Prevalence of complications of male circumcision in Anglophone Africa: a systematic review

BACKGROUND: There is growing evidence that male circumcision (MC) prevents heterosexual acquisition of HIV by males in sub-Saharan Africa, the region of the world heavily affected by the HIV pandemic. While there is growing support for wide-spread availability and accessibility of MC in Africa, there is limited discussion about the prevalence of physical complications of male circumcision on the continent. METHODS: A systematic literature search and review of articles in indexed journals and conference abstracts was conducted to collect and analyze prevalence of complications of MC in Anglophone sub-Saharan Africa. Information extracted included: indications for MC, complications reported, age of patients and category of circumcisers. RESULTS: There were 8 articles and 2 abstracts that were suitable for the analysis. The studies were not strictly comparable as some reported on a wide range of complications while others reported just a limited list of possible complications. Prevalence of reported complications of MC ranged from 0% to 50.1%. Excluding the study with 50.1%, which was on a series of haemophilia patients, the next highest prevalence of complications was 24.1%. Most of the complications were minor. There was no firm evidence to suggest that MCs performed by physician surgeons were associated with lower prevalence of complications when compared with non-physician health professionals. CONCLUSION: The available data are inadequate to obtain a reasonable assessment of the prevalence of complications of MC in sub-Saharan Africa. Some of the available studies however report potentially significant prevalence of complications, though of minor clinical significance. This should be considered as public health policy makers consider whether to scale-up MC as an HIV preventative measure. Decision for the scale-up will depend on a careful cost-benefit assessment of which physical complications are certainly an important aspect. There is need for standardized reporting of complications of male circumcision

New insight into kinetics behavor of the structural formation process in Agar gelation

A time-resolved experimental study on the kinetics and relaxation of the structural formation process in gelling Agar-water solutions was carried out using our custom-built torsion resonator. The study was based on measurements of three naturally cooled solutions with agar concentrations of 0.75%, 1.0% and 2.0% w/w. It was found that the natural-cooling agar gelation process could be divided into three stages, sol stage (Stage I), gelation zone (Stage II) and gel stage (Stage III), based on the time/temperature evolutions of the structural development rate (SDR). An interesting fluctuant decaying behavior of SDR was observed in Stage II and III, indicative of a sum of multiple relaxation processes and well described by a multiple-order Gaussisn-like equation: . More interestingly, the temperature dependences of the fitted values of Wn in Stage II and Stage III were found to follow the different Arrhenius laws, with different activation energies of EaII= 39-74 KJ/mol and EaIII~7.0 KJ/mol. The two different Arrhenius-like behaviors respectively suggest that dispersions in Stage II be attributed to the relaxation of the self-assembly of agar molecules or the growth of junction zones en route to gelation, in which the formation or fission of hydrogen bonding interactions plays an important role; and that dispersions in Stage III be attributed to the relaxation dynamics of water released from various size domains close to the domain of the viscous flow of water during the syneresis process.Comment: 24 pages, 4 figures, 1 tabl

A 5 to 8 year follow-up study of the Rotaglide mobile bearing total knee arthroplasty

We report the medium-term outcomes of the Rotaglide mobile bearing total knee arthroplasty (RTK). Between 1994 and 1999, 357 RTK prostheses were implanted at our institution. Of 150 knees attending for follow-up, none had needed revision. Mean American Knee Society Score (AKSS), Oxford knee score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 8 years were 153.6, 23.1 and 16.5, respectively. Radiological analysis revealed no prosthesis with signs of impending failure requiring revision. Survivorship was 100% in those attending. However, we are aware of two failures requiring revision, both of which were due to infection. We have no reported failures requiring revision due to aseptic loosening. This may be a result of the implant design. Limitations of the study include loss to follow-up and radiological analysis. The RTK gives good to excellent medium-term results and we support its continued use

Two sequential PCR amplifications for detection of Schistosoma mansoni in stool samples with low parasite load

Schistosomiasis constitutes a major public health problem, with an estimated 200 million individuals infected worldwide and 700 million people living in risk areas. In Brazil there are areas of high, medium and low endemicity. Studies have shown that in endemic areas with a low prevalence of Schistosoma infection the sensitivity of parasitological methods is clearly reduced. Consequently diagnosis is often impeded due to the presence of false-negative results. The aim of this study is to present the PCR reamplification (Re-PCR) protocol for the detection of Schistosoma mansoni in samples with low parasite load (with less than 100 eggs per gram (epg) of feces). Three methods were used for the lysis of the envelopes of the S. mansoni eggs and two techniques of DNA extraction were carried out. Extracted DNA was quantified, and the results suggested that the extraction technique, which mixed glass beads with a guanidine isothiocyanate/phenol/chloroform (GT) solution, produced good results. PCR reamplification was conducted and detection sensitivity was found to be five eggs per 500 mg of artificially marked feces. The results achieved using these methods suggest that they are potentially viable for the detection of Schistosoma infection with low parasite load

Optimising femoral component rotation using Equiflex instrumentation: a clinical review

Although there is agreement that flexion and extension spaces should be symmetrical and that rotation of the femoral component impacts outcome in a knee replacement, there is dispute over what is the ‘correct’ rotation and how best to achieve it (Akagi et al., Clin Orthop Relat Res 366:155–163, 1999; Anouchi et al., Clin Orthop Relat Res 287:170–177, 1993; Barrack et al., Clin Orthop Relat Res 392:46–55, 2001; Berger et al., Clin Orthop Relat Res 356:144–153, 1998; Jenny and Boeri, Acta Orthop Scand 75(1):74–77, 2004; Poilvache et al., Clin Orthop Relat Res 331:35–46, 1996; Siston et al., J Bone Joint Surg Am 87(10):2276–2280, 2005). Insall and Scuderi recommended placing a tensor in flexion and rotating the femoral cutting block so that its posterior edge is parallel to the cut tibia (Insall, Surgery of the knee, vol 2, 2nd edn., Churchill Livingstone, New York, 1993; Scuderi and Insall, Orthop Clin N Am 20:71–78, 1989). We feel Equiflex instrumentation will reliably achieve Insall and Scuderi’s recommendation. To evaluate early results and lateral retinacular release rates using Equiflex instrumentation for TKR, we evaluated 209 consecutive knees (31 valgus, 178 varus) using this technique from 4 April 2005 until 19 September 2006. Pre and postop American Knee Society and Oxford scores, deformity, ROM, lateral retinacular release rates and complications were recorded. We could correct alignment and achieve our technical goals in 99% of cases. A lateral retinacular release was required in only five knees (2.4%). The complications are comparable to published data. The Equiflex instrumentation does help in equalising flexion-extension gaps, improves patellar tracking and reduces the incidence of lateral retinacular release