In a meta-analysis of studies conducted in North America, the seroprevalence of CD based on 7 studies including almost 18K subjects was estimated to be 1.4% (95% confidence interval [CI] 0.7%2.2%), whereas the prevalence of biopsy-proven CD, based on a single study including 200 subjects, was estimated to be 0.5% (1517). Police detained him and visually checked him in the police station, forcing him to strip and bend over. [211] States do have some latitude to legitimately intrude upon those rights during bodily searches carried out pursuant to a criminal investigationincluding for example by subjecting some criminal suspects to mandatory DNA testing. Slattery SA, Niaz O, Aziz Q, et al. Tobacco use has predominantly negative effects on human health and concern about health effects of tobacco has a long history. 160. Youre destroying yourself. Then they took us back to the gendarmerie. The NNH for TCAs ranged between 9 (n = 7 studies), based on patients experiencing an AE, and 18 (n = 6 studies), based on AEs prompting discontinuation (3,202). Cockerell KM, Watkins AS, Reeves LB, et al. Lembo AJ, Lacy BE, Zuckerman MJ, et al. While she is conducting the exam, she uses a flashlight to look inside and makes comments: Wow, what a tunnel! He put on gloves and used his fingers, which was wrong. He said, No, no, no, this wont do. Ugandan activists are considering filing a constitutional challenge to the use of forced anal examinations. In addition, research is needed to determine which is the most effective donor for FMT (e.g., fresh vs frozen; random donor vs universal donor) and which is the best technique for FMT (e.g., nasojejunal vs colonoscopy vs capsule). [206] UN Working Group on Arbitrary Detention, A/HRC/16/47/Add.1, opinion no. The reason for this is unclear but was independent of age. The 3-mg plecanatide daily dose achieved a relative risk of symptom persistence of 0.88 (95% CI 0.820.94; NNT = 10) (141) and an OR of response to treatment of 1.87 (95% CI 1.472.38; NNT = 9) compared with placebo using the US FDA responder endpoint (173). Fakhry [the director] said after, Why didnt you cry when men put their things in you? I wanted to spit on him. Urge physicians from member medical associations to participate in national institutions for the prevention of torture (National Preventive Mechanisms) as established by the Optional Protocol to the United Nations Convention against Torture (OPCAT), and to ensure that the National Preventive Mechanisms play a role in stopping or preventing the use of forced anal examinations. Issue a document, in the form of a statement, ethical guidance note, or technical document, condemning the use of forced anal examinations as a method of investigating consensual same-sex conduct on the grounds that the exams are medically worthless and violate medical ethics, and urging member states to abandon this practice. Doshi JA, Cai Q, Buono JL, et al. Drossman DA, Toner BB, Whitehead WE, et al. In response, the head of the Lebanese Order of Physicians, Dr. Sharaf Abu Sharaf, issued a directive on August 7, 2012, calling for an end to the procedure. Aliment Pharmacol Ther 2016;44:111422. Animal studies show a cause-and-effect relationship among IBS symptoms and the development of visceral hypersensitivity (demonstrated by luminal balloon distension of the jejunum and rectum), activation of nociceptive signaling pathways, increased intraepithelial lymphocytes and mast cells within the jejunum, and disruption of the intestinal barrier after Giardiasis (54). The investigator became very angry and told me I would not leave the building. Dig Dis Sci 2017;6:245563. BMJ 2008;336:9958. [61] Abortions are a huge contributing factor to the prevalence rates; one study found that in 1986 only a quarter of the pregnancies with an identified NTD were aborted, but that number had already doubled by 1999. Grider J, Foxx-Orenstein AE, Jin JG. Lacy BE, Everhart KE, Weiser KT, et al. E-mail: [emailprotected]. 