West Africa Journal of Medicine

EDITORIAL: Beyond the Cure: Advancing Towards Holistic Oncology Care Through Multidisciplinary Interventions

2025-06-25T12:59:44+00:00

Beyond the Cure: Advancing Towards Holistic Oncology Care Through Multidisciplinary Interventions

I warmly welcome you to this latest edition of our journal—an issue that promises to be engaging and thought-provoking. We are confident that the diverse range of articles and perspectives presented here will offer valuable insights and stimulate meaningful reflection among our global readership. We deeply appreciate the collective efforts of all our stakeholders—authors, reviewers, editorial board members, administrative staff and the college leadership—whose dedication and collaboration have made this edition possible. Your unwavering commitment to scholarly excellence ensures that the journal continues to serve as a credible and enriching platform for the exchange of ideas, research findings, and innovations in healthcare.

In recent decades, significant progress has been achieved in the diagnosis and treatment of cancer, leading to enhanced survival rates and increasing hope for patients globally. Nevertheless, these advancements have not been without their drawbacks. These include the significant adverse impacts of chemotherapy, radiotherapy, and other contemporary oncological treatments—side effects that can severely affect the quality of life for patients and potentially undermine the overall effectiveness of the treatment. (1)

In this issue of the journal, a number of articles explored some of the often-overlooked complications, with a particular emphasis on the oral and cardiac toxicities that can occur during and after cancer treatment. They highlight not only the prevalence and complexity of these complications, but also the emerging tools—both technological and conceptual—that hold promise for earlier detection, risk assessment, and personalized intervention. Importantly, these contributions emphasize the necessity of interdisciplinary collaboration and context-specific research in settings with limited resources.

The study by Mogaji et al. shines a much-needed spotlight on a frequently under-recognized complication of cancer chemotherapy—oral changes that significantly impair quality of life and may compromise treatment outcomes. Among the 82 participants involved in the study in a Nigerian tertiary health facility, over half reported severe symptoms, including dysgeusia, oral pain, and mucositis. These statistics not only reflect a high incidence but also align with global prevalence trends, highlighting the widespread nature of this issue. Importantly, the study revealed that mucotoxic agents, particularly those based on methotrexate, along with solid tumours, significantly elevated the risk of severe mucositis. Remarkably, the association between solid tumours and oral changes was found to be stronger than that with haematological malignancies, a revelation that challenges existing beliefs and emphasizes the importance of conducting context-specific research across varied populations.

Of particular concern is the high prevalence of fungal infections in patients with mucositis, which underscores the need for robust infection control and prophylactic measures. The absence of significant associations with age, cancer type, or treatment duration suggests that all patients are at risk and should be proactively monitored. There is a need for integration of structured oral assessments into routine oncology care, backed by multidisciplinary collaboration and strong policy support to ensure oral health is prioritized in cancer management, particularly in resource-constrained settings.

In their insightful review, Otakhoigbogie et al. highlight the growing interest in metabolomics as a promising tool in managing oral mucositis (OM). The development of oral mucositis is driven by factors like oxidative stress, immune responses, and infection. Traditional treatments mostly focus on symptom relief but often fall short because the condition is complex and varies between individuals. Metabolomics involves studying small molecules in the body to understand disease processes more precisely. (2) This approach can help identify early biochemical changes that signal the onset or severity of OM, even before symptoms appear. Such early detection could allow doctors to adjust treatments or begin preventive care sooner. It could also help monitor the condition in real-time during therapy.

Beyond diagnosis and monitoring, metabolomics may guide the development of better, more targeted drugs that treat the root causes of OM rather than just relieving pain. Though still emerging, this field holds great promise for improving outcomes and personalizing care for cancer patients suffering from this debilitating condition. (2, 3) As emphasized by the authors, metabolomics is a potentially transformative tool in the management of chemotherapy and radiotherapy-induced oral mucositis. As we continue to move toward precision oncology, integrating metabolomics into clinical workflows holds the promise of not only alleviating patient suffering but also enhancing the efficacy and tolerability of cancer treatments.

