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Expert Review of Respiratory Medicine Nov 2019: Internationally it is estimated that six million people participate in self-contained underwater breathing apparatus (SCUBA) diving each year. Registries suggest a... (Review)
Review
: Internationally it is estimated that six million people participate in self-contained underwater breathing apparatus (SCUBA) diving each year. Registries suggest a significant proportion of divers have a current or historical diagnosis of asthma. Previously individuals with asthma were prohibited from diving, however, several contemporary guidelines suggest a select population of patients with asthma may be able to dive with an acceptable degree of risk. : Divers with asthma may be at an increased risk of a variety of diving-related medical injuries including; pulmonary barotrauma (PBT), pneumothorax, pneumomediastinum, arterial gas embolism (AGE), reduction in pulmonary function, bronchospasm and decompression sickness (DCS). This article will discuss the latest evidence on the incidence of adverse events in diving with a focus on those caused by asthma. : Physicians can be faced with the difficult task of counseling patients with asthma who wish to dive. This review article will aim to explore the current guidelines which can assist a physician in providing a comprehensive dive safety assessment.
Topics: Asthma; Bronchial Spasm; Decompression Sickness; Diving; Humans; Lung Injury; Pneumothorax
PubMed: 31509025
DOI: 10.1080/17476348.2019.1666003 -
Minerva Anestesiologica Oct 2019Our understanding of decompression physiopathology has slowly improved during this last decade and some uncertainties have disappeared. A better understanding of anatomy... (Review)
Review
Our understanding of decompression physiopathology has slowly improved during this last decade and some uncertainties have disappeared. A better understanding of anatomy and functional aspects of patent foramen ovale (PFO) have slowly resulted in a more liberal approach toward the medical fitness to dive for those bearing a PFO. Circulating vascular gas emboli (VGE) are considered the key actors in development of decompression sickness and can be considered as markers of decompression stress indicating induction of pathophysiological processes not necessarily leading to occurrence of disease symptoms. During the last decade, it has appeared possible to influence post-dive VGE by a so-called "preconditioning" as a pre-dive denitrogenation, exercise or some pharmacological agents. In the text we have deeply examined all the scientific evidence about this complicated but challenging theme. Finally, the role of the "normobaric oxygen paradox" has been clarified and it is not surprising that it could be involved in neuroprotection and cardioprotection. However, the best level of inspired oxygen and the exact time frame to achieve optimal effect is still not known. The aim of this paper was to reflect upon the most actual uncertainties and distil out of them a coherent, balanced advice towards the researchers involved in gas-bubbles-related pathologies.
Topics: Decompression Sickness; Diving; Embolism, Air; Foramen Ovale, Patent; Humans; Oxygen Inhalation Therapy
PubMed: 31238641
DOI: 10.23736/S0375-9393.19.13618-8 -
European Journal of Pediatric Surgery :... Apr 2020Our aim is to present the clinical and surgical characteristics of the children affected by the Syrian civil war.
INTRODUCTION
Our aim is to present the clinical and surgical characteristics of the children affected by the Syrian civil war.
MATERIALS AND METHODS
Medical records were reviewed retrospectively for Syrian war victims between the ages of 0 and 18 who were brought to the emergency department of the Education and Research Hospital between March 2011 and March 2019. Each patient was evaluated with respect to demographic data (gender, age), type of injury, history of operations in Syria, injured organ(s), accompanying traumas and the mortality and trauma score.
RESULTS
The majority of our study population of 147 patients were male (108/147, 73.46%), and 39 of the total were girls (26.53%). The mean age of the patients was 9 (7.5 ± 4). The mean age of the girls was 8.5 (range: 7 months to 16 years), and the mean age of the boys was 9.2 (4 months to 17 years). Seventeen patients who had abdominal surgery in Syria were operated on again after clinical and radiological observations. A total of 83 patients were operated on in Turkey. For 66 of those patients, the operation in Turkey was their first surgery on their war injuries. Seventeen patients were operated on in Syria but needed surgery again in Turkey.
CONCLUSION
War affects not only the battlefield, but also the neighboring countries in many aspects such as medical, social, and economic. Hollow organ injuries are the most common intraabdominal pathologies. Delayed intervention is associated with increase mortality and morbidity.
Topics: Adolescent; Blast Injuries; Child; Child, Preschool; Female; Humans; Infant; Injury Severity Score; Male; Retrospective Studies; Syria; Warfare; Wounds, Gunshot
PubMed: 31739348
DOI: 10.1055/s-0039-3400282 -
Annals of African Medicine 2024Hyperbaric therapy is generally considered a safe therapy for the treatment of wounds, mucormycosis, and orthopedic injuries. It is fraught with complications such as... (Review)
Review
Hyperbaric therapy is generally considered a safe therapy for the treatment of wounds, mucormycosis, and orthopedic injuries. It is fraught with complications such as barotrauma, pulmonary toxicity, fire hazards, and claustrophobia. This article discusses the safety protocols and preventive aspects on usefulness of this new emerging therapy.
