Wet cupping therapy was applied to 5 points on the back of 40 healthy participants. Electrocardiography recordings were taken before and after to analyze heart rate variability (HRV), a measure of sympathovagal balance. All HRV parameters, including SDNN, SDANN, RMSSD, pNN50, LF, and HF, increased after cupping therapy compared to before, indicating cupping restored sympathovagal balance. This is the first study to show in humans that cupping therapy may have cardioprotective effects by stimulating the peripheral nervous system.
Prospective Randomized Double-Blind Study of Effectiveness of Dexmedetomidine...asclepiuspdfs
Introduction: Laryngoscopy and endotracheal intubation is associated with transient increase in heart rate (HR) and arterial blood pressure due to the sympathoadrenal stimulation. It can produce deleterious effects in patients with cardiovascular and cerebrovascular disease, in the form of myocardial ischemia, pulmonary edema, and cerebral hemorrhage. Dexmedetomidine has been effective in blunting the hemodynamic response to laryngoscopy and tracheal intubation. In this study, we used dexmedetomidine in pre-operative intravenous infusion dose of 1 mcg/kg over 20 min before induction. Aims and Objectives: The aim of the study was to study the efficacy and safety of dexmedetomidine on attenuation of pressor response during laryngoscopy and tracheal intubation, w.r.t. (1) pressor response during laryngoscopy and tracheal intubation, (2) hemodynamic stability, and (3) any adverse effects.
Prospective Randomized Double-Blind Study of Effectiveness of Dexmedetomidine...asclepiuspdfs
Introduction: Laryngoscopy and endotracheal intubation is associated with transient increase in heart rate (HR) and arterial blood pressure due to the sympathoadrenal stimulation. It can produce deleterious effects in patients with cardiovascular and cerebrovascular disease, in the form of myocardial ischemia, pulmonary edema, and cerebral hemorrhage. Dexmedetomidine has been effective in blunting the hemodynamic response to laryngoscopy and tracheal intubation. In this study, we used dexmedetomidine in pre-operative intravenous infusion dose of 1 mcg/kg over 20 min before induction. Aims and Objectives: The aim of the study was to study the efficacy and safety of dexmedetomidine on attenuation of pressor response during laryngoscopy and tracheal intubation, w.r.t. (1) pressor response during laryngoscopy and tracheal intubation, (2) hemodynamic stability, and (3) any adverse effects.
Causes for syncope are multifaceted. Hormonal etiology, specifically hypothyroidism, is associated with cardiac arrhythmias [1]. Sinus bradycardia, low voltage, nonspecific T-wave changes and dissociative atrioventricular (AV) abnormalities are some of descriptive electrocardiographic features [2]. In the majority of well know clinical presentations complete AV block requires the insertion of a permanent pacemaker. However hypothyroidism related bradycardia and consequential symptomatic AV blocks could be reversible with timely and proper management.
We report a case of severe hypothyroidism resulting in insertion of transient pacemaker with favorable clinical course and fully reversible complete AV block after accordant pharmacological hormonal substitution.
POLYTRAUMA AND DAMAGE CONTROL ORTHOPAEDICSDr Slayer
polytrauma is Injury to 2 or more organ systems leading potentially to a life threatening condition
Damage control orthopaedics is an approach to contain and stabilize an orthopaedic injury to improve patient’s physiology which are designed to avoid worsening pt’s condition due to “second hit” phenomenon
“Hemodynamic and recovery profile with Dexmedetomidine and Fentanyl in intrac...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Evaluvation of Perioperative Haemodynamic Changes in Hypertensive Patients Tr...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Successful management of massive intra-operative pulmonary embolism Apollo Hospitals
Acute Pulmonary Embolism has a high rate of mortality (26%) due to blockade of the pulmonary artery leading to acute increase in right ventricular pressure causing sudden cardiac decompensation. Lack of specific tests for early diagnosis is one of the causes for high rate of mortality but timely diagnosis and active intervention can save the life of the patient.
The autonomic nervous system (ANS) controls all body functions. Dysregulation of this system may be responsible of bradycardia. The main objective of our study is to describe the autonomic profile of patients with bradycardia and to determine, through testing cardiovascular autonomic reflexes its involvement in the pathogenesis of idiopathic symptomatic bradycardia.
