Randomized Control Trial Study On The Effect Of Wet Cupping On Lipid Profile

Dyslipidaemia is one of the risk factors contributing to the pathogenesis of cardiovascular diseases (CVDs). This study was conducted to investigate the effect of wet cupping on lipid profile. Methods: This randomized controlled trial was conducted in 2012 at the School of Medical Sciences, Universiti Sains Malaysia, Malaysia. Sixty-two healthy volunteers ranging from 30 to 60 years old were randomized into control and intervention groups. Subjects in the intervention group were assigned to two sessions of wet cupping at the beginning of the study and at the third month; individuals in the control group did not undergo any cupping procedure. Venous blood sample was collected for serum lipid profile: Total Cholesterol (TC), High Density Lipoprotein Cholesterol (HDL-C), Low Density Lipoprotein Cholesterol (LDL-C), and triglycerides; measured at baseline, first, third and fourth month. Results: Subjects in the cupping group had significant improvements from baseline to third and fourth month for TC (MD=-0.56, P=0.004), HDL-C (MD=-0.22, P<0.001) and LDL-C (MD=0.58, P=0.001). There was also a significant reduction from baseline to one month for triglycerides (MD=0.38, P<0.001). Subjects in the cupping group had significantly better values in HDL-C and LDL-C as compared with the control group at the third and fourth month. Significantly lower levels of TC and triglycerides in the cupping group of the fourth month. In the control group, there were no significant changes in any serum lipid profiles. Conclusion: After two sessions of wet cupping, TC, HDL-C, LDL-C and triglycerides were significantly improved by 8.2%, 13.7%, 16.4% and 20.8% respectively.

Outcomes of stage IIB osteosarcoma treated by limb salvage surgery using extracorporeally irradiated (ECI) autograft.

Background: Extracorporeally irradiated (ECI) technique is an alternative of limb salvage procedure in treating osteosarcoma regarding limitation of endoprosthesis and allograft. This study evaluated the outcomes of limb salvage surgery using extracorporeally irradiated (ECI) autograft and its correlation with patient’s characteristics. Methods: Retrospective cohort design was performed to study 20 patients with stage IIB osteosarcoma treated by ECI autograft from 1995 to 2008. Survival, local recurrence, metastases, complications, union time and functional score based on Musculoskeletal Tumor Society scoring system-(MSTS) were evaluated. Kaplan-Meier method was used to describe survival, local recurrence free survival, and metastases free survival. The correlation among patient’s characteristics that were age, gender, duration, site of tumor size, type of osteosarcoma, SAP (serum alkaline phosphatase) level, type of biopsy, and type of Huvos were analyzed by Log rank test. Chi-square test was used to analyze the correlation between MSTS score and patient’s characteristics, local recurrence, metastases, complications. Results: Five-year survival was 54.97 ± 9.8 %, five-year local recurrence free survival was 66.5 ± 7.6%, and five year metastasis-free survival was 57.13 ± 10.04%. Six patients died, five were due to lung metastases and one due to complication of chemotherapy. Three underwent amputation after local recurrence. Kaplan-Meier curve showed that a good type of Huvos (III, IV) always gave better survival, local recurrence free survival, and metastases free survival than poor type of Huvos (I,II). Normal SAP level gave better local recurrence free survival compare to increased level of SAP. Mean of union rate was 8.13 months. MSTS mean score was good (70.63%) in patients with no evidence of disease. MSTS score was poor in patients with local recurrence (p = 0.025), metastases (p = 0.01), complications (p = 0.03), and the combined of those three outcomes (p = 0.001). Conclusions: Functional outcome was poor in patients with local recurrence, metastases, and complications. SAP level and type of Huvos could be studied further as predictive factors for the outcomes (survival, local recurrence, metastases).

Rabbit model of intervertebral disc degeneration by external compression device characterized by X-ray, MRI, histology, and cell viability.

Appropriate experimental animal models, which mimic the degenerative process occurring in human intervertebral disc (IVD) breakdown and can be used for new treatment studies such as tissue engineering or disc distraction are lacking. We studied the external compression device that used by Kroeber et al to create intervertebral disc degeneration in rabbit model characterized by X-ray, MRI, Histology, and Cell Viability. Ten NZW rabbit were randomly assigned to one of five groups. Intervertebral disc VL4-L5 are compressed using an external loading device, 1.9 MPa. First group rabbit are loaded for 14 days, second loaded for 28 days, thirth group are loaded for 14 days, and unloaded for 14 days, fourth group loaded for 28 days and unloaded for 28 days. The fifth group, rabbits underwent a sham operation. Additional, rabbits were used as sample for cell viability study. In disc height : sample in group one have biggest decreasing of disc height, that is 23.9 unit. In MRI assessment, the worst grade is grade 3. In histological score, the worst group is group three (58.69), and the best is group 4 (45.69). Group one have the largest dead cell, that are 403.5, and the smallest is group four (124.75). Trypan blue staining showed that group four have better viable cell (91.1) compare than group three (86.4). The study conclude disc degeneration can be created by external axial loading for 14 days in rabbit intervertebral disc. Duration of 28 days unloading gave better result for cells to recover.

Shortening procedure : A choice for tuberculous kyphosis correction.

