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Salazar JE, Park DE, Punjani N, Pham T, Aziz M, Kigozi G, Gray RH, Kiboneka SD, Goldstein M, Li PS, Lee R, Liu CM. Comparison of the penile microbiome in infant male circumcision: Mogen clamp versus Shangring. EBioMedicine 2024; 105:105216. [PMID: 38924841 PMCID: PMC11259695 DOI: 10.1016/j.ebiom.2024.105216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/22/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND This study aimed to characterise the infant penile (coronal sulcus) microbiome and the effects of early infant male circumcision (EIMC), following a standard surgical method (Mogen Clamp) and a non-surgical alternative (ShangRing). METHODS We collected coronal sulcus swabs at baseline and on days 7 and 14 post-circumcision from infants assigned to receive EIMC by Mogen Clamp (n = 15) or ShangRing (n = 15), in a randomised trial in Rakai and Kakuuto, Uganda. We used 16S rRNA gene-based sequencing and broad-coverage qPCR to characterise the infant penile microbiome and assess the effects of EIMC in both study arms. FINDINGS Prior to EIMC, the infant penile microbiome had a mixture of facultative and strict anaerobes. In both study arms, EIMC caused penile microbiome proportional abundance changes characterised by decreases in penile anaerobes [ShangRing Prevotella: -15.0%, (SD = 19.1); Mogen clamp Prevotella: -3.6% (11.2); ShangRing Veillonella: -11.3% (17.2); Mogen clamp Veillonella: -2.6% (11.8)] and increases in skin-associated facultative anaerobes [ShangRing Corynebacterium: 24.9%, (22.4); Mogen clamp Corynebacterium: 4.7% (21.3); ShangRing Staphylococcus: 21.1% (20.5); Mogen clamp Staphylococcus: 18.1% (20.1)]. Clostridium tetani was not detected during the study. INTERPRETATION Mogen Clamp and ShangRing EIMC both changed the composition of the infant penile microbiome by reducing the proportional abundances of anaerobes and uropathogens, which is consistent with medical male circumcision findings in adults. C. tetani was not increased by either EIMC method. FUNDING Bill and Melinda Gates Foundation.
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Affiliation(s)
- Juan E Salazar
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Daniel E Park
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Nahid Punjani
- Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, Mayo Clinic, Phoenix, AZ, USA
| | - Tony Pham
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Maliha Aziz
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Ronald H Gray
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda; Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Stephen D Kiboneka
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Marc Goldstein
- Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Philip S Li
- Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Richard Lee
- Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Cindy M Liu
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA.
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Bekker LG, Beyrer C, Mgodi N, Lewin SR, Delany-Moretlwe S, Taiwo B, Masters MC, Lazarus JV. HIV infection. Nat Rev Dis Primers 2023; 9:42. [PMID: 37591865 DOI: 10.1038/s41572-023-00452-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
The AIDS epidemic has been a global public health issue for more than 40 years and has resulted in ~40 million deaths. AIDS is caused by the retrovirus, HIV-1, which is transmitted via body fluids and secretions. After infection, the virus invades host cells by attaching to CD4 receptors and thereafter one of two major chemokine coreceptors, CCR5 or CXCR4, destroying the host cell, most often a T lymphocyte, as it replicates. If unchecked this can lead to an immune-deficient state and demise over a period of ~2-10 years. The discovery and global roll-out of rapid diagnostics and effective antiretroviral therapy led to a large reduction in mortality and morbidity and to an expanding group of individuals requiring lifelong viral suppressive therapy. Viral suppression eliminates sexual transmission of the virus and greatly improves health outcomes. HIV infection, although still stigmatized, is now a chronic and manageable condition. Ultimate epidemic control will require prevention and treatment to be made available, affordable and accessible for all. Furthermore, the focus should be heavily oriented towards long-term well-being, care for multimorbidity and good quality of life. Intense research efforts continue for therapeutic and/or preventive vaccines, novel immunotherapies and a cure.