Causes for syncope are multifaceted. Hormonal etiology, specifically hypothyroidism, is associated with cardiac arrhythmias [1]. Sinus bradycardia, low voltage, nonspecific T-wave changes and dissociative atrioventricular (AV) abnormalities are some of descriptive electrocardiographic features [2]. In the majority of well know clinical presentations complete AV block requires the insertion of a permanent pacemaker. However hypothyroidism related bradycardia and consequential symptomatic AV blocks could be reversible with timely and proper management.
We report a case of severe hypothyroidism resulting in insertion of transient pacemaker with favorable clinical course and fully reversible complete AV block after accordant pharmacological hormonal substitution.
POLYTRAUMA AND DAMAGE CONTROL ORTHOPAEDICSDr Slayer
polytrauma is Injury to 2 or more organ systems leading potentially to a life threatening condition
Damage control orthopaedics is an approach to contain and stabilize an orthopaedic injury to improve patient’s physiology which are designed to avoid worsening pt’s condition due to “second hit” phenomenon
“Hemodynamic and recovery profile with Dexmedetomidine and Fentanyl in intrac...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Evaluvation of Perioperative Haemodynamic Changes in Hypertensive Patients Tr...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Successful management of massive intra-operative pulmonary embolism Apollo Hospitals
Acute Pulmonary Embolism has a high rate of mortality (26%) due to blockade of the pulmonary artery leading to acute increase in right ventricular pressure causing sudden cardiac decompensation. Lack of specific tests for early diagnosis is one of the causes for high rate of mortality but timely diagnosis and active intervention can save the life of the patient.
The autonomic nervous system (ANS) controls all body functions. Dysregulation of this system may be responsible of bradycardia. The main objective of our study is to describe the autonomic profile of patients with bradycardia and to determine, through testing cardiovascular autonomic reflexes its involvement in the pathogenesis of idiopathic symptomatic bradycardia.
To study the variations of autonomic nervous system in hypertensive patients using a set of autonomic function tests
and to correlate cardiac autonomic function with Heart rate variability in hypertensives. Background: The pathophysiological mechanism for the development of hypertension is the lack of balance between sympathetic and parasympathetic nervous system. Both Heart rate variability (HRV) and Autonomic function tests provide a tool to know the concept of autonomic modulation of heart. They also forms an index of cardiac autonomic regulation. Methods: The study included 50 hypertensive patients and 50 normotensive
subjects. All the subjects underwent for the analysis of heart rate variability in time domain (TD) and frequency domain and a set of autonomic function tests were done to assess the autonomic functions. These results were compared with age and sex matched controls (normotensives). The subjects were selected based on exclusion-inclusion criteria. Results: Results showed that S: L ratio, Valsalva ratio & Heart rate response to deep breathing test values were decreased in Hypertensives as compared to Normotensives (p<0.05).><0.05). Both the time domain and frequency domain values of HRV reduced significantly in hypertensives indicated that there is increased sympathetic activity and decreased parasympathetic activity. Conclusion: From this study, it is evident that Hypertension can alter the normal autonomic functions of the body and predisposes to autonomic neuropathy. Early and regular screening of these individuals is necessary to prevent any future complications.
Does Type of Dialysis Affect BNP in Fluid Overload Patients?Premier Publishers
Brain Natriuretic Peptide (BNP) levels are important as predictors of heart failure in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (PD). Twenty-four HD patients and 35 PD patients were included in the study. Each patient underwent an echocardiographic examination besides the determination of BNP, high-sensitivity C-reactive protein (hs-CRP) and homocysteine (Hcy). BNP, left ventricular mass (LVM), left ventricular mass index (LVMI) and Hcy levels were significantly higher in HD group (p<0.05); hs-CRP levels were significantly higher in PD group (p=0.029). Predialysis BNP was significantly higher than the postdialysis BNP (p=0.003). There was a significant correlation between LVMI and BNP in PD (r=0.527, p=0.009) and predialysis BNP in HD (r=0.417, p=0.043) groups. In conclusion, BNP levels were found to be significantly correlated with LVMI in HD and PD patients. Hemodialysis patients had higher BNP and LVMI levels. This may be due to the hemodynamic changes which occur with the hemodialysis.
