A 5-year follow-up study comparing Burch colposuspension and transobturator tape for the surgical treatment of stress urinary incontinence

Objective

To compare the effectiveness of transobturator tape (TOT) and Burch colposuspension in the treatment of stress urinary incontinence (SUI).

Methods

The present retrospective study included 770 patients who underwent SUI surgery with Burch colposuspension (n = 498) or TOT (n = 272). Clinical follow-up occurred at 2 weeks, 3, 6, and 12 months, and annually thereafter. Objective and subjective cure rates and intra- and postoperative complications were assessed.

Results

Among patients who had SUI surgery without another concomitant procedure, the Burch group had a significantly longer mean operation time (41.48 ± 10.61 minutes versus 23.77 ± 10.49 minutes; P < 0.001) and a significantly longer length of hospital stay (3.11 ± 0.49 days versus 1.98 ± 0.40 days; P < 0.001), compared with the TOT group. The rates of unintended functional outcomes were lower among women undergoing TOT than among those undergoing the Burch procedure (long-term voiding dysfunction 0.7% versus 4.2%, P = 0.007; urinary retention 10.7% versus 26.9%, P < 0.001). The 5-year cure rates were similar in the 2 groups (objective cure rate, 73.9% versus 77.5%, P = 0.574; subjective cure rate, 76.8% versus 81.7%, P = 0.416).

Conclusion

In terms of efficacy, TOT appears equal to Burch colposuspension; however, TOT has fewer unintended functional outcomes than Burch colposuspension.     

Evidence of genetic variability of human immunodeficiency virus type 1 in plasma and cervicovaginal lavage in ethiopian women seeking care for sexually transmitted infections

Most human immunodeficiency virus type 1 (HIV-1) transmission in developing countries occurs through heterosexual intercourse or during birth from mother to child. It is critical to characterize the virus of the genital tract variants as a target for the development of an HIV-1 vaccine and microbicidal therapies. We compared the C2V3 env domain genetic diversity of HIV-1 in female genital secretions and in plasma from Ethiopian women seeking care for sexually transmitted infections (STIs). Sequences within an individual differed between the plasma and cervicovaginal lavage (CLV) compartments with nucleotide and amino acid median difference values of 8.3 and 4.8%, respectively. Sequence diversity in CVL was greater than in plasma. And the V3 loop positive charge was often more elevated in CVL. These are markers of the differential evolution of the viruses in CVL and peripheral blood indicating that limited evolution at the site of contact is not the limiting factor determining the preferential transmission of macrophage tropic viruses.     

Latrine promotion for trachoma: assessment of mortality from a cluster-randomized trial in Ethiopia

Trachoma control strategies, including latrine construction and antibiotic distribution, are directed at reducing ocular chlamydia, but may have additional benefits. In a cluster-randomized clinical trial, 24 subkebeles (administrative geographic units) in Ethiopia were offered a single mass azithromycin treatment, and half were randomized to receive an intensive latrine promotion. At a follow-up census 26 months after the baseline treatment, 320 persons had died. The mortality rate of children 1-5 years of age was 3.87 (95% confidence interval [CI] = 2.19-6.82) per 1,000 person-years in the latrine promotion arm, and 2.72 (95% CI = 1.37-5.42) per 1,000 person-years in the control arm. In a multi-level mixed effects logistic regression model controlling for age, there was no difference in mortality in persons randomized into the latrine or control arms (odds ratio = 1.18, 95% CI = 0.89-1.58). Latrine promotion provided no additional effect on mortality in the context of an azithromycin distribution program (clinicaltrials.gov, #NCT00322972).     

Adverse events after mass azithromycin treatments for trachoma in Ethiopia

During a cluster-randomized clinical trial for trachoma in Ethiopia, two rounds of adverse event surveillance were performed in a random sample of communities after community-wide mass azithromycin treatment. The prevalence of any reported adverse event ranged from 4.9% to 7.0% in children 1-9 years of age and from 17.0% to 18.7% in persons ≥ 10 years of age. Adverse events appeared to cluster by household and perhaps by village. Mass azithromycin distributions were well tolerated in this setting.     

Pseudomembranous changes in the dermis: A novel observation and potential clue for evolving lipodermatosclerosis?

Lipodermatosclerosis (LDS) is a well‐recognized form of fibrosing panniculitis. Although chronic cases are readily diagnosed, early and evolving lesions may be clinically mistaken for cellulitis and other forms of panniculitis. Most pathologists are familiar with a pseudomembranous type of fat necrosis as a useful feature of chronic LDS. Although nonspecific, this distinctive pattern of fat necrosis helps in supporting a diagnosis of LDS in the appropriate clinical context. The histopathologic features of early and evolving LDS and those involving the dermis are less well documented. We report a case of early LDS showing extensive pseudomembranous changes in the dermis on a superficial skin biopsy where progression to a classic established lesion was documented clinically. We suspect that this previously unreported and unusual finding may be a histopathologic clue for evolving lesions of LDS.     

Natural dyeing of cotton fabric with extracts from mango tree: A step towards sustainable dyeing

Recently, there has been a great deal of interest to circumvent the environmental problems associated with manufactured colouring agents by using natural dyes. This study focuses on extracting natural dyes from mango leave and mango peel and finds sustainable ways of cotton dyeing. Natural colouring agents were extracted using an aqueous extraction technique and the cotton fabric was dyed using the extracts followed by mordanting using different mordant types. The dyeing performance of extracted colouring agents were assessed in terms of colour values, dye absorption (%), colour fastness properties and colour strength. The mordanting mechanisms of the extracted dyes were also proposed. Dyes extracted from mango leaves results in more colourised material than dye drived from mango fruit extract. Moreover, the dye extract exhibited a deeper shade. Result also shows that cotton fabric dyed with the same dye extract but with different type of mordants resulted in a fabric that showed diverse colours. Moderate to good fastness values were recorded (4–5). Considering the dyes exhibited excellent colour fastness, it can be concluded that the natural dyes extracted from various parts of the mango plant could be an effective colouring agent for use on cotton fabrics.     

A multidisciplinary study of onchocerciasis in Bure area, Ethiopia

A clinicoepidemiological and entomological study of onchocerciasis was conducted in Bure area, Illubabor Administrative Region, in October 1987. All 1063 houses in four villages were numbered and census taken. The total population was 4119. Of the total 1063 houses, 107 (10.07%) were selected by systematic random sampling and all members of these households were examined. History, physical examination, and skin biopsy were taken. Of 4119 people in the area, 3555 (86.3%) were indigenous and 564 (13.7%) settlers. Four hundred and three of the former and 68 of the latter were studied. Clinical manifestations were mild and ocular onchocerciasis was not encountered. One hundred and sixteen (24.6%) had O. volvulus in the skin; with a mean of 11.7 microfilariae per milligram of skin. Positivity in males was 1 1/2 times that in females. None of the settlers had positive skin snips. We concluded that onchocerciasis is hypoendemic in Bure area with mild clinical manifestations. Adult and aquatic stages of Simulium were collected for later identification, and a preliminary report indicates that S. damnosum s.l. is the most likely vector.