In a similar vein, the use of medical technology in early detection of chemotherapy-related complications in breast cancer treatment was studied by Orimolade et al. The study provides valuable insight into the early detection of anthracycline-induced cardiotoxicity using 2D speckle tracking echocardiography (STE) in Nigerian breast cancer patients. It followed up 62 women undergoing anthracycline-based chemotherapy and compared them with matched healthy controls. Through serial echocardiographic assessments, the researchers tracked heart function over three months. They found that more than half of the patients showed early signs of heart damage, even though they had no symptoms. Importantly, changes in global longitudinal strain (GLS) appeared before drops in the more commonly used measure—left ventricular ejection fraction (LVEF). This shows that STE is more sensitive and effective for spotting early heart injury. The study highlights the need for regular heart monitoring during chemotherapy, using advanced tools like STE, to detect problems early and prevent long-term damage in cancer survivors. (4, 5)

A key takeaway from the study is that, as cancer treatments become more effective and survival rates increase, equal attention must be given to protecting long-term heart health. It is essential to prioritize the early identification of cardiac complications alongside the implementation of strategies aimed at preserving cardiac function, ensuring that patients not only survive but also maintain a high quality of life following treatment. (5)

The case report presented by Alburqueque-Melgarejo et al. provides a significant and cautionary narrative regarding the cardiotoxic effects resulting from repeated chemotherapy in a patient diagnosed with non-Hodgkin lymphoma (NHL). The case highlights a critical issue in contemporary oncology: the need to find a balance between aggressive treatment approaches and the long-term safety of cardiovascular health. The authors emphasized the need for increased attention to the prevention, diagnosis, and management of cardiovascular complications associated with cancer treatments. Multidisciplinary collaboration between oncologists and cardiologists is crucial, especially in resource-limited settings where cardiac complications may go unrecognized until late stages.

These contributions highlight the importance of recognizing that the burden of complications arising from oncological care should not be regarded as secondary. Rather, they deserve equal attention in research, policy, and practice. It is clear that the future of oncology lies not only in curing cancer but also in caring for the whole patient—before, during, and long after treatment ends. This calls for investment in supportive care infrastructure, adoption of emerging technologies for early toxicity detection, and the fostering of multidisciplinary teams that place patient-centered care at the heart of every treatment plan. (4-6)

We sincerely acknowledge and commend the authors whose diligent efforts, insightful research, and unwavering commitment have been instrumental in shaping this edition. We look forward to more submissions from authors in our sub-region and from across the globe.

Prof G.E Erhabor

Editor-in-Chief

References

Anand U, Dey A, Chandel AK, Sanyal R, Mishra A, Pandey DK, De Falco V, Upadhyay A, Kandimalla R, Chaudhary A, Dhanjal JK. Cancer chemotherapy and beyond: Current status, drug candidates, associated risks and progress in targeted therapeutics. Genes & diseases. 2023;10(4):1367-401.
Qiu S, Cai Y, Yao H, Lin C, Xie Y, Tang S, Zhang A. Small molecule metabolites: discovery of biomarkers and therapeutic targets. Signal Transduction and Targeted Therapy. 2023;8(1):132.
Pinto J, Troisi J. Metabolomics in personalized cancer medicine. Frontiers in Molecular Biosciences. 2025;12:1593877.
Guo X, Zhang N, Wang N, Zhang Y, Liu Y, Pei M, et al. Early detection of chemotherapy-induced cardiotoxicity in breast cancer patients: a comprehensive analysis using speckle tracking echocardiography. Frontiers in Cardiovascular Medicine. 2024;11:1413827.
Curigliano G, Lenihan D, Fradley M, Ganatra S, Barac A, Blaes A, et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Annals of Oncology. 2020;31(2):171-90.
Anakwue R. Cytotoxic-induced heart failure among breast cancer patients in Nigeria: A call to prevent today’s cancer patients from being tomorrow’s cardiac patients. Annals of African medicine. 2020;19(1):1-7.

