Sexual Inequality in Tuberculosis

Olivier Neyrolles and Lluis Quintana-Murci review the evidence on why tuberulosis notification is twice as high in men as in women in most countries

Al-hijamah (wet cupping therapy of prophetic medicine) significantly and safely reduces iron overload and oxidative stress in thalassemic children: a novel pilot study

Mohamed El-Shanshory,1,2 Nahed M Hablas,2 Yasmin Shebl,2 Ahmed R Fakhreldin,3 Mohamed Attia,4 Hamdi H Almaramhy,5 Hussam Baghdadi,6 Mongi Ayat,1,6 Amal Albeihany,7 Amr El-Dardear,1,8,9 Hoda Ali Ibrahim,10 Hany Salah Mahmoud,11 Manal Mohamed Helmy Nabo,12,13 Salah Mohamed El Sayed1,6,14 1Prophetic Medicine Course and Research, Taibah College of Medicine, Medina, Saudi Arabia; 2Department of Pediatrics, Tanta University Faculty of Medicine, Tanta Gharbia, Egypt; 3Department of Pediatrics, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt; 4Department of Clinical Pathology, Tanta Faculty of Medicine, Tanta University, Tanta, Egypt; 5Department of Surgery, Taibah Faculty of Medicine, Taibah University, Medina, Saudi Arabia; 6Department of Clinical Biochemistry and Molecular Medicine, Taibah Faculty of Medicine, Taibah University, Medina, Saudi Arabia; 7Department of Hematology, King Fahd Hospital, Ministry of Health, Medina, Saudi Arabia; 8Department of Pediatrics, Faculty of Medicine, Taibah University, Medina, Saudi Arabia; 9Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt; 10Department of Biochemistry, Tanta Faculty of Medicine, Tanta University, Tanta, Egypt; 11Scientific Center for Experimental and Research Studies, Cairo, Egypt; 12Division of Pediatric Intensive Care Unit, King Fahad Hospital, Ministry of Health, Medina, Saudi Arabia; 13Division of Pediatric Cardiology, Pediatrics Department, Sohag Teaching Hospital, Ministry of Health, Sohag, Egypt; 14Department of Medical Biochemistry, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt Background: Thalassemia is a major health problem due to iron overload, iron deposition and oxidative stress-induced tissue damage. Here, we introduce Al-hijamah (a minor surgical excretory procedure) as a novel percutaneous iron excretion therapy. Al-hijamah is a wet cupping therapy of prophetic medicine, and prophet Muhammad, peace be upon him, strongly recommended Al-hijamah, saying: “The best of your treatment is Al-hijamah”. Aim of the study: Our study aimed at investigating the safety, iron chelation, pharmacological potentiation and oxidant clearance effects exerted by Al-hijamah to thalassemic children. Patients and methods: Ethical committee’s approval and patients’ written agreement consents were obtained. We treated 20 thalassemic children (15 males and five females aged 9.07±4.26 years) with iron chelation therapy (ICT) plus Al-hijamah (using sterile disposable sets and in a complete aseptic environment) vs a control group treated with ICT only. This clinical trial was registered in the ClinicalTrial.gov registry under the name “Study of the Therapeutic Benefits of Al-hijamah in Children with Beta Thalassemia Major” (identifier no NCT 02761395) on 30 January 2016. Results: Al-hijamah was quite simple, safe, effective, tolerable (with no side effects) and time-saving procedure (30–60 minutes). A single session of Al-hijamah significantly reduced iron overload (P<0.001) in all thalassemic children. Al-hijamah significantly decreased serum ferritin by 25.22% (from 3,778.350±551.633 ng/mL to 2,825.300±558.94 ng/mL), significantly decreased oxidative stress by 68.69% (P<0.05; serum malondialdehyde dropped from 42.155±12.42 to 13.195±0.68 nmol/L), exerted pharmacological potentiation to ICT and significantly increased total antioxidant capacity (P<0.001) by 260.95% (from 13.195±0.68 nmol/L to 42.86±12.40 nmol/L through excreting reactive oxygen species). Moreover, therapeutic indices for evaluating Al-hijamah were promising. Conclusion: Al-hijamah is a novel, safe, effective percutaneous iron excretion therapy through percutaneous iron excretion with minimal blood loss in agreement with the evidence-based Taibah mechanism. Al-hijamah is an effective outpatient hematological procedure that is safer than many pediatric procedures such as catheterization, hemofiltration and dialysis. Increasing the number of cups during Al-hijamah session or the number of sessions reduces iron overload more strongly. Medical practice of Al-hijamah is strongly recommended in hospitals. Keywords: thalassemia, Al-hijamah, iron chelation therapy, oxidative stress, clearance, Al-hijamah indice

Methotrexate and Cardiovascular Protection: Current Evidence and Future Directions

Patients with autoimmune rheumatic conditions, particularly rheumatoid arthritis, have an increased cardiovascular risk when compared with the general population. Methotrexate is a relatively old, yet effective, immunomodulatory drug for the management of autoimmune and chronic inflammatory disorders, such as rheumatoid arthritis, particularly in terms of symptom control, quality of life, and disease progression. Recent meta-analyses have also shown that methotrexate treatment is associated with a lower risk of cardiovascular events when compared with other disease-modifying antirheumatic drugs. This suggests that methotrexate might exert specific protective effects against atherosclerosis and thrombosis. This mini-review discusses the mechanisms associated with the increased cardiovascular risk in rheumatoid arthritis, the pharmacokinetics and pharmacodynamics of methotrexate, the available evidence on the in vitro and in vivo effects of methotrexate on modifiable cardiovascular risk factors, and suggestions for future research directions