Pilot study of the diagnostic value of CRP:albumin ratio for osteomyelitis in patients with diabetic foot ulcers.

OBJECTIVE: Osteomyelitis may complicate diabetic foot ulcers (DFUs). As a new inflammation-based prognostic factor, CRP:albumin ratio's significance is not known in osteomyelitis among patients with or without diabetes. METHOD: Patients with type 2 diabetes and DFUs were divided into two groups: group 1 (n=47) comprised patients without osteomyelitis, and group 2 (n=50) comprised patients with osteomyelitis. RESULTS: Erythrocyte sedimentation rate (ESR) (88.5±23.0 versus 42.0±22.2), white blood cell count (WBC) (14.7±6.9x103 versus 10.0±4.4x103), C-reactive protein (CRP) level (15.6±9.9 versus 2.4±3.3) and CRP:albumin ratio (6.6±4.9 versus 0.7±1.0) were significantly higher, and albumin level was significantly lower in group 2 compared to group 1 (p<0.001 for all). The presence of osteomyelitis was significantly and positively correlated with ESR (r=0.721; p<0.001), WBC (r=0.380; p<0.001), CRP (r=0.667; p<0.001) and CRP:albumin ratio (r=0.638; p<0.001), and negatively correlated with albumin (r=-0.590; p<0.001). A CRP:albumin ratio of 1.74 or above could predict osteomyelitis with 92.0% sensitivity, 80.9% specificity, and the best area under the curve (AUC) score (AUC=0.957; 95% CI: 0.924-0.991). ESR (odds ratio (OR): 1.071 (1.025-1.119); p=0.02) and CRP:albumin ratio (OR: 2.65 (1.437-4.885); p=0.002) were independent predictors in the final model for stepwise linear regression analyses for the estimation of osteomyelitis. CONCLUSION: CRP:albumin ratio is a cheap and repeatable inflammatory marker and can successfully detect osteomyelitis in patients with DFU.

High serum 8-hydroxy-2'-deoxyguanosine levels predict DNA damage and aging in professional divers.

OBJECTIVE: Reactive oxygen species and oxygen free radicals cause oxidative damage to lipids, proteins, and cell DNA in the cell membrane. Although many DNA products are produced during oxidative DNA damage, 8-hydroxy-2'-deoxyguanosine (8-OHdG) is the most common one, since it can be produced in in vivo environment. In recent years, diving has been done quite frequently for business and sports purposes all over the world. Increased environmental pressure in diving leads to hyperoxia and causes oxidative stress. METHODS: The acute effects of diving on DNA damage were evaluated by comparing 8-hydroxy-2'-deoxyguanosine values of 15 professional diver groups before and after diving. In addition to the demographic characteristics, the serum 8-hydroxy-2'-deoxyguanosine levels of these 15 divers were compared with the control group consisting of nondiving medical students to examine the chronic effect of diving on DNA damage. RESULTS: After deep dive, the amount of 8-hydroxy-2'-deoxyguanosine increased significantly in the diver group and acute DNA damage was observed (T1: 38.86±4.7; T2: 51.77±4.53; p<0.05). In the control group, the amount of 8-hydroxy-2'-deoxyguanosine was insignificant (C1: 47.48±3.73; T1: 38.86±4.7; p>0.05). CONCLUSIONS: It was found that air dives caused an increase in serum 8-hydroxy-2'-deoxyguanosine levels, leading to acute oxidative stress and aging. However, there is no chronic side effect, according to the study of samples taken from the control group. This was thought to be due to the relative sedentary life of the control group. The duration of the effect or the ability to return to normal values should be investigated with further studies planned with large populations.

The role of the platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in the prediction of length and cost of hospital stay in patients with infected diabetic foot ulcers: A retrospective comparative study.