209. Like forced anal examinations, virginity tests have no scientific value. Sidhu R, Wilson P, Wright A, et al. Translational studies have found that peppermint oil exerts effects on esophageal, gastric, small bowel, gallbladder, and colonic function (146). Serotonin (5-HT) is a vital neurotransmitter that modulates GI motor and sensory function. Tolerance and long-term efficacy of polyethylene glycol 4000 (Forlax) compared to lactulose in elderly patients with chronic constipation. They have been recognized internationally as a violation of human rights, particularly the prohibition against cruel, inhuman or degrading treatment under article 7 of the International Covenant on Civil and Political Rights (ICCPR), and article 16 of the Convention against Torture. Talley NJ, Kellow JE, Boyce P, et al. These examinations often involve doctors or other medical personnel forcibly inserting their fingers, and sometimes other objects, into the anus of the accused. Justification for a positive diagnosis of IBS, as compared to a diagnosis of exclusion, is based on consensus and data from existing studies (described below) which show a low diagnostic yield of additional workup in suspected IBS without alarm features, and a minimal impact on patient outcomes or satisfaction. PLoS One 2016;11:e0154258. I felt that if I did the exam or if I didnt, he was going to say I was gay. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Study endpoints were highly variable and did not adhere to modern regulatory guidance. Z Klin Med 1991;46:16218. The medical reports, which Human Rights Watch viewed, states that one of the men seemed normal but thatthe digital rectal examination reveals a rectal cavity, which leaves nevertheless a doubt regarding sexorectal activity; that another had anal lesions and rectal hollowness, which suggests frequent and longstanding sexorectal activity; and that a third had a few fleshy bumps and a hollowness, indeed suggesting sexual activity but of moderate degree.[52]. Police take men and transgender women who are arrested on homosexuality-related charges before a forensic medicine specialist, who conducts an anal examination and prepares a report, which is then introduced into court as a form of evidence for the prosecution. Allen SJ, Wareham K, Wang D, et al. Six of the countries in which Human Rights Watch has documented the use of forced anal examinations are in Africa, and the African Charter on Human and Peoples Rights also expressly prohibits torture, cruel, inhuman or degrading punishment and treatment shall be prohibited. Organization of African Unity (OAU), African Charter on Human and Peoples' Rights ("Banjul Charter"), 27 June 1981, CAB/LEG/67/3 rev. Shah ED, Kim HM, Schoenfeld P. Efficacy and tolerability of guanylate cyclase-c agonists for irritable bowel syndrome with constipation and chronic idiopathic constipation: A systematic review and meta-analysis. The prevalence of positive antiendomysial antibodies and/or tissue transglutaminase antibodies was 2.6% (95% CI 1.6%3.8%) and of biopsy-proven CD was 3.3% (95% CI 2.3%4.5%) in patients with IBS symptoms (20). The report was reviewed by Graeme Reid, director of the LGBT Rights Program; Amna Guellali; Viktoriya Kim; Haley Bobseine; Maria Burnett and Dewa Mavingha, senior researchers in the Africa Division; a researcher on Egypt; Nadim Houry, deputy director of the MENA Division; Rachel Denber, deputy director of the Europe and Central Asia Division; Otsieno Namwaya, Kenya researcher; Corinne Dufka, deputy director of the Africa Division; Diederik Lohman, acting director of the Health and Human Rights Program; Aruna Kashyap, senior researcher in the Womens Rights Division; Chris Albin-Lackey, senior legal advisor; and Joseph Saunders, deputy program director. Cullingford GL, Coffey JF, Carr-Locke DL. Dregs of society. In the course of conducting research for this report, it became apparent that many people, including some government officials and medical experts in countries in which forced anal examinations are practiced, had very little awareness of these exams, and were shocked and repulsed to learn what the exams entail. Pancreatitis occurred in 0.4% of patients; lipase normalization generally occurred within days after stopping eluxadoline (221). They do not serve legitimate government interests, and they lack evidentiary value. One meta-analysis comparing fCal with endoscopy showed a sensitivity and specificity of fCal for IBD of 93% (CI 85%97%) and 96% (79%99%), respectively (36). UNAIDS opposes involuntary HIV testing as a violation of human rights. It is unclear whether doctors in Tripoli continue to conduct forced anal examinations. Fiber led to a statistically significant benefit for IBS symptoms compared with placebo (RR of IBS not improving = 0.87; 95% CI 0.800.94). Clin Biochem 2010;45:5525. [21] Email communications with representatives of Human Rights Awareness and Promotion Forum (HRAPF) and Chapter Four