Topics: Humans; Hyperbaric Oxygenation; Barotrauma
PubMed: 38358163
DOI: 10.4103/aam.aam_16_22 -
Disaster Medicine and Public Health... May 2022To compare injury patterns of different types of explosions.
OBJECTIVE
To compare injury patterns of different types of explosions.
METHODS
A retrospective study of 4508 patients hospitalized due to explosions recorded in the Israel National Trauma Registry between January 1997 and December 2018. The events were divided into 4 groups: terror-related, war-related, civilian intentional explosions, and civilian unintentional explosions. The groups were compared in terms of injuries sustained, utilization of hospital resources, and clinical outcomes.
RESULTS
Civilian intentional and terror-related explosions were found to be similar in most aspects except for factors directly influencing mortality and a larger volume of severely injured body regions among terror-victims. Comparisons between other groups produced some parallels, albeit less consistent. Civilian intentional explosions and civilian unintentional explosions were different from each other in most aspects. The latter group also differed from others by its high volume of life-threatening burns and a higher proportion of children casualties.
CONCLUSIONS
While consistent similarities between explosion casualties exist, especially between victims of intentional civilian and terror-related explosions, the general rule is that clinical experience with a type of explosion cannot be directly transferred to other types.
Topics: Child; Humans; Explosions; Blast Injuries; Retrospective Studies; Terrorism; Injury Severity Score; Israel
PubMed: 35514263
DOI: 10.1017/dmp.2022.118 -
Respiratory Medicine 2023Recent studies suggested that Macklin sign is a predictor of barotrauma in patients with acute respiratory distress syndrome (ARDS). We performed a systematic review to... (Review)
Review
INTRODUCTION
Recent studies suggested that Macklin sign is a predictor of barotrauma in patients with acute respiratory distress syndrome (ARDS). We performed a systematic review to further characterize the clinical role of Macklin.
METHODS
PubMed, Scopus, Cochrane Central Register and Embase were searched for studies reporting data on Macklin. Studies without data on chest CT, pediatric studies, non-human and cadaver studies, case reports and series including <5 patients were excluded. The primary objective was to assess the number of patients with Macklin sign and barotrauma. Secondary objectives were: occurrence of Macklin in different populations, clinical use of Macklin, prognostic impact of Macklin.
RESULTS
Seven studies enrolling 979 patients were included. Macklin was present in 4-22% of COVID-19 patients. It was associated with barotrauma in 124/138 (89.8%) of cases. Macklin sign preceded barotrauma in 65/69 cases (94.2%) 3-8 days in advance. Four studies used Macklin as pathophysiological explanation for barotrauma, two studies as a predictor of barotrauma and one as a decision-making tool. Two studies suggested that Macklin is a strong predictor of barotrauma in ARDS patients and one study used Macklin sign to candidate high-risk ARDS patients to awake extracorporeal membrane oxygenation (ECMO). A possible correlation between Macklin and worse prognosis was suggested in two studies on COVID-19 and blunt chest trauma.
CONCLUSIONS
Increasing evidence suggests that Macklin sign anticipate barotrauma in patients with ARDS and there are initial reports on use of Macklin as a decision-making tool. Further studies investigating the role of Macklin sign in ARDS are justified.
Topics: Humans; Child; Thoracic Injuries; COVID-19; Wounds, Nonpenetrating; Respiratory Distress Syndrome; Barotrauma; Respiration, Artificial
PubMed: 36863617
DOI: 10.1016/j.rmed.2023.107178 -
Diving and Hyperbaric Medicine Sep 2022Dysbarism is a medical condition arising from change in ambient pressure which outpace the rate at which the body adapts to it. We report a case of recurrent dysbarism...
Dysbarism is a medical condition arising from change in ambient pressure which outpace the rate at which the body adapts to it. We report a case of recurrent dysbarism consistent with possible decompression illness presenting with amnesia, hypoaesthesia and other neurological manifestations in a professional breath-hold diver treated successfully with hyperbaric oxygen and fluid resuscitation.
Topics: Amnesia; Barotrauma; Decompression Sickness; Diving; Humans; Hypesthesia
PubMed: 36100933
DOI: 10.28920/dhm52.3.213-216 -
Annals of African Medicine 2022Civilian blast injuries are common during celebrations and festivities. In the intervening times, civilian nonterrorist blast events are rare. The aim of this report is... (Review)
Review
BACKGROUND
Civilian blast injuries are common during celebrations and festivities. In the intervening times, civilian nonterrorist blast events are rare. The aim of this report is to highlight the increasing occurrence of blast injuries to the dominant right hand of hunters and the ensuing crippling consequences.
METHODOLOGY
A review of incidental blast injuries to the hand among hunters was conducted. The case files, clinical photographs, and radiographs of consecutive cases of blast injuries presenting to our unit over 3½ years were studied.
RESULT
Six patients had incidental blast injuries to the hand within the period. All the patients were males and hunters by profession. The age range was 30-49 years. The dominant right hand was involved in all the six cases with high-energy soft tissue and bony injuries. Five patients had staged soft tissue coverage while the sixth patient, after initial resuscitation, discharged against medical advice due to economic constraints. Multiple joint stiffness and significant disability occurred in all the affected hands. None of the patients represented for secondary procedures.