Coronary Cameral Fistula in a Nigerian Adult with Chest Pain: A Rare Cause of Angina

2025-09-07T10:28:27+00:00

Background: Coronary artery fistulas (CAFs) are rare defects in the coronary circulation with majority being asymptomatic. A coronary cameral fistula (CCF) is a type of CAFs with an abnormal communication with a cardiac chamber. It is often diagnosed while patients are being investigated for coronary artery disease and diagnosis requires high index of suspicion especially in patients with angina with no obstructive lesions. Symptomatic cases have variable clinical manifestation which depends on the size, origin and drainage site. Coronary computerised tomographic angiography (CCTA) has emerged as investigation of choice in investigating CAFs due to its high spatial and temporal resolution facilitating accurate assessment of the complex anatomy of CAFs. Treatment strategy for CCF is individualised with consideration for its symptomatology, haemodynamic significance and potential complication. Early diagnosis and treatment can improve outcomes in symptomatic patients.

Case report: We report the first case of coronary cameral fistula in Nigeria diagnosed by angiography and confirmed by coronary CTA. The patient was managed conservatively with antiplatelets and long-acting nitrates and monitored closely at outpatient follow up.

Keywords: Angina; Computerised tomographic angiography; Coronary artery disease; Coronary camera; Fistula; Nigeria.

Kartagener Syndrome: A First Report of Two Cases from Benin, West Africa

2025-09-07T10:35:07+00:00

BACKGROUND: Kartagener Syndrome is a rare autosomal recessive genetic disorder, belonging to the larger group of diseases of primary ciliary dyskinesia, including situs inversus. This underdiagnosed disease, especially in developing settings, may be potentially responsible for the impairment of the quality of life of patients and can even be life-threatening. We report on two patients with this condition in Benin, in whom the diagnosis had not previously been made, despite a long history of upper and lower respiratory symptoms. The patients were admitted with complications, a superinfection of bronchiectasis complicated by pneumonia and purulent pleurisy in a 30-year-old male and by a refractory hypoxemia, acute pulmonary heart disease in another 32-year-old male. Treatment outcome was favourable in the first case, but less satisfactory in the second one.

Keywords: Complications; Parakou; Primary ciliary dyskinesia; Situs inversus.

Cardiotoxicity in a Patient with Multiple Relapses of Non-Hodgkin Lymphoma

2025-09-07T10:43:11+00:00

Background: Chemotherapy-induced cardiomyopathy is one of the most important adverse effects in cancer treatment. Many chemotherapeutic agents are known to be cardiotoxic, including anthracyclines, monoclonal antibodies, alkylating agents, and protein kinase inhibitors.

Objective: It is intended to indicate a mechanism of multiple cardiac injury after exposure to various chemotherapeutic agents with cardiotoxic potential. This article illustrates the case of a 70-year-old male patient diagnosed with non-Hodgkin's lymphoma with multiple relapses and malignant transformation to diffuse large B-cell lymphoma who received multiple cycles of chemotherapy with periods of complete remission, who presented to the hospital emergency with decompensated reduced ejection fraction heart failure (EF:40%).

Results: During the hospitalization the patient suffered refractory electrolyte imbalances and hospital-acquired infections. Although the patient received hypertonic saline solution, multiple potassium challenges, and extended spectrum antibiotics, the patient passed away.

Conclusion: Exposure to different chemotherapeutic agents with cardiotoxic potential included in non-Hodgkin lymphoma treatment schemes can trigger myocardial injury by different mechanisms. Cardiooncology is a field that is emerging and working on new strategies for the diagnosis, prevention, and management of chemotherapy-induced cardiotoxicity.

Keywords: Cardiomyopathies; Cardiotoxic Agents; Drug Therapy; Lymphoma; Non-Hodgkin Lymphoma; Recurrence.

