Penile transplant

Wounded U.S. Soldier Soon to Receive First U.S. Penis Transplant

 
BALTIMORE:  A US soldier wounded in an explosion will be the first person in the United States to receive a penis transplant, doctors at Johns Hopkins Hospital said, which could open the way for about 60 other servicemen with genital injuries to have this surgery.

Surgeons hope a donated organ from a recently deceased man will provide full function including urination, sensation and sex. The surgery requires joining nerves and blood vessels under a microscope.

Doctors and advocates who work with wounded soldiers note that the loss of the penis is one of the most emotionally traumatic injuries because it affects a sense of identity and manhood, especially for men hoping to become fathers.

"When you meet these guys and you realize what they've given for the country, it makes a lot of sense," Dr. Richard Redett, a plastic surgeon at Johns Hopkins Hospital who will help perform the operation, told Reuters.

The recipient, who was not identified, lost most of his penis and had substantial groin injuries in a bomb explosion while deployed overseas. Media reports have said he was wounded in Afghanistan.

The surgery could occur in the coming weeks. Doctors are looking for a donor who is a good match in terms of age and skin color. The donor's family will need to give permission for the penis to be removed.

There have been two penis transplants in the world. The first in China in 2006 was unsuccessful. The second in South Africa in 2014 was a success.

Thor Wold, who served as a Marine medic in the Iraq war and now works as an advocate for veterans, said that after suffering genital injuries servicemen immediately wanted to know if they would still have sexual function.

"They would ask, 'Is everything OK down there, doc? My wife's at home and we're trying to have a baby when I get back,'" Wold told Reuters.

Redett said a veteran suffering from a blast injury could need to have not just his penis replaced but also the scrotum, part of the abdominal wall, groin tissue and part of the inner thigh.

"We've sorted out how to take that block of tissue from a donor and give it to a recipient," he said.

The penis transplant does not involve the testes, where sperm are produced, so if a man with a transplanted penis does father a child, the baby would be his genetic offspring, not the donor's.

While for now only wounded veterans are being considered for penis transplants, the surgery could eventually be performed on men with birth defects and transgender men and women.

Secret world of doping

The dark side: The secret world of sports doping

Al Jazeera Staff

Al Jazeera

27 December 2015

The dark side: The secret world of sports doping

Inside a hotel room in Austin, Texas, a pharmacist advises a professional athlete on taking performance-enhancing drugs.

"One anabolic, and I can give you something to use right now is this Delta 2 stuff.

It's a steroid. There's a bunch of football players who take this,” he tells Liam Collins, a British hurdler reporting undercover.

In another conversation, a Vancouver pharmacist poses a question to the same athlete.

"Have I doped people? Oh yeah. And no one's got caught because the system is so easy to beat. That's the sad fact."

Later, a naturopath doctor explains how he would destroy medical records if investigators came looking for them.

"I can just document everything not in this chart but on my own chart. And if somebody ever comes sniffing for it, it's very easy to just delete and say no, this is the real chart. If say, WADA (World Anti-Doping Agency) comes sniffing around."

Normally these conversations take place behind closed doors, but a new investigation by Al Jazeera is bringing them to light.

Liam Collins, working on behalf of Al Jazeera's Investigative Unit, spent six months undercover investigating the murky world of performance enhancing drugs - what athletes refer to as "the dark side".

"For me, it was an opportunity to be the guy, to go undercover, and make a change," said Collins.

At 37, he competes as a hurdler at an international level. For the investigation he claimed that he was making one last push for the Rio Olympics and was willing to do "whatever it takes" to get there.

The investigation has exposed the crucial role of pharmacists and doctors in creating and prescribing programs of performance enhancing drugs designed to cheat the testing system.

It also raises questions about some well-known athletes in American football and baseball who the medical professionals claim to work with.

The athletes and medical professionals who responded to requests for comment denied any wrongdoing.

This includes Payton Manning, a football player for the Denver Broncos, whose wife, one pharmacist alleged, was supplied with human growth hormone. in 2011 while he was recovering from surgery.

That pharmacist, Charlie Sly, has disavowed his statements to Collins that were caught on hidden camera.

Manning has emphatically denied the allegation, telling ESPN it is "complete garbage" and "totally made up".

In a statement, the Broncos said: "Knowing Peyton Manning and everything he stands for, the Denver Broncos support him 100 percent. These are false claims made to Al Jazeera, and we don't believe the report."