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Affiliation(s)
- Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, RSA, Cape Town, South Africa.
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | | | - Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Mary Clare Masters
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Safety, acceptability, and feasibility of male circumcision using the alisklamp device. J Pediatr Urol 2023; 19:107.e1-107.e10. [PMID: 36266169 DOI: 10.1016/j.jpurol.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/24/2022] [Accepted: 09/14/2022] [Indexed: 02/07/2023]
Abstract
Greater than 20 surgical circumcision devices are available worldwide for male circumcision. These have been developed so as to decrease complications. The hemostasis system classifies these devices as crush, clamp or ligature. This study assessed the safety, acceptability, and feasibility of male neonatal circumcision using the Alisklamp device (AKD). The AKD is one of the latest medical devices designed for assisted circumcision. It takes less time to install, has a better complication rate, and has a better cosmetic appearance than conventional surgical circumcision. The study was divided into two sections: assessing the safety of the AKD and evaluating parents' satisfaction. Convenience sampling was used in this study. In the first section, a form was filled by operating pediatric surgeon for children whose parents agreed to participate in the study. In the second section, a total of 100 male children were included in the study based on the sample size guidelines of the World Health Organization. The circumcision was performed by an experienced pediatric surgeon following the manufacturer's instructions. The procedures were completed without AKD failure or unwelcome preputial loss. The results showed that 63.54% of the children were circumcised in their first four weeks of life. About 60.42% of the procedures were completed within 5-10 min. Also, 95.83% of the children had no postoperative complications. Further, 90.63% of parents were satisfied with the AKD and willing to recommend it to others. During the follow-up, all of the children's parents were pleased with the cosmetic and final results of the AKD. In conclusion, the AKD has an outstanding protection profile suitable for male circumcision procedures.
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Zhu D, Zhu H. Efficacy of three types of circumcision for children in the treatment of phimosis: A retrospective study. Medicine (Baltimore) 2022; 101:e32198. [PMID: 36482531 PMCID: PMC9726407 DOI: 10.1097/md.0000000000032198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Phimosis is a common condition of the urinary system in children and often requires surgical treatment. However, the optimal method of circumcision for children has not been determined. Herein, we analyzed the efficacy of 3 circumcision methods for children with phimosis. A retrospective analysis of 112 cases of pediatric phimosis after circumcision was conducted at our hospital. Among them, 36 cases were subjected to conventional operation (group A), 43 cases to ring circumcision (group B), and 33 cases to suturing device circumcision (group C). The duration of operation, amount of bleeding, pain, complications, healing time, and the satisfaction of the guardians were calculated. The operation time of group B and C was (6.26 ± 1.31) min and (7.67 ± 1.29) min, respectively, which was shorter than group A (27.42 ± 2.42) min (P < .05); besides, group A had the most blood loss volume, (9.67 ± 1.67) mL, and group B was the least (1.26 ± 0.44) mL (P < .05); group B had the strongest postoperative pain (4.05 ± 0.37), the longest pain time (6.84 ± 1.29) days, and the longest healing time (21.84 ± 4.23) days (P < .05). Postoperative complications were lowest in group C (11.11% vs 20.93% vs 6.06%), satisfaction of guardians was highest in group C (86.11% vs 85.27% vs 89.99%), but the difference was not statistically significant (P > .05). Three types of surgical procedures present with advantages and disadvantages. The conventional surgery led to longer operation time and more bleeding but did not require special medical equipment and was easy to carry out; ring surgery had the shortest operation time, the least bleeding, accompanied by the longest recovery time and pain duration; the complications of the suturing device were the least, the parents had the highest degree of satisfaction, however, it also needs a specific suturing device. Therefore, each type had its distinctive characteristics and may be flexibly selected based on their own conditions.
