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Abstract
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.
Video abstract
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Supplementary material
Table S1 Effect of Al-hijamah (wet cupping therapy of prophetic medicine) as an effective PIET in reducing iron overload and oxidative stress with subsequent increase in TAC
Acknowledgments
The authors are so grateful for lovely Mohamed Salah for his support in the video abstract. The authors are also so grateful to the excellent computer engineer Mr Ahmed Mohamed El Sayed for his kind support in performing the video abstract. No funding was received. The article is supported by the authors. The authors are so grateful to Taibah University, Saudi Arabia for allowing a helpful environment to conduct this study. The authors are very grateful to Mr Adel Obaidi, Mr Raed Ali Al-Raddadi, Mr Sultan Al-Hussini, Mr Mohamed Abdelsamad, and Mr Wael Barakat from the Administrative Department, College of Medicine, Taibah University for their technical help and support in this work.
Disclosure
The authors report no conflicts of interest in this work.