Uganda, May 8 and May 9, 2016. [71], Although Gamal described police beatings and insults that he underwent before the anal examination in great detail, he grew visibly uncomfortable speaking about the anal examination, and after providing the above information about it, asked to end the interview. Fructan, rather than gluten, induced symptoms in patients with self-reported non-celiac gluten sensitivity. In addition to being cruel, inhuman and degrading, anal exams represent a breach of criminal suspects rights to privacy and physical integrity that would not be justifiable even if the exams did not constitute cruel, inhuman, and degrading treatment. Br Med J 1979;1:3768. Importantly, significant heterogeneity is seen between cutoff values for both FL and fCal with higher levels of FL being more predictive of IBS and thus less helpful in distinguishing between the 2 diseases as compared to fCal (33). 51) at 197, U.N. Doc. Large, multicenter, double-blind, placebo-controlled studies with endpoints similar to large pharmaceutical studies are required to determine the potential role of FMT for the treatment of IBS. We recommend a positive diagnostic strategy as compared to a diagnostic strategy of exclusion for patients with symptoms of IBS to improve cost-effectiveness. Neurogastroenterol Motil 2010;22:7649. Am J Gastroenterol 2010;105:85965. , I was feeling very bad, it's a bad experience. MMWR Morb Mortal Wkly Rep 2015;64:1525. Robert told Human Rights Watch: On Saturday at 6am there was a knock on the door. [211] Article 17 of the International Covenant on Civil and Political Rights guarantees the freedom from arbitrary or unlawful interference with ones privacy. Sixty-nine percent and 16% of dicyclomine and placebo-treated patients, respectively, reported adverse effects (142). [59] It is unclear how common the condition is in low income countries. Due to the range in its location, encephaloceles are classified by the location as well as the type of defect it causes. RCTs for GDH trials are smaller and fewer but show similar outcomes to CBT (256,257). Consensus recommendation; unable to assess using GRADE methodology. Article 7 of the International Covenant on Civil and Political Rights prohibits torture as well as cruel, inhuman or degrading treatment or punishment. On 14/07/2015, upon request from Mr. xxxxx, his mothers name is xxxx, born in 1958, Lebanese according to his ID card, a forensic and clinical test was done at my clinic in Beirut at 16:30, in order to find out if there are any clinical evidence to homosexual practices or not. We were sentenced to 6 months imprisonment and a 29,000 CFA (US$50) fine.[54], In the cases we documented in Cameroon, anal examinations appeared to be largely conducted at the whim of police or gendarmes who were conducting preliminary investigations. These agents improve painful conditions such as fibromyalgia, chronic headaches, and diabetic neuropathy (227229). Several lines of evidence support the concept that alterations in the gut microbiome play a role in symptom generation in some patients with IBS (4,117,259263). 227. Furthermore, and as discussed in detail below, in most if not all cases, the exams are objectively worthless in evidentiary terms. a. IBS-C: >25% of bowel movements associated with BSFS 1 or 2 with BSFS 6 or 7 occurring less than 25%. [239] Human Rights Watch interview with Dr. Jackson Kakembo, Kampala, February 5, 2016. The first yielded a relative risk of symptom persistence of 0.79 (95% CI 0.690.90; NNT = 7.5) based on 8 RCTs (190) and the second an overall symptom improvement RR 1.58 (95% CI 1.421.75) based on 3 RCTs (208). ), real-world, open-label, prospective observational analysis, used the US FDA's current IBS-D clinical trial composite endpoint and identified an overall response rate of 45%. [40] Often, these defects are apparent at birth, but acute defects may not be diagnosed until much later in life. Laird KT, Tanner-Smith EE, Russell AC, et al. Review article: An analysis of safety profiles of treatments for diarrhea-predominant irritable bowel syndrome. [138] On December 17, the appeals court in Sousse reduced the sentence to two months, which Marwen had already spent in detention, and a 300 dinar fine (US$145). Patients should be started on a low dose (e.g., 10-mg amitriptyline or 10 mg of desipramine) with gradual dose titration upward to achieve therapeutic relief of symptoms while minimizing side effects (230). [204] UN Human