Kübra Özgök Kangal

Background and Objectives: Post-amputation flap necrosis in diabetic foot patients is associated with a high risk of reamputation, level-up amputation, and limb loss. Intralesional epidermal growth factor (iEGF) has been shown to promote wound healing in diabetic foot ulcers; however, its role in the management of post-amputation tissue defects and flap necrosis remains unclear. This study aimed to evaluate the association between iEGF use and clinical outcomes in diabetic foot patients with post-amputation flap necrosis and to characterize longitudinal changes in wound macrophage-associated cell populations. Materials and Methods: This single-center observational cohort study, with retrospective identification of eligible patients and longitudinal follow-up, included 164 diabetic foot patients who developed flap necrosis, wound-healing disorders, or tissue defects following transmetatarsal, Lisfranc, Chopart, or below-knee amputations. Eighty-four patients received an iEGF-containing multidisciplinary limb-salvage strategy, while 80 patients received a multidisciplinary limb-salvage strategy without iEGF. The primary endpoint was treatment success, defined as preservation of the original amputation level without reamputation or proximal level-up amputation, together with satisfactory wound healing at the last available clinical follow-up. Secondary endpoints included mortality during follow-up and, in a flow cytometry sub-study of 12 iEGF-treated patients with available paired wound samples, changes in CD38⁺ and CD209⁺ cell proportions within the CD45⁺CD14⁺ macrophage-enriched population in paired wound-tissue samples. Results: Overall treatment success was 68.3% (112/164), and the observed crude cumulative mortality proportion was 21.3% (35/164). Treatment success was higher in the iEGF group than in the control group (95.2% [80/84] vs. 40.0% [32/80], p < 0.001), whereas the observed crude cumulative mortality proportion was lower (2.4% [2/84] vs. 41.3% [33/80], p < 0.001). In the flow-cytometry sub-study (n = 12), CD38⁺ cell proportions within the CD45⁺CD14⁺ macrophage-enriched population increased from 10.8% to 20.3%, whereas CD209⁺ cell proportions increased from 14.5% to 25.7% in paired samples collected before and after the iEGF treatment cycle (both p < 0.001). Conclusions: In this observational cohort of high-risk diabetic foot patients with post-amputation flap necrosis, wound-healing disorders, or tissue defects, iEGF administered as part of a multidisciplinary limb-salvage strategy was associated with higher treatment success, while a lower crude cumulative mortality proportion was also observed in the iEGF group. The mortality difference represents a crude cumulative comparison and should not be interpreted as evidence of a time-adjusted or treatment-associated survival benefit. Given the non-randomized treatment allocation, differences in vascular management and adjunctive therapies, and the potential for residual confounding, these findings should be interpreted as associative rather than causal. The paired tissue substudy demonstrated pre–post changes in CD38+ and CD209+ cell populations; these exploratory findings do not establish macrophage polarization or a causal biological mechanism.

