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Effect of ultrasound cavitation versus radiofrequency on abdominal fat thickness in postnatal women

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Background: Overweight and obesity are predominant among women of conceptive age (25-34 years) with 42% having a BMI more than 25 kg/m 2. Weight gain builds the dangers of having diabetes and cardiovascular disease. The amount of weight gain postpartum can shift women from the healthy weight category into the overweight or obese BMI categories. Purpose: This study was conducted to compare the effectiveness of ultra-sound Cavitation versus radiofrequency on abdominal fat thickness on postnatal women. Subjects and Methods. Fifty overweight primipara women at 6 months postnatally aged from 20-35 years, BMI (25-29.9) kg/m 2 and have waist hip ratio (WHR) > 0.8. They were assigned randomly into 2 equal groups: Group (A) received ultra-sound cavitation 40 KHz applied for 30 minutes, once time weekly for 8 weeks. Group (B) received radiofrequency multi-polar (1 MHZ) applied for 30 minutes, once time weekly for 8 weeks. Both groups got a similar diet program all through the treatment period. All females in both groups were assessed through weight scale for body weight, tape measurement for waist/hip ratio and ultra-sonography for fat thickness of the abdominal area pre and post treatment program. Results: showed that there was a significant reduction of body weight, abdominal fat thickness at three level (at the umbilicus level, above and below umbilicus by 5 cm) in both groups with favorable results for group A. With a significant reduction of waist/hip ratio in group A only. Conclusion: Ultrasound cavitation and radiofrequency are effective strategies for the treatment of abdominal obesity, however US cavitation are more effective than RF in reduction of WHR and abdominal fat thickness in abdominal obese in postnatal ladies.
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EurAsian Journal of BioSciences
Eurasia J Biosci 14, 3337-3347 (2020)
Effect of ultrasound cavitation versus radiofrequency on
abdominal fat thickness in postnatal women
Yasmin M. Assim 1*, Khadiga S. Abd El-Aziz 2, Ghada E. EL Refaye 3,4,
Ashraf T. Youssef 5
1 Specialist Physiotherapist at El Fayoum Fever Hospital, EGYPT
2 Professor at Department of Physical Therapy for Womens Health, Faculty of Physical Therapy, Cairo University,
EGYPT
3 Assistant Professor at Department of Physical therapy for Womens Health, Faculty of Physical Therapy, Cairo
University, EGYPT
4 Assistant Professor at Department of Physical therapy for Womens Health, Faculty of Physical Therapy, Pharos
University in Alexandria, EGYPT
5 Assistant Professor of Radiodiagnosis, Faculty of Medicine, Fayoum University, EGYPT
*Corresponding author: Dryasminassim@yahoo.com
Abstract
Background: Overweight and obesity are predominant among women of conceptive age (2534
years) with 42% having a BMI more than 25 kg/m2. Weight gain builds the dangers of having diabetes
and cardiovascular disease. The amount of weight gain postpartum can shift women from the healthy
weight category into the overweight or obese BMI categories. Purpose: This study was conducted
to compare the effectiveness of ultra-sound Cavitation versus radiofrequency on abdominal fat
thickness on postnatal women. Subjects and Methods. Fifty overweight primipara women at 6
months postnatally aged from 20-35 years, BMI (25-29.9) kg/m2 and have waist hip ratio (WHR) >
0.8. They were assigned randomly into 2 equal groups: Group (A) received ultra-sound cavitation 40
KHz applied for 30 minutes, once time weekly for 8 weeks. Group (B) received radiofrequency multi-
polar (1 MHZ) applied for 30 minutes, once time weekly for 8 weeks. Both groups got a similar diet
program all through the treatment period. All females in both groups were assessed through weight
scale for body weight, tape measurement for waist/hip ratio and ultra-sonography for fat thickness of
the abdominal area pre and post treatment program. Results: showed that there was a significant
reduction of body weight, abdominal fat thickness at three level (at the umbilicus level, above and
below umbilicus by 5 cm) in both groups with favorable results for group A. With a significant reduction
of waist/hip ratio in group A only. Conclusion: Ultrasound cavitation and radiofrequency are effective
strategies for the treatment of abdominal obesity, however US cavitation are more effective than RF
in reduction of WHR and abdominal fat thickness in abdominal obese in postnatal ladies.
Keywords: ultra-sound cavitation, radiofrequency, abdominal fat thickness, postnatal women
Assim YM, El-Aziz KH SA, Refaye GE, Youssef AT (2020) Effect of ultrasound cavitation versus
radiofrequency on abdominal fat thickness in postnatal women. Eurasia J Biosci 14: 3337-3347.
© 2020 Assim et al.
This is an open-access article distributed under the terms of the Creative Commons Attribution License.
INTRODUCTION
Obesity or being overweight are almost identifying
simply as a syndrome of abnormal or excessive fat
accumulate in the adipose tissue to the extent that health
may be declined, whereas the central obesity or the
abdominal adiposity denotes excessive fat in the middle
body region, more of it in the intra-abdominal area (Lin
et al. 2012).
Excessive gestational weight retention builds the
danger of postpartum weight gain and long-term
maternal weight retention, it has been proposed to
abdominal obesity, which may expand a ladys danger
of both cardiovascular diseases and metabolic
syndrome (Nehring et al. 2011).
Pregnancy is also related to increases of the fat mass
thickness at the abdominal region. Fat is gained on both
the central and lower body during pregnancy
(Gunderson et al. 2008). During postnatal period, the
visceral (or intra-abdominal) fat is more metabolically
active than fat depots in other body areas and is linked
to a more adverse cardiometabolic profile. That, the
visceral fat is related to an increased risks of
cardiovascular diseases, diabetes, and the metabolic
syndrome (Fox et al. 2009).
