12 research outputs found

    Rapid, minimally invasive adult voluntary male circumcision: A randomised trial of Unicirc, a novel disposable device

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    Background. Voluntary medical male circumcision (VMMC) is a priority HIV preventive intervention. To facilitate VMMC scale-up, the World Health Organization is seeking circumcision techniques that are faster, easier, and safer than open surgical methods.Objective. To compare open surgical circumcision with suturing v. the Unicirc disposable instrument plus tissue adhesive.Methods. We conducted a non-blinded randomised controlled trial at an outpatient primary healthcare clinic in Cape Town, South Africa, with 2:1 allocation ratio of 150 male volunteers who were at least 18 years of age. Our primary outcome was intraoperative time and secondary outcomes were ease of performance, post-operative pain, adverse events, time to healing, patient satisfaction and cosmetic result. Results. The intraoperative time was less with the Unicirc/adhesive technique (median 13 v. 22.6 min, respectively; p<0.001). The intraoperative suturing rate was 17% using the Unicirc device. Other adverse events and wound healing outcomes were similar in both groups, but the cosmetic result was superior in the Unicirc group. Doctors found the Unicirc procedure easier to perform and preferred it to the open surgical technique. Conclusions. This study has important implications for the scale-up of VMMC services. Excising the foreskin with the Unicirc instrument and sealing the wound with cyanoacrylate tissue adhesive in adults is quicker, easier to learn, and is potentially safer than open surgical VMMC. Further studies should be conducted with the optimised device. This new instrument has the potential to facilitate more rapid scale-up and save costs.

    Success brings new challenges in circumcision campaign

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    Rapid, minimally invasive adult voluntary male circumcision : a randomised trial of Unicirc, a novel disposable device

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    CITATION: Millard, P. S., Wilson, H. R., Goldstuck, N. D. & Anaso, C. 2014. Rapid, minimally invasive adult voluntary male circumcision: a randomised trial of Unicirc, a novel disposable device. South African Medical Journal, 104(1):52-57, doi:10.7196/SAMJ.7357.The original publication is available at http://www.samj.org.zaBackground. Voluntary medical male circumcision (VMMC) is a priority HIV preventive intervention. To facilitate VMMC scale-up, the World Health Organization is seeking circumcision techniques that are faster, easier, and safer than open surgical methods. Objective. To compare open surgical circumcision with suturing v. the Unicirc disposable instrument plus tissue adhesive. Methods. We conducted a non-blinded randomised controlled trial at an outpatient primary healthcare clinic in Cape Town, South Africa, with 2:1 allocation ratio of 150 male volunteers who were at least 18 years of age. Our primary outcome was intraoperative time and secondary outcomes were ease of performance, post-operative pain, adverse events, time to healing, patient satisfaction and cosmetic result. Results. The intraoperative time was less with the Unicirc/adhesive technique (median 13 v. 22.6 min, respectively; p<0.001). The intraoperative suturing rate was 17% using the Unicirc device. Other adverse events and wound healing outcomes were similar in both groups, but the cosmetic result was superior in the Unicirc group. Doctors found the Unicirc procedure easier to perform and preferred it to the open surgical technique. Conclusions. This study has important implications for the scale-up of VMMC services. Excising the foreskin with the Unicirc instrument and sealing the wound with cyanoacrylate tissue adhesive in adults is quicker, easier to learn, and is potentially safer than open surgical VMMC. Further studies should be conducted with the optimised device. This new instrument has the potential to facilitate more rapid scale-up and save costs.http://www.samj.org.za/index.php/samj/article/view/7357Publisher's versio

    Sutureless adult voluntary male circumcision with topical anesthetic: a randomized field trial of Unicirc, a single-use surgical instrument

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    Introduction The World Health Organization has solicited rapid and minimally invasive techniques to facilitate scale-up of voluntary medical male circumcision (VMMC). Study design Non-blinded randomized controlled field trial with 2:1 allocation ratio. Participants 75 adult male volunteers. Setting Outpatient primary care clinic. Intervention Open surgical circumcision under local anesthetic with suturing vs. Unicirc disposable instrument under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive. Primary Outcome Intraoperative duration. Secondary Outcomes Intraoperative and postoperative pain; adverse events; time to healing; patient satisfaction; cosmetic result. RESULTS: The intraoperative time was less with the Unicirc technique (median 12 vs. 25 min, p < 0.001). Wound healing and cosmetic results were superior in the Unicirc group. Adverse events were similar in both groups. CONCLUSIONS: VMMC with Unicirc under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive is rapid, heals by primary intention with superior cosmetic results, and is potentially safer and more cost-effective than open surgical VMMC. Trial Registration Clinicaltrials.gov NCT0244379