Global Insights into the Impact of Endothelial Dysfunction on Coronary Artery Disease: A Systematic Review

2025-09-07T10:10:28+00:00

Background: Coronary artery disease (CAD) is a major global health issue, especially in low- and middle-income countries (LMICs). The dysfunction of the vascular endothelium plays a critical role in CAD progression.

Objectives: This systematic review evaluated existing literature on the role of endothelial dysfunction in the progression of CAD.

Methods: The review protocol was registered with PROSPERO (CRD42024539722). A comprehensive literature search identified 70 relevant articles. After removing 15 duplicates, 55 studies were screened based on title and abstract, leading to the exclusion of 35 articles that did not meet the inclusion criteria. Finally, 15 studies, encompassing a total of 3,673 subjects (with individual study sample sizes ranging from 14 to 936, and a median of 106), were included in the review.

Results: The 15 studies (3,673 subjects, 1998-2023) included 9 cross-sectional, 5 cohort, and 1 retrospective study. CAD diagnosis was confirmed via angiography (10 studies) or other methods like stress ECG and cardiac enzymes. Endothelial dysfunction was assessed using FMD (8 studies) and other techniques. Five studies linked endothelial dysfunction to CAD severity, while cohort studies suggested its role in predicting adverse cardiovascular events, even with normal angiograms.

Conclusion: This systematic review highlights the crucial role of endothelial function in CAD and emphasizes the importance of endothelial function in risk assessment, early detection, and guiding treatment decisions in CAD.

Keywords: Brachial artery flow-mediated dilatation; Coronary artery disease; Endothelial dysfunction.

Chemotherapy and Radiotherapy-Induced Oral Mucositis: The Potentials of Metabolomics in the Management

2025-09-07T10:21:45+00:00

Background: Oral mucositis (OM) is a debilitating complication commonly experienced by patients undergoing chemotherapy and/or radiotherapy for head and neck cancers. The pathogenesis of OM involves multifaceted interplay of inflammatory, immune, and cellular damage pathways triggered by cancer therapy. The pathogenesis of OM can be delineated into five overlapping phases: initiation, signaling, signal amplification, ulceration, and healing.

Metabolomics: The large-scale study of metabolites which are small molecules involved in cellular processes, has emerged as a powerful tool in understanding complex conditions like oral mucositis (OM). This detailed literature review synthesizes current knowledge on the metabolomics of OM, with a focus on its application to understanding the pathogenesis, identifying predictive biomarkers, and exploring therapeutic strategies.

Conclusion: The field of metabolomics has revolutionized the understanding of oral mucositis by providing a dynamic snapshot of the metabolic alterations associated with it. It is a powerful tool for identifying potential biomarkers for early diagnosis, monitoring, and treatment optimization.

Keywords: Chemotherapy; Metabolomics; Oral mucositis; Radiotherapy.

Chemotherapy-Induced Oral Changes in Cancer Patients: Prevalence, Types, and Risk Factors in a Nigerian Tertiary Health Facility

2025-09-07T08:37:23+00:00

Background: Chemotherapy-induced oral changes are common complications after receiving chemotherapy. These complications are often not prioritized in clinical practice, particularly in resource-limited settings like Nigeria. However, they impact patients' quality of life and overall treatment outcomes This study determined the prevalence and types of chemotherapy-induced oral changes, the relationship between chemotherapeutic agents and oral changes, and the associated risk factors.

Audit of Operative Site Marking Practice in a Tertiary Hospital in Nigeria: A Key Step in Patient Safety

2025-09-07T08:44:49+00:00

Background: Wrong-site surgery (WSS) is the most frequent sentinel event, accounting for 13.4 % of all sentinel events, with an incidence of 0.09 - 4.5 per 10,000 surgeries. Adherence to recommendations for surgical site marking to prevent WSS remains poor, with paucity of data on WSS due to underreporting.

