Hello swighit,
You have a very broad and complicated question here! I?m going to
address the MRSA first, and please bear with me, as you may know some
of this already!
MRSA is a methicillin resistant form S.aureus formally known as
Staphlococcus aureus or Staph. aureus in medical terminology.(We
commonly call it Staph A as opposed to Staph E (Staph epidermidis)
Staph aureus is actually a common bacteria, found in the nose and skin
of over 25% of the population. ?Staph? actually means ?cluster of
grapes? in Greek, as this is what S. aureaus looks like under the
microscope. ?Aureus? means ?yellow? as this is the color it is when
grown on sheep blood agar, in the lab. S. aureus is often the cause
of the common boil and pimples. The difference in the garden variety
of S. Aureus and the MRSA form, is that the MRSA form, as the name
implies, has become resistant to methicillin. MRSA is commonly
acquired in hospitals and other health care facilities, most commonly
by patients who are very ill, or with open wounds and or drains and
tubing.
You, as far as I can tell from your question, fit into two of the risk
factor categories for contracting MRSA: Being male, and having
diabetes. Other risk factors include being disabled or immobilized,
being on steroid therapy, being immunosuppressed being catheterized,
being malnourished, and having had surgery.
MRSA is highly contagious, so great care should be taken by yourself
or others who are assisting you with the compression wraps. Wearing
disposable gloves is a good idea, followed by a careful hand-washing.
http://www.cdc.gov/ncidod/hip/Aresist/mrsafaq.htm
In this article, published just last week, researchers Avi Shai, MD;
Natalya Bilenko, MD; Rina Ben-Zeev, RN; Sima Halevy, MD, managed a
diabetic leg ulcer study at Soroka University Medical Center in
Beer-Sheba, Israel. They followed patients who had acquired MRSA while
being hospitalized. This article states that incidences of MRSA has
greatly increased during the last 20 years, and has become a major
nosocomial (meaning hospital acquired) infection, worldwide.
Open ulcer wounds, and the secretions that come from them, offer a
banquet table to bacteria. ?The acquired resistance of S. aureus
strains is not limited to methicillin. S. aureus strains, including
MRSA, acquire resistance against other antibiotics, such as
gentamicin, ciprofloxacin, fusidic acid, mupirocin, and vancomycin.?
This study took the following strict infection control measures to
prevent bacterial contamination of leg ulcers such as:
Strict hand washing, with an antibacterial soap
Wearing gloves
Not allowing the patient to place bare feet on the floor, stepping
onto a stool or floor, covered with a clean sheet.
(You may have to fill out a questionnaire to read the entire article)
http://www.medscape.com/viewarticle/481429_print
Another study, by A. Hjerppe, MD; M. Hjerppe, MD; V. Autio, Bsc; R.
Raudasoja, MD; A. Vaalasti, MD, PhD, published 5/6/2004 studied the
effectiveness of a new fibroblasat dermal covering, Dermagraft.
?The objective of this study was to assess the effectiveness of a
tissue-engineered human fibroblast-derived dermal substitute (HDS)
(Dermagraft®, Smith & Nephew Inc., Largo, Florida) in the treatment of
leg ulcers of varying etiologies. The data presented in this case
series represent the results from the treatment of 114 patients with
151 chronic leg ulcers treated with HDS. This study showed that HDS
was effective, well tolerated, and can be used in the treatment of
hard-to-heal chronic ulcers of various origins. The overall reduction
in size of all the ulcers was 63 percent. Especially good results were
obtained in patients with rheumatic ulcers. In conclusion, it can be
stated that HDS has a role in the treatment of leg ulcers of various
origins as part of a comprehensive treatment package. More studies
about cost effectiveness and optimal patient selection are needed.?