Diminishing body fat is turning into a significant issue
in current society because of unevenness between high
caloric admission and absence of the activity. Extra fat
tissue keeping around the abdominal region, the breasts
Received: February 2019
Accepted: March 2020
Printed: September 2020
EurAsian Journal of BioSciences 14: 3337-3347 (2020) Assim et al.
3338
and the lower limbs leads to individual disappointment
with body constitution and resulting interest for viable,
sheltered and straightforward medicines for body
contouring. Generally, liposuction was the most well-
known strategy for body shaping however this obtrusive
treatment has been related with numerous antagonistic
occasions and complexities (Triana et al. 2009;
Venkatanagaraju, & Divakar, 2015).
RF and ultrasound cavitation are safe and effective
noninvasive technology methods for mobilizing local fat
deposits. They are less invasive and have fewer
complications compared to the liposuction traditional
treatments (Shek et al. 2009).
Ultrasonic lipolysis waves can make evacuation of
the undesirable body fat that affidavit without negative
impact on the skin. Decrease of the intercellular
pressure in the fixed temperatures brings about the
advancement of a huge number of micron bubbles which
prompts emotional blast of the last because of rehashed
patterns of extension and shrinkage (Coleman et al.
2009).
This procedure produces a lot of energy that
interference the adipose cell walls and discharges its
lipid content which is at last channel them to the
hepatobiliary framework by means of the lymphatic
drainage. This framework which is named Cavitation is
conjectured to bring about a lessening of the local fat
tissue volume (Hotta et al. 2010).
Radiofrequency is an electromagnetic wave that was
at first utilized for rewarding the periorbital wrinkles,
rhytids and the skin laxity. Today RF is broadly utilized
for body chiseling, skin fixing and cellulite treatment
(Araujo et al. 2015).
(RF) is usually utilized for expanding further skin
temperature with no epidermal or dermal removal. It isnt
just utilized as a proficient technique for contracting or
initiating skin fixing yet additionally as a compelling
strategy for decreasing fat in redundancy (Weiss 2013).
PARTICIPANTS AND METHODS
Study design
The study was designed as a randomized controlled
trial. Ethical approval was obtained from the Institutional
Review Board of the Faculty of Physical Therapy, Cairo
University, before starting of the study (no:
P.T.REC/012/001970) and the Clinical trial registration
in Clinicaltrial.gov with an identifier number
NCT04452552 The study followed the guidelines of
Declaration of Helsinki on the conduct of human
research.
Participants
Fifty patients overweight primipara women at 6
months postnatally had participated in this study. They
had selected from the outpatient clinic of the family
planning, Obstetrics and Gynecology of Fayoum
Teaching University Hospital. Their age were ranged
from 20 to 35 years, their body mass index BMI 2529.9
kg/m2 and their waist hip ratio (WHR) > 0.8. The duration
of the study was continued 6 months (from July to
December 2019). The women were excluded from this
study if they had heart disease, high cholesterol, liver as
well as kidney diseases, diabetes mellitus, hypertension,
taking oral contraceptives or weight loss medications
and pregnancy were excluded from the study.
Randomization
An independent person randomly assigned to all
participated subjects to either group (A) (n=25) or group
(B) (n=25) by chosen numbers from closed envelopes
having numbers that the number generator was chosen
randomly, and the patients were allocated accordingly to
their groups.
Group (A): Composed of 25 overweight primipara
women, received ultrasound cavitation treatment
sessions on their abdominal region once per week in
addition to balanced diet program which ranged from
1600 kcal to 2000 kcal/day, which was calculated in an
individual basis for each woman according to her basal
metabolic rate (BMR) for 8 weeks. Group (B):
Composed of 25 overweight primipara women, received
radiofrequency treatment sessions on their abdominal
region once per week in addition to the same program
of diet prescribed for group (A) for 8 weeks.
Methods
Ultrasound cavitation (for only participants of
group A): 25 overweight primipara women.
Ultrasound-Cavitation: Mable6 Duo Ultra cavitation
+ Multipolar RF system. Produced by DAEYANG
MEDICAL company, made in Korea. Power input
(AC100/ 240V). Ultrasonic cavitation: Output frequency:
40 KHz, Power: 45W, hand probe diameter: 5.0 cm.
Multipolar RF with output frequency (1 MHZ).
Ultrasound cavitation procedures
1) Clean the skin with alcohol cotton.
2) From standing position, the abdominal area of
every woman divided vertically into 2 sections right
and left segment on the abdominal area which
expanding bilaterally from the line stretching out
from the mid axilla to the iliac crest, and above
from center of diaphragm to the line extending
between two iliac crest below.
3) Patient was placed into a comfortable supine lying
position.
4) Application of conductive gel on the area to be
treated. The cavitional head was moved very
slowly on each abdominal segment in small
circular movement.
5) Application treatment of ultrasound cavitation for
approximately 15 minutes on each side of
abdomen, duration of each session was 30
minutes.
EurAsian Journal of BioSciences 14: 3337-3347 (2020) Assim et al.
3339
6) Cavitation frequency 40 KHz, Power: 45W and
treatment was applied once time per week for 8
sessions (Scorza et al. 2008, Saber et al. 2013).
Radiofrequency (for only participants of group
B): The other 25 overweight primipara women.
Radiofrequency: (Mable6 Duo Ultra cavitation +
Multipolar RF system) machine.
Multipolar mode RF with output frequency (1 MHZ).