Sly also named baseball players Ryan Zimmerman of the Washington Nationals and Ryan Howard of the Philadelphia Phillies as athletes he supplied with human growth hormone. Both have denied the allegations.

But the investigation raises questions about whether medical professionals are helping athletes cross to the dark side, and whether doping in sport is reaching new levels.

By Deborah Davies, Jeremy Young, Kevin Hirten and Craig Pennington

Al Jazeera Investigates: The Dark Side: Secrets of the Sports Dopers

Production team:

Peter Charley - Executive Producer

Deborah Davies - Reporter

Jeremy Young - Senior Producer/Director

Kevin Hirten - Producer

Craig Pennington - Director of Photography

Nicholas Dove - Editor

Business environment, rule of law key to economic growth

By Paul Burrowes

For an economy to grow, a country must have well-run legal and judicial institutions.
In short, the rule of law impacts the quality of regulations for operating an efficient business.
According to the World Justice Project, the rule of law reigns in Denmark while Singapore tops regulatory quality and efficiency for businesses.
More specifically, the rules by which market functions provide the means to resolve disputes, protect economic and social rights and hold governments accountable for their actions.
When a country promotes investment, a good justice system can contribute to economic growth and development.
The United Nations Office on Drugs and Crime says that “the centrality of a strong justice mechanism lies in its essential contribution to fostering economic stability and growth, and to enabling all manner of disputes to be resolved within a structured and orderly framework” [UNODC, 2011*]. 
Legal framework apart, government attitudes toward markets and freedoms and the efficiency of their operations are also very important: excessive bureaucracy and red tape, overregulation, corruption, dishonesty in dealing with public contracts, lack of transparency and trustworthiness, inability to provide appropriate services for the business sector and political dependence of the judicial system impose significant economic costs to businesses and slow the process of economic development.
Data compiled by two independent international agencies clearly show that the overall quality of the legal system as well as the quality of justice (both civil and criminal) are directly correlated with the business environment and economic performance.
Where, therefore, does Jamaica rank in the quality of the its legal system and the efficiency of its business environment.
Those independent international agencies, the World Justice Project and World Bank's Doing Business 2016 as it relates to regulatory quality and efficiency, put Jamaica at 42 in the 2015 rule of law overall score and 79 in the regulatory efficiency of the business environment.
If Jamaica does well in dealing with construction permits, enforcing contracts, getting credit and electricity, paying taxes, protecting minority investors, registering property, and starting a business under a competent and effective legal framework, the sky's the limit for the land of wood and precious water.
Legislators have to work on limiting government powers, rooting out corruption, maintaining order and security with crime under control, protecting fundamental rights, enforcing regulations for businesses, and improving civil and criminal justice.
Denmark and Singapore are showing the way, but so too have Norway, Sweden, Finland, Netherlands, New Zealand, Austria, Germany and Australia especially in the rule of law.
While on the regulatory enivronment front, add South Korea, United Kingdom, Canada, and the cities of New York City, Hong Kong, Los Angleles, and Taiwan to those already mentioned.

Ganja good for epilepsy

Purified marijuana compound may reduce stubborn epileptic seizures

(Reuters Health) - A purified compound derived from marijuana may help reduce seizures in children and young adults with severe forms of epilepsy that resist other treatments, a new study suggests.

Patients who added a 99 percent-cannabidiol (CBD) oil to their current treatments went from an average of 30 seizures a month to fewer than 16 - representing a 37 percent reduction over 12 weeks, researchers report in Lancet Neurology.

"In this group that has been extremely treatment resistant, this was an incredibly positive finding with the caveat that we didn’t have a comparison group," said lead author Dr. Orrin Devinsky, of NYU Langone Medical Center in New York City.

CBD is a compound found naturally in marijuana and known to affect the brain. But it's important to note that CBD does not produce a high, Devinsky said, and the new findings have no bearing on use of medical marijuana or other compounds from the plant.

The form of CBD used in the new study was a solution of the extract in oil called Epidiolex from GW Pharmaceuticals, which partly funded the new study. The drug is currently being evaluated by the U.S. Food and Drug Administration.

Previous research into the effects of CBD and medical marijuana on various types of epilepsy has been limited and produced mixed results with some people having fewer seizures and others having more.

For the new study, the researchers enrolled 214 patients between 2014 and 2015 from 11 U.S. epilepsy treatment centers. They included people with different forms of epilepsy like Dravet and Lennox-Gastaut syndromes. The participants were typically among the centers' most resistant to existing epilepsy treatments.