?Since most leg ulcers are of venous origin, they can be healed with
compression therapy alone or combined with local treatments. In recent
years, the concept of a clean, moist environment has been widely
accepted in the treatment of leg ulcers. In some cases, however, a
moist environment and compression therapy are not sufficient for the
ulcer to heal, and for these hard-to-heal ulcers, the development of
tissue-engineered products can offer new options for treatment.?
http://www.medscape.com/viewarticle/474586?src=search
Lab Workup:
Your doctor is running the tests you have mentioned to rule out
certain etiologies (causes) and medical processes that may be
contributing to your leg ulcers and subsequent MRSA, such as syphilis,
polyarteritis nodosa, LE (Lupus Erythematosus) and other auto-immune
disorders. Commonly ordered tests would include erythrocyte
sedimentation rate (ESR), antinuclear antibodies (ANA), rapid plasma
regain (RPR), anticardiolipin antibodies, lupus anticoagulant
antithrombin III, protein C, protein S, cryoglobulins, cryofibrinogen,
rheumatoid factor(RA), hepatitis A and C antibodies, or hepatitis B
surface antigen. Your doctor also wants to know is you have an
underlying arterial disease, as then you would not want to use the
compression with arterial ulcers. Compression is absolutely necessary
for treating venous ulcers.
http://www.hosppract.com/issues/2000/02/cebello.htm
Venous ulcers
Patients with venous ulcers may have had bouts of DVT (deep vein
thrombosis) previously, and present with irregularly shaped ulcers
between the ankle and calf (as your are). Swelling and eczema may be
present.
Arterial ulcers
Arterial ulcers, which are well demarcated and dry, are found
commonly on bony areas, such as ankle bones and toes, and are common
in diabetics and smokers.
This Praxis site has some excellent information on the care and causes
of leg ulcers. (Contains some graphic photos)
http://merck.praxis.md/index.asp?page=bpm_viewall&article_id=CPM02DE417&show_banner=no
Immunoglobulins:
You may be referring to Anticardiolipin Antibodies (ACA), IgA, IgG,
IgM when speaking of IgG, IgA, and IgM. These antibodies are increased
during an acute bacterial or viral infection, and do not mean the
patient is at risk. The high values are usually transient, and return
to normal, or are decreased 6-8 weeks later, when retested. Patients
with autoimmune disorders, antiphospholipid antibody syndrome, and
malignancies may show consistently elevated levels. Your IgA and IgG
were high, and as you recuperate, your doctor is expecting them to
decrease.
http://www.labcorp.com/datasets/labcorp/html/chapter/mono/se031400.htm
IgA - (NOT to be confused with anti-IgA) is an antibody, composed of
proteins called globulins, synthesized by white blood cells, that the
body utilizes to protect its mucosal surfaces from disease.
If your IgA result is less than 390 mg/dl (or 3.90 g/L)it *could*
indicate that the liver is not producing enough, or that it is being
destroyed by circulating Anti-IgA.
http://millenova.com/tests/antiiga.asp
A study of Arizona Pima Native American peoples has provided us with
some information on the correlation of Immunoglobulins and diabetes.
?Higher gamma globulin levels predicted risk of diabetes. In
univariate analysis, a 1 SD difference in gamma globulin was
associated with a 20% higher incidence of diabetes in those who were
normal glucose tolerant at baseline?
?Higher fibrinogen and white cell count and lower serum albumin were
all found to predict later type 2 diabetes in a single study . More
recently, a preliminary report has suggested that plasminogen
activator inhibitor-1 (PAI-1) predicts the development of diabetes?
?Immunoglobulin concentrations (of IgA, IgG, and IgM classes) have
previously been reported to be higher in those with
diabetes?Interpretation of these cross-sectional observations is
difficult, as they may be confounded by secondary effects; for
example, diabetes may both increase the likelihood of infection and
alter the immune response.?
http://www.medscape.com/viewarticle/406047?src=search
One thing IgA tells us is the condition of the diabetic kidney.
Patients with IgA nephropathy often have a high cholesterol as well.
In this disorder, IgA becomes deposited in the glomerulus of the
kidney, inhibiting the filtering function of the kidney. This
consition may go symptomless for years, and the first sign is often
the presence of blood in the urine, and swelling of the hands and
feet.
The article recommends lowering protein and cholesterol in the diet
to slow the progress. ?Corticosteroids may suppress the production of
IgA but can have harmful side effects. In preliminary studies, fish
oil supplements containing omega 3 fatty acids also appear to slow the
progression of the kidney disease. A new immunosuppressive agent
called mycophenolate mofetil (MMF) is also being tested.?
http://www.clevelandclinic.org/health/health-info/docs/1200/1207.asp?index=5990
http://www.viahealth.org/disease/urology/iganeph.htm
http://kidney.niddk.nih.gov/kudiseases/pubs/iganephropathy/
IgA Normal Ranges (Your lab may report in mg/dl or g/L (SI units). I
am supplying both here for reference.) Each lab has its own normal
range, so any results presented here are to be considered ?ballpark?
ranges.:
40-390 mg/dl is a normal range for people over 10 years of age.
