|Abdullah M. Nasrat1,*, Randa M. Nasrat2 and Mohammad M. Nasrat2|
|1Department of Surgery, Balghsoon Clinic, Jeddah, KSA|
|2Department of Internal Medicine, Helwan General Hospital, Helwan, Egypt|
|Corresponding Author :||Abdullah M. Nasrat
Department of Surgery, Balghsoon Clinic
Jeddah, KSA, P.O. Box 52611, Jed. 21573
Tel: + 966 (012) 667 3645
Fax: + 966 (012) 667 3645
|Received:Oct 23, 2015; Accepted: Dec 26, 2015; Published: Dec 31, 2015|
|Citation: Nasrat AM, Nasrat RM , Nasrat MM (2015) A Therapeutic Answer for the Controversy of Insulin Cardio-protection among Dysglycemic Patients. Gen Med (Los Angel) 3:216. doi:10.4172/2327-5146.1000216|
|Copyright: © 2015 Nasrat AM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Ghrelin and leptin are peptide hormones which, working antagonistically, regulate the energy balance of the body. Abnormal concentrations of these hormones are observed in the course of gastrointestinal diseases, where the clinical picture is characterized by nutritional disorders. Approximately 70% of patients with cystic fibrosis have body weight deficiency due to exocrine pancreatic insufficiency, respiratory failure, and secondary circulatory disorders as well as eating disorders. The aim of the study was to evaluate the levels of ghrelin and leptin in the blood serum of patients diagnosed with cystic fibrosis, in relation to their nutritional status and function of liver cells. Patients and methods: The study group consisted of 34 patients, 17 girls (50%) and 17 boys (50%), aged from 3 months to 18 years (mean age 4.5 years) who were diagnosed with cystic fibrosis on the basis of screening and/ or diagnostic tests. The analysis included the nutritional status (body weight and height, BMI), CFTR gene mutation, assessment of the exocrine pancreas function (albumin and glucose concentration in the blood serum, acid steatocrit in stool), abnormal lipid metabolism (cholesterol and triglyceride levels in blood serum), as well as liver cell function parameters and cholestasis (serum activity amino-transpherase, gamma-glutamyl transpeptidase, concentration of bile acids, coagulation parameters). In all children, serum ghrelin and leptin levels were measured by means of an immunoenzymatic test, using reagents from DRG Instruments. The results were statistically analyzed. Results: Serum ghrelin levels were significantly lower in the youngest patients (<1 year of age) compared with older age groups. Ghrelin concentration was significantly lower in patients with salt wasting syndrome (p<0.05). The statistically lower serum leptin levels were observed in patients with growth deficiency and increased parameters of cholestasis, particularly in the youngest age group. Conclusion: Ghrelin and leptin levels in children with cystic fibrosis correlate with the nutritional status and can be an early marker of exocrine pancreatic insufficiency.
The study aimed to illustrate the cardio-protective effect of blood-let out cupping therapy in dysglycemia. The controversy of insulin cardio-protection among dysglycemic patients is a confusing challenge. Glucose-insulin disproportion is a major reason for accumulation of acidic metabolites in the body leading to the current controversy about insulin role in cardio-protection. The micro-capillary dysfunction, the improper tissue perfusion with blood and the accumulation of acidic metabolites in the myocardium are leading to each other and could contribute to progression into major cardiac events. Withdrawal of these metabolites could disturb this ischemic vicious circle and offer the answer for the controversy of insulin cardio-protection among dysglycemic patients. Suction in cupping therapy works specifically on the blood trapped within the tissues together with the acidic metabolites which are believed to be functionally obliged to it. Skin scratching with the action of repeated suction delivers nitric oxide to the area which is a potent cardio protectant in health and disease.
Seven diabetic patients on insulin with recurrent moderate chest tightness due to variable grades of myocardial ischemia refused coronary catheterization. Therefore; a session of basic cupping therapy on the upper back and front of the chest was advised and employed for them.
Dramatic symptomatic relief and clinical recovery was documented in six patients. They were followed up for 18 months without any further cardiac issues.
On conclusion; cupping therapy in this way becomes a maneuver that could lead to correction of ischemic myocardial situations, and the tissues interstitial space therefore constitutes the intelligent yard where cupping exerts its biological talents.
