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Fulltext The physiological, biochemical and quality of life changes in chronic diabetic foot ulcer after hyperbaric oxygen therapy

Mohd Yazid, B., Ayesyah, A., Mohd Rohaizat, H., Nurhanani, A. B.

Medicine & Health, 2017;12(2):210-219.
MyJurnal

Hyperbaric oxygen therapy (HBOT) was established to increase oxygenation and antimicrobial effect that potentially improve the healing of chronic ulcer. Present study aim to assess the effects of HBOT in chronic diabetic foot ulcer (DFU). A total of sixty patients classified according to Wagner 1, 2 or 3 chronic diabetic foot ulcers, were recruited and subsequently divided randomly into two groups; HBOT and control group. All patients underwent the standard treatment for DFU, but for the HBOT group, underwent 20 HBOT sessions, each lasted 80 – 90 mins at 2.5 atmospheres absolute (ATA). White cell count (WCC) and C-reactive protein (CRP) levels were taken during inclusion, at second and fourth week of treatment. Wound sizes were documented at each follow up until six months follow up. SF-36 at one-month post hyperbaric oxygen therapy was used to measure the health-related quality of life. Reduction of WCC and CRP in HBOT group were significant throughout the treatment (p=0.046 and p=0.039, respectively). A total of 26 patients (86.7%) from the HBOT group achieved complete ulcer healing at six months’ follow-up, while 18 patients (60%) in the control group’s ulcer healed completely. Patients treated with HBOT had significantly better mental and physical health constituent of quality of life. It must be emphasised that HBOT is an adjunctive therapy to the standard management of chronic DFU in accelerating wound healing for a better quality of life.
Keywords: oxygenation, quality of life, wound healing

Matched MeSH terms: Hyperbaric Oxygenation*
Fulltext Osteoradionecrosis in Subaxial Cervical Spine - a Rare and Devastating Complication: A Case Report

Rashid MZ, Ariffin MH, Rhani SA, Baharudin A, Ibrahim K

Malays Orthop J, 2017 Nov;11(3):53-55.
PMID: 29326769 MyJurnal DOI: 10.5704/MOJ.1711.005

Osteoradionecrosis, a rare complication of radiation therapy, is a slow progression disease which affects the surrounding structures of spinal components. It essentially weakens the soft tissue and bony configuration and can cause nerve impingement or cord compression. We describe a patient who underwent radiotherapy for thyroid cancer and presented with cervical kyphosis with anterolisthesis of C3/C4 and C4/C5 some 32 years later. We explore the role of anterior and posterior fusion, as well as hyperbaric oxygen therapy in promoting healing.

Matched MeSH terms: Hyperbaric Oxygenation
Fulltext Development of underwater and hyperbaric medicine in Malaysia

Rozali A, Rampal KG, Zin BM, Mohd Sidik S, Khairuddin H, Abd Halim M, et al.

Med J Malaysia, 2006 Dec;61(5):647-50.
PMID: 17623973 MyJurnal

Underwater and Hyperbaric Medicine is a treatment modality gaining recognition in Malaysia. It uses the hyperbaric oxygen therapy (HBOT) approach where patients are placed in recompression chambers and subjected to oxygen therapy under pressure. In Malaysia it was introduced as early as the 1960's by the Royal Malaysian Navy to treat their divers for decompression illness (DCI), arterial gas embolism (AGE) and barotraumas. Other sectors in the armed forces, universities and private health centres began developing this approach too in the late 1990's, for similar purposes. In 1996, Underwater and Hyperbaric Medicine began gaining its popularity when the Institute of Underwater and Hyperbaric Medicine at the Armed Forces Hospital in Lumut started treating specific clinical diseases such as diabetic foot ulcers, osteomyelitis, and carbon monoxide poisoning and other diseases using HBOT. This paper discusses the development of this interesting treatment modality, giving a brief historical overview to its current development, as well as provides some thought for its future development in Malaysia.

Matched MeSH terms: Hyperbaric Oxygenation*
Incidence of middle ear barotrauma in staged versus linear chamber compression during hyperbaric oxygen therapy: a double blinded, randomized controlled trial

Ng AWA, Muller R, Orton J

Undersea Hyperb Med, 2017 8 5;44(2):101-107.
PMID: 28777900

CONTEXT: Middle ear barotrauma (MEB) is common during chamber compression in hyperbaric oxygen therapy. However, little evidence exists on an optimal compression protocol to minimize the incidence and severity of MEB.
OBJECTIVE: To compare the incidence of MEB during hyperbaric oxygen therapy using two different chamber compression protocols.
DESIGN: Double-blinded, randomized controlled trial.
SETTING: Hyperbaric Medicine Unit, The Townsville Hospital, Queensland, Australia, September 2012 to December 2014.
PATIENTS: 100 participants undergoing their first hyperbaric oxygen therapy session.
INTERVENTION: Random assignment to a staged (n=50) or a linear (n=50) compression protocols. Photographs of tympanic membranes were taken pre- and post-treatment and then graded. Middle ear barotrauma was defined as an increase of at least one grade on a modified TEED scale.
RESULTS: The observed MEB incidence under the staged protocol was 48% compared to 62% using the linear protocol (P=0.12, exact one-sided binomial test), and thus the staged protocol did not show a significant improvement in MEB. However, the staged protocol resulted in significantly less severe deteriorations in MEB grades when compared to the linear protocol (P=0.028, exact one-sided Mann-Whitney type test).
CONCLUSION: The use of the assessed staged compression protocol for the first hyperbaric oxygen treatment showed no significant effect on the overall incidence of MEB when compared to the gold standard linear protocol but resulted in a significant improvement in the severity of the experienced MEBs. Further studies are needed to elucidate an optimal compression protocol to minimize middle ear barotrauma.

