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Lambert D, Binkley M, Gaskill Z. Underwater and Scuba Diving Accidents. Emerg Med Clin North Am 2024; 42:551-563. [PMID: 38925774 DOI: 10.1016/j.emc.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
The evaluation and care of an injured scuba diver requires an understanding of the different types of underwater activities that may be deemed scuba diving. Such activities may range from the complex (eg, commercial or technical diving) all the way up to basic recreational scuba or snorkeling. A thorough physical examination should be completed as early as possible with a focus on specific areas at risk for injury and etiology, such as a detailed cardiopulmonary, skin, and neurologic examination. Serial reassessments and supportive care are as equally important as consultation with a dive medicine expert, especially one with hyperbaric capabilities.
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Affiliation(s)
- David Lambert
- Division of Undersea and Hyperbaric Medicine, University of Pennsylvania, 3610 Hamilton Walk, 1 John Morgan Building, Philadelphia, PA 19104, USA.
| | - Mark Binkley
- Division of Undersea and Hyperbaric Medicine, University of Pennsylvania, 3610 Hamilton Walk, 1 John Morgan Building, Philadelphia, PA 19104, USA
| | - Zachary Gaskill
- Division of Undersea and Hyperbaric Medicine, University of Pennsylvania, 3610 Hamilton Walk, 1 John Morgan Building, Philadelphia, PA 19104, USA
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Tello Montoliu A, Olea González A, Pujante Escudero Á, Martínez Del Villar M, de la Guía Galipienso F, Díaz González L, Fernández Olmo R, Freixa-Pamias R, Vivas Balcones D. Cardiovascular considerations on recreational scuba diving. SEC-Clinical Cardiology Association/SEC-Working Group on Sports Cardiology consensus document. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:566-573. [PMID: 38580141 DOI: 10.1016/j.rec.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/11/2024] [Indexed: 04/07/2024]
Abstract
The practice of recreational scuba diving has increased worldwide, with millions of people taking part each year. The aquatic environment is a hostile setting that requires human physiology to adapt by undergoing a series of changes that stress the body. Therefore, physical fitness and control of cardiovascular risk factors are essential for practicing this sport. Medical assessment is not mandatory before participating in this sport and is only required when recommended by a health questionnaire designed for this purpose. However, due to the significance of cardiovascular disease, cardiology consultations are becoming more frequent. The aim of the present consensus document is to describe the cardiovascular physiological changes that occur during diving, focusing on related cardiovascular diseases, their management, and follow-up recommendations. The assessment and follow-up of individuals who practice diving with previous cardiovascular disease are also discussed. This document, endorsed by the Clinical Cardiology Association of the Spanish Society of Cardiology (SEC) and the SEC Working Group on Sports Cardiology of the Association of Preventive Cardiology, aims to assist both cardiologists in evaluating patients, as well as other specialists responsible for assessing individuals' fitness for diving practice.
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Affiliation(s)
- Antonio Tello Montoliu
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain.
| | - Agustín Olea González
- Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain; Jefatura de Apoyo Sanitario de Cartagena, Armada Española, Cartagena, Murcia, Spain
| | - Ángel Pujante Escudero
- Cuerpo de Sanidad, Centro de Buceo de la Armada, Armada Española, Cartagena, Murcia, Spain
| | | | - Fernando de la Guía Galipienso
- Servicio de Cardiología, Policlínica Glorieta Denia, Denia, Alicante, Spain; Clínica Rehabilitación Marina Alta (REMA)/Cardiología Deportiva Denia, Denia, Alicante, Spain; Hospital Clínica Benidorm (HCB), Benidorm, Alicante, Spain
| | - Leonel Díaz González
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain; Clínica CEMTRO, Madrid, Spain
| | | | - Román Freixa-Pamias
- Servicio de Cardiología, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
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Lentz PC, Lim SY, Betzler BK, Miller DD, Dorairaj SK, Ang BCH. A deep dive into hyperbaric environments and intraocular pressure-a systematic review. Front Med (Lausanne) 2024; 11:1365259. [PMID: 38633303 PMCID: PMC11021581 DOI: 10.3389/fmed.2024.1365259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose SCUBA diving exposes participants to a unique hyperbaric environment, but few studies have examined the effects of such an environment on intraocular pressure (IOP) and glaucoma. This systematic review aims to consolidate recent literature findings regarding the impact of increased atmospheric pressure on IOP and glaucoma. Methods Three online databases were searched to identify publications encompassing the subjects of diving or increased atmospheric pressure in conjunction with IOP or glaucoma. Three reviewers independently screened the publications and identified eligible articles. Relevant data was extracted from each article. The heterogeneity of the data precluded the conduct of a meta-analysis. Results Nine studies met the inclusion criteria. Six experimental studies employed hyperbaric chambers to measure IOP under simulated diving conditions. Among these, IOP exhibited a reduction with increased atmospheric pressures in four studies, while the findings of two studies were inconclusive. One study measured IOP pre- and post-dive and another measured IOP with and without a diving mask. Post-dive, a decrease in IOP was observed, and a statistically significant reduction was noted when subjects wore a diving mask. A retrospective study examining the incidence of acute angle closure glaucoma attack found no association with weather or atmospheric pressure. Conclusion The majority of studies found IOP to decrease with increased atmospheric pressure and after diving. The mechanisms underlying this reduction remain incompletely understood, with potential contributors including changes in ocular blood flow, sympathetic responses, and increased oxygenation. Hyperbaric chambers may have potential in future glaucoma treatments, but more studies are required to draw reliable conclusions regarding the safety of diving for glaucoma patients.
