Prediction of amputation risk of patients with diabetic foot using classification algorithms: A clinical study from a tertiary center.

Diabetic foot ulcers can have vital consequences, such as amputation for patients. The primary purpose of this study is to predict the amputation risk of diabetic foot patients using machine-learning classification algorithms. In this research, 407 patients treated with the diagnosis of diabetic foot between January 2009-September 2019 in Istanbul University Faculty of Medicine in the Department of Undersea and Hyperbaric Medicine were retrospectively evaluated. Principal Component Analysis (PCA) was used to identify the key features associated with the amputation risk in diabetic foot patients within the dataset. Thus, various prediction/classification models were created to predict the "overall" risk of diabetic foot patients. Predictive machine-learning models were created using various algorithms. Additionally to optimize the hyperparameters of the Random Forest Algorithm (RF), experimental use of Bayesian Optimization (BO) has been employed. The sub-dimension data set comprising categorical and numerical values was subjected to a feature selection procedure. Among all the algorithms tested under the defined experimental conditions, the BO-optimized "RF" based on the hybrid approach (PCA-RF-BO) and "Logistic Regression" algorithms demonstrated superior performance with 85% and 90% test accuracies, respectively. In conclusion, our findings would serve as an essential benchmark, offering valuable guidance in reducing such hazards.

Attitudes and practices against COVID-19 vaccines in Turkiye.

OBJECTIVE: Vaccination is the primary way to mitigate the COVID-19 pandemic. Vaccine hesitancy and refusal are one of the most important challenges against to reach herd immunity. The aim of this study is to examine the reasons for not getting vaccinated and the attitudes toward vaccines by people in Turkiye, who were not vaccinated, even though a COVID-19 vaccine was available for them. METHODS: This cross-sectional study is conducted in Eyupsultan district of Istanbul. The study population is 12,540. A questionnaire consisted of three sections as sociodemographic characteristics, attitudes toward COVID-19 vaccines, and Vaccination Attitudes Examination (VAX) scale was used. Among the sample size, participation rate is 69.4%. RESULTS: About 50.2% of the participants (n=259) are male, 80.3% are married, 13.1% are university graduates, and 44.0% are working in a job. About 32.8% of the participants have COVID-19 history. About 34.4% of the participants stated that they would be vaccinated against COVID-19. Although those who define themselves as vaccine refuser are 5.4%, those who still refuse to be vaccinated for COVID-19 are 20.1%. In addition to this, those who are hesitant about COVID-19 vaccines are 45.6%. The most frequently preferred vaccine is comirnaty (41.7%). About 13.1% of the participants stated that "if we had a domestic COVID-19 vaccine, I would have it." The most common sources of information about vaccines are television with 78.4%, and health workers are in the last place with 14.7%. "Concerns about side effects" are the most frequently cited (85.9%) reason for not vaccinating. The mean score of the VAX scale is 42.34±10.93, and the "mistrust of vaccine benefit" is higher among primary school graduates than other educational status groups (p=0.001). CONCLUSION: Anti-vaccination attitudes have increased with the COVID-19 vaccines during pandemic. Our study is valuable in terms of examining the reasons of individuals who have not gotten vaccinated even though they had no access problems. Prominent concerns of the population should be approached seriously. Otherwise, vaccine hesitancy can be a decisive factor that would prevent the success of the struggle against pandemic.

Analysis of risk factors for amputation in patients with diabetic foot ulcers: a cohort study from a tertiary center.

OBJECTIVE: This study aimed to analyze risk factors for amputation (overall, minor and major) in patients with diabetic foot ulcers (DFUs). METHODS: 407 patients with DFUs (286 male, 121 female; mean age = 60, age range = 32-92) who were managed in a tertiary care centre from 2009 to 2019 were retrospectively identified and included in the study. DFUs were categorized based on the Meggit-Wagner, PEDIS, S(AD)SAD, and University of Texas (UT) classification systems. To identify amputation risk-related factors, results of patients with DFUs who underwent amputations (minor or major) were compared to those who received other adjunctive treatments using Chi-Square, oneway analysis of variance (ANOVA) and Spearman correlation analysis. RESULTS: The mean C-reactive protein (CRP) and White Blood Cell (WBC) values were significantly higher in patients with major or minor amputation than in those without amputation. The mean Neutrophil (PNL), Platelets (PLT), wound width, creatinine and sedimentation (ESR) values were significantly higher in patients with major amputation compared to other groups of patients. Elevated levels of Highdensity lipoprotein (HDL), Hemoglobin (HGB) and albumin were determined to be protective factors against the risk of amputation. Spearman correlation analysis revealed a positive-sided, strong-levelled, significant relation between Wagner grades and amputation status of patients. CONCLUSION: This study has identified specific factors for major and minor amputation risk of patients with DFUs. Especially infection markers such as CRP, WBC, ESR and PNL were higher in the amputation group. Most importantly, Meggit Wagner, one of the four different classification systems used in the DFUs, was determined to be highly associated with patients' amputation risk. LEVEL OF EVIDENCE: Level IV, Prognostic Study.