A Study to Assess the Effectiveness of Hibiscus Sabdariffa on Hypertensive Pa...ijtsrd
The present study aim was the assess the effectiveness of hibiscus sabdariffa on hypertensive patients in rural area. A Quantitaive research approach and Quasi experimental pre test and post test control group design have adopted for the present study. 60 participants were selected who are satisfied with inclusion criteria whereas 30 samples in experimental group other 30 sample were in control group, they were selected by convenient sampling technique. A structured questionnaire method to collect the demographic variables and clinical variables, blood pressure is assessed by the sphygmomanometer. Among 60 patient, 30 hypertensive patient participated in the reveals the pretest mean score was 1.83±0.36 and the post test mean score was 1.23±0.66 in systolic blood pressure and the pretest mean score was 1.4±0.48 and post test mean score was 0.5±0.40 in diastolic blood pressure. Paired t test to compare the pre and posttest level of blood pressure among experimental group. The present study regard to the pre and post test level of systolic blood pressure among experimental group it was found that the t value was5.86, With regard to the pre and post test level of diastolic blood pressure among experimental group it was found that the t value was 12.3, indicating that the rewash a highly significant reduction in post test level of blood pressure among the experimental group at p 0.05level. The present study reveals the pretest mean score was 1.83±0.53 and the post test mean score was 1.96 ±1.6 in systolic blood pressure and the pretest mean score was 1.26 ±0.49 and post test mean score was 0.22 ±0.71 in diastolic blood pressure. paired t test to compare the pre and post test level of blood pressure among control group. With regard to the pre and post test level of systolic blood pressure among control group it was found that the t value was 2.35, With regard to the pre and post test level of diastolic blood pressure among control group it was found that the t value was 2.48, indicating that there was no significant reduction in post test level of blood pressure among the control group at p 0.05 level. Sathiyabama. G | Narmadha K | Nivetha. S "A Study to Assess the Effectiveness of Hibiscus Sabdariffa on Hypertensive Patients in Rural Area" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-6 , October 2022, URL: https://www.ijtsrd.com/papers/ijtsrd52202.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/52202/a-study-to-assess-the-effectiveness-of-hibiscus-sabdariffa-on-hypertensive-patients-in-rural-area/sathiyabama-g
Manuscript editing service | Primary and secondary data | Neurogenic ShockPubrica
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jurnal lengkap: Gangguan psikologis dan terutama depresi yang umum pada gagal ginjal kronis dan hemodialisis pasien (HD). Gangguan ini memiliki pengaruh penting terhadap kualitas hidup dan angka kematian meningkat. Penelitian ini dilakukan untuk mengevaluasi frekuensi depresi dan faktor-faktor yang terkait antara pasien HD.
Depresi adalah masalah kejiwaan yang paling sering pada pasien dengan penyakit ginjal kronis dan dapat memprediksi hasil pasien dan kematian. Depresi terkait dengan kehidupan yang penuh stres yang ditandai dengan banyak kerugian dan oleh ketergantungan, yang bahkan dapat menyebabkan bunuh diri. Meskipun sejumlah besar pasien dengan penyakit ginjal kronis dan beban ekonomi mereka mewakili, hanya beberapa dari pasien ini menerima diagnosis dan terapi yang memadai. Pedoman Diagnostik dan Statistik Mental kriteria Gangguan-IV untuk depresi besar dapat membantu dalam membedakan gejala uremia dan depresi. Farmakoterapi tersedia dan antidepresan (trisiklik antidepresan dan selective serotonin re-uptake) telah berhasil digunakan dalam berbagai penelitian. Akhirnya, ada kebutuhan untuk welldesigned lanjut, membujur studi, kelangsungan hidup untuk memperjelas hubungan yang lebih baik antara depresi dan berbagai tahap disfungsi ginjal.
Depresi dan bunuh diri sebagai masalah kesehatan mental yang lazim untuk pasien hemodialisis. Tujuan: Para penulis meneliti faktor-faktor demografi dan psikologis yang terkait dengan depresi pada pasien hemodialisis dan dijelaskan hubungan antara depresi, kecemasan, kelelahan, kualitas kesehatan yang berhubungan hidup yang buruk, dan meningkatkan risiko bunuh diri.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
1. Wet Cupping Therapy Restores Sympathovagal
Imbalances in Cardiac Rhythm
Mu¨zeyyen Arslan, MSc, Nesibe Yesxilc¸am, BSc, Duygu Aydin, MD, Ramazan Yu¨ksel, MD, and Sxenol Dane, MD
Abstract
Objectives: A recent study showed that cupping had therapeutic effects in rats with myocardial infarction and
cardiac arrhythmias. The current studyaimed to investigate the possible useful effects of cupping therapy on
cardiac rhythm in terms of heart rate variability (HRV).
