Urethrocutaneous Fistula Following VMMC: A Case Series from March 2013 to October 2019 in ZAZIC’s Voluntary Medical Male Circumcision Program in Zimbabwe

Background: Urethrocutaneous fistula (subsequently, fistula) is a rare adverse event (AE) in voluntary medical male circumcision (VMMC) programs. Global fistula rates of 0.19 and 0.28 per 100,000 VMMCs were reported. Management of fistula can be complex and requires expert management. We describe seven cases of fistula in our large-scale VMMC program in Zimbabwe. We present fistula rates; provide an overview of initial management, surgical interventions, and patient outcomes; discuss causes; and suggest future prevention efforts. Results: Case details are presented on fistulas identified between March 2013 and October 2019. Among the seven fistula clients, ages ranged from 10-22 years; 6 cases were among boys under 15 years of age. All clients received surgical VMMC by trained providers in an outreach setting. Clients presented with fistulae 2 to 42 days after VMMC. Secondary infection was identified in 6 of 7 cases. Six cases were managed through surgical repair. The number of repair attempts ranged from 1 to 10. One case healed spontaneously with conservative management. Fistula rates are presented as cases/100,000 VMMCs.Conclusion: Fistula is an uncommon but severe AE that requires clinical expertise for successful management and repair. High-quality AE surveillance should identify fistula promptly and include consultation with experienced urologists. Strengthening provider surgical skills and establishment of standard protocols for fistula management would aid future prevention efforts in VMMC programs.

The Consequences of Purposefulness And Human-Likeness on Trust Repair Attempts Made by Self-Driving Vehicles

Autonomous systems are rapidly gaining the capacity to recognize their own errors and utilize social strategies to mitigate the trust deficit that accompanies those errors. While previous research has catalogued the effects of trust repair attempts in human-human relationships, much remains unknown about the consequences of similar strategies when administered by autonomous systems such as self-driving vehicles. While we tend to treat computers like social actors, autonomous systems may have a wider spectrum of perceived human-likeness and may be subject to different interpretations of the purposefulness of their errors. This paper seeks to understand the consequences of these factors on the effectiveness of trust repair attempts administered by self-driving cars, and the results highlight the importance of considering human-likeness and purposefulness in the design of autonomous systems.

Laser Re-Melt Technique for Laser Additive Repair of Narrow Rectangular Cracks in Grade 5 Titanium Alloy (Ti-6Al-4V)

Groove inaccessibility, top groove powder impedance, irregular sidewall powder delivery and lack of sidewall vertical irradiation have been reported as major limitations for the use of Laser Additive Technology (LAT) for narrow rectangular crack repair applications. As a result, most reported repair attempts were concluded unsuccessful. In the present work, a multi-track laser re-melt technique was developed for the repair of narrow rectangular cracks of sizes 2 and 3 mm, both 5 mm deep on 7 mm thick Ti-6Al-4V plates. The laser re-melt technique was carried out at controlled laser power, focal length, spot size, powder feed rate, gas flow rate and scanning speed. The repaired substrates were evaluated for defects through optical microscopy (OM) and scanning electron microscopy (SEM). The obtained results showed densely fused defect-free repaired substrates with good evolving microstructure.

Factors Associated with Obstetric Fistula Repair Failure among Women Admitted at Gynocare Women’s and Fistula Hospital in Kenya, 2012-2016: A Case Control Study

Aim: To determine factors associated with obstetric fistula repair failure at Gynocare Women’s & Fistula Hospital in Kenya. Methods: This is a case-control study of patients who underwent fistula repair at Gynocare from January 2012 to December 2016. Total of 357 patients (119 cases and 238 controls) were taken by simple random sampling. Results: Study participants were mostly married (62.2%) with low or no formal education (90.1%). Delivery that led to fistula development occurred in the hospital for 85.2% of the study participants and 66.7% had Cesarean Section. Only one-third (120) had previous repair(s). Patients classified to have VVF IIA were 20.5%, class IIB were 35.0% and class III were 9.2%, and the rest (35.3%) were classified as class I. The odds of repair failure were 2.9 times more among those with previous repair attempts compared to those with no previous repair attempts. Women with VVF IIB were 4 times more likely to develop failure. While women who attained at least secondary education were 77% less likely to have fi stula repair failure. Conclusion: After controlling the eff ects of age, marital status, comorbidities, parity, time to repair, post-operative complications, having not attained at least secondary education level, having previous repair attempts, and VVF IIB were found to be independent predictors of repair failure. Key words: Failure, Kees Waaldjik, Obstetric Fistula, Obstetric Fistula Classifi cation, Repair

Factors associated with obstetric fistula repair failure among women admitted at Gynocare Women’s and Fistula Hospital in Kenya, 2012-2016: a case control study

Aims: Determine factors associated with obstetric fistula repair failure at Gynocare Women’s & Fistula Hospital in Kenya. Methods: This was a case-control study whosestudy population was patients who underwent repair at Gynocare between January, 2012 to December, 2016; 119 cases and 238 controls were selected by simple random sampling out of 357 cases. Results: Study participants were mostly (62.2%) married with low or no formal education (90.1%). Delivery that led to fistula development occurred in the hospital for 85.2% of the study participants and 66.7% resulted into C/S. Only 1/3 (n = 120) had previous repair(s).Patients classified to have VVF IIA were 20.5%, class IIB were 35.0% and class III were 9.2%, the rest (35.3%) were classified as class I. The odds of repair failure were 2.9 times more among those with previous repair attempts compared to those with no previous repair attempts. Women with VVF IIB were 4 times more likely to develop failure. While women who attained at least secondary educations were 77% less likely to have fistula repair failure. Conclusions: After controlling the effects of age, marital status, comorbidities, parity, time to repair, and post-operative complications: having not attained at least secondary education level, having previous repair attempts, and VVF IIB were found to be independent predictors of repair failure.