Giriş: Tütün kullanımı, dünya genelinde morbidite ve mortalitenin önde gelen önlenebilir nedenlerinden biridir.1,2 Kardiyovasküler hastalıkların gelişiminde temel bir risk faktörü olan sigaranın, egzersiz kapasitesi ve fiziksel performans üzerinde de olumsuz etkileri olduğu geniş ölçüde gösterilmiştir.3 Bununla birlikte, sportif aktivitelerin sağlıksız davranışları azaltabileceği düşünülmesine rağmen, profesyonel sporcular arasında sigara kullanımının hâlâ belirli bir yaygınlığa sahip olduğu bilinmektedir.1,4 Dalış sporu ise diğer sportif aktivitelerden farklı olarak belirgin hemodinamik değişiklikler, solunumsal adaptasyonlar ve otonom sinir sistemi yanıtları ile karakterizedir. Ayrıca dalışla ilişkili mortalite nedenleri incelendiğinde, kardiyovasküler hastalıkların önde gelen nedenler arasında yer aldığı bildirilmektedir.5 Bu durum, kardiyovasküler risk faktörlerinin dalıcı popülasyonda ayrı bir önem taşıdığını düşündürmektedir. Her ne kadar sporcularda sigara kullanımının genel etkileri kısıtlı sayıda çalışmada incelenmiş olsa da, profesyonel dalıcılarda sigara kullanımının kardiyak performans üzerindeki etkilerini değerlendiren bir çalışmaya literatürde rastlanmamaktadır. Bu bağlamda, dalışın özgün fizyolojik özellikleri göz önünde bulundurulduğunda, sigara kullanımının kardiyovasküler yanıtlar üzerindeki etkisinin araştırılması önemli bir gereklilik olarak ortaya çıkmaktadır. Bu çalışmada, profesyonel tüplü dalıcılarda sigara kullanımının kardiyak efor testi parametreleri üzerindeki etkilerinin incelenmesi amaçlanmıştır Yöntem: Bu retrospektif, kesitsel analitik tasarımlı çalışmaya 1 Ocak 2017 – 1 Ağustos 2025 tarihleri arasında SBÜ Gülhane Eğitim ve Araştırma Hastanesi Sualtı Hekimliği ve Hiperbarik Tıp Kliniğine dalışa uygunluk değerlendirmesi için başvuran profesyonel dalıcılar dahil edilmiştir. Katılımcılar aktif sigara içen ve sigara içmeyen olmak üzere iki gruba ayrılmış, kardiyak efor testi parametreleri karşılaştırılmıştır. Ek olarak, sigara kullanımının bağımsız etkisini değerlendirmek amacıyla yaş, cinsiyet ve vücut kitle indeksi (VKİ) için düzeltilmiş çoklu doğrusal regresyon modelleri oluşturulmuştur. Bulgular: Toplam 61 profesyonel dalıcı çalışmaya dahil edilmiştir. Katılımcıların ortanca yaşı 22 (18–51) yıl olup %93,4’ü erkektir. VKİ ortancası ise 23,7 kg/m² olarak hesaplanmıştır. Katılımcıların hiçbirinde bilinen kronik hastalık veya düzenli ilaç kullanımı saptanmamıştır. Sadece 25 dalıcı (%41) aktif sigara içicisi olarak bildirilmiştir. İstatistiksel analizlerde sigara içen ve içmeyen gruplar arasında yaş, cinsiyet ve VKİ açısından anlamlı fark saptanmamıştır (p > 0,05). Tüm dalıcılarda efor testi sonuçları normal sınırlarda raporlanmıştır. Sigara tüketimine göre efor testi parametreleri karşılaştırıldığında, yalnızca pre-test kalp hızı sigara içenlerde anlamlı olarak daha yüksek bulunmuştur (p = 0,050). Düzeltilmiş regresyon analizinde sigara kullanımının pre-test kalp hızı üzerinde bağımsız ve anlamlı bir etkisi olduğu gösterilmiş; sigara içenlerde istirahat kalp hızının içmeyenlere kıyasla yaklaşık 9 bpm daha yüksek olduğu saptanmıştır (β = 9,164, 95% CI: 0,61–17,72, p = 0,036). Egzersiz kapasitesi, maksimal kalp hızı ve toparlanma kalp hızı (HRR) açısından gruplar arasında anlamlı fark izlenmemiştir (p > 0,05). Sonuç: Bu çalışma, profesyonel dalıcılarda sigara kullanımının esas olarak istirahat kalp hızını artırdığını; ancak egzersiz kapasitesi ve maksimal egzersiz yanıtı üzerinde belirgin bir etkisinin olmadığını göstermektedir. Bulgular, sigaranın genç ve sağlıklı bireylerde erken dönem kardiyovasküler etkilerinin özellikle otonom denge ve istirahat kalp hızı üzerinden izlenebileceğini düşündürmektedir. Dalış gibi kardiyovasküler stresin yüksek olduğu spor dallarında sigara kullanımının takibi ve olası sağlık riskleri hakkında farkındalığın artırılması, özellikle dalıcılarda en sık mortalite nedenlerinden olan kardiyovasküler hastalıkların erken saptanmasına katkı sağlayabilir.