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Affiliation(s)
- Paul Connor Lentz
- Mayo Clinic Alix School of Medicine, Jacksonville, FL, United States
| | - Sheng Yang Lim
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Bjorn Kaijun Betzler
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Darby D. Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, United States
| | - Syril K. Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, United States
| | - Bryan Chin Hou Ang
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, United States
- Department of Ophthalmology, Woodlands Health Campus, National Healthcare Group Eye Institute, Singapore, Singapore
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Ostrovska K. Features of diving headache. PAIN MEDICINE 2022. [DOI: 10.31636/pmjua.v6i4.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
WHO estimates that the prevalence of headaches worldwide in the adult population is approximately 50 %. Globally, half to threequarters of people aged 18 to 65 have complained of headaches in the past year, and more than 30 percent have suffered from migraines. At the same time, 1.7 to 4 % of the adult population suffers from headaches that last 15 or more days a month. Undoubtedly, cephalgia constitutes a global problem.However, it is worrying that the causes of headaches are not always correctly diagnosed. The main clinical barrier pointed out by WHO is the lack of knowledge of health professionals about headache management. Thus, the broad coverage of issues related to the management of patients with cephalgia does not lose its relevance, and even more: it needs to be supplemented with current data. In particular, the mechanisms of headache can be associated with several pathophysiological processes that are triggered by the influence of professional activities, specific physical activity, active leisure, or amateur sports.Recreational diving has become a popular form of active leisure for the past 20 years. It is noteworthy that headache is a common symptom in divers and, although it is usually benign, it can sometimes signal the serious consequences of high pressure. Proper diagnostic tactics require specialists to carefully collect the anamnesis and examine the patient, as well as to understand the unique physiological changes in the human body that occur under the influence of underwater environmental factors.
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Xu AL, Suresh KV, Lee RJ. Progress in Cheerleading Safety: Update on the Epidemiology of Cheerleading Injuries Presenting to US Emergency Departments, 2010-2019. Orthop J Sports Med 2021; 9:23259671211038895. [PMID: 34676270 PMCID: PMC8524718 DOI: 10.1177/23259671211038895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/25/2021] [Indexed: 10/29/2022] Open
Abstract
Background Although the athleticism required of cheerleaders has increased, the risks of cheerleading have been less studied as compared with other sports. Purpose To update our understanding of the epidemiology of cheerleading-related injuries. Study Design Descriptive epidemiology study. Methods We analyzed the National Electronic Injury Surveillance System (NEISS) for cheerleading-related injuries presenting to nationally representative emergency departments (EDs) in the United States from January 2010 through December 2019. Extracted data included patient age and sex, injury characteristics (diagnosis, body region injured, time of year, and location where injury occurred), and hospital disposition. Using patient narratives, we recorded the cheerleading skills, settings, and mechanisms that led to injury. NEISS sample weights were used to derive national estimates (NEs) from actual case numbers. Results From 2010 to 2019, a total of 9868 athletes (NE = 350,000; 95% CI, 250,000-450,000) aged 5-25 years presented to US EDs for cheerleading injuries. The annual number of injuries decreased by 15%, from 982 (NE = 35,000; 95% CI, 27,000-44,000) to 897 (NE = 30,000; 95% CI, 18,000-42,000) (P = .048), corresponding to a 27% decline in the injury rate per 100,000 cheerleaders (P < .01). The annual number of injuries caused by performing stunts decreased by 24%, from 240 (NE = 8700; 95% CI, 6700-11,000) to 216 (NE = 6600; 95% CI, 4000-9200) (P = .01), with a 36% decline in the corresponding injury rate per 100,000 cheerleaders (P < .01). Despite these decreases, annual incidence of concussions/closed head injuries increased by 44%, from 128 (NE = 3800; 95% CI, 2900-4700) to 171 (NE = 5500; 95% CI, 3400-7700) (P = .02), and patients requiring hospital admission increased by 118%, from 18 (NE = 330; 95% CI, 250-410) to 24 (NE = 720; 95% CI, 440-1000) (P < .01). The hospital admission rate increased by 9.0% (P = .02). Conclusion The number of cheerleading-related injuries presenting to US EDs decreased from 2010 to 2019. However, the incidence of concussions/closed head injuries and hospital admissions increased, suggesting that further measures are needed to improve safety for cheerleaders.
