We investigate if rTMS has a therapeutic role in the treatment of dysphagia in patients with PD.Material and methods: 33 patients with PD and dysphagia were randomly classified with ratio 1:2 to receive sham or real rTMS (2000 pulses; 20 Hz; 90% RMT; 10 trains of 10s with 25s between each train) over the hand area of each motor cortex (5 min between hemispheres) for 10 days (5 days /week) followed by 5 booster sessions every month for 3 months. Assessments included the Unified Parkinson's Disease Rating Scale part III (UPDRS), Instrumental activity of Daily Living (IADL), and Arabic-dysphagia Handicap Index (A-DHI) before, after the last session, and 3 months later. Video-fluoroscopy measures of pharyngeal transit time (PTT) and time to maximal hyoid elevation (H1-H2) were taken before and after the treatment sessions.Results: There were no significant differences between groups. There was a significant improvement on all rating scales (ANOVA) after real rTMS with a significant time X group interaction. In particular there was a significant and longlasting (3 months) effect of time on all sub-items of the A-DHI (functional: P = 0.0001; physical: P = 0.0001; emotional: P = 0.02) but not in the sham group. This was associated with significant improvement in H1-H2 (P = 0.03) and PTT (P = 0.01) during solid swallows in the real rTMS but not the sham group.

Obesity and its associated metabolic pathologies are the most common and detrimental diseases, affecting over 50% of the adult population. Our knowledge about the protective effects of melatonin against high-fat diet (HFD)-induced obesity is still marginal. In this investigation, we hypothesized that melatonin can minimize the metabolic pathologies and morphological changes associated with obesity in animals receiving an HFD. To examine these effects, and to test our hypothesis, an animal model formed of male Boscat white rabbits was established. The animals were divided into three groups: (i) a control group fed regular diet; (ii) an obesity group fed an HFD for 12 weeks; and (iii) a treated group fed HFD for 12 weeks and then treated with melatonin for 4 weeks. The animals were killed and their serum and tissues were evaluated for: (i) lipid profile (cholesterol, triglycerides and low-density lipoprotein) and glucose; (ii) antioxidant enzyme (serum glutathione peroxidase, GSH-PX); and (iii) fatty changes (liver, kidney and blood vessels). Compared with the control group, intake of HFD (obesity group) was associated with: (i) a statistically significant increase in blood pressure, heart rate, sympathetic nerve activity, body weight, food consumption, serum lipids, blood glucose levels and atherogenic index; (ii) decreased level of GSH-PX and high-density lipoprotein (HDL); and (iii) fatty changes in the liver and kidney as well as atheromatous changes in the blood vessels. Compared with the obesity group, intake of melatonin (treated group) was associated with: (i) a statistically significant decrease in blood pressure, heart rate, sympathetic nerve activity, body weight, food consumption, serum lipids, blood glucose levels and atherogenic index; (ii) increased level of GSH-PX and HDL; and (iii) disappearance of fatty changes in the liver and kidney as well as atheromatous changes in the blood vessels. The administration of melatonin reduced the metabolic pathologies associated with the intake of HFD, suggesting a protective role. Although the underlying mechanisms are unclear, they may include its antioxidant and receptor-mediated effects. The clinical ramifications of these effects await further investigations.

Objective To evaluate the effectiveness of cryotherapy in managing the pain at the puncture site of Arterio-Venous Fistula (AVF) among children undergoing maintenance hemodialysis (HD). Methods A one-group pre-post quasi-experiment was performed in two HD centers affiliated with Cairo University. The experiment involved 40 children with AVF undergoing HD. Before puncturing, cryotherapy was applied using 2 cm–3 cm pieces of frozen distilled water in a plastic bag. Pain was assessed subjectively and objectively in two dialysis sessions before and after cryotherapy. A part from a physiological assessment of vital signs, pain was assessed using the Wong–Baker Faces Pain and the Observed Pain Behavior rating scales. All research ethics were applied. Results HD had a median duration of four years, while cryotherapy had a median application time of 8.8 min. The Wong–Baker Faces Pain score and almost all observed pain behaviors significantly decreased after cryotherapy. Significant improvements were observed in respiratory rate before and after needle puncture and in oxygen saturation after needle puncture. A lower skin dryness was observed after cryotherapy (12.5%) than before cryotherapy (52.5%; p < 0.001). Conclusions Cryotherapy can effectively reduce the venipuncture pain among children with AVF undergoing maintenance HD. However, the confounding effects of distraction and the non-randomized design used must be both considered when interpreting the findings. This study recommends the use of cryotherapy in managing needle puncture pain. Further research must adopt a randomized trial design with a placebo to support further the benefits of this procedure.

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