0.40-3.90 g/L (SI units)
http://www.pathology.med.unc.edu/path/labs/test/i/iga.htm
IgM + IgG
People with kidney disease may present with low levels of IgG, and in
some conditions, high levels of IgM actually suppress the growth of
cells that produce IgG. The fact that your IgG was not low is a good
sign for your kidneys.
A normal range for IgM is 45-250mg/dl.
A normal range for IgG is 650-1500 mg/dL (or 6.5-15 g/L SI units)
http://www.galter.northwestern.edu/reftools/normals.html
For a really detailed explanation of immunoglobulins, this page, from
the National Dairy Council -yes, the milk people!- is complete with a
great illustration.
?The antibodies are divided into 5 classes based on their respective
roles in the immune system. These classes are: IgG, IgE, IgA, IgM, and
IgD. The IgG class of antibodies is the main class of antibodies that
are elicited by immunization or exposure to environmental pathogens.
IgE is involved in allergic reactions. IgA antibodies are thought to
be those present in bodily excretions (saliva, mucus, colostrum etc).
IgM and IgD antibodies function as antigen receptors on lymphocytes
prior to antigen exposure. The latter two classes may have other
functions as well but these are not well described. B-cells kill from
a distance using their ability to produce antibodies while T-cells
kill by direct contact. Some of the B-cells are the so-called memory
cells. They produce soluble immunoglobulin antibodies with a high
degree of recognition specificity. Once programmed to produce an
antibody to a specific antigen they will produce this antibody with a
high degree of fidelity. This is the basis of the immunization
procedures used in infants to protect them from some of the
communicable diseases. When challenged with an antigen, the memory
cell is transformed into short-lived plasma cells. Plasma cells are
protein factories that can produce ~2000 antibody proteins/second
during their brief (5-7 days) lifespan. There are a number of diseases
due to mutations in the genes that encode the many elements of the
immune system. These diseases have been divided into four groups or
types (Table 5). As shown in this table, autoimmune diabetes mellitus
is an example of a Type II immune disease.?
http://www.nationaldairycouncil.org/nutrition/reducing/diabetesMellitus.asp?page=6
http://www.nationaldairycouncil.org/nutrition/reducing/diabetesMellitus.asp?page=7
Cryofibrinogen
Elevated levels of cryofibrinogen are associated with malignancies,
collagen vascular diseases, and thromboembolic disorders, and the
first symptoms to appear are skin necrosis (where the skin is
ulcerated and dying). Cryofibrinogenemia is treated with Stanozolol,
plasmapheresis (which filters out cryofibrinogen), and fibrinolytics
(which break up fibrin clots)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=98410884
?Cryofibrinogen consists of fibrinogen and other substances that
precipitate at cold temperatures. Cryoglobulins are immunoglobulins
that precipitate at cold temperatures. Cryofibrinogenemia or
cryoglobulinemia both can produce cold-induced skin symptoms in the
extremities, ears or nose. Such symptoms include purpura, ulceration,
necrosis, gangrene, bleeding, cold urticaria, bullae, livedo
reticularis, and Raynaud syndrome. In one study, 13% of
cryofibrinogenemia patients had venous and/or arterial thrombosis.
Cryofibrinogenemia can be a primary (essential) condition or it may
arise in association with an underlying condition, such as malignancy,
infection, inflammation, diabetes, pregnancy, scleroderma, or oral
contraceptives. A few familial cases have been reported. Skin biopsies
may show leukocytoclastic vasculitis.?
http://www.mgh.harvard.edu/labmed/lab/coag/handbook/CO001200.htm
According to the following sites, the normal value for cryofibrinogen is negative.
http://etd.paml.com/etd/refrangereport.php
http://www.ohsu.edu/pathology/wardman/testgroups/c.htm
Cryoglobulinemia
?Cryoglobulins are protein complexes which precipitate at temperatures
below normal body temperature (usually 4° C). Patients may suffer
from cold induced precipitation of protein in small, peripheral blood
vessels causing vascular purpura, bleeding, urticaria, Raynaud?s, pain
and cyanosis. Some patients have Essential Mixed Cryoglobinemia that
presents with purpura, arthralgia, weakness, lymphadenopathy,
hepatosplenomegaly, and adrenal failure.?