Matched MeSH terms: Hyperbaric Oxygenation/adverse effects*; Hyperbaric Oxygenation/methods
Fulltext Pyknodysostosis - complications after dental extraction

Bahadun, J., Nik Hussien, N.N., Yunus, N.N.N.

Ann Dent, 2007;14(1):26-30.
MyJurnal

Pyknodysostosis is a rare sclerosing bone disorder with autosomal recessive mode of inheritance. The condition is characterized by continuous bone deposition without physiological resorption, occurring mainly in the trabecular and not the cortical bone. The skeletal features include short stature, brachycephaly, open cranial sutures and fontanelles, diffuse osteosclerosis and obtuse mandibular angles. Among the oral features observed were grooved or furrowed palate and disturbances in eruption and exfoliation of teeth. Multiple fractures of long bones and osteomyelitis of the jaw are frequent complications. These are attributed to the increased brittleness and reduced vascularity of the bone as a result of continuous endosteal bone deposition. Treatment is usually successful with surgical management and sustained bactericidal antibiotic therapy, although hyperbaric oxygen has been recommended as adjunct treatment in the more refractory form.

Matched MeSH terms: Hyperbaric Oxygenation
Managing complications of radiation therapy in head and neck cancer patients: Part IV. Management of osteoradionecrosis

Ramli R, Ngeow WC, Rahman RA, Chai WL

Singapore Dent J, 2006 Dec;28(1):11-5.
PMID: 17378336

Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Pretreatment dental assessment should be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally and, as a result, they succumb to complicated oral adverse effects after radiation therapy. Osteoradionecrosis (ORN) is a severe debilitating condition that impairs healing due to reduction in vascularity and osteocyte population in the affected bone. This article reviews methods of treatment used to treat ORN such as antibiotics, hyperbaric oxygen therapy, therapeutic ultrasound, surgery, and other modalities.

Matched MeSH terms: Hyperbaric Oxygenation
Fulltext The response of hypoxia biomarkers to hyperbaric oxygen therapy in preventing hypoxia at high altitude

Shazreen Shaharuddin, Fathinul Fikri Ahmad Saad, Aminuddin Abdul Hamid Karim

ZULFAQAR International Journal of Defence Science, Engineering & Technology, 2020;3(2):37-40.
MyJurnal

Training at high altitude for prolonged periods can cause low oxygen tension which can developed complication of hypoxia. Hypoxia is a cascade activity from a level of down regulation and function of cell’s nucleus. Early detection of biomarker and physiological changes are important in prevent the hypoxia at high altitude. Hyperbaric medicine is a new treatment that were used an oxygen therapy to treat hypoxic and inflammatory driven conditions which patients are treated with 100% oxygen at pressure greater than atmospheric pressure. The review discusses physiological changes associated with hypoxia, the response of biomarker hypoxia changes in high altitude and the role of hyperbaric oxygen therapy can play as part of the treatment for pilots and athletes training at high altitudes that suffering from disease with underlying hypoxia.

Matched MeSH terms: Hyperbaric Oxygenation
Use of hyperbaric oxygen therapy (HBOT) in chronic diabetic wound - A randomised trial

Nik Hisamuddin NAR, Wan Mohd Zahiruddin WN, Mohd Yazid B, Rahmah S

Med J Malaysia, 2019 Oct;74(5):418-424.
PMID: 31649219

INTRODUCTION: The purpose of this study was to investigate the effect of hyperbaric oxygen therapy (HBOT) towards diabetic foot ulcer (DFU) patients in addition to the standard wound care management.
METHODS: Fifty-eight diabetic patients with ulcers at Wagner Grade 2 and above involved in this study after presented at two study centres of tertiary teaching hospitals. The assigned patients received conventional wound care with additional HBOT given at 2.4 ATA for 90 minutes. Patients in the control group who received conventional wound care only were treated and observed for 30 days. The progress of wound healing was observed and measured at day 0, 10, 20 and 30 of study. The data collected were analysed using SPSS software (ver. 22) to study the association of HBOT towards healing of the diabetic foot ulcers.
RESULTS: Repeated Measures ANOVA analysis with Greenhouse-Geisser correction indicated that the means of wound size over time points (Day 0, 10, 20 and 30) among patients under HBOT group were statistically significantly different [F(1,61)=30.86, p<0.001)] compared to conventional therapy group. Multiple logistic regression analysis showed that HBOT group has nearly 44 times higher odds to achieve at least 30% wound size reduction within the study period (95%CI: 7.18, 268.97, p<0.001).
CONCLUSION: The results obtained in this study indicated that as an adjunctive therapy to conventional wound care, HBOT affected the rate of healing in diabetic foot ulcers significantly in terms of wound size reduction when compared to administering the conventional wound care alone.