Materials and methods: Forty healthy participants were included. Classic wet cupping therapy was applied on
five points of the back. Recording electrocardiography (to determine HRV) was applied 1 hour before and 1
hour after cupping therapy.
Results: All HRV parameters increased after cupping therapy compared with before cupping therapy in healthy
persons.
Conclusions: These results indicate for the first time in humans that cupping might be cardioprotective. In this
study, cupping therapy restored sympathovagal imbalances by stimulating the peripheral nervous system.
Introduction
Cupping is a traditional complementary treatment
used in public medicine and also by clinicians in many
countries.1
This treatment creates a vacuum over certain
points on the skin. There are two methods of cupping: dry and
wet. In general, a glass cup is applied on the skin over an
acupuncture point, painful area, or reflex zone.2
In dry cup-
ping therapy, application consists of creating a small area of
low air pressure next to the skin. Wet cupping therapy in-
volves both dry cupping and medicinal bleeding applications.
Cupping therapy, in both wet and dry forms, is still used
today in many cultures. Cupping is thought to remove
noxious materials from skin microcirculation and interstitial
compartment.3
Both dry and wet cupping have been claimed to drain
excess fluids and toxins, loosen adhesions and lift con-
nective tissue, bring blood flow to skin and muscles, and
stimulate the peripheral nervous system.1
In addition,
cupping is said to reduce pain and high blood pressure, as
well as modulate neurohormones and the immune system.2
Cupping therapy is also used to improve subcutaneous blood
flow and to stimulate the autonomic nervous system.2
Cup-
ping is often used as a symptomatic treatment for a wide
range of conditions seen in clinical practice, such as pain,
hypertension, and stroke rehabilitation.1
Clinical studies have shown that wet cupping has some
modulatory effects on the immune system. The stimulation
of acute pain fibers by puncture of skin in wet cupping
therapy causes release of b-endorphin and adrenocortical
hormone into the circulation. These hormones might help
block inflammation in arthritis. Cupping therapy has some
beneficial effects on the immune system via the central
nervous system pathway, including release of b-endorphin
and activation of the opioid system.4
Ngai and Jones5
in-
vestigated skin impedance and heart rate variability (HRV)
changes in response to transcutaneous electrical nervous
stimulation over an acupoint, similar to the approach used
with cupping therapy. Skin impedance at all acupoints de-
creased and HRV increased after transcutaneous electrical
nervous stimulation.5
A recent animal study6
investigated the effects of wet
cupping on hemodynamic variables, cardiac arrhythmias,
and infarct size after myocardial ischemic reperfusion injury
in male rats. Its results show that cupping did not change
baseline heart rate or mean arterial blood pressure. Ischemic
reperfusion injury caused an infarct size of 50% – 5%,
whereas dry cupping and single and repeated wet cupping
significantly reduced infarct size to 28% – 3%, 35% – 3%,
and 22% – 2% of the area at risk, respectively. The rate of
ischemia-induced arrhythmias was significantly modified by
wet cupping.
There are complex interactions between the sympa-
thetic and parasympathetic nervous system inputs to the
sinus node. The concept of ‘‘sympathovagal balance’’ re-
flects the autonomic state resulting from the sympathetic and
Turgut Ozal University School of Nursing, Ankara, Turkey.
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 20, Number 4, 2014, pp. 318–321
ª Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2013.0291
318
2. parasympathetic influences. Heart rate variability parame-
ters are indexes of sympathovagal balance or imbalance.
Temporal fluctuations in cardiac cycles are mainly de-
termined by the activity of sympathetic and parasympathetic
systems innervating the heart. HRV is defined as fluctua-
tions of the sinus rhythm that are affected by internal and
external factors of the body.7
Furthermore, these fluctua-
tions in heart rate can be determined by ECG as a
straightforward and noninvasive technique that analyzes the
interaction between sympathetic and parasympathetic ner-
vous systems and provides information about the autonomic
nervous system.
