamu D. Bojude, Musa Ali-Gombe, Muhammed M. Manga, Atara I. Ntekim. Co-occurrence of Relapsed Pulmonary Tuberculosis and Breast Cancer Metastasis After Pregnancy and Lactation. Borno Medical Journal, July - December 2017, Volume 14, Issue 2. P237-240

20. Adamu D. Bojude, Musa Ali-Gombe, Aminu U. Usman, Atara I. Ntekim. (2017): Stage IIB Carcinoma of The Uterine Cervix In A Patient With Bilateral Pelvic Kidneys: A Radiotherapeutic Challenge. Borno Medical Journal, , Volume 14, Issue 2. P225-228. Abstract: Background: The occurrence of invasive cervical cancer in a patient with a congenital pelvickidney is a rare clinical condition that complicates the use of external beam radiotherapy to the pelvis for cervical cancer because the kidney(s) lies within the radiation field a situation associated with risk of radiation injury, nephritis and malignant hypertension. Objectives: To report a case of a lady with stage 2B cancer of the cervix who has bilateral pelvic kidneys. Case: A case of 45-year old para 6 lady with stage 2B cancer of the cervix and a bilateral pelvic kidney, she was managed with external beam radiotherapy (box technique), brachytherapy and chemotherapy. The pelvic kidneys were shielded from the radiation beam appropriately. Six years after treatment she was free of locoregional recurrence and distant metastasis, her blood pressure and renal function were normal. Conclusion: Chemoradiotherapy was offered to this patient after shielding of the pelvic kidneys. All patients with cancer of the cervix or pelvic tumours should have a thorough abdominopelvic examination before treatment to rule out and prevent unintended radiation injury to the kidney(s)

21. Anakwenze CP, Ntekim A, Trock B, Uwadiae IB, Page BR. Barriers to radiotherapy access at the University College Hospital in Ibadan, Nigeria. Clin Transl Radiat Oncol [Internet].2017;5:1–5.                                                                                    Abstract: Introduction: Nigeria has the biggest gap between radiotherapy availability and need, with one machine per 19.4 million people, compared to one machine per 250,000 people in high-income countries. This study aims to identify its patient-level barriers to radiotherapy access.

Material and methods: This was a cross sectional study consisting of patient questionnaires (n = 50) conducted in January 2016 to assess patient demographics, types of cancers seen, barriers to receiving radiotherapy, health beliefs and practices, and factors leading to treatment delay.

Results: Eighty percent of patients could not afford radiotherapy without financial assistance and only 6% of the patients had federal insurance, which did not cover radiotherapy services. Of the patients who had completed radiotherapy treatment, 91.3% had experienced treatment delay or often cancellation due to healthcare worker strike, power failure, machine breakdown, or prolonged wait time. The timeliness of a patient’s radiotherapy care correlated with their employment status and distance from radiotherapy center (p < 0.05).

Conclusions: Barriers to care at a radiotherapy center in a low- and middle-income country (LMIC) have previously not been well characterized. These findings can be used to inform efforts to expand the availability of radiotherapy and improve current treatment capacity in Nigeria and in other LMICs.

22. Faruk M, Ibrahim S, Adamu A, Rafindadi AH, Ukwenya Y, Iliyasu Y, Adamu A, Aminu SM, Shehu MS, Ameh DA, Mohammed A, Ahmed SA, Idoko J, Ntekim A, Suleiman AM, Shah KZ, Adoke KU. (2017) An analysis of dietary fiber and fecal fibre components including pH in rural Africans with colorectal cancer.  Intest Research -0001;0013 .                                                                                                                 Abstract: Background/Aims: Colorectal cancer (CRC) is now a major public health problem with heavy morbidity and mortality in rural Africans despite the lingering dietary fibre-rich foodstuffs consumption. Studies have shown that increased intake of dietary fiber which contribute to low fecal pH and also influences the activity of intestinal microbiota, is associated with a lowered risk for CRC. However, whether or not the apparent high dietary fibre consumption by Africans do not longer protects against CRC risk is unknown. This study evaluated dietary fiber intake, fecal fiber components and pH levels in CRC patients. Methods: Thirty-five subjects (CRC=21, control=14), mean age 45 years were recruited for the study. A truncated food frequency questionnaire and modified Goering and Van Soest procedures were used. Results: We found that all subjects consumed variety of dietary fibre-rich foodstuffs. There is slight preponderance in consumption of dietary fibre by the control group than the CRC patients. We also found a significant difference in the mean fecal neutral detergent fiber, acid detergent fiber, hemicellulose, cellulose and lignin contents from the CRC patients compared to the controls (P<0.05). The CRC patients had significantly more fecal pH level than the matched apparently healthy controls (P=0.017). Conclusions: The identified differences in the fecal fiber components and stool pH levels between the 2 groups may relate to CRC incidence and mortality in rural Africans. There is crucial need for more hypothesis-driven research with adequate funding on the cumulative preventive role of dietary fiber-rich foodstuffs against colorectal cancer in rural Africans