Aims: Given the high risk of treatment-related complications such as hemorrhagic cystitis (HC), avascular necrosis (AVN), and impaired wound healing in patients with hematologic malignancies undergoing intensive therapies, this study aims to evaluate the safety and clinical effectiveness of hyperbaric oxygen therapy (HBOT) as a supportive treatment modality in this vulnerable patient population. Methods: This retrospective cohort study evaluated 20 patients with hematologic malignancies who received HBOT at a tertiary hyperbaric medicine center between 2017 and 2023. Demographic data, HBOT indications, complications, outcomes, and mortality were analyzed. HBOT was administered at 2.4 ATA in either monoplace or multiplace chambers. Results: HBOT indications included AVN (35%), HC (30%), impaired wound healing (25%), sudden sensorineural hearing loss (5%), and central retinal artery occlusion (5%). Median follow-up was 595 days. No serious HBOT-related complications were reported except for a single case of mild barotrauma. No statistically significant association was found between the number of HBOT sessions and mortality or recurrence. Improvements in clinical outcomes were observed in most patients with HC and wound healing problems. Conclusion: HBOT appears to be a feasible and well-tolerated supportive treatment in patients with hematologic malignancies, particularly when administered under strict infection control measures. These findings support further prospective studies to validate its safety and efficacy in this vulnerable population.

Background and Objectives: Hyperbaric oxygen therapy (HBOT) has shown promise in managing complications due to cancer treatments, particularly those related to radiotherapy and surgery. Despite its clinical benefits, concerns persist regarding its potential to influence cancer progression. This study aimed to evaluate the safety and clinical outcomes of HBOT in patients with active or previously treated solid tumors. Methods: A retrospective analysis was conducted on patients with solid tumors who underwent at least five HBOT sessions. Comprehensive data, including patient demographics, cancer type, total number of HBOT sessions, imaging findings, and clinical outcomes (recurrence, metastasis, and mortality), were collected. Descriptive statistics and the relationship between the number of HBOT sessions and long-term cancer outcomes were analyzed. Results: This study included 45 patients (median age: 64 years; 60% male) who received a median of 27 HBOT sessions. At initiation, 27.9% of the patients were classified as cured, 53.5% were in remission, and 18.6% had active cancer. Over a median follow-up period of 783 days, 8.7% experienced recurrence, 2.7% had persistent active cancer, and 59.5% had no recurrence. No HBOT-related complications were observed during the course of HBOT. Statistical analyses revealed no significant correlations between the number of HBOT sessions and metastasis (p = 0.213) or mortality (p = 0.881). Conclusions: HBOT appears to be a safe and effective adjunctive therapy for managing complications in patients with solid tumors. No evidence was found to suggest HBOT contributes to tumor progression, recurrence, or metastasis. Future prospective studies with larger cohorts are needed to confirm these results and further evaluate the therapeutic role of HBOT in oncology.

In our study, we aimed to investigate the knowledge, attitude, and behavior of physicians toward hyperbaric oxygen therapy (HBOT). Our study is a cross-sectional study. We included a total of 251 physicians, consisting of Family Medical Specialists, residents of Family Medicine Residency program, contracted residents of Family Medicine Residency program (residents who work actively in primary health units and matched with Family Medicine residency program) and General Practitioners (non-specialized family physicians) working in Ankara, between the dates 01.04.2021 and 26.11.2021. A questionnaire consisting of a total of 51 questions was given to the participants on the internet in order to determine the level of knowledge, attitude and behavior towards HBOT. 251 people, 162 women and 89 men, participated in the study. Of the participants in the study, 137 were residents of the Family Medicine residency program, 57 General practitioners, and 57 Family Medical Specialists. It was observed that 60.2% of the physicians responded with a “no” to the question, “Do you know the indications of HBOT?”. 55% of the physicians did not know about the cost of HBOT therapy. The rate of knowledge of the indication of carbon monoxide poisoning was significantly higher among the physicians who had an HBOT center in their institution (p<0.05). It was observed that 98% of the participants did not know the treatment pressure applied during HBOT, and 97.2% did not know the technique of oxygen administration. While investigating the knowledge, attitudes, and behaviors towards HBOT, we observed that our physicians had some deficiencies, even though they had partial knowledge about it. In our study, we saw that our physicians are aware of their lack of knowledge about HBOT and are open to training on this subject. We think that in order to eliminate this deficiency, a course related to this field can be added to either university curricula or specialist training curricula.

