Number 3

10.22462/05.06.2022.15

10.22462/05.06.2022.14

Overactive bladder (OAB) is a disease with symptoms such as feelings of urgency, nocturia, and frequent urination which is usually accompanied by urinary incontinence. We aimed to assess the effect of hyperbaric oxygen (HBO2) therapy on the symptoms of female patients with overactive bladder (OAB). This study is a prospective observational cohort study. The patients were analyzed into two groups. The patients who received HBO2 therapy were in Group 1, and the patients who received mirabegron treatment were in Group 2. The symptom scores and quality of life scores of the patients before and after treatment were recorded and compared. Significant improvement in symptom scores were seen in both groups after treatment compared to baseline. The study included 31 patients in Group 1 and 44 patients in Group 2. The mean changes in the ICIQ-SF, OAB-V8, and IIQ-7 scores in the third month of treatment in Group 1 were -4.12 ± 3.51, −10.70 ± 6.92, and −4.51 ± 2.68, respectively. The corresponding mean score changes in Group 2 were −4.31 ± 3.16, −11.22 ± 5.93, and −3.68 ± 2.67, respectively. The mean changes in all three scores were not significantly different between Groups 1 and 2 (p = 0.81, 0.73, and ..

Divers are regularly exposed to a unique and changing environment that dentists must consider when treating such patients. This review focuses around two case studies encountered in naval dentistry: (i) diving barotrauma (pressure-induced injury related to an air space); and (ii) scuba diving mouthpiece-related oral conditions. Each condition is described by its effect on the oral cavity and in particular the teeth. Then we generally review the latest literature on the different effects of scuba diving on the diver’s head, face and oral regions and emphasize methods of dental disease prevention, diagnostic tools and treatment guidelines. 10.22462/05.06.2022.11

Background: Underwater rugby is a team sport where players try to score points with a negatively buoyant ball while submerged in a swimming pool. Reports of syncope incidents at the Swedish Championships led to us to investigate end-tidal oxygen and carbon dioxide levels during simulated match play.     Methods: Eight male underwater rugby club players of varying experience participated. Repetitive measurements were made while players were defending during simulated match play. Each time a player surfaced they exhaled through a mouthpiece connected to a flow meter and a gas analyzer to measure tidal volume, PETO2 and PETCO2.  Results: Measurements were made over 12 dives, with an average dive duration of 18.5 seconds. The mean maximal PETCO2 across the eight participants was 10.0 kPa (~75 mmHg) (range, 9.1–11.7 [~68–88]). The corresponding mean minimum PETO2 was 7.6 kPa (~57 mmHg) (6.3–10.4 [~47–78)). PETCO2 drifted upward, with the mean upward change from the first to last dive for each participant being +1.8 (~13.5 mmHg) (SD 1.74) kPa. A similar trend for PETO2 was not detected, with a mean change of -0.1 (~0.75 mmHg) (SD 3.79) kPa.  Conclusion: Despite high PETCO2 values that were close to narcotic being recorded, these players seemed to regulate their urge to breathe based on hypoxia rather than hypercapnia. 10.22462/05.06.2022.10

Similar to aviation, diving is performed in an environment in which acute incapacitation may lead to a fatal outcome. In aeromedicine, a pilot is considered “unfit to fly” when the cardiovascular event risk exceeds one percent per annum, the so-called 1% rule. In diving no formal limits to cardiovascular risk have been established. Cardiovascular risk of divers can be calculated using the modified Canadian Cardiovascular Society (CCS) Risk of Harm formula: risk of harm (RH: cardiovascular fatality rate per year during diving: number × 10-5 divers/year) = time diving (TD: number of dives × 10-4) × sudden cardiac incapacitation (SCI: cardiovascular diver event rate per year (number × 10-5/year). The SCI and thus the RH are strongly dependent on age. Using the CCS criterion for RH, 5 × 10-5 divers/year, and considering an average of 25 dives per year per diver, the calculated maximum acceptable SCI is 2%/year, consistent with current practice for dive medical examinations. If the SCI were to exceed 2%/year, a diver could be considered “unfit to dive,” which could particularly benefit older (≥ 50 years) divers, in whom cardiovascular risk factors are often not properly treated. For the prevention of fatal diving accidents due to atherosclerotic cardiovascular ..

