Utilization, practice of herbal medicine in patients with type 2 diabetes mellitus in Kuwait and their perceptions

Background:Herbal medicine has become a popular treatment among patients with chronic diseases like diabetes mellitus worldwide.Many patients with diabetes mellitus use herbal medicine without consulting their health professionals.The aim of this study was to assess the prevalence,pattern of use,and perceptions in type 2 diabetes patients using herbal medicine.Methods:The study was conducted during the period of 1st January 2019 to the end of June 2019 in the diabetes clinic in Farwaniya hospital in Kuwait.It is cross sectional,quantitative study.Data were collected using a questionnaire in both Arabic and English designed by the investigators after a review of the literature on use of herbal medicine.The questionnaire was administered by working nurses.Results:The study denoted that the prevalence of using herbal medicine in the study sample(350 patients with type 2 diabetes)was 30.6%of all sample,females were greater than males in using herbal medicine about 56%of patients using herbs.Black Cumin(Habba Soda)i.e.Nigella Satival was the most frequent herbs used by the patients and a herbal mixture done by herbalist.The study revealed that 70%of herbal users has bad glycemic control HbA1C³7%and the diabetes complications were greater in herbal users than on conventional therapy.The study showed that irregular use of herbs that were used with diabetes conventional treatment and the majority of herbal users did not inform their treating doctors about herbal use(95.3%)herbal users.Conclusion:The study revealed that 30%of the sample were herbal users and they are in need for increase their awareness and education about risks and complications of herbal medicine.

Assessment of Liver Fatty Acid Binding Protein (L-FABP) as a Diagnostic Marker in Non-Alcoholic Fatty Liver Disease

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common liver disease worldwide, it causes chronic hepatitis, which leads to cirrhosis and hepatocellular carcinoma. We aimed to assess the value of liver fatty acid binding protein (L-FABP) in the diagnosis of non-alcoholic fatty liver disease in comparison to ultrasonography. Patients and Methods: Ninty subjects were enrolled in this study who attended the Hepatology, Gastroenterology and Internal medicine clinics in Benha University Hospitals between January 2017 and January 2018 and divided into group I included 70 consecutive patients with non-alcoholic fatty liver disease who were diagnosed by ultrasound with or without elevated liver enzymes and group II included 20 healthy control subjects without NAFLD (by ultrasound) with normal liver enzymes. Serum levels of L-FABP were determined by enzyme-linked immunosorbent assay. Results: NAFLD patients were slightly older than healthy subjects as mean age in group I was (37.74 ± 11.7) while in group II was (36.5 ± 11.31). There was a slight increase in NAFLD in males, there was a high prevalence of NAFLD in the urban population. L-FABP levels in NAFLD patients were higher than in the control group (levels were 188.6 ± 34.94 and 137.7 ± 13.05 ng/l respectively). A strong correlation was found between L-FABP and ALT, AST, BMI and glucose levels. Analysis of ROC curve revealed that at a level 151.1 ng/sensitivity, specificity, PPV, NPV and accuracy were 83.3%, 71.8%, 31.3%, 96.6% and 73.3% respectively with AUC 0.839 and at a level 189.5 ng/sensitivity, specificity, PPV, NPV and accuracy were 90%, 90%, 95.4%, 95.4%, 88.9% with AUC was 0.950. Conclusion: Serum L-FABP could be used as a new diagnostic biomarker for detecting NAFLD.

Outcome of Laparoscopic Resection for Left Sided Colon and Rectal Cancer

Background: For many years, traditional surgery for left colon and rectal cancers had developed with variable degrees of morbidity. With the evolution of laparoscopy and by the aid of better visualization and magnification, laparoscopic colorectal surgery had appeared, but technically challenging as it involves almost all advanced laparoscopic techniques, with the benefits of minimal morbidity, less pain, earlier recovery, shorter hospital stay, without compromising oncological results. Aim: The aim of this work was to evaluate laparoscopic resection for left sided colon and rectal cancer as regard feasibility, safety and outcomes. Patients and Methods: This prospective study was conducted on 40 patients having left sided colon and rectal cancer, including 29 patients with rectal cancer and 11 patients with left sided colon cancer within the inclusion criteria are evaluated by clinical examination, radiological and colonoscopic study and biopsy and treated by laparoscopic resection and followed ranged from 6 months to 2 years with mean of 20 months. Results: Twenty seven patients (67.5%) underwent laparoscopic anterior resection, 11 patients (27.5%) underwent laparoscopic left hemicolectomy and only 2 patients (5%) underwent laparoscopic abdominoperineal resection, minimal morbidity, no cancer related mortality and no recurrence during the period of follow up either local or systemic. Conclusion: Laparoscopic resection for left sided colon and rectal cancer is technically feasible, oncologically safe and has more benefits on postoperative recovery.

