Saturday, February 23, 2013

JAKARTA: Boy with haemophilia bleeds after circumcision (!)

Jakarta Post
February 21, 2013

Toddler with hemophilia bleeds after circumcision


by Panca Nugraha

Haikal Syafi’i, a three-year-old with hemophilia, has been receiving repeated treatment in hospital for severe bleeding from a circumcision wound.

Haikal from Lombok, West Nusa Tenggara (NTB), was taken to Gerung Hospital in Lombok Barat after a mass circumcision event last month . He continued to suffer constant bleeding so his parents took him to Bhayangkara Hospital in Mataram, NTB.

“After receiving treatment in those two hospitals, his bleeding continued; so, he was brought to NTB General Hospital (RSUP) on Monday. We found that Haikal is suffering from hemophilia, a disorder in the blood clotting process,” the hospital’s Lalu Ahmadijaya, told The Jakarta Post, on Thursday.

Hemophilia is a genetic disorder that affects mainly boys, famously prevalent in the royal families of Europe.

“This should be a lesson for our people that they should check the health conditions of their children before circumcision.” said Ahmadijaya.

Speaking to the Post, Haikal’s mother, Sanemah, said that her boy attended a mass circumcision with seven other boys from their kampung on Jan.27 to commemorate the Prophet Muhammad’s birthday.

“After being circumcised, he had no complaints. But four days after the procedure, he began bleeding from his circumcision wound,” she said.

“Hemophilia treatment can be costly. Koate, for example, costs around Rp 10 million (US$1,030) per injection and Haikal needs three injections to stop his bleeding,” Ahmadijaya said, adding that Haikal’s treatment would be covered by the government-fund health coverage scheme Jamkesmas. (ebf)

Thursday, February 21, 2013

SASKATOON: Father's status more important than "reasons" to cut

Canadian Family Physician (also on this site)
February, 2013

Father's status influences circumcision decision

by Hugh Young

A study in Saskatoon, Saskatchewan, has found that regardless of the reasons parents give to circumcise, the father's status is an important factor in the decision.

Medical student Chris Rediger and his supervisor Dr Andries Muller surveyed 230 people at prenatal classes in the Saskatoon Health Region over a 3-month period.

Of all parents responding who were expecting children, 56.4% indicated they would consider pursuing elective circumcision if they had a son; 24.3% said they would not. They were asked before any prenatal classes, which may have changed their final decision.

The reasons they most often gave for supporting male circumcision were hygiene (61.9%), prevention of infection or cancer (44.8%), and the father being circumcised (40.9%). The reasons most commonly reported for not supporting circumcision were it not being medically necessary (32.0%), the father being uncircumcised (18.8%), and concerns about bleeding or infection (15.5%).

But when the expecting father was circumcised, 81.9% of respondents were in favour of pursuing elective circumcision. When he was not circumcised, only 14.9% were in favour of pursuing elective circumcision. The result was statistically significant.

Father's status and circumcision preference - Rediger

The father's circumcision status also influenced whether parents-to-be thought circumcision was safe. 82.2% with a circumcised father-to-be thinking circumcision by an experienced medical practitioner was a safe procedure for all boys, and none thinking it unsafe, compared to 64.1% of couples with an intact father-to-be thinking it safe and 7.8% thinking it unsafe.

Tuesday, February 19, 2013

NOTTINGHAM: African HIV trials fudged registration dates

So what else did they play fast and loose with?

Ripe Tomatoes, September 13, 2013


Circumcision and HIV

Two out of three key trials registered late

Does circumcision of adult men reduce HIV transmission? Initial scepticism, surely the foreskin reduces friction between penis and vagina, and prevents abrasions and blood transfer, and conflicting observational data, were eventually overcome by three randomised trials, one each from South Africa (click here), Kenya (click here) and Uganda (click here). In each trial men were randomly allocated to immediate circumcision or to wait for two years. All three trials showed about half the number of new HIV infections in the immediate circumcision group. The relevant Cochrane review (click here) summarises them as follows:

“The resultant incidence risk ratio (IRR) was 0.50 at 12 months with a 95% confidence interval (CI) of 0.34 to 0.72; and 0.46 at 21 or 24 months (95% CI: 0.34 to 0.62). These IRRs can be interpreted as a relative risk reduction of acquiring HIV of 50% at 12 months and 54% at 21 or 24 months following circumcision.”

The Cochrane reviewers judged “the potential for significant biases affecting the trial results [as] low to moderate”. Referring to selective reporting they wrote “All three trials clearly stated in their protocols that the primary outcome was HIV incidence. The risk of bias due to incomplete outcome reporting is therefore low in all three trials.”