Introduction: We aimed to analyse the outcomes of hyperbaric oxygen treatment (HBOT) and describe difficulties encountered in infants, a rare patient population in this therapeutic intervention, with limited scientific reports. Methods: This was a retrospective analysis of patients 12 months old or younger who underwent HBOT in two different institutions. Demographic data, clinical presentation, HBOT indication, chamber type, oxygen delivery method, total number of treatments, outcome and complications were extracted from clinical records. Results: There were 54 infants in our study. The patients’ median age was 3.5 (range 0–12) months. The major HBOT indication was acute carbon monoxide intoxication (n = 32). A total of 275 HBOT treatments were administered, mostly performed in multiplace chambers (n = 196, 71%). Only one patient (2%) required mechanical ventilation. Acute signs were fully resolved in the most patients (n = 40, 74%). No complications related to HBOT were reported. Conclusions: This study suggests that HBOT may be a safe and effective treatment for infants. Paediatricians should consider HBOT when indicated in infants even for the preterm age group.

Objective: Fournier gangrene is a form of necrotizing fasciitis with high mortality. Hyperbaric oxygen therapy (HBOT) is a successful and supportive treatment option for Fournier’s gangrene (FG). This study aimed to analyze urologists’ knowledge, opinions, and preferences about HBOT application in FG. Material and Methods: An online or face-to-face questionnaire was applied to physicians who are experts in the field of Urology or who have been continuing Urology residency training for at least one year. Results: Ninety urology physicians filled out the questionnaire. Most of them (56.4%) never refer FG cases to HBOT. Physicians (55.3%) mostly preferred HBOT only in patients unresponsive to surgical debridement and antibiotherapy. Besides, 27.3% of them stated they had no information when asked to self-assess their knowledge. Only 12 physicians (13.3%) had previously been in an HBOT center, and 15 (16.7%) physicians had participated in a scientific study on HBOT. Only three physicians (3.4%) stated HBOT was not beneficial to FG patients. Urologists’ opinions about HBOT efficiency in FG were examined (3-point-Likert type questions) in 5 questions; the median score was 2 points (minimum-maximum: 1-3 points). On the other hand, physicians who did not know HBOT had more negative opinions about HBOT efficiency in FG (p = 0.002). Conclusion: Urology physicians’ knowledge of HBOT, their doubts about HBOT in FG, and their relatively low experience with HBOT are clearly shown in this study. Therefore, urology physicians should be encouraged to increase their HBOT experience in FG and participate in scientific studies. Also, Urology Associations should discuss HBOT efficiency more effectively in guidelines and meetings. Keywords: Fournier’s gangrene, hyperbaric oxygenation, questionnaire, urologists

Introduction: Carbon monoxide (CO) poisoning in pregnant women is linked to foetal mortality of 36–67%. This study assessed long-term fetal outcomes following hyperbaric oxygen treatment (HBOT) for acute CO poisoning in pregnant women. The effects of clinical severity parameters and pregnancy trimester were also analysed. Methods: A retrospective review of 28 pregnant patients who received HBOT for acute CO poisoning between January 2013–June 2016 was made. Adverse events, birth week, birth weight-height, birth complications, and the age of crawling, walking independently, talking (first words) of their children were recorded. Results: Twenty-eight singleton pregnancies were included. One fetus was dead before HBOT. Three adverse events were reported: abortion, premature birth, and limb malformation. All remaining patients (n = 24) delivered healthy term infants and reported normal neurophysiological development. At final interview the median age of babies was 34 (8–44) months and none had any diagnosed disease. There was no relationship between clinical severity parameters and long-term outcomes. However, the pregnancy trimester at the time of CO poisoning had a significant relationship to birth weight (P = 0.029). Also, the week of pregnancy at the time of the incident correlated with the age of walking independently (P = 0.043, r = 0.436). Conclusions: This is the largest relevant series and longest follow-up to date. Adverse outcomes were likely incidental because the mothers’ medical histories revealed alternative aetiologies. There was no definite evidence of fetal morbidity or mortality after HBOT in this study. HBOT may improve long-term fetal outcomes after in-utero CO poisoning without complications.

