14 research outputs found
An experimental study in six fresh human cadavers using a novel approach to avoid abdominal wall incisions in total colectomy: totally transanal laparoendoscopic single-site pull-through colectomy with J-pouch creation
The use of transanal laparoscopic access to completely avoid abdominal wall incisions represents the most current evolution in minimally invasive surgery. The combination of single-site surgery and natural orifice transluminal endoscopic surgery (NOTES (TM)) can be used for totally transanal laparoendoscopic pull-through colectomy with J-pouch creation (TLPC-J). The aim of the present study was to provide evidence for the feasibility of TLPC-J in adult human cadavers. TLPC-J was performed in six fresh adult human cadavers. The procedure involved endorectal submucosal dissection from 1 cm above the dentate line to a point above the peritoneal reflection, where the rectal muscle was divided circumferentially. The edge of the mucosal cuff was closed distally in order to prevent fecal contamination and the endorectal tube was placed back into the abdomen. A Triport+(TM) or QuadPort+(TM) system was introduced transanally, and it served as a multiport device (MD). Resection of the entire colon, mobilization of the distal ileal segment, and extracorporeal suture of the ileal J-loop were performed via the transanal approach. The J-pouch was created using Endo GIA (TM). After removal of the MD, the J-pouch was sutured to the rectal wall. TLPC-J was performed in all cadavers, with a mean operation duration of 236 +/- A 22 min. Conversion to either transabdominal laparoscopy or laparotomy was not required in any of the cadavers. No bowel perforation or damage to other organs was observed. The use of a curved endoscope greatly facilitated visualization during transanal laparoscopic dissection for partial and total colectomy, making the procedure feasible. All specimens were retrieved through the anus, eliminating the need for additional transabdominal incisions. TLPC-J was technically feasible in adult human cadavers, and abdominal wall incisions were not required. However, clinical studies are needed to determine its feasibility in living adults
Study exclusion flow diagram.
Men who have sex with men (MSM) bear a disproportionate burden of new HIV infections in Kenya, while experiencing discrimination, leading to suboptimal levels of HIV care. HIV self-testing (HIVST) is a tool to increase HIV screening and earlier diagnosis; however, questions remain regarding how best to scale-up HIVST to MSM in Kenya. The main objective of this study was to examine changes in knowledge and use of HIVST after implementation of a community-led HIVST project. Participants were MSM recruited from Kisumu, Mombasa, and Kiambu counties. Data were collected from two rounds (Round 1: 2019; Round 2: 2020) of serial cross-sectional integrated biological and behavioural assessments (IBBA), pre-, and post-project implementation. Two main outcomes were measured: 1) whether the respondent had ever heard of HIVST; and 2) whether they had ever used HIVST kits. Changes in outcomes between IBBA rounds were examined using modified multivariable Poisson regression models; adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) are reported. A total of 2,328 respondents were included in main analyses. The proportion of respondents who had heard of HIVST increased from 75% in Round 1 to 94% in Round 2 (aPR: 1.2, 95% CI: 1.2–1.3), while those reporting using an HIVST kit increased from 20% to 53% (aPR: 2.3, 95% CI: 2.0–2.6). Higher levels of education and HIV programme awareness were associated with both outcomes. Awareness and use of HIVST kits increased after implementation of a community-led HIVST implementation project, demonstrating the importance of integration with existing community groups.</div
Contact/Visit exposure by type of exposure, round and lifetime use of HIV self-testing (HIVST) kits.
Contact/Visit exposure by type of exposure, round and lifetime use of HIV self-testing (HIVST) kits.</p
Service exposure: “The last time you visited a clinic or drop-in centre, what services did you use?” by round and lifetime use of HIV self-testing (HIVST) kits.
Service exposure: “The last time you visited a clinic or drop-in centre, what services did you use?” by round and lifetime use of HIV self-testing (HIVST) kits.</p
Crude and fully-adjusted prevalence ratios (PR) and 95% confidence intervals (95%CI) of selected characteristics and their association with ever using an HIV self-test kit from the Kenya HIV self-testing study (N = 2,136).
Crude and fully-adjusted prevalence ratios (PR) and 95% confidence intervals (95%CI) of selected characteristics and their association with ever using an HIV self-test kit from the Kenya HIV self-testing study (N = 2,136).</p
Inclusivity in global research.
CBO: Community-Based Organization. HAPA Kenya: HIV & AIDS People’s Alliance of Kenya. HOYMAS: Healthy Options for Young Men on HIV/AIDS/STIs. MAAYGO: Men Against AIDS Youth Group Organization. MPEG: Mamboleo Peer Empowerment Group. MSM: Men who have sex with men. NASCOP: National AIDS and STI Control Programme. PHDA: Partners for Health and Development in Africa. (DOCX)</p
Crude and fully-adjusted prevalence ratios (PR) and 95% confidence intervals (95%CI) of selected characteristics and their association with ever hearing of HIV self-testing kits, from the Kenya HIV self-testing study (N = 2,328).
Crude and fully-adjusted prevalence ratios (PR) and 95% confidence intervals (95%CI) of selected characteristics and their association with ever hearing of HIV self-testing kits, from the Kenya HIV self-testing study (N = 2,328).</p
Crude and fully-adjusted prevalence ratios (PR) and 95% confidence intervals (95% CI), multivariable regression models, association of sample rounds (Round 1 vs. Round 2) on HIV self-testing outcomes, stratified by education level, Kenya HIV self-testing study. PR: Prevalence Ratio.
CI: Confidence Interval. aAdjusted for places where male partners met, county, age, number of different male sex partners (past 1 month), received money/gifts for sex (ever), condom use with last male sex partner, and contacted by peer/outreach worker in the last 3 months. bAdjusted for places where male partners met, county, age, age at first anal/oral sex with a man, number of different male sex partners (past 1 month), condom use with last male sex partner, and contacted by peer/outreach worker in the last 3 months. (DOCX)</p
Selected characteristics, men who have sex with men enrolled in HIV self-test study Kenya, by survey round (N = 2,328).
Selected characteristics, men who have sex with men enrolled in HIV self-test study Kenya, by survey round (N = 2,328).</p