    Circumcision Clamps for Adults

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    Circumcision is one of the surgical interventions with the longest historical tradition for various medical or non-medical, religious and social, reasons. Due to a high demand for this surgery, in recent years, a large number of plastic and disposable devices have emerged in order to optimize the technique. Although they were initially used in newborns and children, their use in recent years has been expanding to adults. The main objectives of these devices are to shorten the surgical time, simplify the technique, and maintain an adequate safety profile compared to the classic suture technique. All reviewed devices for adult circumcision appear to achieve these goals, making them a safe, fast, and feasible option for use in an outpatient setting or in high-demand areas

    Success brings new challenges in circumcision campaign

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    The Emergence of Multiple-Text Manuscripts

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    Selecting and excerpting, summarizing and canonizing, arranging texts and visual signs in manuscripts appear to be universal practices. This volume analyses the fascinating vicissitudes of birth and development, growth and decrease, of manuscripts consisting of more texts (‘multiple-text manuscripts’), at the example of a vast array of manuscript cultures, from the Indian, African, Christian, Islamic, and European domains

    Systematic review: Safety of surgical male circumcision in context of HIV prevention public health programmes [version 2; peer review: 2 approved]

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    Background: Since the recommendation of voluntary medical male circumcision (VMMC) to reduce the risk of heterosexually acquired HIV, a number of adolescent boys and men in 15 priority countries in Africa have been circumcised. Our primary goal was to identify the incidence of adverse events (AEs) associated with VMMC and to assess the safety profile among adolescent boys 10 – 14 years. Methods: We searched the databases MEDLINE and Embase, WHO, and conference abstracts from 2005 to 2019. The incidence of AEs was estimated by type of AE, size of study and age. Results: We retained 40 studies. Severe and moderate AEs overall were estimated at 0.30 per 100 VMMC clients with wide variability per study type. A higher rate was noted in small and moderate scale programmes and device method research studies compared with larger scale programmes. There was a limited number of studies reporting AEs among younger adolescent boys and they had higher infection-related AEs than those aged 20 years and older. Case studies noted rare AEs such as necrotizing fasciitis, tetanus, and glans injury. Conclusions: AE rates were comparable to those from the randomized controlled trials (RCTs) that led to recommendations and implementation of VMMC in high HIV burden countries, despite being implemented in low resource settings. Clients over time have increasingly included adolescents under the age of 15 years. Studies suggest potentially higher risks in this age group. As VMMC services are sustained, patient safety surveillance systems and promoting a patient safety culture are crucial to identify and mitigate potential harms from medical male circumcision

    Secrets that kill : reflections on violation of cultural rights enshrined in the constitution and human rights through traditional circumcision

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    The study was based on four research objectives: (1) to identify philosophy, psychology, cultural reasons behind the harsh and traumatic experiences of young Xhosa boys and their mothers during ukwaluka (male circumcision) as a mark for transition to manhood; (2) to review perceptions concerning the role of mothers during the male circumcision (MC) process (3) identify cultural and psycho-social construction and meaning of MC and (4) to explore recommended possible strategies on managing MC-related traumas and deaths in the Sub-Saharan region and Eastern Cape Province in particular. Desktop literature review methodology was followed. An in depth literature review was conducted on diverse website search engines using a set of inclusion criteria. Published articles from 1995 to 2015 were selected. Thematic content analysis was used to categorise and interpret emerging themes from the reviewed articles as aligned to set research objectives. Results revealed diverse philosophical and cultural perceptions around MC, its construction and meaning among different cultures whether circumcising or non-circumcising cultures. In addition, various reasons are laid out for the harsh treatment given to initiates in different settings. Results also indicated that the MC is no longer a secret due to social media profuse publications about it. The impact of education and health care benefits around medical male circumcision (MMC) has influenced women from both non-circumcising and circumcising cultures to accept it. It is recommended that MC should continue under strict observation of prescribed protocols to lessen or prevent malpractices in the process. MMC is also highly recommended. In addition, the government and traditional leaders have to continue to conduct capacity building of traditional surgeons, prospective initiates and initiates including nurses and family members about crucial protocols and health matters around MC. Finally, results recommend best practices that could be learnt from other circumcising cultures to restore the respect of MC in the Eastern Cape, as well as inclusion of women in the MC process management
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