http://www.mdsdx.com/MDS_Metro_Laboratories/Patients/TestAZ.asp
?In cryoglobulinemia, vascular purpura and petechia, papules which
often occur in rashes, are the most common findings (60-100%) followed
by Raynaud phenomenon (approximately 50%), arthralgias, skin necrosis
including leg ulcers and distal necrosis (11-30% and nephrosis or
nephritis (10-60%). Associated diseases include hepatitis C infection
(HCV),urticarial vasculitis with papular lesions, bilateral forefoot
ischemia, systemic lupus erythematosus (SLE), polyarteritis nodosa
(PAN), Sjögren syndrome and other autoimmune diseases, Kawasaki
syndrome, IgA nephropathy4 and lymphoproliferative disorders.
Peripheral neuropathy is reported in association with all three types
of cryoglobulinemia. Serum concentrations of complement, especially C3
and C4, are commonly decreased in all three types of
cryoglobulinemia.?
http://heartdisease.specialtylabs.com/books/display.asp?id=195
According to the following sites, the normal value for cryoglobulins is negative.
http://etd.paml.com/etd/refrangereport.php
http://www.ohsu.edu/pathology/wardman/testgroups/c.htm
Lupus anticoagulant andanti-B2-glycoprotein
Lupus Anticoagulant Test (Also known as anticardiolipin antibody) is a
way of measuring how long it takes for your blood to clot. The tube
into which your blood is drawn, for this test, is coated with
phospholipids. If your blood contains the antibody, then the blood in
the tub will not clot. Having a positive lupus anticoagulant test does
not automatically mean you have Lupus.
Lupus anticoagulant and anti-B2-gycoprotein make up what are called
?Antiphospholipid antiboies?. These antibodies are associated with DVT
and pulmonary embolisms, heart attack, and numerous venous and
arterial problems. Lupus anticoagulant andanti-B2-glycoprotein
Together spell trouble as they together can be responsible for clots.
In order for the test to be significant, the result must be positive.
A large number of the general population nas a weakly psotivie result,
with little meaning. The complete set of antiphospholipid antibodies
include:
1.anticardiolipin antibodies
2.lupus anticoagulant
3.anti-b2-glycoprotein-I antibodies
4.anti-phosphatidylserine antibodies
5.anti-phosphatidylinositol antibodies
6.anti-phosphatidylethanolamine antibodies
7.anti-prothrombin antibodies
http://www.fvleiden.org/ask/21.html
?One theory is that the antibody itself irritates the blood vessels.
When cells are irritated, phospholipids flip from the inside to the
outside. Another theory is that an infection triggers the lipids on
the inside to flip to the outside of the cell membrane and trap the
antibody. The result of both theories is that a clot forms.?
http://rheumatology.hss.edu/pat/eduPrograms/SLE/antiPhospholipidRev.asp
One study has found that lupus anticoagulant was found in patients
with venous insufficiency and leg ulcerations, more often that in
those without venous problems.
http://www.ingenta.com/isis/searching/ExpandTOC/ingenta?issue=pubinfobike://tandf/sder/2003/00000083/00000004&index=9
Anti-B2-Glycoprotein(Autoantibodies)
?Presence of b2-glycoprotein-I antibodies is an indicator of the
antiphospholipid antibody syndrome. "Phoslip IgM INT" may stand for
"antiphosphatidyl-inositol IgM antibody", which is one of the many
different types of antiphospholipid antibodies. The significance of
anti-phosphatidylinositol antibodies is not known. A weakly positive
level is of questionable significance. Lipoprotein(a) is not
associated with the antiphospholipid antibody syndrome. Elevated
levels are, however, a risk factor for arteriosclerosis, arterial
thrombosis, and possibly venous thrombosis.?
http://www.fvleiden.org/ask/21.html
?High anti-B2-glycoprotein-I antibodies can present a risk factor for
atherosclerosis, but more epidemiological data are required in order
to confirm whether the pro-atherogenic properties of anti-phospholipid
antibodies signifies an independent risk factor for atherosclerosis
and its complications.?
http://www.ingenta.com/isis/searching/Expand/ingenta?pub=infobike://urban/481/2003/00000207/00000001/art00212
VDRL (30-40%) : I?m not sure what you mean about your VDRL as being a
?false positive or 30-40%.? This type of test is generally reported
as positive, weakly positive, or negative. VDRL is almost never run
these days, and has been replaced by the RPR. Many older doctors still
call *any* test for syphilis, a VDRL. What they actually get ins an
RPR. RPR and VDRL tests are intended to be screening tests, as they
are far cheaper and easier to run than the more specific and sensitive
test, FTA-ABS. Some auto-immune diseases can cause a false positive,
but this can easily be confirmed by running an FTA-ABS, which is
specific for syphilis and can discern a false positive from a true
positive.
