The effect of hyperbaric oxygen therapy on hematological indices and biochemical parameters in patients with diabetic foot.

BACKGROUND: Diabetes Mellitus (DM) is a metabolic disease with a high morbidity and mortality and increasing in prevalence all over the world. Due to the hypoxic, ischemic, inflammatory, and infective environment in DM, diabetic foot ulcers have been treated with medico-surgical interventions and adjuvant hyperbaric oxygen Therapy (HBOT). The purpose of this study was to evaluate the effects of HBOT on hematological indices and biochemical parameters in patients with diabetic foot. METHODS: The study group was formed from the file records of 103 male patients who applied to Yunus Emre State Hospital HBOT Center between September 1, 2016 and December 31, 2020, and were treated HBOT with a multidisciplinary approach. RESULTS: There were negative low correlations between number of HBOT sessions and Mean Corpuscular Hemoglobin (MCH) (P = .037, r = -0.207) and Blood Urea Nitrogen (BUN) (P = .037, r = -0.222). White Blood Cell Count (WBC), Neutrophils (NEU), Monocytes (MON), Platelet Count (PLT), and Plateletcrit (PTC) parameters were found to be decreased, and an increase in lymphocytes (LYM), Eosinophils (EOS), Mean Corpuscular Hemoglobin Concentration (MCHC), and Red Cell Distribution Width (RDW) parameters were detected after the treatments (P < .05). Again, after the treatment, glucose (Glu), C-Reactive Protein (CRP), direct bilirubin, and total protein (TP) levels were decreased, and uric acid (UA) levels increased (P < .05). CONCLUSION: HBOT improved hematological indices in patients and had a beneficial effect on biochemical parameters, particularly Glu and CRP levels. Adjuvant HBOT alleviates diabetic inflammation and has a beneficial effect on diabetic patient treatment.

Evaluation of fatigue and sleep problems in cabin crews during the early COVID-19 pandemic period.

BACKGROUND: The COVID-19 outbreak has affected the aviation sector. The anxiety and fear caused by this newly emerging virus, whose effects are not fully known in the short and long term, may also cause problems in terms of flight safety. We aimed to evaluate fatigue and sleep problems associated with fear of COVID-19 during the early pandemic period in cabin crew. METHODS: This is a cross-sectional survey study consisting of 45 questions in total. Participants were cabin crew members on flight duty. An online questionnaire was sent to 2092 cabin crew in February-April 2021 via TASSA Cabin Crew Member's Association. The survey included questions about socio-demographic characteristics, flight times, flight types and COVID test history, as well as the international physical activity questionnaire-short form (IPAQ-SF), fatigue severity scale (FSS), Jenkins sleep scale (JSS) and fear of COVID-19 scale (FCV-19S). RESULTS: Out of 316 survey results obtained (response rate, 15%), 225 (71%) were included in the study, with a mean age (SD) of 32.54 (4.91) years, and 124 (55.1%) were women. According to IPAQ-SF, 27.6% of cabin crew were found to be inactive, 54.7% minimally active and 17.7% very active. According to FSS, pathological fatigue was found in 43.6%. The FSS score of the inactive group was higher than the others (Kruskal Wallis, p < 0.001). As the number of people living in the same house or flight time in the last 1 month increase, the fear of COVID-19 also increases (Spearman, p = 0.01 r = 0.171, and p = 0.049 r = 0.131). In addition, there was direct correlation between fear of COVID-19 and fatigue and sleep problems (Spearman, p = 0.001 r = 0.218, and p < 0.001 r = 0.26, respectively). CONCLUSION: This study shows that fatigue and sleep problems increase as the fear of COVID-19 increases in cabin crew during the early pandemic period. Consequently, precautions and further studies are needed, as fatigue and sleep disorders may primarily be related to the anxiety, fear and uncertainty surrounding the COVID-19 pandemic.

Effects of aerospace environments on the cardiovascular system.

