Erythropoietin Improves the Healing of Skin Necrosis Resulting From Doxorubicin Extravasation in a Rat Model

AbstractBackgroundDoxorubicin is an antineoplastic agent that causes skin necrosis when extravasated. Various agents have been tried to reduce tissue damage owing to extravasation. Erythropoietin (EPO) is an obligatory growth factor for red blood cells and has beneficial effects on wound healing.ObjectiveThe aim of this study was to test the hypothesis that local EPO injection can prevent and improve healing of necrosis at the doxorubicin injection site in rats.MethodsWe used 31 female Sprague-Dawley rats. The dorsal area of each rat was shaved, and 2 mg of doxorubicin in 0.5 mL saline was injected intradermally. The rats were then divided into 3 groups: control; control with intradermal injection of saline; and treatment, which received an intradermal injection of EPO. EPO in saline was injected into 4 quadrants of the same site where doxorubicin was injected 1 hour before. The rats were monitored and the area of each ulcer was measured. Skin biopsies were excised at the end of 4 weeks using anesthetic pentobarbital. Inflammation, edema, epithelization, neovascularization, necrosis, fibroblast proliferation, and collagen synthesis were evaluated and compared between groups.ResultsThe average areas of the lesions were significantly smaller in the EPO-injected rats (P = 0.03). The histopathologic evaluation revealed that the scores for epithelization, neovascularization, fibroblast proliferation, and collagen synthesis were higher (P < 0.001, P < 0.001, P = 0.002, and P = 0.04, respectively) and the score for necrosis was lower (P < 0.001) in the EPO-injected group than in both the saline-injected and control groups.ConclusionsIn this study using female Sprague-Dawley rats, EPO treatment improved the healing of skin necrosis caused by doxorubicin injection. This finding may lead to a new therapeutic approach for the management of skin necrosis caused by doxorubicin extravasation

The effects of Covid-19 on physical medicine and rehabilitation in Turkey in the first month of pandemic

Objectives: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. Patients and methods: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. Results: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2 +/- 128.5 per week before the pandemic, it significantly decreased to 23.4 +/- 33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7 +/- 39.3 per week to 2.5 +/- 10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. Conclusion: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians

Kikuchi-Fujimoto Disease: A Case Report

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lympadenitis, is an uncommon clinical and patological autolimited feature of bening prognosis that may mimic many other diseases diagnosed chiefly in young adults. It is clinically significant because of possible misdiagnosis of other diseses such as malignant lymphoma or tuberculosis. Thus, an early biopsy is instrumental in making definite diagnosis and preventing unnecessary investigation. We described a case of Kikuchi-Fujimoto disease in a 22-year-old woman who presented with swollen lymph nodes and a fever. A rapid clinical improvement after lymph nodes excisional biopsy was remarkable. No treatment was given, and a full recovery was achived within six weeks. In this case had emphasized the clinical, histologic features, and outcome of Kikuchi-Fujimoto disease