23.Wilfred Ngwa, Emmanuel Ikhile, Atara Ntekim, Nwamaka Lasebikan,Adewumi Alabi’  Uchechukwu N. Shagaya,Fatiregun Omolara,, Musa Ali-Gombe    Adamu Danladi Bojude, Mamsau Ngoma,  Twalib Ngoma, Madar Bhagwat, Omoruyi Credit Irabor, Jonathan Schoenfeld, Paul Nguyen,  Erno Sajo, Fran Laurie,  Janaki Moni, Thomas J. Fitzgerald,  Potential Role of the Quality Assurance Review Center Platform in Global Radiation Oncology. Int J Radiat Oncol. 2017;99(4):956-962.                        Abstract: Participants in the Global Health Catalyst summits at Harvard have repeatedly underscored a high level of interest by radiation oncology health professionals, including those in the African diaspora, for participating in global radiation oncology. The QARC provides an excellent platform for enabling or pooling such participation from anywhere in North America or Europe, with the goal of contributing to the growing field of global radiation oncology, for addressing the growing global burden of cancer and for tacking the disparities in cancer care between HICs and LMICs (21, 22). Multicenter clinical trials, even just among LMIC institutions, could be conducted by leveraging the QARC system. Combination treatments and new low-cost approaches for radiation therapy that can be used to treat many cancer patients in LMICs could also benefit from the use of the QARC services.

24. Jamil Jatto, Evaristus Oboh, Atara Ntekim (2017).   5-Fluorouracil Induced Cardiotoxicity in a Young Patient with Co¬lon Cancer: An Unusual Finding Journal of Oncology Research and Therapy 2017(3)  1-4    Abstract: Cardiotoxicity is a common side effect associated with some chemotherapeutic agents especially anthracyclines such as doxorubicin. It can however be associated with some antimetabolites such as 5-fluorouacil and methotrexate though in lesser degree. Our presentation is a case of 33-year-old female patient with colon cancer treated with 5-fluorouracil and oxaliplatin. She developed bradycardia (pulse rate 39bpm) while on 5-fluorouracil infusion necessitating discontinuation of the infusion. Subsequent 5-FU therapy was carried out with bolus intravenous injection in three dived daily doses and this was well tolerated. In cases of bradycardia following continuous infusion of 5-fluorouracil, bolus intravenous injection in divided doses might be tolerated

25. Aliyu, U. M., Folasire, A. M., & Ntekim, A. I. (2018). Treatment outcome of patients with nasopharyngeal carcinoma in Nigeria: An institutional experience. Precision Radiation Oncology, 2: 68-75                   Abstract: Objective: Nasopharyngeal carcinoma occurs worldwide. The incidence varies according to geographical region, with the highest incidence recorded in Asian countries. In Nigeria, the incidence of nasopharyngeal carcinoma is increasing. Thus, current treatment outcomes must be evaluated to identify areas of possible improvement in the management of this disease. The present study aimed to evaluate the treatment outcome after 2 years in patients with nasopharyngeal carcinoma. Methods: This was a retrospective study that used the records of patients treated for nasopharyngeal carcinoma at the University College Hospital, Ibadan, Nigeria, between 2000 and 2009. The treatment regimen of interest was radical concurrent chemoradiotherapy using cisplatin and 5-fluorouracil. Results: A total of 161 patients were included in the analysis, of which 113 (70%) were men and 48 (30%) were women. The mean age of the patients was 41.7 years (range 15–89 years). Ten (6.3%) patients presented with early-stage disease, whereas 149 (93.7%) had late-stage disease. The median survival timewas 22 months, and the overall disease-free survival rates were 67% and 46% at 12 and 24 months, respectively. Late side-effects included chronic otitis (n = 21, 13.2%), change in voice (n = 11, 6.8%), trismus (n = 7, 4.4%), neck and facial edema (n = 27, 16.7%), and neck fibrosis (n = 8, 4.9%). Conclusions: The treatment outcome in this study is worse than in previous studies in developed countries. This is likely because most patients presented with late-stage disease. Guidelines for the early diagnosis of nasopharyngeal carcinoma are required, and local studies on treatment regimens that can improve survival should be carried out.

26. Dairo, M. D., Adamu, D. B., Onimode, Y. A., Ntekim, A. & Ayeni, O. Characteristics and Determinants of Patients Discontinuation of Breast Cancer Follow-Up Care at the Radiation Oncology Department , University College Hospital , Ibadan , Nigeria. Int. J. Breast Cancer 2018, 1–9 (2018).  Abstract: Objectives.The aim of this study is to describe the characteristics and predictors of discontinuation during follow-up care among breast cancer patients at the Radiation Oncology Department, University College Hospital (UCH), Ibadan, Nigeria. Methodology:This is a retrospective cross-sectional study of 504 patients with histological diagnosis of breast cancer referred for radiotherapy to the breast or chest wall. Data extraction form was used to obtain information on sociodemographic and disease related variables and time to discontinuation of care. Discontinuation rates and its predictors were estimated using Kaplan-Meier, Log rank test, and Cox’s regression method of analyses. Results. Five hundred and four breast cancer patients were studied. The mean age was 47.7years, 58.2% presented late with advanced stage disease, and 40% and 39% had metastasis and anaemia, respectively. Seventyseven percent of patients discontinued follow-up care before completion of ten-year period.The 5-year and 10-year discontinuation rates were 69.8% and 92.6%, respectively. The median discontinuation time was 44 months. Discontinuers were more likely to be older than the age of 45years {HR=1.415; 95% CI= 1.044 - 1.917}, have metastasis {HR=1.793; 95% CI=1.396 - 2.302}, be anaemic {HR=1.404; 95% CI = 1.120 - 1.760)}, and have late-stage disease {HR=1.310; 95% CI = 1.407-1.639)}. Conclusion. Breast cancer care discontinuation is associated with late presentation and advanced stage of disease.Therefore a system of community follow-up care and public awareness about breast cancer symptoms is recommended to reduce late presentation and discontinuity of care.

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