OBJECTIVE: The aim of this study was to determine the role of new inflammatory markers, including the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), in the prediction of length and cost of hospital stay in patients with infected diabetic foot ulcers (DFUs). METHODS: A total of 78 patients with DFUs who were admitted to our endocrinology clinic between January 2016 and July 2017 were included. Patients were then divided into three groups according to the Wagner DFU classification system: group 1: 18 patients with grade 2 DFU (11 men, 7 women; mean age = 57.5±7 years); group 2: 44 patients with grade 3 DFU (18 men, 26 women; mean age = 59.7±8.7 years); and group 3: 16 patients with grade 4 DFU (10 men, 6 women; mean age = 59.9±11.6 years). Laboratory findings were retrospectively obtained from hospital records; the PLR and NLR were calculated in all groups. Length and cost of hospital stay were recorded. Hospital costs were estimated in Turkish Lira (TL) based on the evaluation of glucose regulation, wound care, and antibiotic treatment. RESULTS: The mean NLR was significantly lower in group 1 (2.8±0.9) than in group 2 (6.0±5.2; p=0.017) and group 3 (6.9±5.3; p=0.011). The mean PLR was significantly lower in group 1 (140.8±42.6) than in group 3 (222.1±95.5; p=0.006). The mean length of stay was 7.9±2.7 days in group 1, 15.0±8.9 days in group 2, and 12.5±8.9 days in group 3. The mean cost was 1,310.8±500 TL in group 1, 2,966.9±2105 TL in group 2, and 3,488.1±3603.1 TL in group 3. Length and cost of stay were both significantly lower in group 1 than in groups 2 and 3 (p=0.011 and p=0.002, respectively). Comparative results showed that the length and cost of hospital stay increased with increasing severity of DFUs. Furthermore, correlation analyses demonstrated no correlation of length of stay with PLR and NLR but an obvious correlation between cost of stay and PLR (r=0.412; p<0.001). Additionally, there was no correlation between cost of stay and NLR (r=0.158, p>0.05). CONCLUSION: The PLR is inflammatory marker that can be measured by an inexpensive and easily accessible test and can aid in the prediction of length and cost of hospital stay in patients with DFUs. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Investigation of galectin-3 levels in diabetic foot ulcers.

OBJECTIVE: It has been shown that galectin-3 (Gal-3) promotes angiogenesis and new vessel formation. Serum Gal-3 is a risk factor for vascular complications in type 2 diabetes. The aim of this study is to compare Gal-3 levels with a range of biochemical parameters. METHOD: A prospective study consisted of individuals as a control group (group 1), patients diagnosed with type 2 diabetes without DFUs (group 2), and patients with type 2 diabetes with a DFU (group 3). Patient levels of endothelin-1 (ET-1), vascular endothelial growth factor-A (VEGF-A), nitric oxide (NO), and Gal-3 were measured. RESULTS: In total, 91 patients participated, (28 male, 63 female with a mean age of 55.83±6.35 years) Mean ET-1 (39.0±16.9), NO (17.6±7.6), VEGF-A (33.5±13.4) and Gal-3 (535.1±420.5) levels were significantly higher in group 3 compared with the other two groups (p<0.01). Furthermore, the Gal-3 level was positively and statistically significantly correlated with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ET-1 and NO levels in all groups. CONCLUSION: In our study, the level of Gal-3 was shown to be positively correlated with the VEGF-A level. Hence, Gal-3 can be considered as a defence mechanism against complications of diabetes, thus contributing to wound healing. Gal-3 may play a critical role in DFU formation and progression. Moreover, it could be suggested that Gal-3 may give an indication of prognosis, as it elevates VEGF-A levels and stimulates angiogenesis. Further studies are required to confirm the findings of this study.

Effects of thymoquinone and curcumin on the regeneration of rat livers subject to 70% hepatectomy.

PURPOSE: To investigate thymoquinone, curcumin and a combination of these two drugs were effective or not at the growth of liver. METHODS: Forty female Wistar-Albino rats distributed into five groups of eight rats each, control, thymoquinone, curcumin, and thymoquinone/curcumin groups. Pathological specimens were studied using the Ki-67 Proliferation Index(PI); and arginase(Arg), tissue plasminogen activator(tPA), ceruloplasmin(Cer) and nitric oxide(NO) were studied in biochemical analysis. RESULTS: Our results showed that Ki-67 proliferation index was low in Groups 1. The proliferation coefficient was significantly higher in the Group 2 and Group 4 than in the Group 1 and Group 3.(P < 0.001 between Groups 1 and 2, 1 and 4, and 3 and 4). There was no difference between Groups 2 and 4 (P = 1). The results of the biochemical Arg, tPA and Cer test showed statistically between the Group 1 and Group 2. NO showed significant differences Group 1 and 3. CONCLUSIONS: Thymoquinone and curcumin both have known positive effects on the organism. Histological and biochemical tests showed that thymoquinone is more effective than curcumin.

Effects of thymoquinone and curcumin on the regeneration of rat livers subject to 70% hepatectomy

Abstract Purpose: To investigate thymoquinone, curcumin and a combination of these two drugs were effective or not at the growth of liver. Methods: Forty female Wistar-Albino rats distributed into five groups of eight rats each, control, thymoquinone, curcumin, and thymoquinone/curcumin groups. Pathological specimens were studied using the Ki-67 Proliferation Index(PI); and arginase(Arg), tissue plasminogen activator(tPA), ceruloplasmin(Cer) and nitric oxide(NO) were studied in biochemical analysis. Results: Our results showed that Ki-67 proliferation index was low in Groups 1. The proliferation coefficient was significantly higher in the Group 2 and Group 4 than in the Group 1 and Group 3.(P < 0.001 between Groups 1 and 2, 1 and 4, and 3 and 4). There was no difference between Groups 2 and 4 (P = 1). The results of the biochemical Arg, tPA and Cer test showed statistically between the Group 1 and Group 2. NO showed significant differences Group 1 and 3. Conclusions: Thymoquinone and curcumin both have known positive effects on the organism. Histological and biochemical tests showed that thymoquinone is more effective than curcumin.