|Cardio-protection; Cupping therapy; Dysglycemia; Insulin|
|The rising challenge of cardiovascular disease constitutes an actual burden. The controversy of insulin cardio-protection among dysglycemic patients is also a challenge. Myocardial ischemia/ reperfusion injury during coronary procedures represents a further challenge [1-4]. The real clue in ischemic cardiac conditions is to prevent progression into critical ischemia than treating it; prophylaxis is always far better than treatment.|
|The accumulation of toxic metabolites and inflammatory mediators in the tissues and circulation is a fact that has been reported in literature. Glucose/insulin disproportion is a major reason for accumulation of these toxic metabolites in the body. These substances can induce vascular spasm and other effects on vascular endothelium [4,5]. Elimination of these toxic elements is a challenge that would definitely help to correct an underlying micro-circulatory error.|
|Demonstration of the cardio-protective effect of blood-let out cupping therapy among dysglycemic patients.|
|Design and Setting|
|Multiple-case clinical study study done in Balghsoon Clinics in Jeddah/Saudi Arabia during Jan. 2011- Oct. 2013.|
|Patients and Methods|
|The study included seven diabetic male patients on insulin with recurrent moderate chest discomfort and pain due to variable grades of myocardial ischemia as documented by electrocardiogram (ECG), cardiac enzymes and echocardiography. Their age ranged between 55 and 63 years, two of them were having a history of coronary stents insertion few months earlier. They were scheduled for coronary catheterization and possible stenting. All patients hesitated towards undergoing a coronary procedure, therefore; a session of basic cupping therapy on the upper back and front of the chest was advised and employed for them.|
|Dramatic symptomatic relief and clinical recovery was documented in six patients based on ECG, cardiac enzymes and echocardiography. They were followed up for 18 months without any further cardiac issues. One patient without previous history of coronary stenting did not experience benefit following the cupping procedure possibly because of being heavy smoker and he was not willing to quit smoking, he followed medical treatment for his heart condition.|
|An informed signed consent was taken from all patients, they were made aware about safety of the procedure of cupping therapy and they were free to quit the study whenever they like. The research proposal was approved and the study followed the rules of the Research Ethics Committee of Balghsoon Clinics in Jeddah, Saudi Arabia.|
|Impairment of the vascular endothelial function caused by excess accumulation of metabolites in the tissues and circulation is involved in the pathogenesis of wide variety of cardiovascular diseases and hence is considered a therapeutic target . Micro-capillary dysfunction, improper tissue perfusion with blood and accumulation of acidic metabolites in the tissues are leading to each other and constitute the main hidden truth behind chronic and major illness . Production of ischemic metabolites within the myocardium due to lack of proper myocardial perfusion constitutes a toxic elementwhich can contribute to progression of the coronary heart disease .|
|Glucose/insulin disproportion constitutes a major metabolic error that could lead to accumulation of acidic metabolites in the tissues and circulation . The continuing controversy about the role of insulin in cardio-protection among patients with dysglycemia should logically indicate the presence of a missed underlying pathology; [4,8] accumulation of acidic metabolites in the body due to glucose/insulin disproportion could be the hidden reason behind this controversy.|
|Glucose/insulin proportion can never be precisely adjusted except through the function of the human body pancreatic machine pump. Some leaders in diabetes reported that insulin is cardio protective as diabetic patients who receive insufficient doses of insulin develop cardiac events while other pioneers emphasized that insulin is not cardio protective as some patients who are receiving sufficient insulin still developed heart attacks. Patients who receive insufficient insulin will compensate for their energy needs via consumption of lipids leading to production of acidic metabolites. Patients who are receiving sufficient insulin may consume all their glucose, if they are still in need of energy they will gain it from lipid metabolism which would leave also acidic metabolites behind. This would definitely mean that isulindependant diabetic patients would demonstrate accumulation of these toxic metabolites in their tissues and circulation and those patients would no way suffer a cardiac issue during the course of diabetes in their life. A cupping blood-let out therapy on the upper bach and front of chest done once a year or once during the course of diabetes could include major cardioprotection for dysglycemic patients via withdrawal of accumulated metabolites from the body [9,10].|
|Withdrawal of ischemic tissue metabolites from the body, being interstitial and diffuse, is only feasible via superficial scratching on the skin and suction by the traditional therapeutic cups. Suction in cupping therapy works specifically on the blood trapped within the tissues together with the acidic metabolites which are believed to be functionally obliged to this trapped blood. Skin scratching with the action of repeated suction delivers nitric oxide to the area which is a potent cardioprotectant in health and disease. Sero-clearance mediated through micro-capillary dilatation due to the effect of nitric acid is a further talent of cupping therapy that would improve quality of tissue perfusion with blood and oxygen [10,11]. Cupping blood-let out therapy in this way becomes a maneuver which could lead to correction of an associated ischemic cardiac situation, and the interstitial space is therefore constituting the intelligent yard where cupping exerts its biological talents.|
|Cupping therapy can provide good therapeutic cardio-protection for patients with dysglycemia due to glucose/insulin disproportion. Withdrawal of the toxic metabolites from the body could constitute the cupping therapeutic answer for the controversy of insulin cardioprotection among dysglycemic patients, and the interstitial space therefore constitutes the intelligent yard where cupping exerts its biological talents.|
|The study appreciates the facilities and time allowed by Balghsoon Clinics in Jeddah/Saudi Arabia. The continuous support offered by Abdul-Aziz Al-Sorayai Investment Company (ASIC) in Jeddah/Saudi Arabia, the scientific and emotional support of Dr Ahmed S. Balghsoon are extremely valued and appreciated.|