Procedures of Radiofrequency Application
1) Patient was placed into a comfortable supine lying
position. The treated area cleaned the skin with
alcohol cotton.
2) The treatment was applied one time every week for
8 sessions.
3) Apply RF using the head on spot fat areas, on same
landmarked of cavitation site in group (A), the
applicator was employed with slight pressure in a
continuous sweeping movement over the skin.
4) Application treatment of RF for approximately 15
minutes on each side of abdomen, Treatment
duration was 30 minutes in each session (Khan et
al. 2010).
Diet program
All participants in both groups (A and B) received the
same diet program throughout the treatment period (for
8 weeks) in form of balanced diet program which ranged
from 1600 kcal to 2000 kcal/day, carbohydrates account
for 45 to 65%, proteins for 10 to 35%, and lipids for 20
to 35% of total calorie intake, which was calculated in an
individual basis for each woman according to her basal
metabolic rate (BMR) (Eastwood, 2013).
Estimation of the womans energy
requirements (Diet)
The womans energy requirements were calculated
in two steps: to maintain the weight, utilize the Harris-
Benedict principle and formula below to evaluate the
basal metabolic rate (BMR) (Santos et al. 2011).
Step 1- Basal metabolic rate (BMR):
For every woman: 665 + (9.6 x weight in kg) + (1.8 x
height in cm) (4.7 x age in years).
Step 2 - Applying the Harris-Benedict Principle:
By the following table can enable estimated value is
then multiplied by a number that corresponds to the
persons activity level. The resulting number is the
recommended daily calorie intake to maintain current
weight (Santos et al. 2011).
Sedentary
Mild activity level
Moderate activity level
Heavy activity level
Extreme activity level
Outcome measures
A- Assessment procedures: The study protocol was
explained to all women, who had signed an
informed consent form.
1) BMI calculation
The womans BMI had calculated from measured
weight & height for each woman in both groups (A&B)
before beginning of the study and weight only had
measured after 8 weeks of treatment sessions to
according to the following equation: BMI=weight (Kg)
/height (m2) (Flegal et al. 2014).
2) Waist to hip ratio Measurement procedures
WC was measured at the level of the top of the right
iliac crest. The measuring tape ought to be snug per skin
yet not compressing and held corresponding to the floor.
HC was estimated at the most extreme circumference at
the level of femoral trochanter. At that point WHR was
determined by partitioning WC on HC. The two
estimations were taken for all ladies in all gatherings (A
and B) before beginning and after 8 weeks of treatment
sessions (after the end of study). All measurements
were taken while the women in the standing position.
Skin of the anterior abdominal wall was cleaned while
the woman in hip circumference worn light clothes and
sometimes measurements repeated twice for more
accurate. That measured WC, HC to measure (WHR)
calculated by dividing the measurement of the waist by
the measurement of the hips.
WHR= (waist circumference / hip circumference)
(Jensen 2006).
3) Measurements Abdominal fat thickness: by
using Ultrasound diagnostic:
Xario Toshiba made in Japan ultrasound Machine
was utilized to quantify the abdominal fat thickness for
all ladies in two groups (A & B) before beginning and
after the end of 8 weeks of the treatment sessions.
Investigation medical ultrasound have been utilized to
assess the thickness of the abdominal fat layer at the
affected region comparable to a fixed point for each
measurement. Measurement was carried out by the
similar investigator (was done by radiology specialist).
With the patient in relaxed supine lying position the area
to be examined was uncovered and the gel was applied
over it. Estimation of fat thickness at the level, above and
beneath the umbilicus were registered (around
umbilicus by 5 cm). The scan was attained and
transferred to the monitor screen (Rallan and Harland,
2003).
Statistical analysis
Statistical analysis was conducted using SPSS for
windows, version 22 (SPSS, Inc., Chicago, IL).
Descriptive analysis using histograms with the normal
distribution curve showed that weight, waist and hip
circumference, waist/hip ratio, subcutaneous fat
thickness at level, 5 cm above and 5 cm below umbilicus
were normally distributed and not violates the parametric
assumption for the measured dependent variable.
Additionally, testing for the homogeneity of covariance
revealed that there was no significant difference with p
values of > 0.05. The box and whiskers plots of the
tested variable were done to detect outliers. Normality
test of data using Shapiro-Wilk test was used, that reflect
EurAsian Journal of BioSciences 14: 3337-3347 (2020) Assim et al.
3340
the data was normally distributed for all dependent
variables. Accordingly, 2×2 mixed design MANOVA was
used to compare the tested variables of interest at
different tested groups and measuring periods. With the
initial alpha level set at 0.05.
RESULTS
Physical Characteristics of the patients in
both groups (A & B)
Table 1 shows no significant differences in the mean
values of age, height and BMI between both tested
groups (A&B) at the beginning of the study (P=0.965,
0.079, and 0.648, respectively).
Effect of treatment on all dependent variables
Multiple pairwise comparisons (within and between
groups) for each variable:
Weight
Multiple pairwise comparison tests (Post hoc tests)
revealed that there was significant reduction of the body
weight at post treatment in compare to pre-treatment (P-
value =0.0001*).
Considering the effect of the tested group (first
independent variable) on body weight, Multiple pairwise
comparison tests (Post hoc tests) revealed that the
mean values of the pre test between both groups
(A&B) showed no significant differences with (P=0.839).
As well as, multiple pairwise comparison tests (Post hoc
tests) revealed that there was no significant difference of
the mean values of the post test between both groups
(A&B) with (p=0.072). In spite of there was no statistical
significant difference between group A and group B,
there was clinical difference and high percent of
improvement in favor to group A (Table 2).
