Obi Ekwenna | The University of Toledo (original) (raw)

Papers by Obi Ekwenna

Healthcare, Feb 10, 2024

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

International Journal of Clinical and Experimental Medical Sciences, May 10, 2023

Transplantation Proceedings

Transplantation, Sep 1, 2022

Indian Journal of Urology, 2022

Clinical case reports and reviews, 2018

Background: Renal cell carcinoma (RCC) commonly metastasizes, and unusual sites of spread are cha... more Background: Renal cell carcinoma (RCC) commonly metastasizes, and unusual sites of spread are characteristic. However, metastatic RCC without an identified primary site is extremely rare, and only a few cases have been documented. We report the first case of clear cell RCC identified in retroperitoneal, supraclavicular, and mediastinal lymph nodes (LN) without a primary site in a kidney transplant patient. Case report: A 68-year-old patient presented with abdominal pain accompanied by weight loss, decreased appetite, and night sweats 6 months post female living donor kidney transplant. A CT scan revealed retroperitoneal, supraclavicular, and mediastinal lymphadenopathy. An excisional supraclavicular LN biopsy stained for markers consistent with RCC (pancytokertain, PAX8, CD10, and vimentin). Subsequent karyotyping revealed a female aneuploid cell line and raised suspicion for a donor derived RCC. A primary site for the RCC could not be identified on imaging of the native and allograft kidneys. The patient expired waiting for the pathology report, and an autopsy was performed to identify the origin of the RCC. Autopsy could not identify a primary site and cytologic studies indicated that the cell line was derived from the patient. Additional chromosomal abnormalities identified in the cytologic studies (loss of VHL, PBRM1, SETD2, BAP1, CDKN2A/B TP53) narrowed the diagnosis to clear cell RCC. Conclusion: Metastatic RCC can present without a primary site. IHC plays a vital role in making the diagnosis and cytologic studies can confirm the diagnosis and exclude the renal allograft as the origin in a kidney transplant patient.

Indian Journal of Urology

Healthcare, Feb 18, 2023

Cancer Medicine

BackgroundThe aim of this study is to evaluate the extent and associations with patient‐reported ... more BackgroundThe aim of this study is to evaluate the extent and associations with patient‐reported disruptions to cancer treatment and cancer‐related care during the COVID‐19 pandemic utilizing nationally representative data.MethodsThis analysis uses data from the 2020 National Health Interview Survey (NHIS), an annual, cross‐sectional survey of US adults. Adults (age >18) who reported requiring current cancer treatment or other cancer‐related medical care in the second half of 2020 were included. Estimated proportions of patients with self‐reported changes, delays, or cancelations to cancer treatment or other cancer care due to the COVID‐19 pandemic were calculated using sampling weights and associations with sociodemographic and other health‐related variables were analyzed.ResultsIn total, 574 (sample‐weighted estimate of 2,867,326) adults reported requiring cancer treatment and/or other cancer care since the start of the COVID‐19 pandemic. An estimated 32.1% reported any change,...

American journal of clinical and experimental urology, 2022

Bilirubin is a signaling molecule that alters the immune response and metabolism. While bilirubin... more Bilirubin is a signaling molecule that alters the immune response and metabolism. While bilirubin has been employed as a marker of renal and cardiovascular health, its role in renal transplant recipients is not known. In this study, we sought to determine the impact of bilirubin (total, direct and indirect) on the estimated glomerular filtration rate (eGFR) after renal transplantation. We conducted a retrospective review of pre- and postoperative bilirubin levels in 457 renal transplant recipients at a single center. Pre- and post-rejection bilirubin levels were also assessed in those patients who experienced a rejection episode. No statistically significant differences were found in bilirubin levels during the pre-transplant to post-rejection period among patients who experienced rejection with kidney allograft survival. No statistically significant associations were observed between baseline bilirubin and post-transplant eGFR in the full patient group or within the gender- or race...