?Many conditions cause false-positive results with the VDRL and RPR
tests including mycoplasma pneumonia, malaria, acute bacterial and
viral infections, and autoimmune disorders.?
http://www.healthcentral.com/mhc/top/003515.cfm#Normal%20values:
http://my.webmd.com/hw/healthy_sexuality/hw5839.asp
Additional Information:
Antimicrobial dressings, specifically for ulcers/wounds colonized with MRSA
Aquacel Ag from Convatec, a Bristol-Meyers Squibb Company in the UK,
is available in sheets and ribbons, intended to treat diabetic ulcers
with MRSA.
·?Kills a broad spectrum of of wound pathogens in the dressing
including methicillin-resistant Staphylococcus aureus (MRSA) and
vancomycin-resistant Enterococcus (VRE)
·Prevents colonisation in the dressing, killing microorganisms that
can cause infection2
oSilver is continuously available in the dressing while in place
·Provides an effective barrier to bacterial penetration to help reduce infection?
http://www.convatec.com/ag/uk/foot_ulcer/start.htm
If you were interested in ordering this dressing, you will have to use
the US site, found here:
http://www.aquacelag.com/us/leg_ulcer/start.htm
Kerlix A.M.D. Antimicrobial Dressings
· Contains PHMB (Polyhexethylene Biguanide).
· Resist bacterial colonization within the dressing.
· Reduces bacterial penetration through the dressing.
· Broad-spectrum effectiveness provides protection against gram
negative, gram positive and fungi/yeast microorganisms including MRSA
and VRE.
· Limits cross-contamination from patient to patient, patient to
clinician, and patient to the environment.
· Sterile.
http://www.kendallhq.com/KerlixAMD/default.asp
Mutidex Powder
?MULTIDEX Powder can be used on infected and non-infected wounds
including all dermal ulcers, both partial and full thickness, stages
II, III, or IV, (e g, leg ulcers, pressure ulcers, and other exudative
lesions), diabetic ulcers, abdominal wounds, infected wounds,
superficial wounds, donor sites and 2nd degree burns?
http://woundcare.org/newsvol2n2/pr1.htm
Panafil is an excellent product used by hospital staff to treat leg
ulcers. Very graphic photos on this site.
http://www.healthpoint.com/divisions/tm/PanafilCaseStudies.pdf
Biolex Wound Cleanser is a product used in some hospitals to clean and
debride diabetic leg ulcers.
http://www.bardmedical.com/skinwound/woundmgmt/products/biolex.html
Regranex
Certainly not for your entire leg, and you may not need it now, but
Regranex is a wonderful therapy for foot ulcers, and ?holes?. It is
rather pricey,(Around $400/tube) but very effective, and only a very
small amount is needed. I have seen this work "miracles".
http://www.regranex.com/about/about_index.htm
I would check with your doctor before trying anything other than
prescribed therapies, but you might find this quote from one of my
favorite medical sites, eMedicine.com :
?Horse chestnut seed (available in supermarkets and health food
specialty stores) have been shown to expedite healing of venous stasis
ulcers.?
http://www.attract.wales.nhs.uk/question_answers.cfm?question_id=1033
If you?d like to be kept informed of new leg ulcer therapies, you may
want to fill out this form
http://www.woundcare.org/research_web/index.htm
Select a new mattress for your comfort, to relieve pressure on your
legs. Waterbeds, memory foam mattresses or mattress covers, and air
mattresses like the Select comfort/Sleep Number beds will be more
comfortable for you. At the minimum, a pad made of absorbent and soft
material placed under your legs.
?"We used to think waterbeds were the best bed, and for the majority
of individuals, they probably are. They're especially good for people
who have diabetes and can develop ulcers from pressure. But as you get
older, a waterbed doesn't provide adequate support."