Waist circumference
Multiple pairwise comparison tests (Post hoc tests)
revealed that there was significant reduction of the waist
circumference at post treatment in compare to pre-
treatment (P-value =0.0001*).
Considering the effect of the tested group (first
independent variable) on waist circumference, Multiple
pairwise comparison tests (Post hoc tests) revealed that
the mean values of the pre test between both groups
(A&B) showed no significant differences with (P=0.71).
As well as, multiple pairwise comparison tests (Post hoc
tests) revealed that there was significant difference of
the mean values of the post test between both groups
(A&B) with (p=0.003*) and this significant reduction in
favor to group A (Table 3).
Hip circumference
Multiple pairwise comparison tests (Post hoc tests)
revealed that there was significant reduction of hip
circumference at post treatment in compare to pre-
treatment (P-value =0.0001*).
Considering the effect of the tested group (first
independent variable) on hip circumference, Multiple
pairwise comparison tests (Post hoc tests) revealed that
the mean values of the pre test between both groups
(A&B) showed no significant differences with (P=0.639).
As well as, multiple pairwise comparison tests (Post hoc
tests) revealed that there was no significant difference of
the mean values of the post test between both groups
(A&B) with (p=0.684). In spite of there was no statistical
significant difference between group A and group B,
there was clinical difference and high percent of
improvement in favor to group A (Table 4).
Table 1. Physical characteristics of patients in both groups (A&B)
Items
Group A
Group B
Comparison
S
Mean ± SD
Mean ± SD
t-value
P-value
Age (years)
26.32±3.26
26.28±3.19
0.044
0.965
NS
Height (cm)
162.43±4.03
160.28±4.24
1.799
0.079
NS
BMI (kg/m2)
28.42±0.68
28.32±0.9
0.459
0.648
NS
*SD: standard deviation, P: probability, S: significance, NS: non-significant.
Table 2. Mean ±SD and p values of weight pre-and post-test at both groups (A&B)
Weight
Pre test
Post test
MD
% of change
p- value
Mean± SD
Mean± SD
Group A
75.8±5.04
68.12 ±4.59
7.68
10.13 %
0.0001*
Group B
75.52 ±4.61
70.52±4.63
5
6.62 %
0.0001*
MD
0.28
-2.4
p- value
0.839
0.072
*Significant level is set at alpha level <0.05 SD: standard deviation
MD: Mean difference p-value: probability value
Table 3. Mean ±SD and p values of waist circumference pre-and post-test at both groups (A&B)
Waist circumference
Pre test
Post test
MD
% of change
p- value
Mean± SD
Mean± SD
Group A
94.16±6.43
86.2 ±5.92
7.96
8.45 %
0.0001*
Group B
93.52 ±5.62
91.2±5.48
2.32
2.48 %
0.0001*
MD
0.64
-5
p- value
0.71
0.003*
*Significant level is set at alpha level <0.05 SD: standard deviation
MD: Mean difference p-value: probability value
EurAsian Journal of BioSciences 14: 3337-3347 (2020) Assim et al.
3341
Waist/hip ratio
Multiple pairwise comparison tests (Post hoc tests)
revealed that there was no significant difference of
waist/hip ratio at post treatment in compare to pre-
treatment (P-value =0.051).
Considering the effect of the tested group (first
independent variable) on waist/hip ratio, Multiple
pairwise comparison tests (Post hoc tests) revealed that
the mean values of the pre test between both groups
(A&B) showed no significant differences with (P=0.913).
As well as, multiple pairwise comparison tests (Post hoc
tests) revealed that there was significant difference of
the mean values of the post test between both groups
(A&B) with (p=0.0001*) and this significant reduction in
favor to group A (Table 5).
Fat thickness at level of umbilicus
Multiple pairwise comparison tests (Post hoc tests)
revealed that there was significant reduction of fat
thickness at level of umbilicus at post treatment in
compare to pre-treatment (P-value =0.0001*).
Considering the effect of the tested group (first
independent variable) on fat thickness at level of
umbilicus, Multiple pairwise comparison tests (Post hoc
tests) revealed that the mean values of the pre test
between both groups (A&B) showed no significant
differences with (P=0.797). As well as, multiple pairwise
comparison tests (Post hoc tests) revealed that there
was significant difference of the mean values of the
post test between both groups (A&B) with (p=0.0001*)
and this significant reduction in favor to group A (Table
6). Fat thickness above level of umbilicus by 5
cm
Multiple pairwise comparison tests (Post hoc tests)
revealed that there was significant reduction of fat
thickness above level of umbilicus by 5 cm at post
treatment in compare to pre-treatment (P-value
=0.0001*).
Considering the effect of the tested group (first
independent variable) on fat thickness above level of
umbilicus by 5 cm, Multiple pairwise comparison tests
(Post hoc tests) revealed that the mean values of the
pre test between both groups (A&B) showed no
significant differences with (P=0.407). As well as,
multiple pairwise comparison tests (Post hoc tests)
revealed that there was significant difference of the
mean values of the post test between both groups
(A&B) with (p=0.0001*) and this significant reduction in
favor to group A (Table 7).
