Peripheral Circulatory Disorders Research Articles

The importance of dynamic assessment of type 2 diabetes mellitus and its complications in patients of different age groups and clinical data monitoring

The authors present the results of an analysis of the incidence rates of type 2 diabetes mellitus in the city of Nizhny Novgorod for 2018–2022, and identify the main changes for this period. The paper analyzes the data on the incidence and frequency of complications of type 2 diabetes mellitus with kidney damage, peripheral circulatory disorders, neurological complications, and multiple and unspecified complications, depending on the age and duration of the disease of patient

The Ageing Foot.

Feet suffer significant stress throughout a lifetime and undergo ageing-associated problems due to gradual tissue degeneration affecting the skin, connective tissue, and nerves. Oxygen supply to the tissues may be diminished. The skin gets dry and calluses, ulcers and fungal infections of the skin and nails are not uncommon. Ligaments and tendons degenerate and, without proper prevention, deformities including claw toes, hammer toes, tendonitis, and bursitis may occur. Skeletal toe deformities such as bunions, bony spurs, and hallux valgus may increase discomfort, while stress fractures may have an adverse impact on the patients' quality of life. The ageing foot pathology may add up to common age-related problems, such as crystal deposition arthropathies, diabetes mellitus, peripheral circulatory disorders, and peripheral edema, increasing morbidity. This review summarizes ageing-related feet problems, focusing on prevention and treatment. Foot health has a paramount role in overall wellbeing, therefore prevention, proper foot care, and prompt diagnosis and management of ageing-related changes are vital for maintaining a healthy, active status.

An Overview of the Treatment Strategies of Extremities Ischemia in the Intensive Care Unit.

To investigate the effect of the peripheral block on peripheral ischemia on the extremities of patients in the intensive care unit (ICU). Sixty-two patients with ischemic peripheral vascular disease were divided retrospectively into two groups; Group 1 (patients who underwent USG-guided infraclavicular or femoral block, n=20) and Group 2 (patients who did not experience any block, n=42). The demographic characteristics of the patients, the diagnosis of hospitalization, the day when the circulatory disorder developed, laboratory tests at the time of diagnosis, other medical treatments applied, presence of inotropic support, the response of ischemia on extremities, amputation, duration of hospital stay, discharge and mortality were compared. The most common reason for hospitalization was cerebrovascular disease. There was no statistical difference between the groups regarding age, gender, height, body weight, and diagnosis. There was no statistical difference between the groups regarding hematocrit, lactate, creatinine, and albumin values, the day when the peripheral ischemia developed in extremities, inotropic and prednisolone use, presence of cannulation, length of hospital stays, and mortality. The number of patients discharged from the intensive care unit in Group 1 was significantly higher than in Group 2 (p=0.048). Amputation was performed on one patient in Group 1 and two patientsin Group 2. There was a decrease in peripheral ischemia in 14 (70%) of the patients in Group 1 and 25 (59.5%) of the patients in Group 2. Targeted peripheral block techniques for peripheral circulatory disorders for selected ICU patients in conjunction with preventive and medical treatments may decrease peripheral ischemia in extremities and increase ICU discharge.

The Impact of Controlled Physical Training with Hydrotherapy on Changes in Swelling and Claudication Distance in Patients with Atherosclerotic Ischemia of the Lower Limbs

Patients with peripheral artery disease (PAD) often experience intermittent claudication. It is manifested by pain typically seen in the distal part of the legs during walking, which impairs the ability to walk, limits physical activity and results in lower health-related quality of life. It often leads to chronic ischemic pain, ulceration and even amputation. The aim of the study was to evaluate the effect of controlled physical training and whirlpool massage on changes in circuits, range of motion and distance of claudication in people with atherosclerotic ischemia of the lower limbs. The study included 100 patients, males and females aged 39 to 79 years, with peripheral circulation disorders of the lower limbs. The subjects were randomly divided into two groups. Group I (G) was treated with a series of 10 lower-limb whirling massages and took part in individually planned training, including breathing, relaxation and active free lower-limb exercises. Group II-control group (GC) took part only in individually planned training. Prior to the treatment procedures and after their completion, the ranges of movement of the ankle joint and the circumference of the lower limbs were measured and the corridor test (6MWT, six-minute walk test) was performed. Statistically significant reduction in the circumference of the foot, ankle, calf and thigh in the G group was noticed. Both, in G and in GC group, a statistically significant increase in the range of dorsiflexion of the foot was found in comparison to the period before the procedures (p = 0.010; p = 0.006, respectively). There was also a statistically significant increase in the range of motion of the plantar flexion of the foot after the procedures in G (p = 0.007) and in GC (p = 0.048). Differences in the circumference of the lower limbs and the range of ankle joint movements between the study group and the control group before and after the therapy were not statistically significant. However, there was a statistically significant difference between these groups after the procedures in the 6-min walk test-significantly higher values of 6MWT were recorded in group G (p = 0.003). Individually planned training, supplemented with hydrotherapy as thermal therapy, has a beneficial effect on reducing swelling of the lower limbs, increasing the range of foot movements and extending the distance in the 6-min walk test.

Pathophysiological justification of acupuncture in the treatment of traumatic diseases of the musculoskeletal system (literature review)

The main pathogenetic mechanisms of the development of a traumatic disease of the musculoskeletal system are peripheral circulation disorder, hypoxia, and inflammation, which is accompanied by the development of pain. Pain management is a primary component in helping patients with various injuries. The activation of sanogenetic reactions is also crucial in accelerating the processes of damaged tissues regeneration. A scientific search on the impact of acupuncture on typical pathophysiological processes of traumatic disease was conducted in the Medline and Google Scholar databases. The analysis of scientific journal articles showed that despite the ambiguous attitude to acupuncture, the effectiveness of the method is quite high. Acupuncture is a branch of complementary medicine that has been used for thousands of years. Scientific research in recent decades has established a positive therapeutic effect on various links of pathogenesis through the implementation of the main mechanisms of acupuncture, at the segmental, suprasegmental and cortical levels, manifested in the form of neurohumoral and neuroimmune reactions. The presented literature review directs researchers to further study the possibilities of acupuncture in the treatment of traumatic diseases of the musculoskeletal system from the standpoint of evidence-based medicine.

Prominent D‐dimer elevation and pretibial edema related to alemtuzumab treatment: A case report and literature review

Alemtuzumab is one of the most effective agents in the treatment of multiple sclerosis (MS). On the other hand, the spectrum of possible side effects is wide and carries the potential to cause a variety of inflammatory and thrombotic complications. In this report firstly, a case who developed a systemic thrombotic and inflammatory response after alemtuzumab administration and then presented with pretibial edema in a period of 1 month is discussed. Then, based on the findings detected via this case, the possible side effects of alemtuzumab, both during drug infusion and in the early and late periods after administration, were classified. This classification was created by compiling the reported adverse effects in the literature related to the use of alemtuzumab for the treatment of multiple sclerosis. This presented case shows that prothrombotic predisposition after alemtuzumab administration may result in peripheral microvascular circulatory disorders even in the long term and one of them is pretibial edema. According to the current literature data, side effects of alemtuzumab treatment which is used for multiple sclerosis are categorized as follows: (i) infusion-related reactions, (ii) acute/subacute inflammatory and pro-thrombotic effects, (iii) immunosuppression-related opportunistic infections, (iv) immune reconstitution-related secondary autoimmune disorders. Increasing awareness of the possible side effects of alemtuzumab treatment used in the course of multiple sclerosis will enable both the development of possible prophylactic treatment options and the early control of emerging complications.

PECULIARITIES OF THE REHABILITATION PROGRAM IN ELDERLY PATIENTS IN THE POST-OPERATIVE PERIOD WITH ACUTE CALCULOUS CHOLECYSTITIS

Currently, the elderly and senile account for 10 to 25% of all hospitalized for acute calculous cholecystitis.
 High operative-anesthetic risk, concomitant diseases and low resistance to surgical trauma are the cause of high frequency of postoperative complications and fatalities in this category of patients. In recent years, a reduction in postoperative mortality in acute cholecystitis, which is currently 0.28-2.9%, with gangrenous cholecystitis, it is higher to 17.8%.
 The aim of the study is to analyze and develop a rehabilitation program in the postoperative period in elderly and senile patients after surgery with acute calculous cholecystitis.
 Materials and methods We conducted an analysis of surgical treatment of 53 elderly and senile patients with acute calculous cholecystitis. In all patients, this diagnosis was confirmed intraoperatively and histologically.
 The age of all patients ranged from 61 to 89 years (mean 72.4 ± 8.7 years). Among the examined sick men there were 12 (22.6%), women - 41 (77.4%).
 The main criteria for assessing and creating a rehabilitation program in patients after surgery with acute calculous cholecystitis were the following processes: improving the general condition of patients, restoring intestinal motility, restoring or improving all impaired cardiovascular and respiratory functions, prevention of general complications (cardiovascular, respiratory, urinary, digestive and other systems), local (from the wound), normalization of blood parameters, One of the important components of successful surgical treatment of patients in the postoperative period is the timely restoration of respiratory, cardiovascular, digestive system after surgery. a guarantee of prevention of probable postoperative complications which are formed in the first 3-5 days after surgery.
 Objectives of the rehabilitation program in the early postoperative period in elderly and senile patients with acute calculous cholecystitis: to reduce the impact of drugs and accelerate the excretion of toxic substances from the body; restore adequate respiration and oxygen saturation; improve external respiration function, bronchial patency and bronchial drainage function; stabilize central hemodynamics to reduce peripheral circulatory disorders; prevent complications from the gastrointestinal tract, thromboembolic complications; prevent complications from the postoperative wound.
 Conclusions:
 
 Development of a rehabilitation program is a mandatory component in operated patients.
 Particular attention is paid to elderly and senile patients, who require a set of rehabilitation measures to be minimal, but sufficient to restore lost or reduced body functions in the early postoperative period, but at the same time, it should not exceed the patient's capabilities and ensure maximum efficiency. restoration.
 Start a rehabilitation program (breathing exercises, kinesiotherapy, massage, inhalation in combination with physiotherapy procedures) should be 12 - 16 hours after surgery.
 
 Prospects for further development Continue to develop a rehabilitation program for elderly and senile patients, taking into account the functional capabilities of the body in the long period of rehabilitation.

The role of peripheral circulation disorders in the development of diabetic myopathy in children with diabetes mellitus

Abstract. The significance and role of peripheral blood circulation sufficiency in the formation of disorders of the muscular system in children with diabetes mellitus remain insufficiently studied. At the same time, the formation of some chronic complications of diabetes is associated with a deficient muscular system function. Aim of study. To discover the state of blood supply to the lower extremities in children with type 1 diabetes mellitus, according to the ankle-brachial index and to determine the value of deviations in the development of diabetic myopathy. Materials and methods. We examined 137 children with type 1 diabetes mellitus. The control group included 41 apparently healthy children. Assessment of the functional state of skeletal muscles, determination of the skeletal muscle index, hand force index and ankle-brachial index before and after exercise were studied in all patients. The ROC analysis was used to calculate cut-off points for the hand force index and the skeletal muscle index in order to determine the diagnostic criteria for dynapenia and diabetic myopathy. Results. We observed functional disorders of skeletal muscles and a decrease in the skeletal muscle index already in the first year of diabetes mellitus. In dynamics, the progression of violations was noted. Found a negative correlation between the level of glycated hemoglobin and the skeletal muscle index (r = -0.49, p <0.05), and muscle strength (r = -0.31, p <0.05), and a positive correlation with the index percentage of body fat (r = + 0.49, p <0.05). Dinapenia was diagnosed in 68 (49.6%) children with type 1 diabetes mellitus. Diabetic myopathy was established in 37 (27.0%) patients. Changes in skeletal muscles in children with diabetes mellitus were accompanied by a deterioration in peripheral blood supply. This was supported by a decrease in the ankle-brachial index at rest and more significantly after exercise. The worst results were obtained in the group of children with diabetic myopathy. Conclusions.1. We discovered impairment in the functional state of skeletal muscles and a decrease in muscle mass in the form of dynapenia (49.6% of cases) and diabetic myopathy (27.0% of cases) in children with diabetes mellitus, taking into account the increase in the duration of the course of the disease and the insufficient state of glycemic control. 2. Impairment of peripheral circulation is one of the factors in the development of diabetic myopathy in children with type 1 diabetes mellitus. 3. The study of the ankle-brachial index after dosed physical activity can be used to diagnose latent disorders of peripheral blood supply. We can use the definition of the ankle-brachial index as a screening for children with type 1 diabetes mellitus.

Microcirculation and tissue oxygenation in the head and limbs during hyperbaric oxygen treatment.

Hyperbaric oxygen (HBO) exposure for 10-15 min has been shown to reduce peripheral blood flow due to vasoconstriction. However, the relationship between decreased peripheral blood flow and the therapeutic effects of HBO treatment on peripheral circulatory disorders remain unknown. Longer exposures have been reported to have vasodilatory effects and increase peripheral blood flow. This study investigated the effect of HBO treatment on blood flow and transcutaneous oxygen pressure (TcPO2). Twenty healthy volunteers aged 20-65 years (nine males) participated in this study. All participants breathed oxygen for 60 min at 253.3 kPa. Peripheral blood flow using laser Doppler flowmetry and TcPO2 on the ear, hand, and foot were continuously measured from pre-HBO exposure to 10 min post-exposure. Peripheral blood flow in each body part decreased by 7-23% at the beginning of the HBO exposure, followed by a slow increase. Post-exposure, peripheral blood flow increased 4-76% in each body part. TcPO2 increased by 840-1,513% during the exposure period, and remained elevated for at least 10 min after the exposure. The findings of the current study suggest vasoconstriction during HBO treatment is transient, and even when present does not inhibit the development of increased tissue oxygen partial pressure. These findings are relevant to studies investigating changes in peripheral blood flow during HBO treatment in patients with circulatory disorders.

A systematic review of cardiovascular risk factors in patients with traumatic spinal cord injury.

Objective: The main risk factors for cardiac events, and particularly for the development of atherosclerosis, are diabetes mellitus, arterial hypertension, dyslipidemia and smoking. Patients with a traumatic spinal cord injury (SCI) may present with autonomic nervous system dysfunction depending on their level of spinal cord injury. Studies have found a rise in cardiovascular mortality. A systematic review was conducted that focused on this patient group's predisposition to vascular risk. Methods: We performed a PubMed and Cochrane database search. After applying specific search criteria, 42 articles were included in our analysis out of a total of 10,784 matches. The articles were selected with the aim of establishing cardiovascular risk factors in patients with traumatic spinal cord injury. Results: Patients with SCI are at an increased risk for peripheral artery disease even in the absence of cardiovascular risk factors. Major vascular changes to the arteries of patients with SCI include: a reduction in lumen size, increased vessel wall tension, higher vascular stiffness, an impaired reactive hyperemic response, and a lack of reduced vascular resistance. The findings for carotid atherosclerosis were inconclusive. This group of patients also has a higher disposition for diabetes mellitus, lipid metabolism disorders and coronary artery disease. Paraplegics are more likely to suffer from dyslipidemia, obesity and PAD, while tetraplegics are more likely to have diabetes mellitus. Conclusions: Patients with SCI are more likely to have cardiovascular risk factors and have cardiovascular disease compared to the normal population. Peripheral circulatory disorders are particularly common. Patients with SCI are now considered to be a new risk group for cardiovascular disease; however, large epidemiological studies are needed to verify in more detail the cardiovascular risk profile of this patient group.

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Актуальные вопросы инфекции мочевой системы у детей раннего возраста

В статье приведены современные взгляды зарубежных авторов на вопросы распространенности, этиологии и патогенеза, диагностики, лечения и профилактики инфекции мочевой системы (ИМС) у детей раннего возраста (0–3 года). Речь идет о том, что ИМС остается наиболее распространенной инфекцией у детей до 2 лет и занимает 2–3-е место среди всех инфекций детского возраста. ИМС остается глобальной проблемой педиатрии. Диагностика заболевания у детей первых 3 лет жизни не является простым вопросом. Так, в неонатальном периоде симптомы и признаки ИМС неспецифические: температурная нестабильность, нарушение периферического кровообращения, летаргия, раздражительность, апноэ, анорексия, плохое сосание, рвота, длительная желтуха и др. Мочевой синдром у таких детей встречается редко, но считается более специфичным. У новорожденных с ИМС существует высокая вероятность бактериемии, что свидетельствует об актуальности гематогенного пути распространения инфекции. Доказано, что дети с функциональной или анатомической патологией органов мочевой системы, с иммунодефицитом подвержены ИМС. Акцентированы важность своевременной диагностики заболевания и риск факторов ее реализации. В этом смысле имеет значение разработка неинвазивных методов и устройств для сбора мочи у детей с максимально исключенным риском загрязнения образца. Существует насущная необходимость в выявлении более специфических биомаркеров для повышения точности и скорости диагностики ИМС, в современных бактериологических методах культуральной идентификации. Проводится апробация новых неинвазивных методов исследования, таких как МРТ без контраста и ультразвуковая допплеровская методика для тканевой и микрососудистой визуализации соответственно. Некоторые аспекты ИМС остаются дискутабельными. К ним относятся вопросы естественного развития заболевания, оптимальные варианты антибактериального режима, профилактического ведения пациента и др. В последнее время во всем мире устойчивость к противомикробным препаратам возрастает по мере появления организмов, продуцирующих бета-лактамазу с расширенным спектром. Так что следует использовать антибиотик наименее широкого спектра действия с учетом данных локальной чувствительности. Рекуррентная ИМС обычно не приводит к образованию рубцов на почках у детей без структурной почечной аномалии. Таким образом, учитывая побочные эффекты и появление резистентности, рутинная антимикробная профилактика редко оправдывается. В этом смысле уместным становится изучение новых вакцинных композиций и составов для лечения рекуррентной ИМС, в том числе у детей младшего возраста.

Incidence of Proliferative Diabetic Retinopathy and Other Neovascular Sequelae at 5 Years Following Diagnosis of Type 2 Diabetes.

To determine the incidence and risk factors for developing proliferative diabetic retinopathy (PDR), tractional retinal detachment (TRD), and neovascular glaucoma (NVG) at 5 years after the initial diagnosis of type 2 diabetes. Insured patients aged ≥18 years with newly diagnosed type 2 diabetes and 5 years of continuous enrollment were identified from a nationwide commercial claims database containing data from 2007 to 2015. The incidences of PDR, TRD, and NVG were computed at 5 years following the index diagnosis of type 2 diabetes. Associations between these outcomes and demographic, socioeconomic, and medical factors were tested with multivariable logistic regression. At 5 years following the initial diagnosis of type 2 diabetes, 1.74% (1,249 of 71,817) of patients had developed PDR, 0.25% of patients had developed TRD, and 0.14% of patients had developed NVG. Insulin use (odds ratio [OR] 3.59, 95% CI 3.16-4.08), maximum HbA1c >9% or >75 mmol/mol (OR 2.10, 95% CI 1.54-2.69), renal disease (OR 2.68, 95% CI 2.09-3.42), peripheral circulatory disorders (OR 1.88, 95% CI 1.25-2.83), neurological disease (OR 1.62, 95% CI 1.24-2.11), and older age (age 65-74 years) at diagnosis (OR 1.62, 95% CI 1.28-2.03) were identified as risk factors for development of PDR at 5 years. Young age (age 18-23 years) at diagnosis (OR 0.46, 95% CI 0.29-0.74), Medicare insurance (OR 0.60, 95% CI 0.70-0.76), morbid obesity (OR 0.72, 95% CI 0.59-0.87), and smoking (OR 0.84, 95% CI 0.70-1.00) were identified as protective factors. A subset of patients with type 2 diabetes develop PDR and other neovascular sequelae within the first 5 years following the diagnosis with type 2 diabetes. These patients may benefit from increased efforts for screening and early intervention.

The Effect of Buerger Allen Exercise on The Lower Extremity Peripheral Circulation in Type 2 Diabetic Patients

Prolonged elevated blood glucose levels leads to chronic microvascular complications, neuropathy complications and lower extremity peripheral circulation disorders. Actions that can be taken care in non-pharmacological that is Buerger Allen exercise.To determine the effect of Buerger Allen Exercise in lower limb peripheral circulation in diabetes mellitus patients.Study used a quantitative method with a pre-experimental design using a pre-post test without control group. Sampling technique is non-probability sampling with accidental sampling approach is obtained 5 respondents.The Wilcoxon Signed Rank Test results of the ABI value in the right limb are 0.043 or p <0.05 and the ABI value on the left limb are 0.025 or p <0.05.Buerger Allen Exercise is effective in improving peripheral circulation of the lower extremities and is an alternative for repairing impaired tissue perfusion in diabetic feet. Future research can examine the most appropriate frequency and duration.

Thermal Disparity among Fingers and Its Amelioration by CO2-Water Bathing in Connective Tissue Disease Patients

Objective. Correlation between a low finger temperature and thermal disparity among fingers was studied in connective tissue disease (CTD) patients. Whether the thermal disparity may be ameliorated by hand immersion in a warm carbon dioxide- (CO2-) water bath was analyzed. Methods. CTD patients with suspected peripheral circulation disorder underwent a thermography test. From before to 30 min after hand immersion in CO2-water (CO2 bathing; 1000 ppm CO2, 42°C, 10 min), the nailfold temperatures were measured. The mean temperature (m-Temp) and the coefficient of variation of the temperature ( CV = SD / m ‐ Temp of one hand; the mean of CVs of both hands was adopted as the indicator of thermal disparity) were monitored. The correlation between m-Temp and CV was also analyzed. Results. Forty-seven (45 females and 2 males) patients were included, 32 of whom had Raynaud’s phenomenon. The m-Temp was 30.8 ± 3.0 ° C at the baseline, increased to 35.3 ± 1.0 ° C immediately after CO2 bathing, and remained significantly higher than that at the baseline until 30 min after ( 32.1 ± 1.9 ° C ). The CV was 0.0291 ± 0.0247 at the baseline, decreased to 0.0135 ± 0.0039 immediately after CO2 bathing, and remained significantly lower than the baseline until 30 min after ( 0.0163 ± 0.0143 ). Between m-Temp and CV, a negative correlation was observed throughout the measurements. Conclusion. Thermal disparity was observed at baseline measurement in CTD patients. Warm CO2 bathing markedly ameliorated the disparity, and this amelioration remained until after 30 min. Throughout the observation, the lower the m-Temp, the more severe the thermal disparity among fingers.

Study on the interaction between Clostridium perfringens and the host

Clostridium perfringens type A causes gas gangrene, which is a serious disease caused by wound infection. α-Toxin produced by C. perfringens is known to be the primary pathogenic factor of gas gangrene. Although it has been proposed to induce tissue damage by impairing the host immune system and peripheral circulation, sufficient findings have not been obtained to explain the high virulence of C. perfringens. For the purpose of elucidating the pathogenic mechanism of this bacterium, I focused on the disease progressions such as the bacterial colonization, muscle tissue destruction and repair, and sepsis. In this review, focusing on the action of α-toxin, it will be explained together with the latest research results that the toxin suppresses the activation of the host immune response, represents toxicity to vascular endothelial cells, induces peripheral circulatory disorders due to hematopoietic disorders, inhibits muscle tissue repair, and induces excessive immune response. These mechanisms suggest that α-toxin acts in multiple steps to disrupt host defense and that C. perfringens attacks the host with a highly sophisticated mechanism. It is expected that the onset mechanism of gas gangrene would be elucidated, and I hope that new therapeutic strategies are developed.

Effects of selected herbal supplements in persons with type 2 diabetes

Diabetes mellitus is a metabolic abnormality leading to an increase in the plasma concentration of glucose and is a major cause of stroke and peripheral circulatory disorders. Momordica charantia (MC), commonly known as bitter gourd/Karela, and Trigonella foenum-graecum (TFG) (fenugreek/Methi) have several medicinal values like anti-diabetic, lipid-lowering property, anti-oxidant activity, anti-inflammatory, and anti-mutagenic activity. This is an open-label, four-parallel-group, prospective interventional clinical trial with a total number of 48 patients enrolled in the study and divided into four equal groups (12 in each group) viz; Group I (allopathic drug), Group II (allopathic drug and Karela (MC), Group III (allopathic drug and Methi (TFG) and Group IV (allopathic drug, methi, and karela). Blood sugar and lipid profile were measured at day 0 and day 90. One way ANOVA test was applied to find the significant difference between the groups and Tukey HSD post hoc test was applied for multiple comparisons among the four groups with probability p-value 0.05%. Multiple comparisons by post-hoc analysis between groups on day 90 showed a significant reduction of fasting blood sugar by 19.0% (p = 0.021), postprandial blood sugar by 35.0% (p= 0.001), total serum cholesterol by 14.0% (p= 0.000), serum triglyceride by 21.0% (p=0.000), and serum LDL cholesterol by 17.0% (p= 0.000)ingroup receiving Karela and fenugreek seeds supplementation. Whereas serum HDL cholesterol on the 90th day was higher in the group by 10.0% (p=0.015) receiving only fenugreek seeds as a supplementation. Fenugreek and karela, when given as a supplement, have a beneficial effect on blood sugar and lipid profile.

Tetragonia tetragonoides (Pall.) Kuntze Restores Blood Perfusion from Hind-Limb Ischemic Mice

Tetragonia tetragonoides (Pall.) Kuntze (TTK) is grown for the edible leaves, and can be used as food. And which commonly called Beonhaengcho in Republic of Korea. TTK is found along the seaside of the Jeju-Island and it has long been consumed as a food for women’s health. We investigated the effects of TTK on peripheral circulation disorder during menopausal transition and/or menopause in a hind-limb ischemic (HLI) mouse model. Chemotactic motility and tube formation of vascular epithelial cells were evaluated in human umbilical vein endothelial cells (HUVECs). Female C57BL/6 mice were fed a TTK (150 or 450 mg/kg/day) for four weeks and the rate of blood flow was assessed using a laser Doppler after HLI. TTK treatment significantly increased cell migration and the branch interval value of tubular structure in a dose-dependently. In the TTK treatment group, blood flow rate was significant induced at 7, 14, and 28 days after HLI, compared with the vehicle. TTK treatment also an increase in capillary density, and the highest levels of pERK(1/2), pAkt, pPLCγ1 and pFAK proteins compared to the vehicle control. These results suggest that extract of TTK may ameliorate the blood flow via improvement of peripheral angiogenesis under hind-limb ischemic stress in a menopausal mouse model.

Hyperbaric oxygen therapy may be effective to improve hypoxemia in patients with severe COVID-2019 pneumonia: two case reports

To determine whether hyperbaric oxygen (HBO2) therapy be effective to improve hypoxemia for severe COVID-19 pneumonia patients. Two male patients ages 57 and 64 years old were treated. Each met at least one of the following criteria: shortness of breath; respiratory rate (RR) ≥30 breaths/minute; finger pulse oxygen saturation (SpO2) ≤93% at rest; and oxygen index (P/F ratio: PaO2/FiO2 ≤300 mmHg). Each case excluded any combination with pneumothorax, pulmonary bullae or other absolute contraindications to HBO2. Patients were treated with 1.5 atmospheres absolute HBO2 with an oxygen concentration of more than 95% for 60 minutes per treatment, once a day for one week. Patients' self-reported symptoms, daily mean SpO2 (SO2), arterial blood gas analysis, D-dimer, lymphocyte, cholinesterase (che) and chest CT were conducted and measured. For both patients, dyspnea and shortness of breath were immediately alleviated after the first HBO2 treatment and remarkably relieved after seven days of HBO2 therapy. The RR also decreased daily. Neither patient became critically ill. The decreasing trend of SO2 and P/F ratio was immediately reversed and increased day by day. The lymphocyte count and ratio corresponding to immune function gradually recovered. D-dimer corresponding to peripheral circulation disorders and serum cholinesterase, reflecting liver function had improved. Follow-up chest CT showed that the pulmonary inflammation had clearly subsided. Our preliminary uncontrolled case reports suggest that HBO2 therapy may promptly improve the progressive hypoxemia of patients with COVID-2019 pneumonia. However, the limited sample size and study design preclude a definitive statement about the potential effectiveness of HBO2 therapy to COVID-2019 pneumonia. It requires evaluation in randomized clinical trials in future.

Effect of Foot Exercise and Care on Peripheral Vascular Status in Patients with Diabetes Mellitus

Introduction: Diabetes mellitus is a cause of health problems which occurs in most countries. Approximately 13 - 15% of all patients with diabetes mellitus will experience peripheral circulatory disorders. Foot exercise and foot care are interventions that can be implemented to prevent foot ulcers.Methods: This study employed a pre-post-test quasi-experimental design with a control group. The sample consisted of 94 patients with diabetes mellitus who were assigned to the intervention group (n=47) and the control group (n=47) respectively. Consecutive sampling was used to recruit the samples. The instruments used to collect the data included 10-g monofilament for the diabetic neuropathy test, a HbA1c test and a sphygmomanometer. The collected data was analyzed using a paired t-test.Results: The results of this study showed there to be significant effects from foot exercise and foot care on the HbA1c test, in relation to the frequency of the dorsalis pedis artery and diabetic neuropathy with a significance value of 0.00 (p&lt;0.05). However, in the ankle-brachial index measurement, there were no significant differences between the intervention and control groups with a significance value of 0.26 (p&gt;0.05).Conclusion: Foot exercise and foot care can be one of the independent nursing interventions used to prevent the complications of diabetes mellitus, as they have been proven to improve the peripheral vascular status of patients with diabetes mellitus by 70-80%.