Undersea and Hyperbaric Medicine最新文献

Introduction: Preterm birth may significantly impair the functional and anatomical development of the respiratory system and could be a background for various life-long medical sequelae. Prematurity has been recently connected to changes in hypercapnic reactions at adult age. Altered reactions to pCO₂ in premature-born subjects may impact breath-hold underwater exercises (freediving) results.

Methods: AIDA International provided the list of top-100 rankings freediving athletes for the years 2016- 2021 with their personal best results. Data was collected using a subject questionnaire developed for the study (subject-reporting outcomes).

Period of data collection: March 2022 to June 2022.

Results: Within the sample of divers (n=146), 17.1% (n=25) were born prematurely. 13.7% (n=20) were moderate to late preterm, and 3.4% (n=6) were very preterm. The proportion of the athletes whose birth was premature was 18.1% for females and 16.2% for males. These figures are higher than the standardized estimated mean of the preterm birth rate of 8.5% calculated based on the geographical distribution of our sample. There was no difference in best personal results in freediving between the preterm and full-term elite freedivers.

Conclusions: The proportion of preterm within the elite freedivers is higher than could be estimated for the general population. There is no difference in best personal results between preterm and full-term elite freedivers.

The hip is the most common location for avascular necrosis of the femoral head (AVN), with an estimated incidence in the United States of 10,000 to 20,000 new cases per year. The current standard of care for early disease is core decompression, with bone marrow injections becoming more commonplace. Hyperbaric oxygen enhances oxygen delivery to tissue, promotes an anti-inflammatory and pro-healing environment, and helps initiate angiogenesis. We believe that these properties of HBO₂ make it a unique tool for AVN and applied it in conjunction with the standard of care for our patient.

Renal abscess (RA) is a collection of infective fluid in or around the renal parenchyma. It typically occurs in immunocompromised patients, including those with diabetes mellitus (DM), poor nutritional status, or steroid administration. We herein report a case of RA associated with DM in which hyperbaric oxygen (HBO₂) therapy greatly contributed to the resolution of this disease. The patient was an 85-year-old man with poorly controlled type 2 DM. Contrast-enhanced computed tomography for postoperative follow-up of appendiceal cancer showed a mass lesion with poor contrast enhancement extending from the upper pole of the left kidney to the dorsal side. Therefore, a diagnosis of RA was established. The lesion was percutaneously punctured, and a drainage tube was placed. Antibiotics following sensitivity testing were administered. The catheter was removed six days after its placement. However, pus discharge continued from the catheter removal site, with persistent redness around the wound. Therefore, a lumbotomy incision for abscess drainage was performed on the 49th day. However, the pus discharge persisted, and we decided to perform HBO₂ therapy, expecting decreases in bacterial proliferation, reduction in local edema, and improvement of host defense. HBO₂ therapy for 90 min at two atmospheres absolute was performed ten times. The amount of pus discharge decreased, and redness improved from the fifth day after HBO₂ therapy. One month after starting HBO₂ therapy, the wound was closed, and the pus discharge resolved completely. Four years have passed since the HBO₂ therapy, and there have been no symptomatic or imaging relapses of RA.

Studies suggest that COVID-19 infections may have longer-term and more significant complications, even with mild or absent symptoms. This may predispose divers to pulmonary barotrauma, arterial gas embolisms, and reduced exercise tolerance, and impact physical and cognitive performance during diving. Military diving is physically, physiologically, and psychologically taxing on the individual. This study aims to assess the incidence of complications after COVID-19 infections in a cohort of active military divers and the incidence of diving-related injuries such as decompression sickness and barotrauma following recovery from acute COVID-19 infections. A single-center, retrospective cohort study of complications after COVID-19 infections was done in a cohort of the Republic of Singapore Navy (RSN) Naval Diving Unit (NDU) Divers and involved the collection of retrospective data for 329 military divers who were diagnosed with COVID-19 infection from 25 Mar 2020 and 13 Feb 2023. We found no clinical or subclinical complications after COVID-19 infection in our fully vaccinated, low-risk population of NDU divers after asymptomatic or mild COVID-19 infection. There were also no incidences of diving-related injuries related to COVID-19 after recovery from the acute illness. Based on the study results, it is recommended that all military divers with asymptomatic or mild COVID-19 infections return to military diving activities immediately after recovery from acute COVID-19 infection with resolution of symptoms. As existing guidelines recommend, divers with moderate to critical COVID-19 infection should be reviewed by a diving physician and undergo necessary investigations before returning to military diving.

In clinical management of carbon monoxide (CO) poisoning, serum cardiac enzyme biomarkers and electrocardiogram (ECG) are both highly recommended emergency check-ups to evaluate myocardial injuries. Medical imaging - including head CT or MRI - are not routine for CO poisoning emergency management. We herein report on a comatose patient who was diagnosed with cerebral infarction secondary to 24 hours previous acute CO poisoning, warned by a typical cerebral-type T waves on ECG in advance, and confirmed by a head MRI. Fortunately, the patient made a full recovery based on a timely treatment with medications and hyperbaric oxygen (HBO₂) therapy. We would like to propose that a vital, stable, conscious CO poisoning patient who remains a higher risk for hemorrhagic or ischemic stroke should be closely monitored for potential neurological abnormalities, and a continuous ECG monitoring should be reinforced throughout the treatment. A head MRI or CT is a priority in evaluating the secondary cerebral stroke and should be arranged immediately in the event of an abnormal ECG or if unusual new symptoms are apparent.