Table 4. Mean ±SD and p values of hip circumference pre-and post-test at both groups (A&B)
Hip circumference
Pre test
Post test
MD
% of change
p- value
Mean± SD
Mean± SD
Group A
107.48±7.04
103.8 ±6.51
3.68
3.42 %
0.0001*
Group B
106.56 ±6.74
104.56±6.6
2
1.87 %
0.0001*
MD
0.92
-0.76
p- value
0.639
0.684
*Significant level is set at alpha level <0.05 SD: standard deviation
MD: Mean difference p-value: probability value
Table 5. Mean ±SD and p values of Waist / hip ratio pre-and post-test at both groups (A&B)
Waist / hip ratio
Pre test
Post test
MD
% of change
p- value
Mean± SD
Mean± SD
Group A
0.874±0.013
0.82 ±0.017
0.054
6.17 %
0.0001*
Group B
0.873 ±0.012
0.86±0.014
0.013
1.48 %
0.051
MD
0.001
-0.04
p- value
0.913
0.0001*
*Significant level is set at alpha level <0.05 SD: standard deviation
MD: Mean difference p-value: probability value
Table 6. Mean ±SD and p values of Fat thickness at level of umbilicus pre-and post-test at both groups (A&B)
Fat thickness at level of
umbilicus
Pre test
Post test
MD
% of change
p- value
Mean± SD
Mean± SD
Group A
34.16±3.38
25.52 ±3.24
8.64
25.29 %
0.0001*
Group B
34.4 ±3.16
30.64±3.06
3.76
10.93 %
0.0001*
MD
-0.24
-5.12
p- value
0.797
0.0001*
*Significant level is set at alpha level <0.05 SD: standard deviation
MD: Mean difference p-value: probability value
Table 7. Mean ±SD and p values of Fat thickness above level of umbilicus by 5 cm pre-and post-test at both groups (A&B)
Fat thickness above level
of umbilicus by 5 cm
Pre test
Post test
MD
% of change
p- value
Mean± SD
Mean± SD
Group A
29.76±2.58
24.48 ±2.53
5.28
17.74 %
0.0001*
Group B
30.36 ±2.48
28.32±2.47
2.04
6.71 %
0.0001*
MD
-0.6
-3.84
p- value
0.407
0.0001*
*Significant level is set at alpha level <0.05 SD: standard deviation
MD: Mean difference p-value: probability value
EurAsian Journal of BioSciences 14: 3337-3347 (2020) Assim et al.
3342
Fat thickness below level of umbilicus by 5
cm
Multiple pairwise comparison tests (Post hoc tests)
revealed that there was significant reduction of fat
thickness below level of umbilicus by 5 cm at post
treatment in compare to pre-treatment (P-value
=0.0001*).
Considering the effect of the tested group (first
independent variable) on the fat thickness below level of
umbilicus by 5 cm, Multiple pairwise comparison tests
(Post hoc tests) revealed that the mean values of the
pre test between both groups (A&B) showed no
significant differences with (P=0.881). As well as,
multiple pairwise comparison tests (Post hoc tests)
revealed that there was significant difference of the
mean values of the post test between both groups
(A&B) with (p=0.0001*) and this significant reduction in
favor to group A (Table 8).
DISCUSSION
The results of the present study showed that there
was a significant reduction of the body weight and the
abdominal fat thickness after the treatment program in
both groups (A&B) but, a significant reduction of the
waist hip ratio in group (A) Only (P-value =0.0001*) after
application of the ultrasound cavitation. While, group (B)
revealed that there was no significant difference of
Waist/hip ratio at post treatment values of
radiofrequency in compare to pre-treatment values (P-
value =0.051).
By comparison between post treatment values of the
body weight, waist/hip ratio and the abdominal fat
thickness at the level, above and underneath the
umbilicus demonstrated significant difference between
both groups with favorable results for group A.
Regarding the results of body weight, there was
statistically significant decrease of the body weight in
both groups A and B with percentage of improvement
(10.13 % and 6.62 %) respectively with statistically non-
significant difference between both groups A and B after
the treatment application. Regarding the results of
waist/hip ratio, there was statistically significant
decrease of waist/hip ratio in both groups A and B with
percentage of improvement (6.17 % and 1.48%)
respectively. Regarding the results of the fat thickness
at the umbilicus level, there was statistically significant
decrease of fat thickness at the umbilicus level in both
groups A and B with percentage of improvement (25.29
% and 10.93%) respectively. Regarding the results of
the fat thickness above umbilicus, there was statistically
significant decrease of the fat thickness above the
umbilicus in both groups A and B with percentage of
improvement (17.74 % and 6.71%) respectively.
Regarding the results of fat thickness below the
umbilicus, there was statistically significant decrease of
fat thickness below the umbilicus in both groups A and
B with percentage of improvement (18.56 % and 8.67%)
respectively.
Regarding the results of present study in group (A)
that are can be credited to the mechanism of the fat cell
destruction in which ultrasound-induced cavitation was
appeared to cause particular fat cell decrease without
interruption to the skin, vessels, nerves, or the
connective tissue. Like the present findings, ultrasound
treatment was accounted for to actuate the development
of different little bubbles in the adipocytes, permitting
disintegration of triglycerides into the interstitial space
and the lymphatic systems (Garcia et al. 2013). It is can
drain them, that triglycerides would then be able to be
absorbed and used by the endogenous lipases that
alternated into glycerol and free fatty acids and
consolidated in the total lipoprotein pool. Of note, serum
lipids were unaltered or somewhat expanded, yet at the
same time inside the normal range (Moreno-Moraga et
al. 2007).
That energy discharged from the ultrasound wave is
in the form of heat (minimal effect) and pressure waves
(major effect). As lipid cells membranes do not have the
structural ability to withstand such vibrations, the impact
of cavitation easily effectively breaks them while saving
vascular, nervous and muscular tissue (Murray et al.
2005).
