Effect of Acupuncture on Body Weight Reduction and Inflammatory Mediators in Egyptian Obese Patients

AIM: Aim of this study was to examine the effectiveness of body acupuncture on body weight loss, routine laboratory tests and pro-inflammatory markers.METHODOLOGY: The study was performed on eighty obese patients. They were divided into three groups according to their body mass index. Subjects received acupuncture for three- six months in combination with a low-calorie diet. They were assessed pre and post acupuncture, by anthropometric measurement, routine laboratory tests and, tumor necrosis factor- alpha (TNF-α), interleukin- 6 (IL-6), and high sensitivity C-reactive protein (hsCRP) levels in serum.RESULTS: The pre-acupuncture results showed significant difference between the three grades of obesity and the controls regarding TNFα, IL-6 and hsCRP. We found significant reduction in anthropometric measurement of adiposity after acupuncture. In comparing the pre &post acupuncture results of TNF-α, IL-6 and hsCRP showed high significant reduction after acupuncture. There are highly significant decrease in kidney function (creatinine and uric acid) and lipid profile (cholesterol and triglycerides) and fasting blood glucose, but there was no significant difference in urea, SGPT, SGOT, HDL and LDL.CONCLUSION: Body acupuncture in combination with diet restriction was found to be effective for weight loss and also reduction of the inflammatory reactions. Acupuncture could be used as a synergistic treatment option for obesity control

Correlation between optical coherence tomography parameters and retinal sensitivity in idiopathic intracranial hypertension

Purpose The aim of this study was to report the findings of optical coherence tomography measurement of retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) in idiopathic intracranial hypertension (IIH) patients and to assess whether the RNFL and GCC correlate with retinal sensitivity determined by automated perimetry in the form of mean deviation (MD) and pattern standard deviation. Patients and methods A prospective observational study was carried out for 30 patients with confirmed IIH (age ≥18 years), BMI below 25, intracranial pressure (ICP) of at least 20 cmH 2 O, and normal neurological examination (except for papilloedema and horizontal diplopia). All patients received a complete neurological examination and most recent lumbar puncture opening pressure (latest ICP) was recorded. Complete ophthalmic evaluation including best-corrected visual acuity, perimetry, RNFL, and GCC thickness within 24 h of performing lumber puncture. Results In IIH patients the initial RNFL thickness was significantly higher, whereas GCC was significantly lower than controls (P = 0.045 and 0.004, respectively). The value of ICP measured was found to be positively correlated with the stage of papilloedema (r = 0.494, P = 0.000). The final recordings showed a significant decrease in GCC and RNFL values (P = 0.000 and 0.002, respectively), and improvement in MD (P = 0.003). Regression analysis showed that for every 10 μm increase in mean RNFL thickness, there was worsening in MD of 0.56 dB, whereas for every 10 μm decrease in mean GCC thickness, there was worsening in MD of 0.9 dB at the last follow-up. Conclusion GCC and RNFL thickness abnormalities assessed by optical coherence tomography in IIH patients were quantitatively correlated with visual field sensitivity losses and can be definitively useful to quantify optic nerve damage

Correlation between spectral-domain optical coherence tomography parameters and neurological functional disability in multiple sclerosis

Purpose The aim of the present study was to correlate optical coherence tomography (OCT) parameters, including peripapillary retinal nerve fibre layer (RNFL) thickness and ganglion cell complex (GCC), retinal sensitivity (mean deviation and pattern SD of perimetry) and best-corrected visual acuity, with disease duration and neurological functional disability in multiple sclerosis (MS) patients with a history of optic neuritis (MS-ON) and without history of optic neuritis (MS-NON). Patients and methods The present cross-sectional, observational cohort study included 68 patients with MS and 23 age-matched and sex-matched healthy controls. All patients and controls underwent ophthalmic examination including visual acuity, visual field examination, OCT and neurological assessment. Results RNFL thickness was found to be decreased in MS eyes (89.35 μm) compared with controls (117.79 μm) (P < 0.000). MS eyes had decreased GCC (85.58 μm) compared with controls (96.16 μm) (P < 0.048). MS-ON eyes had decreased RNFL thickness (84.05 μm) compared with patients with MS-NON (92.41 μm) (P < 0.047). RNFL thickness was significantly negatively correlated to functional disability (Expanded Disability Status Scale) (P < 0.042) and disease duration (P < 0.000). GCC was significantly negatively correlated to disease duration (P < 0.008). Conclusion RNFL and GCC are significantly decreased in MS. OCT is a promising tool to detect subclinical changes in RNFL and GCC in patients with MS, and should be examined in longitudinal studies as a potential biomarker of retinal pathology in MS