Background: A hyperbaric oxygen (HBO) treatment session carries a high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission since patients stay in a closed area for 2 hours. The primary aim of this study was to evaluate the effects of the preventive measures taken in the HBO centre. Materials and methods: This study evaluated the measures taken during the coronavirus disease 2019 (COVID-19) pandemic for multiplace hyperbaric chamber operated in department (Health Sciences University-Gulhane Research and Training Hospital, Ankara, Turkey) between March 16th, 2020 and December 31st, 2020. The medical records of patients who underwent HBO treatment during this period were evaluated retrospectively. Their demographic attributes, the presence of risk factors, HBO indications, HBO session data, and COVID-19 inquiry forms were analysed. Results: A total of 122 patients underwent HBO treatment, and 150 people were subjected to pressure tolerance test (PTT). No COVID-19 case was treated with HBO in our department. The hyperbaric chamber was operated 608 times in total. Of these, 9.7% (n = 59) procedures were carried out under emergency conditions, and 10% (n = 61) were PTTs. Accordingly, 59.8% (n = 73) of the HBO-treated patients were considered at risk for a severe clinical presentation of SARS-CoV-2. SARS-CoV-2 was detected in 5.7% (n = 7) of the HBO-treated patients during the HBO treatment period. Besides, two inside attendants (14.3%) were diagnosed with COVID-19. There were only two concurrent cases in the same session among SARS-CoV-2 positive cases. The records revealed that these patients were sitting three seats away from each other. Another patient was sitting in between the two infected patients but was not diagnosed with SARS-CoV-2. Conclusions: There is no clear evidence that these two patients infected each other; on the contrary, since no other patient was infected with SARS-CoV-2 in the same session, we may suspect that the infections were coincidental. The measures taken in our department seem to suffice in preventing in-session transmission of COVID-19 and similar infectious diseases in an HBO centre. Background: A hyperbaric oxygen (HBO) treatment session carries a high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission since patients stay in a closed area for 2 hours. The primary aim of this study was to evaluate the effects of the preventive measures taken in the HBO centre. Materials and methods: This study evaluated the measures taken during the coronavirus disease 2019 (COVID-19) pandemic for multiplace hyperbaric chamber operated in department (Health Sciences University-Gulhane Research and Training Hospital, Ankara, Turkey) between March 16th, 2020 and December 31st, 2020. The medical records of patients who underwent HBO treatment during this period were evaluated retrospectively. Their demographic attributes, the presence of risk factors, HBO indications, HBO session data, and COVID-19 inquiry forms were analysed. Results: A total of 122 patients underwent HBO treatment, and 150 people were subjected to pressure tolerance test (PTT). No COVID-19 case was treated with HBO in our department. The hyperbaric chamber was operated 608 times in total. Of these, 9.7% (n = 59) procedures were carried out under emergency conditions, and 10% (n = 61) were PTTs. Accordingly, 59.8% (n = 73) of the HBO-treated patients were considered at risk for a severe clinical presentation of SARS-CoV-2. SARS-CoV-2 was detected in 5.7% (n = 7) of the HBO-treated patients during the HBO treatment period. Besides, two inside attendants (14.3%) were diagnosed with COVID-19. There were only two concurrent cases in the same session among SARS-CoV-2 positive cases. The records revealed that these patients were sitting three seats away from each other. Another patient was sitting in between the two infected patients but was not diagnosed with SARS-CoV-2. Conclusions: There is no clear evidence that these two patients infected each other; on the contrary, since no other patient was infected with SARS-CoV-2 in the same session, we may suspect that the infections were coincidental. The measures taken in our department seem to suffice in preventing in-session transmission of COVID-19 and similar infectious diseases in an HBO centre.