Methods: The first institutional audit of preoperative site marking in Nigeria was prospectively conducted in the 11 surgical and obstetrics and gynecology units of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, between March-April 2024. Data obtained was analysed using the Statistical Product and Service Solutions (SPSS) version 25. Associations between surgical characteristics and operative site marking were ascertained using chi square, with the level of significance set at a P value of <0.05.

Results: Surgical site marking was done for only 36.4 % of surgeries involving laterality. Surgical site was marked in 90.2 % of cases by junior resident doctors (RDs) and nurses, and paper tape was used for marking in 92.2 % of cases. There were significant associations between surgical site marking and surgical specialty (P<0.001) and urgency of surgery (P=0.001), with ophthalmology (94.0 %) and general (17.6 %) surgeries, elective surgeries (41.8 %), consultant/attending-led surgeries (41.1 %), and major surgeries (43.8 %) involving laterality being significantly more likely to be marked compared to emergency (0.0 %), RD-led (29.3 %) and minor (30.3 %) surgeries.

Conclusion: The practice of surgical site marking in OAUTHC is low. There is need for institutional and national protocols on surgical site marking and the education of surgical and theatre staff on its benefits, to engender a change of practice for patient safety.

Early Detection of Anthracycline-Induced Cardiotoxicity in Female Breast Cancer Patients Using Speckle Tracking Echocardiography in an African Tertiary Institution

2025-09-07T09:26:10+00:00

Background: Although, survival rates have improved in breast cancer care, cardiotoxicity from chemotherapy used for breast cancer has emerged as an important cause of morbidity in these individuals. This study evaluated early myocardial dysfunction using two-dimensional (2D) speckle tracking echocardiography in breast cancer patients treated with anthracyclines.

Methodology: Sixty-two patients with anthracycline naïve breast cancer and 62 controls were studied. All patients were treated with standard regimens containing epirubicin. Echocardiography was done at three time points (baseline, one month and three months). Left ventricular ejection fraction and global longitudinal strain were measured.

Results: The mean age of the subjects was 47.6±10.46 years, obesity was the most common co-morbidity (27.4%) followed by hypertension (14.5%). Over the three month-follow-up period, the left atrial volume increased from 21.4±6.90mls/m2 at baseline to 24.8±6.38mls/m2, the mean left ventricular ejection fraction decreased from 62.4±9.35% at baseline to 54.8±7.22%, and the average left ventricular global longitudinal strain decreased from -19.0±5.91% at baseline to -16.1±3.70% by three month-follow-up. The percentage change in GLS at one month was 15.98% compared to 4.06% change in ejection fraction at one month follow-up. Thirty-five patients (56.5%) developed cardiotoxicity; however, no significant predictor of cardiotoxicity was noted.

Conclusion: This study showed reduced left ventricular ejection fraction, reduced left ventricular global longitudinal strain, and increased left atrial volume over a period of three months in breast cancer patients treated with anthracycline-based chemotherapy. It also confirms the usefulness of speckle tracking echocardiography in evaluating breast cancer patients pre-, intra-, and post-chemotherapy.

Keywords: 2D speckle trackingechocardiography; Anthracycline cardiotoxicity; Anthracycline-induced cardiotoxicity; Left ventricular ejection fraction; Leftventricular global longitudinal strain.

Primary and Delayed Primary Wound Closure in Low Energy Open Tibia Shaft Fracture: Randomized Controlled Study

2025-09-07T09:38:55+00:00

Background: Traditionally, delayed primary and secondary wound closure are commonly used for the treatment of open fractures especially before the advent of modern antibiotics. Despite the availability of antibiotics, primary wound closure is still not frequently used even for the treatment of low-energy open tibia shaft fractures especially in developing countries.