Rights Council, Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, A/HRC/31/57, January 5, 2016, http://www.refworld.org/docid/56c435714.html (accessed May 19, 2016), para. However, interpreting the existing literature is problematic because of small studies, the multiple types and strains of probiotics, the inconsistent benefits on individual symptoms, and the lack of rigorous trials based on US FDA endpoints. Cash BD, Lacy BE, Schoenfeld PS, et al. I looked around. The sodomy law was originally imposed by French colonizers in 1913, and was retained when most of the Penal Code was revised in 1964 following independence. Historical recommendations supporting antispasmodics for treating global IBS symptoms have been predicated on systematic reviews and meta-analyses inclusive of all agents (141). [97] Human Rights Watch interview with Ghida Frangieh, Beirut, April 1, 2016. Kais said that police physically held him down during the anal examination: When they took me inside, I said, I dont want to get the test, and one of the policemen forced me onto the examination table. He tried to justify the exams, stating: I dont see it as a human rights violation. Awad RA, Camacho S. A randomized, double-blind, placebo-controlled trial of polyethylene glycol effects on fasting and postprandial rectal sensitivity and symptoms in hypersensitive constipation-predominant irritable bowel syndrome. Pooled odds ratios (ORs) from the world's literature showed an increased likelihood of positive antiendomysial antibodies and/or tissue transglutaminase antibodies (2.75, 95% CI 1.355.61) and biopsy-proven CD (4.48, 95% CI 2.334.60) in patients with IBS symptoms compared with controls. [88] Kenyan law provides for the collection of medical samples for forensic testing from suspects charged with offenses under the Sexual Offences Act, but that act does not prohibit consensual same-sex conduct. Buono JL, Mathur K, Averitt AJ, et al. We suggest that either fecal calprotectin. Strong recommendation; moderate quality of evidence. [109] Sarah Wansa, Lebanons Republic of Shame: Law and Medicine as Means to Humiliate and Frighten, Legal Agenda, July 29, 2014, http://english.legal-agenda.com/article.php?id=632&lang=en (accessed March 31, 2016). 134. Prott G, Shim L, Hanson R, et al. Qortbawi told the BBC: From a humanitarian point of view, this is totally unacceptable.[106], The new public prosecutor, Samir Hammoud, reportedly forwarded the Ministers communication to prosecutors throughout the country, without actually issuing a directive ordering them to abide by it. [31] World Health Organization, et al., Healthcare for Women Subjected to Intimate Partner Violence or Sexual Violence, 2014, (accessed May 13, 2016), p. 46. Kassinen A, Krogius-Kurrika L, Makivuokko H, et al. [85] Post Rape Care Form (second victim), February 24, 2015, signed by Kalai S.M. 27. Lucey MR, Clark ML, Lowndes JO, et al. Nine trials used the currently approved dose of tegaserod, 6 mg b.i.d. No study has evaluated the utility of testing and compared it with empiric therapy using a bile acid sequestrant, which is a reasonable course of action if BAM is suspected. On June 15, 2016, the court ruled against the petitioners, claiming that the two men gave consent for the exams to take place and that Kenyan law allows for courts to order medical examinations of persons accused of sexual offenses. The petitioners have appealed the decision. Ann Intern Med 2014;161:63949. Chaussade S, Minic M. Comparison of efficacy and safety of two doses of two different polyethylene glycol-based laxatives in the treatment of constipation. A shorted resistor will show very low or even 0 ohms. Clinically relevant questions were developed by a panel of experts who focus their clinical and research efforts on disorders of gut-brain interaction (previously called functional GI disorders). IBS is characterized by the presence of abdominal pain in association with abnormal bowel habits of constipation, diarrhea, or both (4,141). law provides for the collection of medical samples for forensic testing from suspects charged with offenses under the Sexual Offences Act, but that act does not prohibit consensual same-sex conduct. 