The trial protocols have not been published so we have to trust that the Cochrane reviewers interpreted them correctly. But if they relied on trial registration documents (click here, for South Africa, here for Kenya and here for Uganda) they would have been misled. They they all indicate more of less the same primary outcomes and planned sample sizes as in the respective papers. But according to the date of first entry, only the Kenyan trial was prospectively registered. The South African trial was registered a year and a half after recruitment ended and seven days before the results were published! The Ugandan one a month after recruitment ended,and a month before publication.

Recruitment period Date of 1st publication of results 1st trial registration date Registry planned sample size Primary outcome in registry Primary outcome in paper
South Africa July 2002 – Feb 2004 26 July 2005 July 19 2005 3274 planned.
3274 in paper
HIV infection at 3, 12 and 21 months All HIV infections at 3, 12 and 21 months
Kenya Feb 2002 – Dec 12 2006 24 Feb 2007 April 23 2003 Initially 3,000. Altered to 2887 in registry.
2784 in paper
HIV incidence at 2 years
Complications of circumcision
HIV incidence after three interim analyses
Uganda August 2002 – Dec 2006 24 Feb 2007 Jan 23 2007 5,000 planned
4996 in paper.
HIV acquisition no time point specified HIV incidence

It looks like PLOS One and The Lancet wanted to publish sexy high impact trials, found they weren’t registered, so got the authors to do it retrospectively, and hoped no-one would notice! All three trials were funded by the public sector.

Jim Thornton (Professor of Obstetrics and Gynaecology at Nottingham University)

BRAZIL: Circumcision kills one in 7700 (=156 deaths/p.a. in the USA)

Einstein (Sao Paulo) 2012 Sep;10(3):342-346.

Circumcisions for medical reasons in the Brazilian public health system: epidemiology and trends.

Korkes F, Silva Ii JL Pompeo AC

Abstract
OBJECTIVE
:
To evaluate the epidemiological factors associated to medical circumcision, based on data from the Brazilian public health system.

METHODS: Using the Unified Health System public database between 1984 and 2010, hospital admissions associated with surgical treatment of phimosis were searched. A total of 668,818 men admitted to public hospitals who underwent circumcision were identified and included in the present study.

RESULTS:
A mean±standard deviation of 47.8±13.4 circumcisions/100,000 men/year was performed through the Unified Health System for medical reasons. During the 27-year period evaluated, 1.3% of the male population required circumcision for medical reasons. [So 98.7% of routine circumcisions are wasted on boys and men who will never need it.] Total number of circumcisions and circumcision rate increased in childhood, declined progressively after 5 years of age and rose again progressively after the sixth decade of life. In the regions of the country with better access to healthcare, 5.8% of boys aged 1 to 9 years old required circumcisions. [Or were circumcised whether they needed it or not.] From 1992 to 2010 there were 63 deaths associated with circumcisions (mortality rate of 0.013%).

[That's one death in 7692 circumcisions. In this USA, that would amount to 156 circumcision deaths per year.]

CONCLUSION:
In conclusion, yearly circumcision rates could be estimated in Brazil, and a very low mortality rate was associated with this procedures. Circumcision is mostly performed in children in the first decade of life and a second peak of incidence of penile foreskin diseases occurs after the sixth decade of life, when circumcision is progressively performed again.

[This study was circulated by Prof. Brian Morris, who presumably thinks this is an "acceptable" death rate.]

CANBERRA: Circumcising doctors restricted, one must see psychiatrist

Canberra Times
February 17, 2013

Unkindest cut: Restrictions placed on doctors


by Phillip Thomson

Several doctors have had restrictions placed on them by the ACT Medical Board.

THE national watchdog has slapped restrictions on more than 40 Canberra health practitioners to ‘‘protect the public’’.

Those with restrictions placed on them include one practitioner under scrutiny for the way he performs circumcisions, with the regulator stating he is not to perform circumcisions without the use of adequate pain relief and that he must use the correct equipment during these procedures. [So what equipment was he using?]

Until the end of 2013, the doctor must list for the ACT Medical Board each circumcision he has performed and the anaesthetic used in each procedure.

The doctor’s future use of analgesics during circumcisions must be in line with the Royal Australian College of Physicians guidelines and he must see a psychiatrist paid for and appointed by the medical board.

He has been allowed to choose his own mentor who was to supervise him for six months and write a report for the board.

The doctor declined to comment when contacted

...

Friday, February 15, 2013

BELGIUM: Circumcised men get less pleasure

Reuters
February 14, 2013

Male circumcision tied to less sexual pleasure

by Andrew M. Seaman
(Reuters Health) - Men circumcised either as children or adults report less intense sexual pleasure and orgasm than their uncircumcised counterparts, according to a new study from Belgium.