Transplantation direct, Apr 21, 2022

Background. Established in 2013, the Open Payments Program (OPP) mandated that medical device and... more Background. Established in 2013, the Open Payments Program (OPP) mandated that medical device and pharmaceutical manufacturers submit record of any financial incentive given to physicians to the Centers for Medicare and Medicaid Services, which is in turn made publicly available. This study aims to characterize these payments to transplant surgeons over the first 6 y of OPP data. Methods. The study sample included all physicians who received at least one nonresearch payment as transplant surgeons to the OPP. To capture transplant surgeons who may be listed under their pipeline specialty, the American Society of Transplant Surgeons member directory as of January 2021 was queried. Payments were analyzed temporally, geographically, and by payment type, physician, and industry payer. Results. In total, payments totaling 15661536weremadeto1335transplantsurgeonsoverthestudyperiod.Themeanpaymentwas15 661 536 were made to 1335 transplant surgeons over the study period. The mean payment was 15661536weremadeto1335transplantsurgeonsoverthestudyperiod.Themeanpaymentwas436.90 (SD, 1760),andthemedianpaymentwas1760), and the median payment was 1760),andthemedianpaymentwas52.94 (interquartile range, 18.29–18.29–18.29–159.80). The top contributing companies were Intuitive Surgical, Inc.; Gilead Sciences, Inc.; and Novartis Pharmaceuticals. Only 5.3% ($827 236) was paid toward faculty or as a speaker for a nonaccredited and noncertified continuing education program and honorarium. Educational payments came in at 1233141(7.91 233 141 (7.9%) over the study period. 1233141(7.913 750 828.60 (87.8%) of the payments were for other categories (consulting fees, food and beverages, etc). Organ transplant and procurement region 7 and 8 transplant surgeons received the highest median payments during the study period. Conclusions. This study is the first to characterize the payments made to transplant surgeons since the passage of the Sunshine Act. Further studies are needed to understand and interpret the relationship between industry and transplant surgeons, as the payments may or may not translate to influence in medical decisions or use of medical devices. Precis: The Open Payments Program (OPP), established in 2013, mandates that medical device and pharmaceutical manufacturers submit record of any financial incentive given to physicians to the Centers for Medicare and Medicaid Services. This study aims to characterize these payments to transplant surgeons over the first six years of OPP data.

Translation: The University of Toledo Journal of Medical Sciences, 2021

Background: Striking disparity exists in the incidence and treatment of chronic kidney disease (C... more Background: Striking disparity exists in the incidence and treatment of chronic kidney disease (CKD) secondary to individual social determinants of health. Additionally, the uninsured, minority racial-ethnic groups, and Medicaid enrollees receive less nephrology care prior to being diagnosed with end-stage renal disease (ESRD). The most effective treatment for the management of kidney failure is kidney transplantation. This review addresses how social determinants of health impact the workup for patients with ESRD, with emphasis on the kidney transplant process. Methods: A search was conducted via multiple online databases (MedLine, PubMed, etc.) for articles that addressed the interplay between CKD, ESRD and kidney transplantation with the social determinants of health. Findings: The impact of the social determinants of health on CKD, ESRD, and the kidney transplantation process can be qualitatively and quantitatively measured using the five categories of education, health car...

Gynecologic Oncology, 2021

• There is a lack of diversity in gynecologic oncology fellowships in the US. • Gynecologic oncol... more • There is a lack of diversity in gynecologic oncology fellowships in the US. • Gynecologic oncology representation is lower than other specialties. • Black and Hispanic fellows bear most of the representation disparity. • Interventions to increase diversity are necessary to ensure proper care.

Transplantation Proceedings, 2022

Outcomes of vaccination against SARS-COV-2 in organ transplant recipients are unclear. Recent stu... more Outcomes of vaccination against SARS-COV-2 in organ transplant recipients are unclear. Recent studies have investigated outcomes for patients who are several years post-transplant. There hasn't been much data in peri-transplant patients. This is important because patients are highly immunosuppressed during this period due to induction immunosuppression and thus susceptible to infection. We looked at 6 patients who were transplanted at our center after receiving their first dose of mRNA vaccines. We assessed their antibody response after one, two and in a few cases, three doses of the vaccine. Two patients received their third booster dose, one of whom had a detectable antibody level after the third dose. We report that the overall antibody response to vaccination was weaker in transplant patients compared to the general population with a rapid attrition of antibody response over time. There is a need for more studies which follow-up antibody levels in transplant patients over time, especially those in the peri-transplant period to help guide the vaccination plan and frequency for immunosuppressed transplant patients.

International Urology and Nephrology, 2021

Current American Urological Association guidelines recommend pre-operative antimicrobial therapy ... more Current American Urological Association guidelines recommend pre-operative antimicrobial therapy based on prior urine cultures (UC); however, the role of stent culture (SC) in urologic practice is unclear. We examined whether UC and SC differed at the time of stent removal, as well as the association, microbiology, and timing of subsequent UTIs as related to SC. This was a retrospective review of 159 patients with ureteral stents for indications of urolithiasis, benign stricture, malignant obstruction, and kidney transplant. UC and SC were analyzed at the time of stent removal. Patients were followed for 12 months after stent removal for development, concordance, and timing of clinical UTIs. In 159 patients, 15% had positive UC and 45% had positive SC. Of patients who had positive SC, 66% had negative UC. All patients with positive UC had identical micro-organisms on SC; however, 33% of these had SC with additional micro-organisms. Relative to those with both negative UC and SC, patients with negative UC and positive SC had a 5.7 odds, and those with both positive UC and SC had a 13.6 odds of developing a clinical UTI within 12 months. Concordance of SC and future UTI was highest in those with post-operative sepsis, and those with Candida species on SC. SC was a unique risk factor for development of UTI within 12 months of stent removal. Clinicians should consider SC results when empirically treating those with post-operative sepsis or those with UTI after Candida on SC.

Kidney International Reports, 2021