During the past 30 years, an increasing number of studies
have related the imbalance of the autonomic nervous system
(as assessed by HRV) to several pathophysiologic condi-
tions, particularly in the setting of cardiovascular disease.
Sudden death, coronary artery disease, heart failure, and
cardiovascular risk factors (smoking, diabetes, hyperlipid-
emia, and hypertension) are the best-known clinical cir-
cumstances that can affect or be affected by the autonomic
nervous system. Analyses of HRV variables have been
proposed as a component of the clinical evaluation for pa-
tient risk stratification because of it’s the independent
prognostic information these variables provide. Yet the wide
use of HRV in clinical practice remains to be established.
An increase in HRV parameters shows good cardiac
health, but a decrease in HRV indicates poor cardiac health.
In light of these reports, especially because of a decrease in
the rate of ischemia-induced arrhythmias by wet cupping,6
it
can be speculated that cupping therapy can result in in-
creased HRV parameters in humans. Therefore, the current
study investigated HRV parameters before and after wet
cupping therapy in a healthy population.
Materials and Methods
Participants
Forty healthy people (26 women and 14 men; mean
age – standard deviation, 30.32 – 5.39 years) participated in
this study. Exclusion criteria were health problems, such as
psychiatric, respiratory, metabolic, cardiac, or autonomic
nervous system diseases, that might change the heart rate.
The Ethical Committee of the Faculty of Medicine of the
University of TurgutOzal approved this study.
Cupping therapy
All cupping procedures were applied by physicians cer-
tificated by the British Cupping Society and Natural Health
Institute. For the cupping therapy, sterile disposable cups
5 cm in diameter were used. Five points of the posterior
neck, bilateral perispinal areas of the neck, and thoracic
spine were selected for treatment. These points are classic
wet cupping points chosen for all cupping therapies (Figs. 1
and 2). Application areas were cleaned with antiseptic so-
lutions. Cups were placed on these points, and negative
pressure was applied by a cupping pump on the middle
level. The cups were removed after 2 to 3 minutes. Then, the
skin within the cupping sites was punctured to a 2-mm depth
by using a 26-gauge disposable lancet. Then, pumping with
vacuum was applied three times and 3 to 5 mL of blood was
drained per cupping site. This method was suggested by the
British Cupping Society and Natural Health Institutes in
their certification courses. Application sites were covered
with sterile pads.
Recording electrocardiography (HRV)
Recording electrocardiography (ECG) was applied 1 hour
before and 1 hour after cupping therapy. Participants rested
for 10 minutes without recording ECG in order to stabilize
autonomic parameters. ECG was performed by using Pow-
erLab 26T (AD Instruments, Bella Vista, Australia), a device
used for multimodal monitoring of bio-signals. According to
the standard Einthoven triangle, three self-adhesive ECG
electrodes were applied to the right wrist and right and left
legs, respectively. The digital signals were then transferred to
a laptop computer and analyzed by using LabChartÒ soft-
ware (MLS310/7 HRV Module; AD Instruments). A full
FIG. 1. Vacuum application before wet cupping.
FIG. 2. A view after wet cupping.
WET CUPPING THERAPY FOR IMBALANCES IN CARDIAC RHYTHM 319
3. continuous ECG recording could be viewed and saved for
later analysis, and software-based filters were used to exclude
movement artifacts and ectopic beats before HRV analyses
(Fig. 3).
Results
In dry cupping therapy, application consists only of cre-
ating a small area of low air pressure next to the skin. Wet
cupping therapy involves both dry cupping and medicinal
bleeding applications.
HRV is the physiologic event of variation in the time in-
terval between heart beats. HRV consists of different param-
eters, such as SDNN and SDANN. It is measured by the
variation in the beat-to-beat interval on ECG. Other terms used
for HRV are ‘‘cycle length variability’’ and ‘‘RR variability.’’
R is a point corresponding to the peak of the QRS complex of
the ECG wave, and RR is the interval between successive Rs.
As HRV parameters increase, cardiac health is good, but a
decrease in HRV shows negativity in cardiac rhythm.