The goal of the study was to inform future research by tracking doses, side effects and whether or not the patients improved.

Participants were started on 2 milligrams (mg) to 5 mg of the solution, broken into two daily doses. The dosage slowly increased to 25 mg or 50 mg daily over the 12 weeks. Patients continued taking their existing medications.

Of those who started the study, 52 patients were lost to follow up and 11 stopped taking CBD before the study ended. Others were excluded from part of the analysis due to age, other health conditions or not experiencing seizures.

About 37 percent of patients had their seizures reduced by at least half. The researchers point out that 22 percent of patients had seizures reduced by at least 70 percent and 8 percent had their seizures reduced by at least 90 percent.

Overall, 20 patients had severe side effects possibly related to CBD. The most common was a severe bout of seizures known as status epilepticus. Only five participants stopped taking the solution due to side effects, however.

Less severe side effects included drowsiness, diarrhea, loss of appetite, fatigue and convulsions.

Devinsky said ongoing double-blind randomized controlled trials, which are considered the gold standard of medical research, will be able to shine more light on CBD's effectiveness and which side effects are caused by the drug.

Dr. Kevin Chapman, of Children's Hospital Colorado in Aurora, said he'll be interested to see the results of those trials.

"From my standpoint, I don’t think it’s going to quite be the panacea we’re hoping it to be," said Chapman, who studies CBD for epilepsy but wasn't involved in the new study.

For example, he said, the side effects found in the new study suggest CBD's safety is similar to that of current drugs. Also, the study suggests there may be better outcomes among people taking CBD and another popular epilepsy drug known as clobazam.

"I think it raises some questions about the utility for CBD, but it lays the groundwork for future studies," Chapman said.

Devinsky said his team's ongoing clinical trials of CBD should be completed around February.

Liverpool @ Manchester

Liverpool @ Manchester City, Etihad Stadium, Saturday, November 21 - 12:30 pm

Preview Stats
• Man City have won four and lost none of their last six Premier League games against Liverpool at the Etihad Stadium.
• The Reds have lost just one of their last six Premier League away games (W2 D3 L1), but that came in Manchester at Old Trafford v Man Utd.
• Liverpool have scored just 13 Premier League goals, the joint-lowest tally of any Premier League season for the Reds after 12 matches.
• This is Manchester City's third best start to a Premier League season after 2011-12 (34 points) and 2012-13 (28).
• Manchester City have fired in the most shots on target of any team in the Premier League (83).
• Liverpool have the worst chance conversion rate of any team in the Premier League (10.5%).
• Philippe Coutinho has scored three goals in four Premier League appearances against Man City.
• Only opposing goalkeeper Joe Hart (14) has kept more Premier League clean sheets in 2015 than Simon Mignolet (13).
• Man City have allowed their opponents just 28 shots on target this season, fewer than any other team in the Premier League.
• Philippe Coutinho has scored as many goals in his last two Premier League appearances under Jurgen Klopp as his final 18 under Brendan Rodgers.

“If the rich could hire someone else to die for them, the poor would make a wonderful living.” (Jewish Proverb)

The Blues still in hunt

A bad beginning, a good end for Chelsea?

By Paul Burrowes

For the first time in the history of the English Premier League, Chelsea FC are in 16th place after match day eight.
The only other season that Chelsea started so badly was in the 1993-94 season when they were in 14th place after eight matches. They finished that season in 14th place.
English top-flight football, however, has not been at its best this 2015-16 season, as leaders Manchester City (18 points) secured the 34th best leaders tally in English top-tier football.
The 2011-12 season was better for the Citizens; in fact it was their best, as they sped to 22 points that season from eight matches, a season they won after edging Manchester United on goal difference — both finishing with 89 points.
Those 22 points after eight matches remained as the second best in EPL history, topped only by Chelsea in in 2005-06 when The Blues grabbed 24 points from the eight matches. Of course Chelsea won that season, their third of five titles.
Despite the Blues poor start, they are expected to finish in fourth place with 72 points, after Manchester City (80 points), Arsenal (78 points), and Manchester United (76 points).
Not surprisingly Chelsea are 13 points below the expected money league ranking, which measures teams' transfer expenditure in signing squad members.
Eden Hazard stands as Chelsea's best player so for the season, but he is outside the top 50 led by Leicester City's Riyad Mahrez, who has scored five goals and added three assists.