Likewise, the results of this investigation came in
concurrence with the investigation of Sabbour and El-
Banna, (2009) that was led to decide the proficiency of
cavitation ultrasound treatment in lessening of the
visceral adiposity in fifty premenopausal obese ladies
with their BMI ranged between 31.5 and 40.04Kg/ m2,
WHR between 0.9 and 0.95% and waist circumference
in the range of 89 and 108 cm. Group A followed low-
calorie diet alone. While, group B got cavitation
ultrasound treatment on the abdominal area and
followed a low-calorie diet. The aftereffects of this
examination affirmed that the mixture of cavitation
ultrasound treatment and low-calorie diet portrayed by a
higher productivity than a low-calorie diet alone in
Table 8. Mean ±SD and p values of Fat thickness below level of umbilicus by 5 cm pre-and post-test at both groups
Fat thickness below level
of umbilicus by 5 cm
Pre test
Post test
MD
% of change
p- value
Mean± SD
Mean± SD
Group A
31.68±2.98
25.8 ±2.64
5.88
18.56 %
0.0001*
Group B
31.8 ±2.62
29.04±2.44
2.76
8.67 %
0.0001*
MD
-0.12
-3.24
p- value
0.881
0.0001*
*Significant level is set at alpha level <0.05 SD: standard deviation
MD: Mean difference p-value: probability value
EurAsian Journal of BioSciences 14: 3337-3347 (2020) Assim et al.
3343
bringing down the anthropometric, complete body
arrangement and plasma liopoprotein factors.
These outcomes are steady with the consequences
of Hamideh et al. (2015), in their published investigation
of ultrasonic lipolysis (cavitation) on the abdominal area
by decrease of the waist circumference. Twenty-eight
females (age: 37.8 ± 8 years) with local abdominal
obesity experienced. Subjects were assessed utilizing
estimations of outline when last treatment. The lipolysis
procedure was done with twofold transducer hand piece
which conveys centered ultrasonic waves to the fat
tissue underneath the skin. The duration went on for 30
to 45 minutes a limit of 8 sessions with frequencies of 20
Hz to 60 Hz and at powers of 0.5 to 3 w/cm2 relying upon
the patients temperature resistance 28 subjects. A
statistically significant (P <.001) average of 1.89 cm
reduction of the waist circumference value was seen in
every session of the ultrasonic lipolysis. The mean
pretreatment to post-treatment circumference decrease
was 8.21 cm.
Besides, the outcomes validate those from Jewell et
al. (2012), who carried out a sham-controlled,
randomized trial to assess the safety, decency, and
adequacy of HIFU for body contouring. The patients
were haphazardly allocated to treatment of their anterior
abdomen and flanks with three passes of 47 J/cm2 (141
J/cm2 total), 59 J/cm2 (177 J/cm2 total), or 0 J/cm2 (0
J/cm2 total). Patients who got 141 J/cm2 demonstrated a
normal decrease of the waist circumference of 2.1 cm
12 weeks after the treatment. Patients treated with 177
J/cm2 had an average reduction of 2.52 cm while those
in the control group averaged a 1.21 cm decrease with
no serious unfavorable occasions were accounted for.
Also the result comes in agreement with a
retrospective study by Fatemi and Kane, (2010) with 85
participants (57 females and 28 males with a mean age
of 43.8 years). Showed similar findings at 16-week
fellow-up. Mean energy level of the HIFU device was
134.8 J/cm2 and the treatment session duration ranged
from 60 to 90 minutes. The average reduction in the
waist circumference was 4.6 cm, 12 weeks after
treatment.
Whats more, Shek et al. (2014), Who completed a
single center prospective study by utilizing the
ultrasound cavitation on 12 Chinese participants (nine
females and three males, with a mean age of 39.5
years). Who experienced single treatment on their
anterior abdominal wall. Subjects with BMI 30 kg/m2
and subcutaneous adipose tissue 2.5 mm in the
targeted zone were enlisted in the examination. The
normal diminishing of the waist circumference was 1 cm
at the 12th week follow-up.
Moreover, our outcomes certify those from Moreno
Moraga et al. (2007), who led an investigation was to
survey the adequacy and safety of the ultrasound
cavitation system on thirty patients. Every patient
experienced three treatments at 1-month spans.
Regions treated were the abdomen, inner and outer
thighs, flanks, inner knees, and male breasts. The
Ultrasound estimations and circumference estimations
were utilized to survey changes in fat thickness. This
investigation demonstrated the viability and wellbeing of
ultrasound cavitation (USC) as a non-intrusive
transdermal technique for lessening undesirable fat
stores in the body.
An ongoing report completed by Wallner et al.
(2013), affirmed that, the utilization of subcutaneous
adipose tissue topography (SAT-Top) is more
competent than BMI in evaluating the obesity in
physically active individuals and youthful grown-ups.
These outcomes recommend that subcutaneous fat
patterns are a superior screening device to portray
fatness in physically active young individuals.
On the other hand, our outcomes are in
inconsistency with Shek et al. (2009), who examined the
wellbeing and adequacy of this focused ultrasound
device in body shaping in Asians on fifty-three patients.
The general fulfillment between the patients was poor.
Objective estimations by ultrasound, abdominal
circumference, and caliper did not show significant
difference after treatment didnt show noteworthy
contrast after treatment. There was a negative
connection between the abdominal fat thickness and the
shots number per treatment session. Such perception is
likely because of littler body figures. Structure
adjustments can beat this issue and in doing as such,
improve clinical result.
Likewise, Nazanin and Michael, (2013) recorded the
negative impacts of ultrasound cavitation involved mild
to moderate, ecchymosis, discomfort and edema.
The results of present study in group (B) that are
discoveries can be ascribed to the activity of
radiofrequency. The instrument activity of
radiofrequency waves on fat reason local extra dermal
warming and increment the dissemination in the skin
causing collagen fibrillar denaturation and redesigning.