Matched MeSH terms: Hyperbaric Oxygenation
Fulltext Pulmonary overinflation syndrome in an underwater logger

Rozali A, Sulaiman A, Zin BM, Khairuddin H, Abd-Halim M, Mohd Sidik S

Med J Malaysia, 2006 Oct;61(4):496-8.
PMID: 17243532 MyJurnal

Pulmonary overinflation syndrome (POIS) is a group of barotrauma-related diseases caused by the expansion of gas trapped in the lung, or over-pressurization of the lung with subsequent over-expansion and rupture of the alveolar air sacs. This group of disorders includes arterial gas embolism, tension pneumothorax, mediastinal emphysema, subcutaneous emphysema and rarely pneumopericardium. In the case of diving activities, POIS is rarely reported and is frequently related to unsafe diving techniques. We report a classical case of POIS in an underwater logger while cutting trees for logs in Tasik Kenyir, Terengganu. The patient, a 24-year-old worker, made a rapid free ascent to the surface after his breathing equipment malfunctioned while he was working underwater. He suffered from bilateral tension pneumothoraces, arterial gas embolism giving rise to multiple cerebral and cerebellar infarcts, mediastinal and subcutaneous emphysema as well as pneumopericardium. He was treated in a recompression chamber with hyperbaric oxygen therapy and discharged with residual weakness in his right leg.

Matched MeSH terms: Hyperbaric Oxygenation*
Oxygenation of frog gastric mucosa in vitro

Kidder GW, Montgomery CW

Am J Physiol, 1975 Dec;229(6):1510-3.
PMID: 2018

We have recently shown that 5% CO2/95% O2 in the serosal bathing solution, with 100% O2 in the mucosal solution, results in CO2-diffusion limitation of acid secretion in bullfrog gastric mucosa. Changing to 10% CO2/90% 02 on both surfaces doubles the acid secretory rate. We calculate that, were the rate of oxygen consumption to increase significantly as a result of secretory stimulation, the tissue would now be oxygen limited. This prediction is tested by raising the P02 by increasing the total pressure in a hyperbaric chamber. Since no change in acid secretory rate or potential difference was observed upon changing from PO2 = 0.9 to PO2 = 1.9 atm, we conclude that the tissue is not O2 limited at normal pressure. Decreasing PO2 below 0.9 atm, by contrast, decreases the acid secretory rate and raises both PD and resistance. We infer that the rate of oxygen consumption did not rise significantly when acid secretion was increased by supplying sufficient CO2.

Matched MeSH terms: Hyperbaric Oxygenation
Cerebral arterial gas embolism in air force ground maintenance crew--a report of two cases

Lee CT

Aviat Space Environ Med, 1999 Jul;70(7):698-700.
PMID: 10417007

Two cases of cerebral arterial gas embolism (CAGE) occurred after a decompression incident involving five maintenance crew during a cabin leakage system test of a Hercules C-130 aircraft. During the incident, the cabin pressure increased to 8 in Hg (203.2 mm Hg, 27 kPa) above atmospheric pressure causing intense pain in the ears of all the crew inside. The system was rapidly depressurized to ground level. After the incident, one of the crew reported chest discomfort and fatigue. The next morning, he developed a sensation of numbness in the left hand, with persistence of the earlier symptoms. A second crewmember, who only experienced earache and heaviness in the head after the incident, developed retrosternal chest discomfort, restlessness, fatigue and numbness in his left hand the next morning. Both were subsequently referred to a recompression facility 4 d after the incident. Examination by the Diving Medical Officer on duty recorded left-sided hemianesthesia and Grade II middle ear barotrauma as the only abnormalities in both cases. Chest X-rays did not reveal any extra-alveolar gas. Diagnoses of Static Neurological Decompression Illness were made and both patients recompressed on a RN 62 table. The first case recovered fully after two treatments, and the second case after one treatment. Magnetic resonance imaging (MRI) of the brain and bubble contrast echocardiography performed on the first case 6 mo after the incident were reported to be normal. The second case was lost to follow-up. Decompression illness (DCI) generally occurs in occupational groups such as compressed air workers, divers, aviators, and astronauts. This is believed to be the first report of DCI occurring among aircraft's ground maintenance crew.

Matched MeSH terms: Hyperbaric Oxygenation
Acute hand ischemia after intra-arterial injection of meprobamate powder

Seak CK, Kooi XJ, Seak CJ

J Emerg Med, 2012 Sep;43(3):468-71.
PMID: 22497894 DOI: 10.1016/j.jemermed.2012.02.014

Meprobamate tablets contain microcrystalline cellulose, a potent embolic agent that has been shown to cause gangrene in animal studies. Microvascular embolization caused by microcrystalline cellulose can contribute to the ischemic process.

Matched MeSH terms: Hyperbaric Oxygenation