Hyperbaric oxygen treatment for refractory haemorrhagic cystitis occurring after chemotherapy and haematopoietic stem cell transplantation: retrospective analysis of 25 patients.

INTRODUCTION: Intractable haemorrhagic cystitis (HC) is a serious complication of chemotherapy (CT) and haematopoietic stem cell transplantation (HSCT). Hyperbaric oxygen treatment (HBOT) is a promising treatment option based on the similarities in injury pattern and observed histological changes with radiation induced HC, which is an approved indication. We present our experience with HBOT in HC occurring after CT and HSCT. METHODS: Medical files of patients who underwent HBOT between the years 2000-2020 for HC that developed after chemotherapy and/or HSCT were reviewed. Demographic data, primary diagnosis, history of HC and details of HBOT were documented. Treatment outcomes were grouped as complete and partial healing, no response and deterioration. RESULTS: Twenty-five patients underwent a median of 12 HBOT sessions for HC occurring after CT and HSCT. Complete healing was observed in 11 patients whereas haematuria improved in seven patients. HC grades after HBOT were significantly better than referral grades. A significant correlation was shown with the number of HBOT sessions and change in haematuria. Patients who underwent seven or more HBOT sessions benefitted most. CONCLUSIONS: HBOT appears to be a safe and effective treatment for refractory HC following CT and HSCT. Higher quality evidence would be needed to prove efficacy. However, given the difficulty of conducting randomised controlled trials on such a vulnerable and small group of patients with few treatment options, and given the consistency of current observational evidence, HC occurring after CT and HSCT may be considered as an optional or investigational indication for HBOT.

Hyperbaric oxygen treatment for intrauterine limb ischaemia: a newborn in the chamber.

Intrauterine limb ischaemia is a rare condition that may have devastating results. Various treatments are reported in the literature; however, results are not always promising and amputations may be required for some patients. Post-natal hyperbaric oxygen treatment (HBOT) may be a useful treatment option for the salvage of affected limbs. A patient who was born with total brachial artery occlusion and severe limb ischaemia was referred for HBOT. The patient underwent the first HBOT session at her 48th hour of life. A total of 47 HBOT sessions were completed (243.1 kPa [2.4 atmospheres absolute], duration 115 minutes being: 15 minutes of compression; three 25-minute oxygen periods separated by five-minute air breaks; and 15 minutes of decompression), four in the first 24 hours. Full recovery was achieved with this intense HBOT schedule combined with anticoagulation, fasciotomy and supportive care. The new-born tolerated HBOT well and no complications or side effects occurred. To the best of our knowledge, our patient is one of the youngest patients reported to undergo HBOT.

Possible antiapoptotic and neuroprotective effects of magnesium sulphate on retina in a preterm hypoxic-ischemic rat model

Background/aim: The effects of systemic magnesium sulfate (MgSO4) on retina in preterm hypoxic-ischemic (HI) rat model are not known. Our aim was to investigate the effects of MgSO4 on retinal ganglion cell (RGC) count, retinal ganglion cell (RGC) apoptotic index, retinal vascular endothelial growth factor receptor-2 (VEGFR-2), and glial fibrillary acidic protein (GFAP) expressions in preterm HI rat model. Materials and methods: Fifteen, postnatal day (PND) 7 rat pups were divided into 3 groups: 1. Sham-operated group, 2. HI group, and 3. MgSO4-treated HI group. The second and third groups underwent ischemia followed by exposure to hypoxia for 2 h (Vannucci model). The first and second groups received intraperitoneal saline and the third group received intraperitoneal MgSO4. On PND 10, eyes of the pups were evaluated for RGC count, apoptotic index, VEGFR-2, and GFAP expressions. Results: In both HI and MgSO4-treated HI group, the mean total RGC counts were found to be significantly decreased. However, the mean total RGC count in the MgSO4-treated HI group was significantly higher than that of the HI group. The mean apoptotic index was found to be significantly increased in the HI group. Retinal VEGFR-2 and GFAP expressions were found to be significantly higher in the HI group. Conclusions: Magnesium sulfate preconditioning and treatment in preterm HI rat model might diminish apoptosis, relatively preserve RGCs, and reduce retinal VEGFR-2 and GFAP expressions.