Aim: Reports of fatal incidents in recreational scuba divers from carbon monoxide (CO) poisoning are rare. This study aimed to identify scuba fatalities in the Asia-Pacific region caused by breathing-gas contamination to better understand the likely sources of contamination and reduce such preventable deaths.  Methods: A hand search of Project Stickybeak reports, subsequent Australian fatality series reports, and of published New Zealand diving fatality reports and associated data was conducted, as well as key word searches of the National Coronial Information System for scuba fatalities in Australia and New Zealand. Cases identified were matched with the Australasian Diving Safety Foundation diving fatality database. Available reports were examined. Results: Four scuba deaths resulting from CO poisoning were identified from 645 scuba fatalities, including one report from each of Australia, New Zealand, Singapore, and the Maldives. A near-fatal incident was also identified in Indonesia. Two of the fatal incidents and the near-fatal incident involved internal combustion engine exhaust gases from the compressor system or elsewhere entering the air intake. Two deaths likely resulted from combustion within compressor systems.  Conclusions: Scuba fatalities from CO poisoning are uncommon, albeit likely under-reported. Sources of CO include exhaust gases entering the compressor and CO production by pyrolysis or ..

Background: SARs-Cov-2 infections can produce prolonged illness and significant disability. Patients recovering from COVID-19 can have persistent symptoms leading to long-term morbidity. Methods: Six patients with long-lasting (> 30 days) COVID-19 symptoms were treated with hyperbaric oxygen (HBO2) therapy. All patients were assessed for symptoms using the ImPACT questionnaire, a muscle and joint pain scale, and a modified Borg dyspnea scale. Patients were assessed before, during and after HBO2 treatments. Results: All patients saw improvements in the measured symptoms to levels that were the same as pre-infection levels (five of six patients) or had significant improvement in symptoms (one patient).  Conclusions: The results suggest that HBO2 helped to improve symptom scores, reduce the length of time of symptoms, and improved the quality of life. More detailed and randomized studies are needed to confirm the results in this report. 10.22462/05.06.2022.7

Carbon monoxide (CO) inhalation is a common method of suicide. The combination of formic acid with sulfuric acid creates carbon monoxide.  This novel method is described in readily accessible internet-based resources. We present the case of a 35-year-old woman who developed CO toxicity by using this method. It is important for hyperbaric medicine physicians to be aware of this source of CO toxicity. 10.22462/05.06.2022.6

Purpose: To perform a literature review on hyperbaric oxygen (HBO2) therapy as a treatment forexercise-induced muscle damage (EIMD).  Methods: PubMed, Web of Science and Google Scholar were searched for articles related to HBO2therapy as a treatment for exercise-induced muscle damage. Inclusion criteria included HBO2 therapy as the primary intervention to treat EIMD. Articles used in this review ranged from 1995-2021. Conclusion: Current literature on the effectiveness of HBO2 therapy to treat EIMD is mixed. Early and frequent treatments seem to be important factors when it comes to the success of HBO2 therapy. Additional research is needed to determine if HBO2 therapy has potential to treat more severe forms of EIMD and the role HBO2 therapy has on inflammation and satellite cell function after EIMD. 10.22462/05.06.2022.5

Introduction/Background: Interest in carbon monoxide (CO) alarms that are more sensitive than is required for standard residential CO alarms is growing, as reflected by increased marketing of “low-level” alarms capable of measuring CO levels as low as 10 PPM. At the same time, publicity surrounding CO poisoning events among travelers in lodging facilities has stimulated interest in travel CO alarms. We sought to evaluate four low-level alarms that could be used in the home and especially when traveling. Materials/Methods: Two each of four brands of low-level alarms (CO Experts, Forensics, Kidde, and Sensorcon) were acquired by retail purchase and tested. The eight alarms were simultaneously exposed in an environment with a slowly increasing level of CO from indoor burning of charcoal briquets. CO levels displayed on the alarms were recorded once per minute. Activation of preset alerts on the alarms were noted. Finally, alarms were compared for ease of use and features available. Results: All brands of alarms measured CO similarly over the range from 10-120 PPM. All alarms performed as claimed by their manufacturers, both regarding range of CO reported and preset alert activation. Each alerted at CO levels below that required by the Underwriters Laboratories 2034 Standard. Summary/Conclusions: Since all low-level CO alarms ..