World War II was approaching its end in Italy in 1944 when one of the worst train disasters in world history occurred near the small town of Balvano in the Apennine Mountains. The train did not derail or crash into something as in most major train disasters. Instead, it entered a mountainous railway tunnel, and when it emerged, over 500 passengers were dead from carbon monoxide poisoning. The event was not allowed to be publicized for almost two decades. This manuscript reconstructs the story of possibly the most significant incident of carbon monoxide mortality ever recorded.

Background: Diabetes Mellitus is a chronic disease characterized by uncontrolled blood sugar levels, which lead to end-organ damage. While the diagnosis and treatment of its complications have been extensively studied, the effect of Hyperbaric Oxygen Therapy (HBO₂) on diabetes-related oral complications remains unexplored.

Aim: This prospective clinical study aims to investigate the effect of HBO₂ on diabetes-related oral complications.

Methods: Twenty patients diagnosed with diabetic foot ulcers and scheduled for HBO₂ were included in this study. We recorded stimulated and unstimulated saliva pH, buffering capacity, flow rate, and subjective symptoms such as dry mouth, halitosis, taste loss, difficulty swallowing, and clinical examination findings before HBO₂ and after the 21st session.

Results: Upon comparing the findings, we observed a significant decrease in dry mouth and halitosis, periodontal disease severity, and healing of candida-related stomatitis and angular cheilitis. Despite not reaching statistical significance for other saliva parameters, the unstimulated salivary flow rate increased to normal limits (0.3-0.4 ml/min) in 6 out of 8 patients with a flow rate of less than 0.25 ml/min.

Conclusion: Our study investigated the effect of HBO₂ on diabetes-related oral complications for the first time, highlighting symptomatic relief for dry mouth and halitosis. Although our results are insufficient to report a definitive benefit, they underscore the need for further research on the oral health effects of HBO₂.

Work in compressed air and diving are both occupational activities that have been around since the mid-19th century, and those undertaking their work under elevated pressure. Meeting the demand to go to "higher pressure for longer" in tunneling has lagged in diving, but both activities have found it necessary to adopt mixed gas breathing and saturation exposure techniques. This paper explains how work in hyperbaric conditions at high pressure is undertaken in tunneling and is illustrated by the hyperbaric activity likely to be involved in constructing a large-diameter road tunnel below a body of water such as an estuary. It also explores the practical differences between work in compressed air and diving.

Introduction: Increasing cancer survivorship, in part due to new radiation treatments, has created a larger population at risk for delayed complications of treatment. Radiation cystitis continues to occur despite targeted radiation techniques.

Materials and methods: To investigate value-based care applying hyperbaric oxygen (HBO₂) to treat delayed radiation cystitis, we reviewed public-access Medicare data from 3,309 patients from Oct 1, 2014, through Dec 31, 2019. Using novel statistical modeling, we compared cost and clinical effectiveness in a hyperbaric oxygen group to a control group receiving conventional therapies.

Results: Treatment in the hyperbaric group provided a 36% reduction in urinary bleeding, a 78% reduced frequency of blood transfusion for hematuria, a 31% reduction in endoscopic procedures, and fewer hospitalizations when study patients were compared to control. There was a 53% reduction in mortality and reduced unadjusted Medicare costs of $5,059 per patient within the first year after completion of HBO₂ treatment per patient. When at least 40 treatments were provided, cost savings per patient increased to $11,548 for the HBO₂ study group compared to the control group. This represents a 37% reduction in Medicare spending for the HBO₂-treated group. We also validate a dose-response curve effect with a complete course of 40 or more HBO₂ treatments having better clinical outcomes than those treated with fewer treatments.

Conclusion: These data support previous studies that demonstrate clinical benefits now with cost- effectiveness when adjunctive HBO₂ treatments are added to routine interventions. The methodology provides a comparative group selected without bias. It also provides validation of statistical modeling techniques that may be valuable in future analysis, complementary to more traditional methods.

Emergency hyperbaric oxygen treatment capability is limited in the United States, and there is little documentation of calls received by centers available 24 hours a day, seven days a week, 365 days a year. Our study aimed to calculate the number of calls received for urgent hyperbaric oxygen (HBO₂). We logged calls from two HBO₂ chambers on the East Coast of the United States that serve a densely populated region in 2021. The total number of emergency calls was 187 at the University of Maryland (UMD) and 127 at the University of Pennsylvania (UPenn). There were calls on 180/365 (46%) days during the study period at UMD and 239/365 (63%) days at UPenn. The most common indication was carbon monoxide toxicity. The peak month of calls was March. Emergency HBO₂ calls are common, and more centers must accept emergency cases. Data from geographically diverse centers would add generalizability to these results and capture more diving-related emergencies.