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Affiliation(s)
- Dongsheng Zhu
- Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, Haizhou District, Lianyungang, P.R. China
- * Correspondence: Dongsheng Zhu, Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, No.182, North Tongguan Road, Haizhou District, Lianyungang 222000, P.R. China (e-mail: )
| | - Hongqi Zhu
- Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, Haizhou District, Lianyungang, P.R. China
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Shabanzadeh DM, Clausen S, Maigaard K, Fode M. Male Circumcision Complications - A Systematic Review, Meta-Analysis and Meta-Regression. Urology 2021; 152:25-34. [PMID: 33545206 DOI: 10.1016/j.urology.2021.01.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the risk of complications requiring treatment following male circumcision by health-care professionals and to explore the impact of participant characteristics, type of circumcision and study design. METHODS We identified studies through systematic searches in online databases (MEDLINE, EMBASE and CENTRAL) and hand searches. We performed random-effects meta-analysis to determine risk of circumcision complications and mixed-effects metaregression analyses to explore the impact of participant characteristics, type of circumcision and study design. Methods were prespecified in a registered protocol (Prospero CRD42020116770) and according to PRISMA guidelines. RESULTS We included 351 studies with 4.042.988 participants. Overall complication risk was 3.84% (95% confidence interval 3.35-4.37). Our meta-analysis revealed that therapeutic circumcisions were associated with a 2-fold increase in complications as compared to nontherapeutic (7.47% and 3.34%, respectively). Adhesions, meatal stenosis and infections were the most frequent complication subgroups to therapeutic circumcisions. Bleeding, device removals and infections occurred more frequently in nontherapeutic circumcisions. Additionally, adjusted metaregression analyses revealed that children above 2 years, South American continent, older publication year and smaller study populations increased complication risk. Type of circumcision method, provider and setting were not associated with complication risk. Sensitivity analyses including only better-quality studies reporting indication, age at circumcision, treatment for complications, full-text articles, and adequate follow-up clinically for a minimum of one month or through databases confirmed our main findings while accounting better for heterogeneity. CONCLUSION Circumcision complications occur in about 4 per hundred circumcisions. Higher risks of complications were determined by therapeutic circumcisions and by childhood age when compared to infant. Future studies should assess therapeutic and childhood circumcisions separately.
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Affiliation(s)
- Daniel Mønsted Shabanzadeh
- Department of Gastroenterology, Surgical Unit, Copenhagen University Hospital, Hvidovre, Capital Region of Denmark.
| | - Signe Clausen
- Mental Health Services, Capital Region of Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Capital Region of Denmark
| | | | - Mikkel Fode
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Capital Region of Denmark; Department of Urology, Zealand University Hospital, Roskilde, Capital Region of Denmark
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Barone MA, Li PS, Lee RK, Ouma D, Oundo M, Barasa M, Oketch J, Otiende P, Nyangweso N, Maina M, Kiswi N, Chirchir B, Goldstein M, Awori QD. Simplifying the ShangRing technique for circumcision in boys and men: use of the no-flip technique with randomization to removal at 7 days versus spontaneous detachment. Asian J Androl 2020; 21:324-331. [PMID: 30520424 PMCID: PMC6628734 DOI: 10.4103/aja.aja_91_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To assess safety of the no-flip ShangRing male circumcision technique and to determine clinical course and safety of spontaneous detachment (i.e., allowing the device to fall off), we conducted a case series of no-flip ShangRing circumcision combined with a randomized controlled trial of removal 7 days postcircumcision versus spontaneous detachment at two health facilities in Kenya. The primary outcome was the safety of the no-flip technique based on moderate and severe adverse events (AEs) during the procedure and through 42-day follow-up. A main secondary outcome was clinical course and safety of spontaneous detachment. Two hundred and thirty males 10 years and older underwent no-flip circumcision; 114 randomized to 7-day removal and 116 to spontaneous detachment. All circumcisions were successfully completed. Overall 5.3% (6/114) of participants in the 7-day group and 1.7% (2/116) in the spontaneous group had an AE; with no differences when compared to the 3% AE rate in historical data from African studies using the original flip technique (P = 0.07 and P = 0.79, respectively). Overall 72.4% (84/116) of participants in the spontaneous group wore the ShangRing until it detached. Among the remaining (27.6%; 32/116), the ring was removed, primarily at the participants' request, due to pain or discomfort. There was no difference in AE rates (P = 0.169), visit day declared healed (P = 0.324), or satisfaction (P = 0.371) between randomization groups. The median time to detachment was 14.0 (IQR: 7–21, range: 5–35) days. The no-flip technique and spontaneous detachment are safe, effective, and acceptable to boys and men 10 years and older. Phimosis and penile adhesions do not limit successful ShangRing circumcision with the no-flip technique.