CONCLUSION
Incidental blast injuries to the hands of local hunters are lifestyle threatening. The dominant right hand is invariably involved with attendant crippling socioeconomic consequences. Meticulous clinical care and methodical operative intervention are primal to hand salvage.
Topics: Adult; Africa; Blast Injuries; Female; Humans; Male; Middle Aged; Radiography; Retrospective Studies
PubMed: 36204909
DOI: 10.4103/aam.aam_113_20 -
Computer Methods and Programs in... Nov 2021Bomb blast injuries exerts a shearing force on the air-tissue interfaces, causing devastating ocular injury from the blast wave. Improvised explosive devices (IEDs) are...
BACKGROUND AND OBJECTIVE
Bomb blast injuries exerts a shearing force on the air-tissue interfaces, causing devastating ocular injury from the blast wave. Improvised explosive devices (IEDs) are usually placed at different heights from the ground to induce more severe injury through ground blast reinforcement (GBR). However, there is still a lack of knowledge of the role of GBR and IED height from the ground on ocular biomechanics, and how they can affect the intraocular pressure (IOP) in the eye. This study aimed to estimate the IOP due to frontal IED explosion at different heights from the ground using a fluid-structure interaction model with and without GBR effects.
METHODS
A 2 kg IED was placed within 5 m of the victim at 5 different heights from the ground, including 0, 0.42, 0.85, 1.27, and 1.70 m. Two different blast formulations were used to simulate the IED explosion: (a) spherical airburst, with no amplification of the initial shock wave due to interaction with the ground-surface, and (b) hemispherical surface-burst, where the initial blast wave is immediately reflected and reinforced by the ground (GBR).
RESULTS
Results revealed that the blast wave due to GBR reaches to the skull prior to the IED blast itself. The GBR also reached to the skull ∼ 0.6 ms earlier when the IED was on the ground compared to the height of 1.70 m. The highest and lowest IOPs of ∼ 17,000 and ∼ 15,000 mmHg were observed at the IED heights of 1.70 and 0 m from the ground considering GBR. However, when the role of the GBR is ignored, IOP of ∼ 9,000 mmHg was observed regardless of the IED height from the ground. The deformation in the apex of the cornea was higher when considering the GBR (∼ 0.75 cm) versus no GBR (∼ 0.65 cm). Considering GBR led to higher stresses and strains in the sclera.
CONCLUSIONS
When the role of GBR was ignored, the results showed similar patterns and magnitudes of stresses and deformations in the skull and eye regardless of the height of the IED from the ground, which was not the case when GBR was considered. The findings of this study suggest the critical role of GBR in ocular blast simulations.
Topics: Biomechanical Phenomena; Biophysics; Blast Injuries; Explosions; Eye; Humans
PubMed: 34598082
DOI: 10.1016/j.cmpb.2021.106425 -
Undersea & Hyperbaric Medicine :... 2021Middle ear barotrauma (MEB) is a common complication of hyperbaric oxygen (HBO2) therapy. It has been reported in more than 40% of HBO2 treatments and can interrupt the...
Middle ear barotrauma (MEB) is a common complication of hyperbaric oxygen (HBO2) therapy. It has been reported in more than 40% of HBO2 treatments and can interrupt the sequence of HBO2. MEB may lead to pain, tympanic membrane rupture, and even hearing loss. The aim of this study was to determine if pretreatment with intranasal fluticasone and oxymetazoline affected the incidence of MEB. We conducted a retrospective chart review of subjects undergoing HBO2 at our institution between February 1, 2014, and May 31, 2019. Subjects in the fluticasone/oxymetazoline (FOT) treatment group used intranasal fluticasone 50 mcg two times per day and oxymetazoline 0.05% one spray two times per day beginning 48 hours prior to initial HBO2. Oxymetazoline was discontinued after four days. Fluticasone was continued for the duration of HBO2 therapy. A total of 154 unique subjects underwent 5,683 HBO2 treatments: 39 unique subjects in the FOT group underwent 1,501 HBO2; 115 unique subjects in the nFOT (no oxymetazoline or fluticasone treatment) group underwent 4,182 HBO2 treatments. The incidence of MEB was 15.4% in the FOT group and 16.2% in the nFOT group. This was not a statistically significant difference (OR = 0.77; p = 0.636). Treatment pressure, age over 65 years, male sex, and BMI were not associated with a difference in MEB incidence. In summary, pretreatment with intranasal oxymetazoline and fluticasone in patients undergoing HBO2 did not significantly reduce MEB. More investigation with larger numbers of participants and prospective studies could further clarify this issue.
Topics: Administration, Intranasal; Aged; Anti-Inflammatory Agents; Barotrauma; Drug Administration Schedule; Ear, Middle; Female; Fluticasone; Humans; Hyperbaric Oxygenation; Incidence; Male; Middle Aged; Nasal Decongestants; Nasal Sprays; Oxymetazoline; Retrospective Studies
PubMed: 33975404
DOI: 10.22462/03.04.2021.4