RESUMO
INTRODUCTION: Autologous adipose-derived stromal vascular fraction (SVF) has been described to have therapeutic benefits in the treatment of keloids. However, most of the evidence on its efficacy is based on observational studies the majority of which are conducted in high-income countries and yet the highest burden of keloids is in low- and middle-income countries (LMICs). OBJECTIVES: We set out to determine the safety and feasibility of using autologous adipose derived stromal vascular fraction in the treatment of keloids in LMICs. METHODS: In this phase II randomized controlled pilot clinical trial conducted in the Plastic Surgery Unit of Kirruddu National Referral Hospital in Kampala Uganda, 8 patients were assigned a 1:1 ratio to either SVF or triamcinolone acetonide (TAC) arms. In the SVF arm, a median (Inter quartile range) amount of stromal cell infiltration of 2.7×106 (11×106) was administered, while the controls received 10 mg/ml TAC at a ratio of 1:1 TAC to keloid volume. Primary endpoints were adverse event development based on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 tool and feasibility assessment based on ≥ 70% recruitment feasibility and ≥ 80% interventional feasibility rates. RESULTS: The participants' mean age was 27.9 (±6.5) years, with a female predilection of 5 (63%). Overall, no adverse events were reported in the SVF arm, while ulceration in a single patient in the TAC arm, which was a grade II adverse event, was reported. Recruitment feasibility of 80% and interventional feasibility with 100% completion were reported. CONCLUSION: Based on our findings, an autologous adipose-derived stromal vascular fraction is feasible and safe for the treatment of keloids in LMICs.
RESUMO
Testicular torsion remains a common surgical emergency of adolescent males presenting with sudden onset of intense scrotal pain in Africa. While the magnitude of testicular torsion is not known it has been identified as a cause of male infertility. Testicular loss in Africa is directly related to delay in surgery and the referral patterns at the point of first contact with health workers. This paper sets out to demonstrate the importance of the patient's age in the diagnosis of testicular torsion. A surgical audit was made of patients records collected over the last 30 years, for presentation of testicular related symptoms and analyzed to identify changes in the patterns of diagnosis over time and in different countries. There were 305 records found, for patients with an age range of 9-56 years. There were 195/305 (64%) with orchitis and 110/305 (36%) with testicular torsion. Testicular torsion is more common under the age of 18 years while orchitis was more common after 18 years of age (rho=-0.834, p value>0.001 one tailed). This paper supports the development of educational interventions that promote the use of age in a simple diagnostic rule of the thumb for communities and lower cadre health workers in low resource settings.