Sphenoid sinus mucocele as an unusual differential diagnosis in diving injuries.

Sphenoid sinus mucocele is a rare cystic lesion. It grows gradually and causes visual disturbances, ocular motility abnormalities and headache due to cavernous sinus compression. Sudden change in sinus cavity volume by a barotrauma may compress a mucocele and precipitate symptoms that may easily be confused with decompression sickness. A diver suffering from vertigo, nausea, blurry vision and hearing loss following uneventful dives is presented in this report. He underwent hyperbaric oxygen treatment for inner ear decompression sickness but later was diagnosed as sphenoid sinus mucocele. A high index of suspicion is necessary to capture rare conditions like mucocele in the differential diagnosis for divers with symptoms suggesting vestibulocochlear origin. To our knowledge, only one sphenoid sinus mucocele case presenting as a diving injury has been previously reported.

Hyperbaric oxygen therapy for severe blast injury of lower extremity after terrorist attack: case report.

More blast injuries are encountered in the civilian setting in recent years as terrorist attacks have increased globally. A 17-year-old male patient with severe blast injury of the right lower extremity was admitted to our department on the fifth day after a terrorist bombing attack. Initially he had been admitted to an emergency department with segmental tibia fracture and arterial injury (Gustilo IIIC). An amputation had been foreseen due to ischemia that persisted even after orthopedic fixation and revascularization interventions, followed by fasciotomy incisions. After consultation with our department hyperbaric oxygen (HBO2) therapy was administered twice daily for the first week. Ischemia improved prominently after 10 HBO2 sessions. HBO2 therapy was continued together with antibiotherapy and wound care. The patient underwent a total of 40 HBO2 sessions and two reconstructive operations and healed without amputation. Vascular injuries with concomitant orthopedic trauma cause most of the delayed amputations in bombing attacks since ischemia can persist at the microvascular level even though adequate treatments are applied. HBO2 corrects hypoxia at tissue level and so provides oxygen for the critically ischemic cells in the injured area. HBO2 also enhances host defense and decreases the ischemia reperfusion injury. In this case, HBO2 was effective in survival and functional recovery (salvage) of the extremity together with regular wound care, antibiotherapy and surgical repair.

Comments on unresponsive decompression illness case.

We have read the case report about a decompression sickness that was unresponsive to hyperbaric oxygen treatment in your journal. Presented case is intriguing; however, we think there are some contradictive issues in the discussion of the case. In this letter, we aim to comment on these issues that may raise further question. Bubble formation plays a very important role for decompression sickness, but proposed mechanism is incorrect as nitrogen does not change state during decompression. Use of terminology for diving-related diseases and comments on properties of helium may cause misunderstandings. Also importance of history of the dive in evaluating an accident should be emphasized.

Eurasian Tunnel Project: the first saturation dives during compressed-air work in Turkey.

The Eurasian Tunnel is a 5.64-km crossroad tunnel that connects Europe and Asia. Located under the seabed for the first time, 3.34 km of the tunnel that crosses the Bosphorus was built by advanced tunneling techniques. An exclusively designed tunnel boring machine (TBM), which has an operating pressure of 11 bars and a diameter of 13.7 meters was used for boring the seabed tunnel. The deepest point was 106 meters below sea level. One bounce diving period and seven saturation diving periods were needed for the repair and maintenance of the TBM during the project. Total time spent under pressure was 5,763 hours. A saturation decompression chamber for four divers was used for the saturation interventions, and divers breathed trimix at storage and excursion depths. The longest saturation run was the second, with storage at 10 bars and excursions to 10.4 bars. Twenty-three professional divers who were all experienced in compressed-air work were assigned to work on the project. Four dive physicians provided medical support, which included screening of divers before and during the hyperbaric interventions as well as on-site supervision. There were no diving-related accidents. A minor hand trauma, an external otitis and occasional insomnia were non-diving-related health issues that occurred during saturation and bounce diving. To our knowledge, the Eurasian Tunnel was the first project to perform TBM repair operations at such depths under the seabed and the first saturation diving in Turkey. In this report, we aimed to share our experiences of hyperbaric medical consulting in support of this type of tunneling project.

New trends in the orthopaedic management of diabetic foot.