Success Rate of Urogenital Fistula Repair and Predictors of Success-An Audit of Ten Years Data

Aims: To evaluate the association of various predictive factors with the outcome of surgical repair of vesicovaginal fistula. Methods: The retrospective analysis was conducted at Maternal and Child Health, Pakistan Institute of Medical Sciences, Islamabad, and it comprised data related to patients having undergone vesicovaginal fistula repair from January 2008 to June 2018. Statistical analysis of the record was done using SPSS 21 software. Results: A total of 364 patients of urogenital fistula repair were reviewed, with an overall success in 318 (87.4%) cases. There were no significant differences in fistula duration (p0.4), size of fistula (p 0.34) and accessibility (p0.5) between successful and unsuccessful group. However, we found the association between the type of fistula and history of previous repair attempts with the success of fistula repair. Primary surgical repair of vesicovaginal (90.0%), vesicouterine (86%), ureteric (100%) and ureterovaginal (98%) were more successful as compared to repair with the history of 1 previous attempt (90.3%, 83.3%, 66.6% and 75% respectively). Success rate was found to further decrease with the history of more than one repair attempt of vesicovaginal (71.4%) and vesicouterine (66.5%) fistula. Further, successful fistula repair in women was also found to be significantly associated with parity less than 4 (p 0.038). Conclusion: Despite the higher success rate of urogenital fistula repair, it’s important to refer the urogenital fistula patients timely to specialized fistula centres in order to achieve best results.

PP08 Health Technology Assessment Of Autologous Chondrocyte Implantation

Introduction:Microfracture (MF) has been the main intervention in symptomatic articular cartilage knee defects. Autologous chondrocyte implantation (ACI) has looked promising, but was not recommended by the UK National Institute for Health and Care Excellence (NICE) in 2015 due to the short-term follow-up data from trials.Methods:Most long-term data comes from observational studies. We provided new unpublished analyses to NICE based on survival data of these studies, with appropriate caveats. They included: a large ACI study by Nawaz with useful subgroup data by osteoarthritis Kellgren-Lawrence stage and previous repair attempts; a very large MF study by Layton, and a small RCT by Knutsen indicating MF was as ‘good’ as ACI. A Markov model explored the cost-effectiveness of ACI vs. MF. Different scenarios were explored: ACI or MF as a first procedure, followed by ACI or MF in those needing a second repair. A NHS England perspective was adopted. Health outcomes were expressed as quality-adjusted life-years (QALYs).Results:The revised base-case analysis, used a list price of £16,000 (EUR 17,380 in 2013 prices) for cells, used ACI failure data from Nawaz with no previous procedures for ACI, and pooled MF failure data from two studies-Saris and Knutsen. ACI was more expensive but provided more QALYs. The incremental cost-effectiveness ratio comparing ACI then MF with MF then ACI was £8,000 (EUR 8,690) per QALY. Various sensitivity analyses were conducted assuming a threshold of £20,000 (EUR 21,730) per QALY: previous repair attempts reduced success of ACI (£22,000 (EUR 23,900) per QALY); reducing cell costs, ACI improved its cost-effectiveness; and limiting intervention to patients with higher Kellgren-Lawrence score did not appear cost-effectiveness.Conclusions:The final NICE guidance published in October 2017 approved the use of ACI for patients who had no previous knee repairs, for people with minimal osteoarthritic damage to the knee, and for people with articular defects of over 2cm2.

Restoration of Historic Buildings in Zanzibar

Looking at current state of most repaired historic buildings in Stone Town of Zanzibar, it is quite clear that the repair attempts made have not been very successful. Modern materials and techniques introduced in the repair works have often proven to be incompatible with the original materials causing accelerated deterioration of buildings fabric. This shows that, there is no comprehensive study undertaken so far on identifying the appropriate materials and restoration techniques. To solve this problem, a study has been made with the main objective of developing the means of restoring historic buildings by using materials existing in Stone Town of Zanzibar. The study was conducted through visual investigation and laboratory testing of materials taken from existing historical buildings and those that are currently being used for repair. Laboratory test conducted includes chemical analysis, grading, compressive strength and water absorption. The results showed some similarities in both materials, however, the combination ratios are not the same resulting into different properties. It has therefore been established that sand of the same grading pattern as the one found in the historic building mortar must be sought and utilized in making repair mortar at a ratio of 1 part lime to 3 parts sand.