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

Abstract

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 indices

Keywords

• Thalassemia
• Al-hijamah
• iron chelation therapy
• oxidative stress
• clearance
• Al-hijamah indices.