Although there are various types of therapeutic footwear currently used to treat diabetic foot ulcers (DFUs), recent literature has enforced the concept that total-contact casts are the benchmark.Besides conventional clinical tests and imaging modalities, advanced MRI techniques and high-sensitivity nuclear medicine modalities present several advantages for the investigation of diabetic foot problems.The currently accepted principles of DFU care are rigorous debridement followed by modern wound dressings to provide a moist wound environment. Recently, hyperbaric oxygen and negative pressure wound therapy have aroused increasing attention as an adjunctive treatment for patients with DFUs.For DFU, various surgical treatments are currently available, including resection arthroplasty, metatarsal osteotomies and metatarsal head resections.In the modern management of the Charcot foot, surgery in the acute phase remains controversial and under investigation. While conventional fixation techniques are frequently insufficient to keep alignment postoperatively, superconstruct techniques could provide a successful fixation.Retrograde intramedullary nailing has been a generally accepted method of achieving stability. The midfoot fusion bolt is a current treatment device that maintains the longitudinal columns of the foot. Also, Achilles tendon lengthening remains a popular method in the management of Charcot foot. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170073.

Turkish recreational divers: a comparative study of their demographics, diving habits, health and attitudes towards safety.

INTRODUCTION: In Turkey, scuba diving has become more popular and accessible in the past decade and there has been a commensurate rise in the number of certified divers. This new generation of recreational divers has not been described in detail previously. The aim of this study was to profile this group, while investigating any gender differences and making comparisons with the global diving community. METHODS: Turkish dive club members and diving forum/blog readers were invited to complete an online questionnaire investigating their demography, medical issues and diving history and habits. RESULTS: The questionnaire was completed by 303 female and 363 male divers. Significant differences were found between the sexes in terms of demographics, diving experience and attitudes toward safety. Previous or ongoing medical conditions were reported by 100 female divers and 141 males. Only 29% of females and 22% of males had been examined by a physician trained to conduct assessments of fitness to dive. Female divers did not report problems while diving during menstruation or while taking oral contraceptives. There was no significant difference in the occurrence of decompression sickness (DCS) and DCS-like symptoms between the sexes. CONCLUSION: This is the largest study to date conducted on recreational divers in Turkey and so carries some value. It profiles their physical and behavioral attributes as well as differences in diving practices between the sexes in Turkey. Our findings should have implications for medical screening and dive training standards.

Effect of hyperbaric oxygen therapy on complete blood count.

Complete blood count (CBC) is a routine diagnostic procedure for patients and a part of routine health inspection for healthy individuals. The effect of hyperbaric oxygen (HBO2) on CBC is not known. The objective of this study was to determine the effects of HBO2 on blood parameters in CBC with long-term HBO2 therapy. In this study, patients received HBO2 at the department of Underwater and Hyperbaric Clinical Medicine. CBC results were obtained at specific time points during HBO2 therapy. The study recruited a total of 140 patients who met the research inclusion criteria. Patients were treated for 55.5 ± 41 days. During the treatment period, they underwent HBO2 sessions for an average of 35.9 ± 24.9 times. Five groups were created as follows: before the treatment; between 1-20 sessions; between 21-40 sessions; between 41-60 sessions; and more than 60 sessions. The results of the present study showed that a number of alterations occurred in CBC values in patients who received HBO2. HBO2 reduces the number of platelets, but this was not clinically significant. According to the results, HBO2 does not have any effect on hemoglobin, hematocrit, red blood cells, mean corpuscular volume, mean corpuscular hemoglobin, red blood cell distribution width, mean corpuscular hemoglobin concentration, platelet count, platelet distribution width and mean platelet volume. Except for a temporary reduction in platelet count, HBO2 has no effect on CBC parameters. Medical professionals may use the outcome of this study in their routine examinations, as it suggests that the changes in CBC driven by HBO2 are not statistically significant, and could be disregarded. More research is needed to examine the effects of HBO2 on other blood parameters.

Hyperbaric oxygen therapy for chronic ulcers in systemic sclerosis - case series.

BACKGROUND: Digital and leg ulcers are extremely painful, hard to heal manifestations of systemic sclerosis (SSc). Many treatments have been tried for these challenging complications, but use of hyperbaric oxygen therapy (HBOT) is very limited. HBOT has been used as an adjunctive therapy for treating chronic wounds, and nonhealing SSc wounds, which have a hypoxic nature, may also benefit from it. METHODS: This is a retrospective analysis of six SSc patients who underwent HBOT for their ulcers. Patient demographics, ulcer properties, and details of treatments were evaluated. RESULTS: Three patients had digital ulcers, and the other three had leg ulcers. Three patients (two leg ulcers and one digital ulcer) had bilateral lesions. All patients had been treated for at least one and a half months with various modalities. After HBOT was applied, four patients' ulcers healed completely and two patients had near-complete healing. Amputation was not required for any. CONCLUSION: This case series, which has the largest patient population up to present, shows adjunctive HBOT may be helpful in the treatment of SSc ulcers.