Certain physical and physiological changes occur in the atmospheric levels where flight and space activities take place. Air pressure decreases with increasing altitude and the partial pres¬sure of O2 decreases in parallel with the atmospheric pressure drop and creates hypoxia in the flight crew and in the passen¬gers. In case of acute hypobaric hypoxia, blood is redistributed to the brain and the heart, whereas blood supply to internal organs, such as kidney and skin is reduced. Peripheral cyanosis can be observed on the fingertips and the lips during hypoxia-induced blood redistribution. Tachycardia develops, but the stroke volume does not change. The coronary blood flow increases in parallel with the rise of cardiac output; however, the presence of severe hypoxia leads to myocardial depression. Coronary reflex vasoconstriction is followed by cardiac arrest. Another important pathology caused by low pressure is decompression sickness. In this disease, immediate reduction of the environmental pressure leads to the dissolved nitrogen transforms into gas, and nitrogen bubbles form in the tissue and in the blood. These bubbles interfere the perfusion of the blood and cause ischemia. Symptoms and signs of cardiac decompression sicknesses are dyspnea, tachypnea, chest pain, cough, hemoptysis, cyanosis, retrosternal discomfort, and rarely, shock. Air embolism of coronary vessels manifests as rhythm disturbances, myocardial infarction, and circulatory collapse. The physical forces that occur because of aircraft move¬ment and affect both the pilot and the aircraft, are called acceleration (G) forces. The basic physical effect of G forces is weight increments and motion restriction. During high +Gz, blood pressure decreases in the brain and increases in the lower extremities. Blood forced to move into the lower parts of the body and lower extremities. Thus, brain perfusion cannot be achieved, and loss of consciousness occurs at approximately +4 Gz acceleration levels. Earth also applies an acceleration force to the objects on or around the world. Therefore, gravitational force is also applied to orbiting spacecraft by Earth. The centrifugal force and the gravitational force are in an equilibrium, weightlessness is created inside the orbiting spacecraft, and this is called microgravity. Blood redistributed to the neck and head veins, and astronauts feel nasal fullness, and bulging around the eyes during space missions. As the time spent in the space progresses, a 22% decrease in plasma volume is observed in the cardiovascular system within 1 week owing to increased venous return, and this causes a temporary hemoconcentration. After staying one week in space, cardiac output increases by 22% whereas peripheral resistance decreases by 14%. Rhythm disturbances are also seen during activities performed in space is and thought to be caused by electrolyte imbalance or stress. There is an increasing demand for high altitude and space travel nowadays. These trips cause several physical and physiological effects on both passenger and flight crew. Therefore, it is necessary to take precautionary measures to carry out these activities safely.

Incidence of decompression sickness in hypobaric hypoxia training.

Simulated flight in a hypobaric chamber is a fundamental component in the physiological training of aviators. Although rare, there is always a risk of decompression sickness (DCS) in trainees during hypobaric hypoxia training. In this study we aimed to determine the incidence of altitude-induced DCS and the symptoms manifested in trainees and inside chamber observers (ICOs) during the training sessions. We retrospectively reviewed the records of DCS cases during the period of January 1, 2011, and October 1, 2018. The records of 6,657 trainees and 615 ICOs were evaluated. The gender distribution in 6,657 trainees was 6,578 (98.81%) male and 79 (1.19%) female. The numbers of DCS cases in trainees and ICOs were six (0.09%) and two (0.33%), respectively [(ICOs versus trainees - odds ratio (OR): 3.574; 95% CI 0.720-17.744; (p > 0.05)]. All ICOs were male; no DCS incident was observed among female trainees. Recompression treatments were applied on site, and complete recovery was achieved in all cases. Overall DCS incidence was found to be 0.11% among the 7,193 male subjects, which included trainees and ICOs. The higher incidence of DCS in ICOs was attributed to the physical activities performed at altitudes by ICOs. In such training, established instructions have to be strictly followed by physicians, ICOs and trainees. All trainees and ICOs should be aware of the symptoms and signs of DCS, and medical support including a recompression facility, should be provided on site during hypobaric hypoxia training.

Early hyperbaric oxygen therapy for cerebral air embolism during atrial fibrillation ablation.

Cerebral air embolism is a potentially life-threatening complication of left-sided ablation procedures. We present a 51-year-old woman with cerebral air embolism during atrial fibrillation cryoballoon ablation. Taking a deep breath while removing the dilatator was the most likely mechanism in our case. The patient was successfully treated with hyperbaric oxygen therapy at early stage and was discharged without any neurological sequelae.

A prospective randomized controlled trial assessing the efficacy of adjunctive hyperbaric oxygen therapy in the treatment of hidradenitis suppurativa.

Hyperbaric oxygen therapy (HBOT) appears to enhance wound healing, increase bactericidal activity, and act synergistically with a number of antibiotics. The aim of this study was to evaluate the efficacy of HBOT as an adjunctive therapy in patients with hidradenitis suppurativa (HS) treated with a combination of systemic rifampicin and clindamycin. The study was a prospective, single-center, single-dose, open-label, randomized controlled clinical study of HBOT in patients with moderate to severe HS. Efficacy was measured by modified Sartorius score (SS), HS Severity Index (HSSI), Dermatology Life Quality Index (DLQI), and a visual analog scale (VAS) before treatment and after the completion of 4 and 10 weeks of treatment. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were also measured. Forty-three patients were enrolled in the study. More patients in the HBOT than in the control group showed a decrease of ≥50% from baseline parameters at week 10 for SS (100%), HSSI (100%), DLQI (95.5%), VAS (100%), ESR (100%), and CRP (72.7%). Clinically and statistically significant improvements from baseline were observed at 4 and 10 weeks in HSSI (P = 0.009 at both), SS (P = 0.021 at both), and DLQI (P = 0.044 at week 4, P = 0.009 at week 10). Adjunctive HBOT was considered to be effective in significantly improving antibiotic treatment of HS. The treatment was well tolerated, and no unexpected safety issues were identified.