Bergin says the memory foam mattress is best for anyone with back pain
or osteoarthritis. The term "memory foam" is often misunderstood. It
doesn't mean the mattress remembers the contours of your body but that
the mattress returns to its original flat plane once you get up.
Memory foam is made of heat and pressure sensitive material that
responds to your body temperature and conforms to near-perfect
pressure, weight distribution, and support.
"It gets as close to weightless sleep as possible," says Bergin. "It
supports the entire body at all the pressure points as though you're
floating. It really is a remarkable discovery. Unfortunately a
high-quality mattress that will last 20 years without being flipped is
high priced, about $1,800 to $2,500."
He recently bought a Tempur-Pedic mattress, which uses the memory foam
developed by NASA. "NASA put it in seats to absorb G-forces so it
doesn't hurt. When G-forces push the astronaut into the seat, the
material gives. We're bombarded by G-forces when we sleep, and memory
foam allows the heavier or denser parts of the body to sink into the
foam.
A number of manufacturers make memory foam mattresses or top
conventional mattresses with a layer of it.
Like foam, air also absorbs rather than resists pressure to provide a
sleeping surface that accepts your body contours and distributes
pressure. Sleep Number and similar beds enable a couple to adjust
firmness on each side of the bed, putting an end to arguments about
how firm a mattress to buy. "Sleeping on air does offer good support,
and if you can adjust the firmness, that's even better"
http://my.webmd.com/content/article/85/98467.htm?action=related_link
If you can afford it, and/or your insurance will help cover the cost,
I?d highly recommend a RIK mattress, manufactured by KCI.
?How is the RIK Mattress different from Gel and Foam Mattresses?
All the KCI RIK products utilize a unique, patented, viscous fluid
called Microflow, which differs from gel and foam in several ways.
Microflow is a proven product based on the fluid technology used in
the wheelchair seating industry for many years. Unlike gel, Microflow
fluid has no memory. Memory is the tendency of a material to return to
its original shape, which can cause additional pressure on the skin.
Foam has memory, gel has memory?fluid does not. Microflow?s unique
consistency allows it to conform to the ?micro? contours of the body,
providing greater immersion. Greater immersion provides better
pressure relief through the distribution of weight/pressure over a
greater surface area. The greater the immersion the better the
pressure relief.?
http://www.kci1.com/products/surfaces/mrs/rikmrs/faq.asp
RIK makes an overlay mattress for $459
http://www.medicalmodalities.com/viewitem.cfm?i=2641
Other mattresses cost in the thousands, but can be rented:
http://www.medicalmodalities.com/viewitem.cfm?i=2635
http://www.medicalmodalities.com/viewitem.cfm?i=2636
http://www.medicalmodalities.com/categories_zoom.cfm?cat=13
Since you state you are searching for a new doctor, why not search for
a good endocrinologist, as opposed to a family physician.
Endocrinologists specialize in disorders such as diabetes, and would
be better suited for treating conditions such as yours. I don?t know
where you live, but is you go to
www.google.com and enter your zip code and endocrinologists, like
this example, but of course substituting your zip code.
27703 + endocrinologists
This should pull up a list of endocrinologists in your area. If you
live in a small town, use the zip code of the nearest larger town. Of
course, this list won?t tell you who the best doctors are, so you may
have to ask nursing personnel you may have come to know and trust
during the course of your care.
You might also try these search terms, using again, your own zip code.
27703 + diabetes specialists
This site charges for information regarding endocrinologists (Or any
doctor, for that matter). You can get a report on up to 20 doctors for
$9.95
Helpful websites:
http://www.ndei.org/
http://www.postgradmed.com/issues/2002/04_02/puzzles_answer.htm
This is an MRSA support web site you may find useful:
http://www.mrsasupport.co.uk/
There you go swighit ,I hope this answer has satisfactorily explained
your question. Remember too, that it would be advantageous to maintain
a very healthy diet, to help your immune system resist the MRSA! S.
aureus loves it when its host is tired and run down!
If any part of my answer is unclear, please request an Answer
Clarification, before rating. This will allow me to assist you
further, if possible. I wish you all the best.
Sincerely,
crabcakes
Search Terms
humoral immune system + diabetes
MRSA
immunological evaluation diabetes II
diabetic leg ulcers
MRSA leg ulcers
Immunoglobulins
Immunogloblulins IgA IgG IgM
Anti B2 Glycoprotein + diabetes |
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