Materials and methods: Sixty-four patients with GustiloAnderson type I and II tibia fractures were recruited for this randomized prospective intervention study to compare the infection rate, duration of wound healing, duration of hospital stay, and cost of treatment between primary and delayed primary wound closure. We randomized 68 patients into two blocks of 34 participants each using a randomization plan generated on the website, randomization.com. Each random number in a sealed serially numbered brown envelope. Clinical information and clinical findings were entered into a proforma, and data obtained were analyzed.

Results: The majority of cases, 54 (84.4%), were Gustilo-Anderson type II. The infection rate was higher for primary wound closure (9.6%) than for delayed primary wound closure (3.0%). The mean duration of wound healing was 14.8 (±3.8) days for primary wound closure, which was significantly shorter than the 16.1 (±2.0) days recorded for delayed wound closure (p= 0.08). Also, the mean duration of hospital stay was shorter for patients treated with primary wound closure (4.1 ±3.6) days than for delayed wound closure patients 4.7 (±1.3); with a p value of 0.37. The mean cost of treatment for primary wound closure (N34,487 ±4911.4) was significantly less than that for delayed primary wound closure (N 40,536 ±1709.0), with a p-value of 0.01.

Conclusion: Primary wound closure for low-energy open tibia shaft fractures is both more cost-effective and associated with a shorter time to wound healing compared to delayed primary closure. Therefore, primary wound closure should be used for low energy tibia shaft fracture even in low and middle-income countries. KEY WORDS: Open fracture, Tibia shaft, Wound closure, Management.

Keywords: Management; Open fracture; Tibia shaft; Wound closure.

Blood Pressure and Associated Risk Factors for Hypertension in Children with Sickle Cell Anaemia Attending University of Nigeria Teaching Hospital, Enugu, South-East Nigeria

2025-09-07T09:53:08+00:00

Introduction: Sickle Cell Anaemia (SCA) is the homozygous state of heamoglobin SS gene. It is highly prevalent in Sub-saharan Africa with Nigeria ranking highest for people living with the disease. Blood pressure recording in individuals with SCA has been known to be influenced by certain factors such as age, sex, body mass index and hemoglobin level.

Aim: The study seeks to examine the relationship of certain pre-selected factors -age, gender, body mass index, disease severity and microalbuminuria/proteinuria on the blood pressure of children with SCA and document the relationship (if any) between above factors and the blood pressure readings of Nigerian children with SCA.

Methodology: A cross-sectional hospital-based study that consecutively recruited 106 children with sickle cell anaemia (HbSS) aged 3-17 years in steady state as well as age and sex-matched controls with HbAA genotype. Sociodemographic, clinical and anthropometric parameters were obtained. Severity of the disease and renal complication were assessed using Adeleke scoring method and microalbuminuria/ proteinuria assay. Subjects in crisis or had crisis in the past 4 weeks or genotype HbSC were excluded. For controls (genotype AA), those on management for congenital heart disease (CHD), hypertension and renal pathology were excluded.

Results: Weight and body mass index (BMI) were significantly lower in subjects compared to controls (p = 0.010 & 0.029 respectively). In subjects, the most common clinical attributes at presentation was bone pain (31.1% subjects), previous hospital admission (74.5%) and known steady state PCV (33.9%). Most of the subjects (87.74%) had mild SCA disease severity. Only two subjects (1.8%) had elevated BP while one subject (0.9%) had hypertension.Microalbuminuria (28.2%) and proteinuria (13.2%) were seen in subjects. While one control had elevated BP, none had hypertension. There was an initial positive relationship between increasing age (p= 0.007), low BMI (p= 0.008), presence of microalbuminuria/ proteinuria (Renal injury) p= 0.03 and raised blood pressure,but none of these associations was found to be an independent predictor of hypertension.

Conclusion/ recommendation: Elevated diastolic blood pressure and diastolic hypertension in children with SCA were shown to have an initial positive association with increasing age, low BMI and renal injury. These should be guarded against by instituting screening program and measures to stall progression.

Keywords: Blood pressure; Children; Sickle cell anaemia.