488/1992, U.N. Doc CCPR/C/50/D/488/1992, April, 14, 1994, sec. Decriminalize consensual same-sex conduct between individuals who are above the minimum age of consent to sex. Recovery of mucosal barrier function in ischemic porcine ileum and colon is stimulated by a novel agonist of the ClC-2 chloride channel, lubiprostone. Chloe told Human Rights Watch that police interrogated her, beat her, and took her and Eric to Muyenga Dispensary for forced anal examinations. Baker J, Eswaran S, Saad R, et al. (No. They said that he inserted one finger in their anuses. Aggressive surgical management has improved survival and the functions of infants with spina bifida, meningoceles and mild myelomeningoceles. Am J Physiol Gastrointest Liver Physiol 2016;310:G57485. In the third phase, this information is used to personalize and liberalize the diet for extended use. In Indonesia, the national police incorporate virginity tests as part of recruitment procedures for women candidates. Your message has been successfully sent to your colleague. J Clin Microbiol 1992;30:123842. It felt painful. [126] However, article 401 of the Lebanese Penal Code still falls short of meeting Lebanon's obligations under the Convention against Torture as it does not apply to non-physical forms of torture, such as mental or psychological torture, and does not cover situations where the torture is used for objectives other than obtaining confessions. Although this difference may not initially seem significant, in a highly prevalent condition such as IBS, the cost difference is substantial (57). IBS is an independent risk factor for obstructive defecation with OR 1.78 (95% CI 1.212.60) and is associated with higher obstructive defecation scores (P < 0.001), altered pelvic mobility, and decreased perineal decent which predisposes patients to overflow diarrhea (97). I signed them in the desperate hope that the beating would cease. A randomized, double-blind, placebo-controlled study to assess efficacy and safety of 0.5 and 1 mg alosetron in women with severe diarrhea-predominant IBS. Whitehead WE, Palsson OS, Simren M. Biomarkers to distinguish functional constipation from irritable bowel syndrome with constipation. 92. [8] EIPR, informal briefing paper, May 2014, on file with Human Rights Watch. 72. Gastroenterology 2002;123:45060. [61], Group of birth defects of the brain or spinal cord, "Neural Tube Defects (NTDs): Condition Information", "A loss-of-function NUAK2 mutation in humans causes anencephaly due to impaired Hippo-YAP signaling", "Hydranencephaly: Symptoms, Causes, Complications, and Treatment", "Fetal development: What happens during the first trimester? Camilleri M, Vijayvargiya P. The role of bile acids in chronic diarrhea. In Kenya, Human Rights Watch and its Kenyan partner organizations are only aware of one instance of forced anal examinations, conducted in February 2015, on two men arrested for unnatural offenses. In September 2015, with the support of Kenyas National Gay and Lesbian Human Rights Commission, the men filed a petition with the High Court of Kenya in Mombasa, challenging the constitutionality of forced anal examinations, and HIV and hepatitis tests. The tests are used in prosecutions for consensual sex outside of marriage; on women who allege rape; at the behest of their families; or even to determine their eligibility for employment. [108], Indeed, the Order of Physicians circular and the Ministry of Justice communication did not entirely put a stop to anal exams. Many patients with CD present with abdominal pain, bloating, and/or altered bowel habits which can be mistaken for IBS (1821). Anorectal manometry in irritable bowel syndrome: Differences between diarrhea and constipation predominant subjects. [69]. This test imposes a significant burden to the patient because of lost work hours, morbidity from the preparation, sedation-related effects, and direct financial costs. J Acad Nutr Diet 2020;120:6419. 239. Gut 1987;28:15103. Minor clinical enhancements to the criteria increased its overall specificityhigh somatization, no nocturnal passage of stool plus high level of somatization, hospital anxiety and depression score >8 plus normal hemoglobin and CRP. Lacy, Brian E. PhD, MD, FACG1; Pimentel, Mark MD, FACG2; Brenner, Darren M. MD, FACG3; Chey, William D. MD, FACG4; Keefer, Laurie A. PhD5; Long, Millie D. MDMPH, FACG (GRADE Methodologist)6; Moshiree, Baha MD, MSc, FACG7. 83. 