In the present study, maximal NN or RR intervals (maxi
NN) (ms), the mean of all NN intervals (mean NN) (ms),
the number of pulse in minutes (pulse rate) (1/min), the
standard deviation of the NN intervals (SDNN) (ms), and
the standard deviation of the averages of NN intervals in all
5-minute segments of the entire recording (SDANN) (ms),
the square root of the mean of the sum of the squares of
differences between adjacent NN intervals (RMSSD) (ms)
and the percentage of difference between adjacent NN in-
tervals that are greater than 50 ms (pNN50) (%), power in
low-frequency range (0.04–0.15 Hz) (LF) (ms2
) and power
in high-frequency range (0.15–0.4 Hz) (HF) (ms2
) were in-
creased after cupping therapy compared with before cupping
therapy (maxi NN: t = 3.45, p = 0.001; mean NN: t = 3.47,
p = 0.001; pulse rate: t = 2.87, p = 0.006; SDNN: t = 2.39, p =
0.02; SDANN: t = 4.56, p = 0.00; RMSSD: t = 4.55, p = 0.00;
pNN50: t = 3.77, p = 0.001; LF: t = 2.95, p = 0.005; HF: t =
2.06, p = 0.04) (Table 1). It can be stated that many HRV
parameters were increased after cupping therapy compared
with before cupping therapy. Other HRV parameters (min-
imal NN intervals [ms], the variance of all NN intervals
[ £ 0.4 Hz; total power; ms2
], power in the very-low-
frequency range [0.003–0.04 Hz; VLF; ms2
] and LF/HF
rate) were also increased, but these differences were not
statistically significant.
Discussion
In the present study, all HRV parameters increased after
cupping therapy compared with before cupping therapy in
healthy persons. These results indicate for the first time in
humans that cupping might be cardioprotective. These re-
sults were consistent with those of a recent study performed
in rats by Shekarforoush et al.6
Those authors reported that
FIG. 3. Electrocardiography record and heart rate variability parameters.
Table 1. HRV Parameters Before and After Cupping Therapy
HRV parameters Before cupping (mean – SD) After cupping (mean – SD) t P-Value
Maximum NN (ms) 1013.4 – 141.55 1058.1 – 147.61 3.45 0.001
Minimum NN (ms) 722.84 – 92.31 734.33 – 91.14 0.89 0.38
Mean NN (ms) 869.99 – 92.54 910.04 – 97.28 3.47 0.001
Pulse rate (1/min) 69.71 – 7.18 66.69 – 7.45 2.87 0.006
SDNN (ms) 41.19 – 19.57 44.91 – 21.28 2.39 0.02
SDANN (ms) 32.27 – 34.41 37.97 – 38.92 4.56 0.00
RMSSD (ms) 32.25 – 34.38 37.94 – 38.89 4.55 0.00
pNN50 (%) 5.46 – 5.85 8.74 – 17.26 3.77 0.001
Total power (ms2
) 2090.79 – 2664.63 2433.76 – 3702.17 1.56 0.13
VLF (ms2
) 910.98 – 776.49 914.67 – 668.18 0.02 0.98
LF (ms2
) 343.19 – 245.69 416.38 – 228.10 2.95 0.005
HF (ms2
) 466.11 – 1028.01 637.42 – 1547.57 2.06 0.04
LF/HF 1.82 – 1.48 1.97 – 1.68 0.85 0.41
HF, high frequency; HRV, heart rate variability; LF, low frequency; pNN50, percentage of difference between adjacent NN intervals that
are greater than 50 ms; RM SSD, square root of the mean of the sum of the squares of differences between adjacent NN intervals; SD,
standard deviation; SDANN, standard deviation of the averages of NN intervals in all 5-minute segments of the entire recording; SDNN,
standard deviation of the NN intervals; VLF, very low frequency.
320 ARSLAN ET AL.
4. cupping was beneficial in terms of cardiac effects on myo-
cardial infarction and cardiac arrhythmias.
Reduced HRV has been shown to be a predictor of
mortality after myocardial infarction.8,9
Some other clinical
conditions may also be associated with the lower HRV,
including congestive heart failure, diabetic neuropathy, de-
pression, sudden infant death syndrome risk, and poor sur-
vival in premature babies.
Cupping therapy can relieve a variety of diseases or clinical
conditions as a result of the comprehensive effects of multiple
types of stimulation exerted onto the regional acupoint areas.
