A retrospective review of diabetic foot ulcers treated with hyperbaric oxygen therapy in the Kingdom of Bahrain

Alzaben, Ghadeer Salman (2020-03)

Thesis (MSc)--Stellenbosch University, 2020.

Thesis

ENGLISH ABSTRACT : Background: Diabetic foot ulcer (DFU) is a common complication of uncontrolled diabetes mellitus (DM). Ulcers can be neuropathic, ischemic or neuro-ischemic. Its impact on the patient can be dramatic and can lead to amputation and loss of limb function. Hyperbaric oxygen therapy (HBOT) is used as an adjunct treatment to hasten the healing process or limit the extent of the damage caused by ischemia or necrotizing fasciitis. Since patients respond differently to HBOT, this study was carried out to identify factors that influence their response to the treatment after appropriate initial selection. Methods: We performed a case-control study of all patients with DFU treated in the hyperbaric and wound care unit at the King Hamad University Hospital between January 2013 and December 2018. Patients’ data were obtained upon patient hospital visit from clinical records. Various baseline factors were compared between patients with and without adequate HBOT treatment responses. Results: A total of 123 patients (cases n= 75 and controls n=48) were included in the study. There was no significant difference in age, gender, duration of DM, weight and body mass index between the groups (p>0.05). Cases group (11.9 ± 4.9 ) had higher white blood cell count than the control group (10.1 ± 3.7) (p=0.038). Haemoglobin level was significantly lower in the cases (11.4 ± 1.7 mg/dl) compared to control group (12.3 ± 1.7 mg/dl) (p=0.009). The number of patients who had new breakdown (19% cases and 4% control) and had smell wounds (45% cases and 21% control) were significantly higher in cases group compared to the control (p<0.03). Conclusion: Inflammation and haemoglobin status are major factors influencing wound healing in diabetic patients with ulcer subjected to HBOT.

AFRIKAANSE OPSOMMING : Agtergrond: Diabeetvoetulkusse is 'n algemene komplikasie van onbeheerde diabetes mellitus (DM). Ulkusse kan neuropaties, ischemies of neuro-ischemies van aard wees. Die impak daarvan op die pasiënt kan dramaties wees en kan lei tot amputasie en verlies van ledemaatfunksie. Hiperbariese suurstofterapie (HST) word gebruik as aanvullende behandeling om die genesingsproses te versnel of om die omvang van die skade wat veroorsaak word deur ischemie of nekrotiserende fasciitis te beperk. Aangesien pasiënte verskillend reageer op HST, word hierdie studie uitgevoer om faktore te identifiseer wat hul reaksie op behandeling beïnvloed nadat hulle toepaslik geselekteer was Metodes: Ons het 'n gevals-kontrolestudie uitgevoer van alle pasiënte met diabeetvoetulkusse wat tussen Januarie 2013 en Desember 2018 in die hiperbariese en wondversorgingseenheid by die Koning Hamed Universiteits-Hospitaal behandel is. Die data van die pasiënte is verkry uit die kliniese notas van die hospitaal. Verskeie basislynfaktore is vergelyk tussen pasiënte met en sonder voldoende HST-behandelingsreaksies. Resultate: Altesaam 123 pasiënte (75 gevalle en 48 kontrole) is by die studie ingesluit. Daar was geen beduidende verskil in ouderdom, geslag, duurte van DM, gewig en liggaamsmassa-indeks tussen die groepe nie (p>0,05). Die gevalle (11,9 ± 4,9) het 'n hoër aantal witbloedselle gehad as die kontrole (10,1 ± 3,7) (p = 0,038). Die hemoglobienvlak was aansienlik laer in die gevalle (11,4 ± 1,7 mg/dl) in vergelyking met die kontrolegroep (12,3 ± 1,7 mg/dl) (p = 0,009). Die aantal pasiënte wat nuwe wondafbraak gehad het (19% gevalle en 4% kontrole) en onwelriekende wonder gehad het (45% gevalle en 21% kontrole), was aansienlik hoër in die gevallegroep as die kontrolegroep (p <0,03). Gevolgtrekking: Inflammasie en hemoglobienstatus is die belangrikste faktore wat wondgenesing beïnvloed by diabetiese pasiënte met ulkusse wat HST ontvang.

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