57. Double blind trial of ispaghula/poloxamer in the irritable bowel syndrome. [133] Human Rights Watch interview with a forensic doctor, Tunisia, February 2016, exact location and date withheld at the doctors request. I said, No, I will not do that test. The policeman screamed at me, Respect the doctor! I said, I am respecting the doctor, but I refuse the test. [61] Through this data, it is clear that excluding data from abortions could greatly affect the prevalence rates. The officer told Shadi, I will insert this into your anus to determine how many times youve had sexan indication that the form of torture may have been inspired by Lebanons use of forced anal exams. 253. Gut 2015;64:8492. Conditional recommendation; low quality of evidence. 167. International survey of patients with IBS: Symptom features and their severity, health status, treatments, and risk Taking to achieve clinical benefit. He told me to take down my pants completely and get on the bed. However, in April 2013, an anti-gay moral panic spread throughout Zambia after local media outlets reported that four same-sex couples had attempted to register marriages, a claim that Zambian activists believe was falsified to intentionally provoke hostility toward LGBT people. 46. The impact of peppermint oil on the irritable bowel syndrome: A meta-analysis of the pooled clinical data. 25/2009 (Egypt), paras. Currently, there are no approved medications for the treatment of IBS-M or IBS-U; this is an important gap to be addressed in future research. [166] Human Rights Watch interview with Christopher (pseudonym), Entebbe, November 26, 2013. The use of anal examinations varies from country to country. 230. Di Palma, Cleveland MV, McGowan J, et al. [139] Even the minister of justice spoke out in support of decriminalization. One lady was typing, one male doctor and one female doctor and a few nurses.The female doctor [ordered]: Get undressed and take off your underwear. 116. 85. Healthychildren.org website., American College of Obstetricians and Gynecologists., Black LI, Barnes PM, Clarke TC, Stussman BJ, Nahin RL., Chugh-Gupta N, Baldassarre FG, Vrkljan BH., Clarke TC, Barnes PM, Black LI, Stussman BJ, Nahin RL., Ng Q-X, Venkatanarayanan N, Loke W, et al., Stussman BJ, Black LI, Barnes PM, Clarke TC, Nahin RL.. It reads: Whoever voluntarily has carnal intercourse against the order of nature with any man, woman or animal shall be punished with imprisonment for life, or with imprisonment for a term which may extend to 10 years, and shall be liable to fine. Interviews were conducted in English, French, Arabic, or Russian, by interviewers fluent in those languages, or in English with the assistance of translators. [193] Kapiri Homosexual Couple set free, State failed to prove the case beyond any reasonable doubt, Lusaka Times, July 3, 2014, https://www.lusakatimes.com/2014/07/03/kapiri-homosexual-couple-set-free-state-failed-prove-case-beyond-reasonable-doubt/ (accessed April 11, 2016). Treatment-related AEs were more frequent in patients treated with PEG compared with placebo (16.4% vs 8.6%, respectively) (157). I felt like I was an animal, because I felt like I didnt have any respect. Serum IgG panels have not been validated and cannot be recommended at present (95). We do not suggest the use of bile acid sequestrants to treat global IBS-D symptoms. BMC Gastroenterol 2014;14:121. J Neurogastroenterol Motil 2012;18:25868. Jalihal A, Kurian G. Ispaghula therapy in irritable bowel syndrome: Improvement in overall well-being is related to reduction in bowel dissatisfaction. Ford AC, Quigley EM, Lacy BE, et al. Overall, 34% of 802 enrollees in 2 phase III North American studies receiving 290 g of linaclotide met the US FDA endpoint (175178). 145. We suggest against probiotics for the treatment of global IBS symptoms. Side effects are common, particularly in the elderly, although anecdotal data suggest that these agents are relatively safe. When the neural tube does not close completely, an NTD develops. Three antispasmodics are commercially accessibledicyclomine, hyoscyamine, and hyoscinewith a paucity of data supporting their efficacy. Tehran Univ Med J 2011;69:3528. Between 2010 and 2012, Human Rights Watch documented 28 prosecutions for consensual same-sex conduct, and official statistics from the Ministry of Justice indicated that dozens more had taken place. Res. Particularly relevant are the following: Principle 2. Anorectal disorders. Spiegel BM, Farid M, Esrailian E, et al. A systematic review and meta-analysis of more than 1,000 patients compared a range of diagnostic approaches including the symptom-based Rome III criteria to diagnose IBS and noted that the symptom-based Rome criteria performed quite modestly (69.6% sensitivity and 82.0% specificity).