Introduction: Few treatments have demonstrated mortality benefits among hospitalized hypoxic COVID-19 patients. We evaluated the use of hyperbaric oxygen (HBO2) therapy as a therapeutic intervention among hospitalized patients with a high oxygen requirement prior to vaccine approval. Methods: We extracted data on patients with COVID-19 hypoxia who required oxygen supplementation ranging from a 6L nasal cannula up to a high-flow nasal cannula at 100% FiO2 at 60L/minute with a 100% non-rebreather mask at 15 L/minute and were eligible for off-label HBO2 therapy from October 2020 to February 2021. We followed the Monitored Emergency use of Unregistered and Investigational Interventions or (MEURI) in conjunction with the consistent re-evaluation of the protocol using the Plan-Do-Study-Act (PDSA) tool [1]. We compared patient characteristics and used Fisher’s exact test and a survival analysis to assess the primary endpoint of inpatient death. Results: HBO2 therapy was offered to 36 patients, of which 24 received treatment and 12 did not receive treatment. Patients who did not receive treatment were significantly older (p < 0.01) and had worse baseline hypoxia (p = 0.06). Three of the 24 (13%) patients who received treatment died compared to six of 12 (50%) patients who did not receive treatment (RR ratio: 0.25, p = 0.04, 95% CI: 0.08 ..

Decompression sickness (DCS) is a known complication of scuba diving. DCS occurs when bubbles are formed as pressure is reduced during and after ascent from a dive, following inert gas uptake during the dive. The bubbles cause inflammation and hypoxia. The definitive treatment for decompression sickness is hyperbaric oxygen therapy. We present a case of a healthy 16-year-old male who presented with decompression sickness and an incidental pulmonary cyst discovered by chest CT, likely congenital. The patient was successfully treated with U.S. Navy Treatment Table 6 (TT6) for his decompression sickness, but he continued to have chest pain, requiring hospitalization and consultation with pediatric pulmonology and cardiothoracic surgery from the cyst. Three years later he complained of chest pain with changes in altitude. Chest CT showed persistence of this cyst, and additional cysts. Case conference with pulmonologists and chest radiologist could not offer a definite etiology without lung biopsy, felt to not be indicated. We believe that the changes in pressure/volumes during the dives and TT6 exacerbated his pulmonary cyst. 10.22462/05.06.2022.2

  Introduction: The International Multicenter Registry for Hyperbaric Oxygen Therapy (International Report Registered Identifier DERR1-10.2196/18857) was established in 2011 to capture outcomes and complications data for both Undersea and Hyperbaric Medical Society (UHMS) approved and selected unapproved hyperbaric oxygen (HBO2) therapy indications.  Methods: A Research Electronic Data Capture (REDCap) template was designed and distributed to all participating centers for prospective data collection. Centers contributed de-identified demographic, treatment, complications, and outcome data. This report provides summary data on sites and enrollment, as well as pre- and post-treatment data on quality of life (EQ-5D-5L questionnaire), head and neck radiationoutcomes, non-healing wounds (Strauss score), and idiopathic sudden sensorineural hearing loss. Data were analyzed mainly using the Wilcoxon signed-rank test.  Results: Twenty-two centers contributed data for 2,880 patients. The most common UHMS-approved indication was delayed radiation injury, followed by enhancement of wound healing, and carbon monoxide poisoning. One hundred and twenty-five patients were treated for non-UHMS approved indications. Quality of life, head and neck radiation symptoms, Strauss wound scores, and hearing were significantly improved after HBO2. Complication rates were low and comparable to previous reports. The registry also offered the ability to analyze factors that affect outcomes, such as smoking and severity of hearing loss.  Discussion: The registry accrues prospective data on ..