Reduction of side effects of hyperbaric oxygen therapy with thymoquinone treatment in rats.

INTRODUCTION: Hyperbaric oxygen (HBO2) treatment results in elevated production of reactive oxygen species (ROS) that leads to cellular damage. Thymoquinone (TQ) is reported to have anti-inflammatory and antimicrobial activity and may suppress the generation of free radicals. The goal of this study is reduction of side effects of hyperbaric oxygen therapy with thymoquinone treatment. METHODS: 30 female Sprague-Dawley rats were randomly assigned to one of three groups (n = 10 per group). Group 1 represented the control group (no treatment). Group 2 was exposed to 100% oxygen at 2.5 ATA for two sessions of two hours'duration each day for five days. Group 3 was treated identically to Group 2 and was also given thymoquinone once daily at 50 mg/kg/day by oral gavage for five days, after first session of HBO2. RESULTS: LOOH and SH levels were significantly elevated in the group receiving HBO2 treatment relative to the control group rats. Fetuin A is increased during TQ treatment. LOOH and SH levels were significantly decreased in animals treated with TQ. CONCLUSIONS: Long-term and repeated HBO2 treatment leads to damage to the lung tissue. In urgent situations or cases of severe hypoxia, repeated HBO2 sessions may be necessary, and TQ antioxidant agents may be useful for prevention of HBO2-associated injury. TQ may represent a useful therapeutic option during HBO2 treatment.

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.

Can amputation be prevented in diabetic foot? Interdisciplinary approach to diabetic foot: a case report.

Diabetic foot ulcers may result in loss of an extremity and may even lead to mortality. The use of comprehensive foot care programs which include early screening and evaluation of problems, foot care education, preventive therapy and referral to specialists has been shown to reduce amputation rates by 49-85 [percent]. A 51-year-old woman with Type 2 diabetes under surveillance for nine months was referred from the emergency department. She presented with an entirely inflamed right foot with ulcer covering two-thirds proximal of the foot for 30 days' duration. There was extensive edema as well as cellulitis extending to the knee, fluctuating abscesses and lymphangitis to the ankle. Magnetic resonance imaging showed extensive abscesses and edema in foot compartments. After a further four weeks of antibiotics, 80 sessions of hyperbaric oxygen therapy shrank the wound from 15x15x2 cm to 3x3x0.2 cm. The wound was closed with a split thickness graft, and healing completed four months after presentation. Patients with diabetic foot deserve clinical evaluations of the whole body rather than a regional treatment. An interdisciplinary approach involving both medical and surgical treatment options should be conducted according to this perspective. It could be effective in lowering major amputation rates and even preventing amputations. Simultaneously administered effective debridement methods, utilization of minor amputations for necrotic tissue and lowering the infectious load with appropriate antibiotics, aggressive wound care with the appropriate wound care products, unconventional treatment methods like hyperbaric oxygen treatment and negative pressure wound care may help reduce amputation levels and save extremities.

The prevalence of electrocardiogram abnormalities in professional divers.

BACKGROUND: The underwater environment presents physiological challenges for the cardiovascular, renal and pulmonary systems. Increases in external hydrostatic pressure reduce the capacity of the venous compartment and cause blood to move toward the lung. The aim of this study was to evaluate retrospectively electrocardiographic (ECG) changes in a cohort of professional divers. METHODS: Between January 2009 and January 2012, 225 randomly selected professional divers, 204 male (91%) and 21 female (9%) attended our clinic for their biannual diving medical assessment. Their ECG records were evaluated retrospectively. RESULTS: The most common ECG abnormality observed was incomplete right bundle branch block (IRBBB) in 30 divers (13.3%). Eleven divers (4.9%) showed right QRS axis deviation (seven with IRBBB). Six divers had a sinus tachycardia; in four divers there was early repolarization; three divers had ventricular extrasystoles; one diver had ST elevation in lead V3; there was one with sinus arrhythmia and another with T-wave inversion in leads V2, V3 and aVF. These ECG changes were evaluated retrospectively by a cardiologist who made various recommendations for further review including bubble contrast echocardiography for IRBBB. CONCLUSIONS: No serious ECG abnormalities were identified, but IRBBB should be further investigated because of its association with persistent (patent) foramen ovale. Rapid cardiological review of ECGs could be achieved using modern communications technology, such as telecardiography, and further clinical investigations directed by specialist recommendation arranged promptly if indicated.