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Affiliation(s)
| | - Philip S Li
- Center for Male Reproductive Medicine and Surgery, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
| | - Richard K Lee
- Center for Male Reproductive Medicine and Surgery, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
| | | | | | | | - Jairus Oketch
- Homa Bay County Teaching and Referral Hospital, Homa Bay 40300, Kenya
| | - Patrick Otiende
- Homa Bay County Teaching and Referral Hospital, Homa Bay 40300, Kenya
| | - Nixon Nyangweso
- Homa Bay County Teaching and Referral Hospital, Homa Bay 40300, Kenya
| | - Mary Maina
- Vipingo Health Centre, Vipingo 80119, Kenya
| | | | | | - Marc Goldstein
- Center for Male Reproductive Medicine and Surgery, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
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Tobian AAR, Dam KH, Van Lith LM, Hatzold K, Marcell AV, Mavhu W, Kahabuka C, Mahlasela L, Patel EU, Njeuhmeli E, Seifert Ahanda K, Ncube G, Lija G, Bonnecwe C, Kaufman MR. Providers' Perceptions and Training Needs for Counseling Adolescents Undergoing Voluntary Medical Male Circumcision. Clin Infect Dis 2019; 66:S198-S204. [PMID: 29617772 PMCID: PMC5888966 DOI: 10.1093/cid/cix1036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The majority of individuals who seek voluntary medical male circumcision (VMMC) services in sub-Saharan Africa are adolescents (ages 10–19 years). However, adolescents who obtain VMMC services report receiving little information on human immunodeficiency virus (HIV) prevention and care. In this study, we assessed the perceptions of VMMC facility managers and providers about current training content and their perspectives on age-appropriate adolescent counseling. Methods Semistructured in-depth interviews were conducted with 33 VMMC providers in Tanzania (n = 12), South Africa (n = 9), and Zimbabwe (n = 12) and with 4 key informant facility managers in each country (total 12). Two coders independently coded the data thematically using a 2-step process and Atlas.ti qualitative coding software. Results Providers and facility managers discussed limitations with current VMMC training, noting the need for adolescent-specific guidelines and counseling skills. Providers expressed hesitation in communicating complete sexual health information—including HIV testing, HIV prevention, proper condom usage, the importance of knowing a partner’s HIV status, and abstinence from sex or masturbation during wound healing—with younger males (aged <15 years) and/or those assumed to be sexually inexperienced. Many providers revealed that they did not assess adolescent clients’ sexual experience and deemed sexual topics to be irrelevant or inappropriate. Providers preferred counseling younger adolescents with their parents or guardians present, typically focusing primarily on wound care and procedural information. Conclusions Lack of training for working with adolescents influences the type of information communicated. Preconceptions hinder counseling that supports comprehensive HIV preventive behaviors and complete wound care information, particularly for younger adolescents.