"We're not saying less sexual activity or satisfaction, but sensitivity," said the study's senior researcher Dr. Piet Hoebeke, from Ghent University Hospital.

The new study surveyed 1,369 men over the age of 18, who responded to leaflets handed out in train stations across Belgium.

The men were asked whether they were circumcised, and were then asked to rate how sensitive their penis was, how intense their orgasms were and whether they experience any pain or numbness when they are aroused.

Overall, 310 men who took the survey were circumcised, and 1,059 were not. Each rated how sensitive their penis was on a scale from 0 to 5, with higher numbers being the most sensitive.

Overall, uncircumcised men reported between 0.2 points and 0.4 points higher sensitivity and sexual pleasure when their penis's head - known as the glans - was stroked during arousal, compared to circumcised men.

For example, uncircumcised men reported an average sensitivity score of 3.72 when they or their partner stroked the top part of their penis's glans, compared to 3.31 amongst circumcised men.
Uncircumcised men also reported more intense orgasms.

"It's not a very big difference in sensitivity, but it's a significant difference," Hoebeke said.

Currently, about half of U.S. baby boys have their foreskin surgically removed at birth, and about 30 percent of men around the world are circumcised.

Some religions, such as Judaism and Islam, consider circumcision part of religious practice, while other people choose circumcision for possible health benefits - including a reduced risk of urinary tract infections (see Reuters Health article of December 7, 2012 here:).

Hoebeke and his colleagues write in BJU International that there are few studies researching whether foreskin plays a role in sexual pleasure. But Dr. Aaron Tobian, who studies circumcision but was not part of the new study, said that previous randomized controlled trials - considered the gold standard of medical research - looked at sexual performance and satisfaction. [They were studies of adult volunteers for circumcision - not the gold standard at all.] Those studies, he said, did not find a difference. [Becauses the questions were too vague to do so.]

One possible explanation for any potential difference in sensitivity is that a man's foreskin may protect his penis's head from rubbing against underwear and clothing. It's possible, the researchers write, that friction makes the head of the penis thicker, drier and ultimately less sensitive. [Another is simply that the foreskin itself is sensitive, as Taylor found.]

The researchers also found circumcised men were more likely to report more pain and numbness during arousal than uncircumcised men, which Hoebeke said is likely due to scar tissue.
"I'm amazed that people report pain during sexual pleasure… That's very amazing and that was unexpected," he said.

‘ABUNDANTLY CLEAR' EVIDENCE
Tobian, from Johns Hopkins University in Baltimore, said the findings are missing important context.
"The medical evidence and the benefits of male circumcision are abundantly clear," Tobian told Reuters Health. [This is not "context", but another issue altogether.]

"If there was a vaccine out there that reduces the risk of HIV by 60 percent, herpes by 30 percent and the penile cancer causing HPV by 35 percent, the medical community would rally behind it," said Tobian. [There is little or no evidence that circumcision does any of those things.]

The American Academy of Pediatrics says the benefits of male circumcision outweigh the risks, but stops short of recommending universal circumcision (see Reuters story of August 27, 2012 here:).

SOURCE: bit.ly/X7j39D BJU International, online February 4, 2013.

Wednesday, February 13, 2013

TANZANIA: Campaign to COMPEL men to be circumcised

AllAfrica.com
February 11, 2013


Tanzania: Handeni Promotes Male Circumcision to Curb HIV Spread


Handeni — HANDENI district have launched a campaign to compel men in the area to undergo circumcision as a preventive measure against HIV/AIDS.

The campaign was announced over the weekend by the District Medical Officer (DMO), Dr Somoka Mwakapalala, when speaking during a public rally at Kabuku ward on the last leg of Tanga Regional Commissioner Chiku Gallawa's tour of Handeni.

The RC wanted to know measures that the district has taken so far in sensitizing the public on preventive measures against HIV/AIDS especially those living along highways where the infection rate is still high.

The DMO said apart from sensitizing the people to be faithful to their partners, abstain from sex or use condom, the district had also launched a campaign of encouraging men to undergo circumcision.

According to Dr Mwakapalala, circumcised men have lower chances of being infected with the deadly virus than those who are uncircumcised. He said health workers and activists in the district have been moving around the district to sensitize men do so bearing in mind that some tribes do not practice circumcision.

...

Tanzania
HIV Rates: Circumcised men6.5%
Intact men5.6%
Source: measuredhs.com/pubs/pdf/CR22/CR22.pdf
[We may hope that "compel" is faulty English, but this has been expected for a long time.]