These progressions may bring about the skin tightening
and cellulite improvement. RF heat likewise has an
effect on the digestion of adipocytes apoptosis and
decreasing adipocyte volume (Afrooz et al. 2011).
Additionally, the consequence of this investigation
came in concurrence with investigation of Emilia et al.
(2006), who surveyed the impacts of applying RF on
subcutaneous fat of the posterior and thighs of 26 female
subjects (ages 18 to 50 years). Two treatment sessions,
two weeks separated were thought of. They utilized
constant-time scanning image ultrasound for estimating
the separation between the dermis and the campers
fascia, and their findings demonstrated that controlled
tissue heating with RF could diminish the thickness
between the dermis and the fascia. The average
decrease in thigh and buttocks were 2.64 and 1.8 mm,
respectively. Understanding the effect of treatment
sessions from changes on the skin surface and clothing
EurAsian Journal of BioSciences 14: 3337-3347 (2020) Assim et al.
3344
leads to patients satisfaction with the methodology and
was surveyed by the examining gathering.
RF is a safe and effective strategy for diminishing
body circumferences and lessen the sagging skin in the
postpartum period (Brightman et al. 2009).
Radiofrequency field is made out of both electrical
and magnetic segments (Lolis and Goldberg, 2012). The
RF frequency is inversely proportional to the of
penetration depth. It is known that the lower frequencies
RF having higher rates of penetration. The penetration
depth of 40 MHz frequency will stay superficial
contrasted with that of a 1MHz frequency (Belenky et al.
2012).
Finally, multipolar devices work comparatively to the
bipolar ones however comprise of at least three
electrodes. One electrode keeps up a positive charge
while the others convey negative charges. Electrodes
alternate among the positive and negative charges to
abstain from overheating. These devices permit a larger
volume to be warmed with less inconvenience (Jiménez-
Lozano et al. 2013).
Likewise, the aftereffect of this examination came in
concurrence with Pumperla et al. (2015), who assessed
the quick and continued impacts of RF treatment on the
cardiovascular autonomic function, the metabolism
parameters and the anthropometric parameters. Toward
the finish of 4 sessions, RF treatment was related with a
critical decrease in the abdominal circumference (p <
0.001). Likewise, Goldberg et al. (2008), who showed
that multipolar Radiofrequency alone is innovation that
gave helpful impacts on the decrease of mid-region and
thigh boundaries and a general improvement in the
presence of cellulite.
Venus Freeze is a multipolar radiofrequency, which
uses pulsed electromagnetic field that activate the
fibroblast proliferation, the angiogenesis (new collagen),
and collagen synthesis in a nonthermal way (Sadick et
al. 2014). EndyMed PRO 3 (3DEEPR) is an
innovation, utilizing the multipolar radiofrequency with
realtime skin protection readings hand pieces for the
facial and the body sites (Harth 2015).
Radiofrequency could expand the local blood
stream, up controlling the local adipose metabolism, and
is able of invigorating lipase-mediated degradation of
triglycerides or even adipocytes apoptosis (Levy et al.
2016). Delayed impacts incorporate thermal instigated
microinflammatory reaction in the skin tissue prompting
neocollagenesis, which is the aftereffect of the dermal
remodeling to decay damaged collagen by the
collagenase enzyme, and replace it with a new collagen
(Dunbar and Goldberg, 2015).
In like manner, Malerich et al. (2014), who utilize the
multipolar RF and PEMF (pulsed electromagnetic field)
device can give good outcomes for treating photoaged
skin and cellulite. This consolidated innovation is not the
same as the utilization of radiofrequency alone, as it
conveys RF vitality with the all the while expansion of
beat electromagnetic field. The synchronized treatment
permits the conveyance of more energy to the treated
area, accomplishing higher temperature with minimal
hazard and pain, keeping up the epidermis intact, and
prompting less symptoms and shorter recovery periods.
The results of the current study are in consistence
with Adatto et al. (2014), who recorded a progressive
decrease in the patient circumferences by utilizing the
diagnostic US and cutometer, respectively. When apply
radiofrequency (RF) on the thickness of the fat layer
showed on average a 29 % decrease among the
baseline and the 1-month follow up. The normal
decrease in the circumference of the abdomen/flanks,
buttocks and thighs from the standard to the 3-month
follow-up was 1.4, 0.5, and 1.2 cm, respectively, and 93
% of study participants showed a 160 % advance in the
fat layer thickness. Patients abstractly portrayed comfort
and fulfillment from the treatment and 97 % of them were
satisfied with the outcomes at the subsequent visit.
Likewise, it comes in concurrence with, Manuskiatti
et al. (2003), who assessed the impacts of a tripolar RF
technology on the abdomen and thigh circumferences.
The subjects got eight treatment sessions, seven days
separated with no adjustment in their physical action and
diet. A month after the last treatment session, the
examination demonstrated huge outline decrease of the
abdomen and thigh areas. By and by, there was no
noteworthy decrease in buttocks and arms.
On the other hand, our outcomes are in
inconsistency with, study by Paul and Mulholland,
(2009) who reported the effect of the RF produced heat
in the induction of collagenesis and elastogenesis, with
the subsequent remodeling occurring during the
treatment and for a considerable length of time after the
application. While the impacts of RF on the skin
retraction, subdermal tissue and subcutaneous tissue
tightening are minimal impact as undisputed, many
studies portrayed as limitations. The thermal impacts of
unipolar and bipolar and multipolar RF were
demonstrated valuable in skin tightening even so.