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Affiliation(s)
- Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kim H Dam
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland
| | - Lynn M Van Lith
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland
| | | | - Arik V Marcell
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Webster Mavhu
- Centre for Sexual Health & HIV/AIDS Research, Harare, Zimbabwe
| | | | | | - Eshan U Patel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emmanuel Njeuhmeli
- Office of HIV/AIDS, Global Health Bureau, United States Agency for International Development, Washington, District of Columbia, Washington D.C
| | - Kim Seifert Ahanda
- Office of HIV/AIDS, Global Health Bureau, United States Agency for International Development, Washington, District of Columbia, Washington D.C
| | | | - Gissenge Lija
- Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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Comparative efficacy and safety of different circumcisions for patients with redundant prepuce or phimosis: A network meta-analysis. Int J Surg 2017; 43:17-25. [PMID: 28522221 DOI: 10.1016/j.ijsu.2017.04.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Phimosis and redundant prepuce are defined as the inability of the foreskin to be retracted behind the glans penis in uncircumcised males. To synthesize the evidence and provide the hierarchies of different circumcisions for phimosis and redundant prepuce, we performed an overall network meta-analysis (NMA) based on their comparative efficacy and safety. MATERIAL AND METHODS Electronic databases including PubMed, Embase, Wan Fang, VIP, CNKI and CBM database were researched from randomized controlled trials (RCTs) for redundant prepuce or phimosis. We conducted the direct and indirect comparisons by aggregate data drug information system (ADDIS) software. Moreover, consistency models were applied to assess the differences among the male circumcision practices, and the ranks based on probabilities of intervention for the different endpoints were performed. Node-splitting analysis was used to test inconsistency. RESULTS Eighteen RCTs were included with 6179 participants. Compared with the conventional circumcision(CC), two new styles of circumcisions, the disposable circumcision suture device(DCSD) and Shang Ring circumcision(SRC), provided significantly shorter operation time[DCSD: standardized mean difference (SMD) = -20.60, 95% credible interval(CI) (-23.38, -17.82); SRC: SMD = -19.16, 95%CI (-21.86, -16.52)], shorter wound healing time [DCSD:SMD = -4.19, 95%CI (-8.24,-0.04); SRC: SMD = 4.55, 95%CI (1.62, 7.57); ] and better postoperative penile appearance [DCSD: odds ratios odds ratios (OR) = 11.42, 95%CI (3.60, 37.68); SRC: OR = 3.85,95%CI (1.29, 12.79)]. Additionally, DCSD showed a lower adverse events rate than other two treatments. However, no significant difference was shown in all surgeries for 24 h postoperative pain score. Node-splitting analysis showed that no significant inconsistency was existed (P > 0.05). CONCLUSIONS Based on the results of NMA, DCSD may be a most effective and safest choice for phimosis and redundant prepuce. DCSD has the advantages of a shorter operation time, better postoperative penile appearance, fewer complication and shorter wound healing time. However, with the limitations of our study, additional multi-center RCTs are needed to evaluate the outcomes.
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9
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Hankins C, Warren M, Njeuhmeli E. Voluntary Medical Male Circumcision for HIV Prevention: New Mathematical Models for Strategic Demand Creation Prioritizing Subpopulations by Age and Geography. PLoS One 2016; 11:e0160699. [PMID: 27783613 PMCID: PMC5082625 DOI: 10.1371/journal.pone.0160699] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Over 11 million voluntary medical male circumcisions (VMMC) have been performed of the projected 20.3 million needed to reach 80% adult male circumcision prevalence in priority sub-Saharan African countries. Striking numbers of adolescent males, outside the 15-49-year-old age target, have been accessing VMMC services. What are the implications of overall progress in scale-up to date? Can mathematical modeling provide further insights on how to efficiently reach the male circumcision coverage levels needed to create and sustain further reductions in HIV incidence to make AIDS no longer a public health threat by 2030? Considering ease of implementation and cultural acceptability, decision makers may also value the estimates that mathematical models can generate of immediacy of impact, cost-effectiveness, and magnitude of impact resulting from different policy choices. This supplement presents the results of mathematical modeling using the Decision Makers' Program Planning Tool Version 2.0 (DMPPT 2.0), the Actuarial Society of South Africa (ASSA2008) model, and the age structured mathematical (ASM) model. These models are helping countries examine the potential effects on program impact and cost-effectiveness of prioritizing specific subpopulations for VMMC services, for example, by client age, HIV-positive status, risk group, and geographical location. The modeling also examines long-term sustainability strategies, such as adolescent and/or early infant male circumcision, to preserve VMMC coverage gains achieved during rapid scale-up. The 2016-2021 UNAIDS strategy target for VMMC is an additional 27 million VMMC in high HIV-prevalence settings by 2020, as part of access to integrated sexual and reproductive health services for men. To achieve further scale-up, a combination of evidence, analysis, and impact estimates can usefully guide strategic planning and funding of VMMC services and related demand-creation strategies in priority countries. Mid-course corrections now can improve cost-effectiveness and scale to achieve the impact needed to help turn the HIV pandemic on its head within 15 years.