Evaluating sex hormones and cytokine profile in Egyptian females with relapsing-remitting multiple sclerosis

Abstract Background Sexual dimorphism shown in multiple sclerosis suggests an interaction between immune system and sex hormones. The objective of this study is to determine the hormonal profile and serum cytokine levels in Egyptian female patients with relapsing-remitting MS (RRMS) compared with healthy controls and their associations with disease disability. Methods This study was conducted on 40 female patients with RRMS and 20 age-matched controls subjected to measurements of the hormonal profile (estrogen, testosterone) and cytokine levels (interleukin 10 and 4 and tumor necrosis factor alpha) and disability assessment using Expanded Disability Status Scale (EDSS). Results Levels of estrogen, testosterone, interleukin 10 and 4 (IL-10 and IL-4), and tumor necrosis factor alpha (TNF-α) were higher in patients compared to control with no statistically significant difference. Estrogen levels were positively correlated with interleukin 10 and interleukin 4 levels and negatively correlated with tumor necrosis factor alpha (TNF-α), but there was no statistically significant correlation between hormonal profile or cytokine profile (IL-10, IL-4, and TNF-α) and EDSS. Conclusions It is suggested that estrogen has an anti-inflammatory effect on cytokine milieu; therefore, it can be tried as a treatment option in multiple sclerosis

Practice patterns of obstetric care in twin gestations: the value of MFM consultation

Objectives To evaluate the practice patterns among Lebanese obstetricians regarding obstetric care of twins and to compare selected practice patterns between general obstetricians and maternal fetal medicine physicians. Methods Questionnaires distributed during the annual meeting of the Lebanese Society of Obstetrics and Gynecology. Results Questionnaires were returned by 69.2% of the 296 physicians approached. Ten percent had fellowship training in Maternal Fetal Medicine (MFM). Thirty-nine percent perform cervical length measurement at 20-24 weeks of gestation and 34% recommend vaginal progesterone in case of a short cervix. When comparing selected practice patterns between MFM & general obstetricians, MFM specialists were less likely to perform cervical cerclage in the first trimester (5.9% versus 49%,p = .001), more likely to offer prenatal screening for aneuploidy (66.6% vs 46.4%,p = .03), less likely to use vaginal progesterone in the second trimester in the case of a short cervix (42.1% vs 61.8%,p = .04), less likely to perform serial ultrasound exam in the third trimester to assess fetal growth (50% vs 78%,p = .005) and more likely to deliver monoamniotic twins at 32-34 weeks of gestation (55% vs 37%,p = .05). Conclusion Because of the different background of the Lebanese physicians, MFM specialists are more likely to follow obstetric care guidelines in twin gestation

Assessment of vascular endothelial growth factor a serum level in pediatric hemophilic arthropathy

Abstract Background Children with hemophilia have serious, recurrent joint bleeding that causes disabilities. Regular factor VIII concentrate replacements have not yet completely stopped intra-articular subclinical hemorrhages and permanent joint damage. The prevention of joint damage requires the early detection and management of this hemorrhage. Neoangiogenesis is crucial in the development of synovitis after recurrent hemophilic joint bleeding. This study assessed the level of serum Vascular endothelial growth factor A (VEGF-A) as a vascular biomarker in children with hemophilia A to determine its possible role as a diagnostic biomarker for hemophilic arthropathy. Result A case–control study with 30 male children who had hemophilia A and 30 healthy controls was conducted. Patients had significantly higher serum VEGF-A levels than the control group (specificity was 70.0% and sensitivity was 83.3%). Hemophilia severity and Hemophilia Joint Health Score had a significant positive correlation with VEGF-A. Conclusion Children with hemophilia A had significantly higher levels of VEGF-A in their serum. Additionally, VEGF-A had a significant positive correlation with Hemophilia Joint Health Score as well as the severity of the disease. In children with hemophilia A, VEGF-A can be used as a marker for early hemophilic arthropathy detection

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially