قياس بعض الحركيات الخلوية والمعايير الدموية في مرضى قرحة القدم السكري المعالج بالماء الفائق الأوكسيد

Estimation of Some Cytokines and Haematological Parameters in Diabetic Foot Ulcer Patient’s Treated with Superoxidized Water

Diabetic Foot ulcers (DFU) are a common and important complication
of diabetes mellitus and the most common foot condition leading to lower
extremity amputation. DFU is characterized by delayed healing and this delay
is hypothesized to be a result of dysregulated immunity. Superoxidaized water
(SOW) showed potential to cure DFU in relatively short time. The aim of this
study was to characterize the DFU patients in terms of some blood and
immunological indices and to study the effect of superoxidized treatment on
those indices.
This study includes 58 patients with type 2 diabetes mellitus and have
DFU (43 males and 15 females). This study was performed in Iraq in 2022
AD. Patients attending to Al-Kafeel Super Specialty Hospital in Karbala and
private clinic in the period extending from 9 April 2021 to 6 September 2021.
All patients were diagnosed with diabetic Foot ulcer based on clinical
diagnosis and X-ray by specialists. In this study diabetic Foot ulcer patients
had visited the clinic regularly and received regular treatment by
Superoxidized water. Of the 58 patients, 26 patients had results before and
after treatment, out of those 26 patients, who received treatment with SOW
24 had recovered completely and only 2 did not recover.
The demographic and clinical data were collected from patients and /or
their families through a questionnaire. Sera and whole blood were collected
from each participant noting that the sera were used to determine serum IL1β, IL-17 and TGF-β levels for all samples, while whole blood was used for
complete blood count, glycosylated haemoglobin and C-reactive protein and
the data were statistically analysed by software SPSS version 25.Most of the patients (79.3%) were above the age of 50 years and most
of them (74.1%) were male. Most of the patients (93.1%) had poor glycaemic
control.
These results indicate that DFU is largely of older male patients with
poor glycaemic control. Regarding the characteristics of ulcers, most of
patients (81%) had ulcers for more than 20 weeks’ duration. Most of the ulcers
(65.5%) associated with swollen feet and the area of ulcers in most of the
patients (69%) were equal or less then15cm2
. Most of the patients (87. 9%)
present with single ulcers and ulcers were new (72.4%) were painless (79.3%)
and non-bleeding (62.1%).
This study showed an increase in both total WBCs counts and
neutrophils counts in ulcer patients with bone involvement (13.9×103
cell/mm2
, 10.19 ×103
cell /mm2
respectively) and ulcers with gangrene
(14.59×103
cell/mm2
, 11.35×103
cell/mm2
respectively) in comparison to
superficial ulcers (7.39 ×103
cell/mm2
and 7.15 ×103
cell/mm2
respectively).
However, the increasing lymphocyte counts were significantly
associated with increasing in the duration of ulcers (p=0.001). Volar site of
ulcers was associated with significant lower haemoglobin and haematocrit in
comparison to dorsal site of ulcers (p=0.025).
Interestingly, ulcers with gangrene were associated with increase in
RBC count (mean= 9.91 ×1012 cell/L). Mean corpuscular haemoglobin
(MCH), mean corpuscular haemoglobin concentration (MCHC) and red cell
distribution width (RDW) are affected by the area of ulcers. Indeed, there was
inverse relation between ulcer area and MCH (p=0.007), MCHC (p=0.025) and RDW (p=0.005). Furthermore, ulcers with bad smell were Significantly
associated increased MCH (p=0.004).
Regarding the platelets indices volar site of ulcers was associated with
lower platelet large cell count (P-LCC) (p=0.038) Interestingly, increasing
ulcer duration was associated with significant increase in platelets count (p=
0.013). Furthermore, higher PCT was associated with presence of multiple
ulcers (p=0.005) and recurrence of the ulcers(p=0.05) In addition presence of
painful ulcer was associated higher mean platelet volume (MPV) (p=0.025).
High levels of HbA1c were found to be associated with increasing in
the ulcer area (p=0.016).
Regarding the correlation of the studied cytokines with the ulcers
characteristics, only IL-1β levels were found to be correlated with depth of
ulcers. In this regard, higher IL-1β levels were significantly increase with the
increase in the depth of ulcer (p=0.049). Regarding the correlations of the
cytokines levels and blood indices, this study reported several significant
associations That could be good subjects for further studies. High IL-1β levels
were significantly associated with low MCHC (p=0.026) but with high levels
of RDW (p=0.052). These results shows That IL-1β has direct effects on
multiple blood indices in DFU patients. on the other hand, a significant
negative correlation was seen in this study between IL-17 levels and HbA1c
concentration.
In this study 26 patients were successfully followed up until the final
outcomes of The treatment by superoxidized water, 24 of them were cured
completely. The data before treatment were compared to that after treatment.In this regard total WBCs counts and neutrophils count were significantly
reduced after the treatments, whereas lymphocytes were significantly
elevated.
Cytokines were also reduced after treatment however this reduction
was only significant in case of IL-1β (p=0.043).
In addition, in this study duration of recovery was reported to be
affected by several factors. Duration of recovery reduced in association with
reduced ulcer duration (p= 0.001) and increase in lymphocyte count
(p=0.001).