Additionally, are in inconsistency with Harth and
Lischinsky, (2011) who hypothesis for the need or
unpredictability of the capability of RF systems is the
difficulty to adjust the power conveyed to various
individual skin impedances.
Also, in a clinical preliminary trial by Ruiz-Esparza et
al. (2003), who reported nearly of patients encountered
some level of constriction of sagging skin coming about
because of the treatment with a RF device.
Finlay in this investigation that radiofrequency is an
adaptable strategy that can be utilized on any area of the
body from large regions like the abdomen to a very small
regions, for example, the chin with the variable level of
progress as per RF devices. Individuals who are not
considered overweight yet have difficult pockets
undesirable fat that are not reacting to abstain from food
EurAsian Journal of BioSciences 14: 3337-3347 (2020) Assim et al.
3345
and exercise, radiofrequency is very useful. Our
consequences of this investigation are consistent with
Fajkošová et al. (2014), who affirmed selective RF body
contouring is a perfect procedure for the patients who
need moderate amounts of adipose tissue removal after
some time utilizing single or various treatments or who
in any case would not be considered for enormous
volume liposuction strategies.
These outcomes are likewise consistent with the
consequences of Mohamed et al. (2015), in their
published study to compare among cavitation with
radiofrequency and mesotherapy on abdominal
adiposity. Body weight, height, waist hip ratio and skin
fold were estimated before and after the intervention.
Results indicated a noteworthy improvement in the three
gatherings in the waist circumference, waist hip ratio,
and suprailiac skin fold in favor of cavitation
radiofrequency groups, with no significant difference in
the body weight and BMI in the three gatherings after
intervention.
CONCLUSION
It can be concluded from this study that US cavitation
and multipolar RF could be utilize for management of
abdominal obesity, but US cavitation more effective than
RF Lipolysis in reduction of waist/hip ratio and
subcutaneous fat thickness in management of the
abdominal obesity in postnatal women.
RECOMMENDATIONS
It is recommended to add US cavitation and
multipolar RF for management of the abdominal obesity
in postnatal women.
ACKNOWLEDGEMENTS
The author thanks all the participants in this study for
their cooperation.
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www.ejobios.org
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Serum Anti Ular Bisa (SABU) is the only snake antivenom produced locally in Indonesia; however, its effectiveness has not been rigorously evaluated. This study aimed to assess the protein composition and neutralization efficacy of SABU. SDS polyacrylamide gel electrophoresis, size-exclusion liquid chromatography and shotgun proteomics revealed that SABU consists of F(ab’)2 but a significant amount of dimers, protein aggregates and contaminant albumins. SABU moderately neutralized Calloselasma rhodostoma venom (potency of 12.7 mg venom neutralized per ml antivenom, or 121.8 mg venom per g antivenom protein) and Bungarus fasciatus venom (0.9 mg/ml; 8.5 mg/g) but it was weak against the venoms of Naja sputatrix (0.3 mg/ml; 2.9 mg/g), Naja sumatrana (0.2 mg/ml; 1.8 mg/g) and Bungarus candidus (0.1 mg/ml; 1.0 mg/g). In comparison, NPAV, the Thai Neuro Polyvalent Antivenom, outperformed SABU with greater potencies against the venoms of N. sputatrix (0.6 mg/ml; 8.3 mg/g), N. sumatrana (0.5 mg/ml; 7.1 mg/g) and B. candidus (1.7 mg/ml; 23.2 mg/g). The inferior efficacy of SABU implies that a large antivenom dose is required clinically for effective treatment. Besides, the antivenom contains numerous impurities e.g., albumins that greatly increase the risk of hypersensitivity. Together, the findings indicate that the production of SABU warrants further improvement.
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Unlabelled: Previous studies showed that venoms of the monocled cobra, Naja kaouthia from Thailand and Malaysia are substantially different in their median lethal doses. The intraspecific venom variations of N. kaouthia, however, have not been fully elucidated. Here we investigated the venom proteomes of N. kaouthia from Malaysia (NK-M), Thailand (NK-T) and Vietnam (NK-V) through reverse-phase HPLC, SDS-PAGE and tandem mass spectrometry. The venom proteins comprise 13 toxin families, with three-finger toxins being the most abundant (63-77%) and the most varied (11-18 isoforms) among the three populations. NK-T has the highest content of neurotoxins (50%, predominantly long neurotoxins), followed by NK-V (29%, predominantly weak neurotoxins and some short neurotoxins), while NK-M has the least (18%, some weak neurotoxins but less short and long neurotoxins). On the other hand, cytotoxins constitute the main bulk of toxins in NK-M and NK-V venoms (up to 45% each), but less in NK-T venom (27%). The three venoms show different lethal potencies that generally reflect the proteomic findings. Despite the proteomic variations, the use of Thai monovalent and Neuro polyvalent antivenoms for N. kaouthia envenomation in the three regions is appropriate as the different venoms were neutralized by the antivenoms albeit at different degrees of effectiveness. Biological significance: Biogeographical variations were observed in the venom proteome of monocled cobra (Naja kaouthia) from Malaysia, Thailand and Vietnam. The Thai N. kaouthia venom is particularly rich in long neurotoxins, while the Malaysian and Vietnamese specimens were predominated with cytotoxins. The differentially expressed toxin profile accounts for the discrepancy in the lethal dose of the venom from different populations. Commercially available Thai antivenoms (monovalent and polyvalent) were able to neutralize the three venoms at different effective doses, hence supporting their uses in the three regions. While dose adjustment according to geographical region seems possible, changes to standard recommended dosage should only be made if further study validates that the monocled cobras within a population do not exhibit remarkable inter-individual venom variation.