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Affiliation(s)
- Catherine Hankins
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | | | - Emmanuel Njeuhmeli
- USAID, Washington, District of Columbia, United States of America
- * E-mail:
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10
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Liu CM, Prodger JL, Tobian AAR, Serwadda D, Galiwango RM, Nalugoda F, Kighoma N, Mwinike J, Anyokorit M, Price LB, Wawer MJ, Kigozi G, Gray RH. Genital Anaerobic Bacterial Overgrowth and the PrePex Male Circumcision Device, Rakai, Uganda. J Infect Dis 2016; 214:595-8. [PMID: 27190185 DOI: 10.1093/infdis/jiw182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/28/2016] [Indexed: 12/28/2022] Open
Abstract
The PrePex circumcision device causes ischemic necrosis of the foreskin, raising concerns of anaerobic overgrowth. We compared the subpreputial microbiome of 2 men 7 days after PrePex device placement to that of 145 uncircumcised men in Rakai, Uganda, using 16S ribosomal (rRNA) RNA gene-based quantitative polymerase chain reaction analysis and sequencing. PrePex users had higher absolute abundance of all bacteria than uncircumcised men (P = .001), largely due to increased numbers of the following anaerobes: Porphyromonas (5.2 × 10(7) 16S rRNA gene copies/swab in the PrePex group and 1.1 × 10(6) 16S rRNA gene copies/swab in uncircumcised men; P = .002), Peptoniphilus (1.0 × 10(7) and 1.8 × 10(6) 16S rRNA gene copies/swab, respectively; P < .05), Anaerococcus (1.0 × 10(7) and 1.1 × 10(6) 16S rRNA gene copies/swab, respectively; P < .001), and Campylobacter ureolyticus (1.7 × 10(5) and 1.6 × 10(7)16S rRNA gene copies/swab, respectively; P < .001). The PrePex-associated increase in anaerobes may account for unpleasant odor and a possible heightened risk of tetanus.
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Affiliation(s)
- Cindy M Liu
- Department of Pathology, School of Medicine Center for Microbial Genetics and Genomics, Northern Arizona University Division of Pathogen Genomics, Translational Genomics Research Institute, Flagstaff, Arizona
| | - Jessica L Prodger
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Aaron A R Tobian
- Department of Pathology, School of Medicine Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | | | | | | | | | - Lance B Price
- Division of Pathogen Genomics, Translational Genomics Research Institute, Flagstaff, Arizona Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University
| | - Maria J Wawer
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland Rakai Health Sciences Program, Entebbe, Uganda
| | | | - Ronald H Gray
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland Rakai Health Sciences Program, Entebbe, Uganda
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11
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Millard P, Goldstuck N. The Unicirc(®) instrument enables rapid, single-visit, convenient and safe medical male circumcision. Nat Rev Urol 2016; 13:295. [PMID: 27112387 DOI: 10.1038/nrurol.2016.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Peter Millard
- Seaport Community Health Center, 53 Schoodic Drive, Belfast, Maine 04915, USA
| | - Norman Goldstuck
- 101 Francie van Zyl Street, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Western Cape, South Africa
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