Omission of the Bladder Flap Suggests Short Term and Long Term Benefits

Background: Cesarean section is now the most common major surgical procedure performed on women worldwide. With the increasing numbers of cesarean sections, there is the need to utilize evidence based techniques to optimize outcomes and minimize complications. We hypothesize that omission of the bladder flap in both primary and repeat cesarean sections will be associated with shorter operating time without a significant increase in intraoperative and postoperative complications. Methods: 550 patients were enrolled in the study. They were randomly allocated in the 2 groups to evaluate the effects of cancelling the bladder dissection. Results: Significant reduction of the total operating time (p = 0.01), skin to delivery time (p = 0.02) and micro-hematuria (p = 0.01) in group with bladder omission. Long term result: Including more bladder adhesion and fibrosis in the cases with bladder dissection. Conclusions: Omission of the bladder dissection achieved short-term advantages as regards reduction of operating time, incision-delivery duration and decreased blood loss as well as long-term effects include different in the bladder adhesion.

Clinical Safety and Efficacy of Platelet-Rich Plasma in Wound Healing

Background: Platelet-rich plasma has been extensively used in several clinical settings. However, there still a lack of conclusive evidence concerning the benefits of platelet-rich plasma in the field of wound healing. We aimed to evaluate the safety and the efficacy of autologous platelet-rich plasma in acute wound healing. Methods: This prospective study enrolled forty adult patients of both sexes and aged between 18 - 50 years. All patients in need for split-thickness skin graft were included in our study. The donor sites were randomly divided into two equal halves: the platelet-rich plasma side, which was injected with recently activated platelet-rich plasma;and the control side, in which the conventional method of dressing was used. Measurement of the platelet count and transforming growth factor-B1 concentration in each platelet-rich plasma preparation and the whole blood was done for all patients. Clinical monitoring of the donor sites was done every 7 days for 3 weeks, regarding pain perception, epithelialization surface area and possible side effects of the platelet-rich plasma. Histopathological monitoring was done on the 7th postoperative day. Results: The platelet count was increased about 3.5 folds and transforming growth factor-B1 was increased 2.4 folds in the platelet-rich plasma compared to the patients’ blood. The platelet-rich plasma side had significantly lower pain scores at day 7 (4.8 ± 0.18 vs 5.9 ± 0.07) and day 14 (1.4 ± 0.11 vs 1.9 ± 0.09) postoperative (p = 0.002 and p = 0.004, respectively) and had significantly higher rate of epithelialization at day 7 (9.8 ± 0.35 cm2 vs 7.5 ± 0.32 cm2) and day 14 (38.4 ± 0.36 cm2 vs 36.9 ± 0.42 cm2) postoperative (p p = 0.039, respectively), while at day 21 postoperative, there was no significant difference between both sides. There was no significant difference between both sides regarding the incidence of complications. The platelet-rich plasma side showed intact epithelium, differentiation of the cells in stratum spongiosum and stratum granulosum, neovascularization and earlier collagen deposition. Conclusion: The platelet-rich plasma is safe and effective adjuvant in the management of acute wounds. However, we recommend for larger clinical trials for standardized method for PRP preparation and better understanding of the efficacy of this blood product.

Herbal Use and Perceptions among Patients with Type 2 Diabetes Mellitus in Kuwait

Herbal medicine has become a popular treatment among patients with chronic diseases worldwide. Many patients with diabetes mellitus use herbal medicine without consulting their health professionals. The aim of this study was to assess the prevalence, pattern of use, and perceptions in type 2 diabetes patients using herbal medicine. It was conducted between 1st January 2019 and end of June 2019 diabetes clinic in Farwaniya Hospital in Kuwait. In this cross sectional quantitative study, 350 patients were asked to complete questionnaire administered by nurses. The study found that 30.6% of sample used herbal medicine—women more than men. Black cumin (habba soda) i.e. Nigella sativa was the most common herb used by diabetic patients. The study revealed that 70% of herbal medicine users had poor glycemic control (HbA1c ≥ 7%). Diabetic complications were greater in herbal users than in those receiving conventional therapy. The study also showed that 95.3% of herbal medicine users did not inform their treating doctors. Our conclusion was that herbal medicine users needed to increase their awareness and education about the risks and complications of herbal medicine.