Intralesional application of epidermal growth factor in limb-threatening ischemic diabetic foot ulcers.

OBJECTIVE: The intralesional injection of recombinant human epidermal growth factor (EGF-IL), a new therapy, has been claimed to prevent major amputations in advanced diabetic foot lesions. In this study, the efficacy of EGF-IL on advanced diabetic foot ulcers (DFU) was reviewed. METHODS: Intralesional 75 µg EGF application (Heberprot-P® 75, Heber Biotec, Havana, Cuba) to 12 diabetic foot lesions in 11 patients (8 males, 3 females; mean age: 62.2±10.6 years) was evaluated. Most of the patients had undergone revascularization and received hyperbaric oxygen therapy (HBOT) and negative pressure wound therapy (NPWT), along with standard care, but failed to heal. After amputation was offered as the final option, EGF-IL was applied to evaluate its effects. RESULTS: Two patients underwent amputation, while 10 lesions of the remaining 9 patients healed completely. CONCLUSION: Our results prove that intralesional application of EGF can prevent amputations in advanced diabetic foot cases with an ischemic component. However, evidence in the literature supporting its use remains lacking, and its high cost presents an additional problem. Thus, we believe that intralesional application of EGF should be an option for ischemic wounds only after vascular evaluation (and intervention when possible), HBOT, NPWT, and standard care have proven insufficient.

The changes in histopathology and mass in hyperbaric oxygen-treated auricular cartilage grafts in a rabbit model.

The aim of the study is to investigate the histopathologic and cartilage mass changes in hyperbaric oxygen (HBO)-treated auricular cartilage grafts either crushed or fascia wrapped in a rabbit model. This is a prospective, controlled experimental study. Sixteen rabbits were randomly allocated into control (n = 8) and treatment groups (n = 8). Each group was further grouped as crushed cartilage (n = 4) and fascia wrapped crushed cartilage (n = 4). The eight rabbits in the treatment group had HBO once daily for 10 days as total of 10 sessions. The mass of cartilage, cartilage edge layout, structural layout, staining disorders of the chondroid matrix, necrosis, calcification besides bone metaplasia, chronic inflammation in the surrounding tissues, fibrosis, and increased vascularity were evaluated in the hematoxylin and eosin (H&E)-stained sections. Fibrosis in the surrounding tissue and cartilage matrix was evaluated with Masson's trichrome stain. The toluidine blue staining was used to evaluate loss of metachromasia in matrix. The prevalence of glial fibrillary acidic protein (GFAP) staining in chondrocytes was also evaluated. Although the remaining amount of cartilage mass after implantation does not show a significant difference between the control and the study group (p = 0.322, p <0.05).The difference between control and study group in terms of positive staining with GFAP was statistically significant (p = 0.01, p <0.05). Necrosis and loss of matrix metachromasia were significantly low in the study group compared with control group (p = 0.001, p = 0.006, p <0.05). HBO therapy did not have significant effect on the mass of rabbit auricular cartilage graft. HBO therapy significantly reduced loss of metachromasia, necrosis, and GFAP staining in the auricular cartilage grafts of the animal model.

Decompression sickness cases treated with recompression therapy between 1963 and 1998 in Turkey: review of 179 cases.

The purpose of this study was to review the cases diagnosed as decompression sickness (DCS) with recompression therapy treament between 1963 and 1998 in Turkey. The records of 179 cases were analyzed for age, gender, type of DCS, presenting signs and symptoms, time to onset of symptoms, time to recompression therapy, recompression table used, total number of treatments and outcomes. The diving depth on the day of injury ranged between 60 and 215 fsw (18 and 65 msw). The symptoms developed during ascent or within 10 minutes after surfacing in 47% of divers and within the first hour in 87% of the divers. The most frequent symptom was sensory loss in the extremities. The dive before the symptoms was a repetitive dive in 50% of the cases and the diagnosis was Type II DCS in 79% of these divers. Most of the divers (84%) received recompression therapy after a delay of more than 12 hours. Healing rate was 68% with the air recompression tables and 86% with the oxygen tables. Repetitive dives were associated with a higher incidence of Type II DCS than single dives (79% and 66%, respectively). The results using recompression tables with oxygen were more successful than the treatment with air tables.