Efficacy of comprehensive ozone therapy in diabetic foot ulcer healing.

BACKGROUND: Diabetic foot ulcer is one of the common complications of diabetes disease that is costly and difficult to treat. This problem can lead to morbidity and even mortality. Ozone is a gas that can optimize cellular metabolism and, because of its antioxidant and antibacterial effects, can help the better healing of diabetic foot ulcer. METHOD: Two hundred patients, aged 18-85 with diabetic foot ulcers ranging from grade 1 to 4 according to Wagner classification in two groups were studied. Group 1 was treated by full ozone therapy besides the standard regular DFU treatment while group two just was received routine diabetic foot care. Wound size, wound grade, healing time, Fasting blood sugar and inflammatory biomarker before and after treatment were checked. RESULTS: All patients have had complete wound closure in the ozone group. The mean age of the patients included in the results was 59.03 ±â€¯12.593 and 53.5 ±â€¯10.212 for ozone group and control group. The baseline average surface area of ulcers was 13.41 ±â€¯14.092 cm2 (range 1-70 cm2) in ozone group and 12.72 ±â€¯0.911 (range 1_64 cm2) in the control group. Average healing time was 69.44 ±â€¯36.055 days (range 15-180 days), which is significantly lower than the median healing time measured in the control group and some previous studies. CONCLUSION: Our study results support the efficacy of ozone therapy especially in its comprehensive use in DFU healing and reduction in the chances of infection and amputation.

Is vancomycine still a choice for chronic osteomyelitis empirical therapy in iran?

BACKGROUND: Pyogenic bacteria and especially Staphylococcus aurous (S. aurous) are the most common cause of chronic osteomyelitis. Not only treatment protocol of chronic osteomyelitis occasionally is amiss but also this malady responds to treatment difficultly. OBJECTIVES: This study investigates antibiotic resistance pattern of S. aurous isolated from Iranian patients who suffer from chronic osteomyelitis by two methods: disk diffusion (Kirby bauyer) and E-test (Epsilometer test) to find Vancomycin susceptibility and MIC (Minimum inhibitory concentration). PATIENTS AND METHODS: One hundred and thirty one patients who suffer from chronic osteomyelitis which have been referred to both governmental and private hospitals at 2010 were tried out for culturing of osteomyelitis site (sites). Antibiotic susceptibility and MIC of isolated bacteria were investigated by Kirby bauyer and E-test respectively. RESULTS: Samples were collected from bone (73.4%), surrounding tissue (14.6%) and wound discharge (12%). S. aureus was isolated from 49.6% of the samples. According to disc diffusion, methicillin resistance S. aureus (MRSA) was 75% and Vancomycin resistance S. aurous (VRSA) was 0% and based on MIC, MRSA was 68.5% and VRSA was 0%. According to MIC experiments, maximum sensitivity was against to Vancomycin (90.2%) and ciprofloxacin (54.4%) respectively but based on disc diffusion, maximum sensitivity was against to Vancomycin (97.7%) and ciprofloxacin (43.2%), respectively (P = 0.001). E-test (9.8%) in comparison with Disc diffusion (2.3%) showed higher percent of intermediate susceptibility to Vancomycin (P = 0.017). CONCLUSIONS: Comparison of antibiograms and MICs showed that Kirby bauyer technique especially for detection of VISA strains is not reliable comparison with E-test. Already VRSA strains have not detected in Iranian chronic osteomyelitis, Thus Vancomycin is the first choice for chronic osteomyelitis empirical therapy in Iran yet.

The effect of preoperative aspirin use on postoperative bleeding and perioperative myocardial infarction in patients undergoing coronary artery bypass surgery.

BACKGROUND: We tried to evaluate the clinical outcomes (mortality, postoperative bleeding and perioperative myocardial infarction) of patients who underwent first elective coronary artery bypass grafting and received aspirin during the preoperative period. METHODS: The study was a prospective, randomized and single-blinded clinical trial. Two hundred patients were included and divided into two groups. One group received aspirin 80-160 mg, while in the other aspirin was stopped at least seven days before surgery. The primary end-points of the study were in-hospital mortality and hemorrhage-related complications (postoperative blood loss in the intensive care unit, re-exploration for bleeding and red blood cell and non-red blood cell requirements). The secondary end-point was perioperative myocardial infarction. RESULTS: There were no differences in patient characteristics between the aspirin users and non-aspirin users. We found a significant difference between postoperative blood loss (608 +/- +/- 359.7 ml vs. 483 +/- 251.5 ml; p = 0.005) and red blood cell product requirements (1.32 +/- +/- 0.97 unit packed cell vs. 0.94 +/- 1.02 unit packed cell; p = 0.008). There was no significant difference between the two groups regarding platelet requirement and the rate of in-hospital mortality and re-exploration for bleeding. Similarly, we found no significant difference in the incidence of definite and probable perioperative myocardial infarction (p = 0.24 and p = 0.56 respectively) or in-hospital mortality between the two groups. CONCLUSION: Preoperative aspirin administration increased postoperative bleeding and red blood cell requirements with no effect on mortality, re-exploration rate and perioperative myocardial infarction. We recommend withdrawal of aspirin seven days prior to surgery. (Cardiol J 2007; 14: 453-457).