Among the stimuli, the negative pressure from cupping is one
of the main factors inducing therapeutic effects. The possible
underlying mechanism of therapeutic effects of the negative
pressure from cupping may be associated with the releasing of
b-endorphin and adrenocortical hormone into the circulation,
the central nervous system effects by the stimulation of su-
perficial end depth tactile and pain receptors. It can be stated
that cupping therapy restored sympathovagal imbalances by
stimulating the peripheral nervous system. The literature
clearly shows that acupuncture has therapeutic effects for
individuals with hypertension, myocardial ischemia, and
certain arrhythmias.10
Tham et al. showed that cupping may
be capable of stimulating individual acupuncture points.11
Similar to this study in cupping therapy, a separate study
investigated skin impedance and HRV changes in response to
transcutaneous electrical nervous stimulation over an acu-
point. Skin impedance at all acupoints decreased and HRV
increased after transcutaneous electrical nervous stimulation.5
Generally, cupping-induced negative pressure can dilate
local blood vessels to improve microcirculation, promote
capillary endothelial cell repair, and accelerate granulation
and angiogenesis in the regional tissues, normalizing the
patients’ functional state at last.12
In addition, cupping
therapy removes different stresses and exhaustion from the
human body that cause the sympathovagal imbalances. In
addition, it can be suggested that cupping therapy restores
homeostasis disturbances by stimulating acupuncture points
or sites or by using another mechanism mentioned above.
As a consequence, wet cupping therapy is a noninvasive
harmless therapeutic application that can be confidently
used to restore sympathovagali mbalances in cardiac
rhythm. Therefore, it may be useful for preventing cardiac
arrhythmias and as a complement to medical treatment.
Author Disclosure Statement
No competing financial interests exist.
References
1. Lee MS, Kim J, Ernst E. Is cupping an effective treatment?
An overview of systematic reviews. J Acupunct Meridian
Stud 2011;4:1–4.
2. Yoo SS, Tausk F. Cupping: east meets west. Int J Dermatol
2004;43:664–665.
3. Goodwin J. Alternative therapy: cupping for asthma. Chest
2011;139:475.
4. Ahmed SM, Madbouly NH, Maklad SS, Abu-Shady EA.
Immunomodulatory effects of blood letting cupping ther-
apy in patients with rheumatoid arthritis. Egypt J Immunol
2005;12:39–51.
5. Ngai SP, Jones AY. Changes in skin impedance and
heart rate variability with application of Acu-TENS to BL
13 (Feishu). J Altern Complement Med 2013;19:558–563.
6. Shekarforoush S, Foadoddini M, Noroozzadeh A,
Akbarinia H, Khoshbaten A. Cardiac effects of cupping:
myocardial infarction, arrhythmias, heart rate and mean ar-
terial blood pressure in the rat heart. Chin J Physiol 2012;55:
253–258.
7. Kristal-Boneh E, Raifel M, Froom P, Ribak J. Heart rate
variability in health and disease. Scand J Work Environ
Health 1995;21:85–95.
8. Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM,
Kleiger RE, Rottman JN. Frequency domain measures of
heart period variability and mortality after myocardial in-
farction. Circulation 1992;85:164–171.
9. Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ. Decreased
heart rate variability and its association with increased
mortality after acute myocardial infarction. Am J Cardiol
1987;59:256–262.
10. Vogel JHK, Bolling SF, Costello RB, et al. Integrating
complementary medicine into cardiovascular medicine: a
report of the American College of Cardiology Foundation
Task Force on clinical expert consensus documents. J Am
Coll Cardiol 2005;46:184–221.
11. Tham LM, Lee HP, Lu C. Cupping: from a biomechanical
perspective. J Biomech 2006;39:2183–2193.
12. Cui S, Cui J. Progress of researches on the mechanism of
cupping therapy. Zhen Ci Yan Jiu 2012;37:506–510.
Address correspondence to:
Mu¨zeyyen Arslan
Turgut Ozal University School of Nursing
Anadolu Bulvarı No:16-A Yenimahalle
Ankara 06200
Turkey
E-mail: muzeyyen24@hotmail.com
WET CUPPING THERAPY FOR IMBALANCES IN CARDIAC RHYTHM 321