Tuberculous kyphosis is an unstable lesion that tends to progress and lead to many problems.Various corrective osteotomies for kyphosis have been described for various conditions, but not for tuberculosis. This articles proposed shortening procedure to correct tuberculous kyphosis. The preexperimental study was conducted in 49 patients with tuberculous kyphosis treated surgically at Cipto Mangunkusumo and Fatmawati hospital since June 1996 till June 2001. All patients were evaluated radiographically in the preoperative period, postoperative period, and at the latest follow-up (6-36 months). Neurological deficit risk of operation was also evaluated by Frankel grading. The kyphosis were classified into three group, group A (kyphosis 30° - 59°) group B (60° - 89°) and group C (90° - 120°). The average postoperative kyphosis correction was 30.82° (67.5%); in group A 28° (75.49%), in group B 42.3° (62.43%), and in group C 27° (23.36%). Anova test gave significant difference in persentage of postoperative correction. Paired t-test also gave significance postoperative correction in all groups. Neurological complication was found in 6 patients (12.2%); 4 (11,8%) in group A dan 2 (40%) in group C, and no statistical difference between the two groups concerning this complication (p=0.1023). We concluded that shortening procedure for tuberculous kyphosis gave significant correction. In TB-kyphosis > 90° shortening procedure still gave significant correction although a potential risk of serious neurologic complication.

Protein C, protein S, antithrombin III, and hyperfibrinogenemia in deep vein thrombosis (DVT) among patients who underwent high risk orthopaedic surgery.

Post operative DVT is believed to be rare in Indonesia, and so is trombophilia. It is necessary to know the incidence of postoperative DVT in Indonesia and thrombophlia profile (protein C, S, AT III deficiency and hyperfibrinogenemia) in DVT and non DVT patient who underwent orthopedic surgery involving the hip and knee (high risk surgery). A cross sectional study was conducted in 20 patients who underwent surgery involving the hip (total hip replacement and fixation of proximal femoral fracture) and knee (total knee replacement and fixation of distal femoral fracture). Protein C, protein S, antithrombin III, and fibrinogen were examined in day 5 post operative, as well as with compression/Doppler USG between day 10 to 21 post operative, and confirmed by venography if USG findings was positive. Post operative DVT were found in 5 of 20 patients (25%). Deficiency of protein C (P= 0.46) protein S (P= 0.81), antithrombin III (P= 0.46), and hyperfibrinogenemia (P= 0.0547) did not correlate to post operative DVT. However, hyperfibrinogenemia was found to be a risk factor to post operative DVT (attributable risk= 1). Other confounding factor such as diabetes mellitus (P= 1.0), obesity (P= 0.28), hypertention (P= 1.0), hypertrigliseridemia, and hypercholesterolemia did not correlate to post operative DVT. The study suggested the existence of postoperative DVT cases in Indonesia. Hyperfibrinogenemia is a risk factor to promote post operative DVT. Deep vein thrombosis did not correlate to protein S, protein C, and antithrombin III deficiency.

Apolipoprotein E alleles in relation to serum lipids, lipoproteins and apolipoproteins in infants of diabetic mothers

Objectives: To determine whether infants of diabetic mothers have altered lipoprotein metabolism, whether these alterations persist or regress after one month of life and whether these alterations are genetically determined through Apolipoprotein E genotypes

Methods: The present study was performed in Ain Shams University, Neonatal Intensive Care Unit Children’s Hospital, and the follow up was done in the Newborn Clinic in the period from March 2002 to March 2003. The subjects were classified into the following groups: Group I: included 81 newborns of diabetic mothers [gestational or pregestational], 40 females and 41 males. Group II: included 76 full term healthy newborns to healthy mothers, 43 males and 33 females. They were subjected to: full history taking, thorough clinical examination, cord Serum lipid profiles [total cholesterol, triglyceride, HDL-c, LDL-c, Serum ApoA1, and ApoB100] serum glucose level, and serum insulin level for IDM. Follow up of only 33 newborns of group I and 23 newborns of group II after I month for repeating lipid profiles. ApoE genotyping by PCR was performed for 20 hyperlipidemic newborns of diabetic mothers [those with more than 2 SD increase in lipid profiles in the follow up samples after one month]

Results: There was a significantly higher cord blood lipids, lipoproteins and apolipoproteins concentrations in the IDM group compared to the control group. Both groups whether IDM and control group showed significant rise in lipid, lipoproteins and apolipoproteins levels at one month of life compared to their cord blood levels. But still there were significant higher levels in IDM group than the control group. Comparison between infants of gestational diabetic mothers and those of initially diabetic mothers as regard their lipid profiles at birth and at day 30 of life showed non significant difference. The frequency prevalence of Apo E alleles E2, E3 and E4 were 0, 75 and 25% respectively with Apo E 3 being the commonest allele followed by E4. No significant difference was detected as regards allele frequencies between the studied IDM. No significant difference was detected between IDMs with Apo E 4/3 genotype and those with Apo E 3/3 genotype as regard their lipid profiles whether at birth or after one month of life

Conclusion: IDM had altered lipid metabolism at birth, some of which persisted after one month and might play a role in the pathogenesis of diabetes and atherosclerosis in adulthood, however, these changes could not be related to Apo E genotyping as lipid metabolism is influenced by variety of environmental and physical factors

Recommendations: Longitudinal studies with prolonged follow up of lipid profile in IDM are needed to determine whether hyperlipidemia persists or disappears later in life