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Affiliation(s)
- Amy L Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Krishna V Suresh
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Jay Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Tso JV, Powers JM, Kim JH. Cardiovascular considerations for scuba divers. Heart 2021; 108:1084-1089. [PMID: 34670825 DOI: 10.1136/heartjnl-2021-319601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022] Open
Abstract
As the popularity of scuba diving increases internationally, physicians interacting with divers in the clinical setting must be familiar with the cardiovascular stresses and risks inherent to this activity. Scuba presents a formidable cardiovascular challenge by combining unique environmental conditions with the physiologic demands of underwater exercise. Haemodynamic stresses encountered at depth include increased hydrostatic pressure leading to central shifts in plasma volume coupled with cold water stimuli leading to simultaneous parasympathetic and sympathetic autonomic responses. Among older divers and those with underlying cardiovascular risk factors, these physiologic changes increase acute cardiac risks while diving. Additional scuba risks, as a consequence of physical gas laws, include arterial gas emboli and decompression sickness. These pathologies are particularly dangerous with altered sensorium in hostile dive conditions. When present, the appropriate management of patent foramen ovale (PFO) is uncertain, but closure of PFO may reduce the risk of paradoxical gas embolism in divers with a prior history of decompression sickness. Finally, similar to other Masters-level athletes, divers with underlying traditional cardiovascular risk should undergo complete cardiac risk stratification to determine 'fitness-to-dive'. The presence of undertreated coronary artery disease, occult cardiomyopathy, channelopathy and arrhythmias must all be investigated and appropriately treated in order to ensure diver safety. A patient-centred approach facilitating shared decision-making between divers and experienced practitioners should be utilised in the management of prospective scuba divers.
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Affiliation(s)
- Jason V Tso
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joshua M Powers
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan H Kim
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Othman S, Bosco S, Cohn JE, Shokri T, Ducic Y. Dangers beyond drowning: craniomaxillofacial trauma in adult water activities. Oral Maxillofac Surg 2020; 24:441-446. [PMID: 32601833 DOI: 10.1007/s10006-020-00869-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Water recreation is one of the most popular activities for both fitness and leisure. The dangers of water activities have mostly been examined in the context of drowning and general bodily injuries. Despite the existing research, little is known about adult maxillofacial injuries in these settings. METHODS We accessed the National Electronic Injury Surveillance System in order to identify adult patients presenting to emergency departments with traumatic maxillofacial injuries secondary to a water-based sport or activity over the most recent 10-year period (2009-2018). Data collected included demographical information, anatomical location, mechanism of injury, and visit circumstances, as well as visit disposition. RESULTS A total of 1350 total patients were identified as appropriate for study inclusion. Young, Caucasian male adults were the most common age group to present with maxillofacial injuries secondary to water sport activities. Surfing and water skiing were associated with lacerations, while diving board incidents posed a higher fracture risk. Patients participating in all water activities were more likely to be treated and released rather than admitted. CONCLUSION There appears to be a distinct pattern profile for individuals who sustain maxillofacial trauma while participating in water sports: young, Caucasian males in particular. Additionally, specific activities may be associated with varying injury types. The results of this study may increase interest in legislature and patient counseling when seeking such activities.
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Affiliation(s)
- Sammy Othman
- Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA, 19129, USA
| | - Samuel Bosco
- Marian University College of Osteopathic Medicine, 3200 Cold Spring Rd, Indianapolis, IN, 46222, USA
| | - Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, 4190 City Line Avenue, Philadelphia, PA, 19131, USA.
| | - Tom Shokri
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Ave, Fort Worth, TX, 76104, USA
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Kojima Y, Kojima A, Niizeki Y, Yagishita K. Recreational diving-related injury insurance claims among Divers Alert Network Japan members: Retrospective analysis of 321 cases from 2010 to 2014. Diving Hyperb Med 2020; 50:92-97. [PMID: 32557409 DOI: 10.28920/dhm50.2.92-97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/11/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Monitoring trends in diving-related injuries enables implementation of effective safety measures. Divers Alert Network Japan (DAN Japan) membership includes insurance covering recreational diving-related injuries and fatalities. Use of claim data provides both a known denominator and demographic data about injured members. METHODS The study analysed 325 insurance claims reported to DAN Japan from 2010 to 2014. Four fatalities were excluded, leaving 321 claims for analysis. Claimants were divided into three age groups: young adults (< 40 years); middle-aged (40-59 years) and older adults (≥ 60 years). The total injury claims rate (ICR), decompression illness (DCI) rate (DCR) and trauma rate (TCR) were calculated. Differences between the sexes within each age group were analysed. RESULTS The total number of DAN Japan member-years in the period was 80,617, with a mean age of 45 years. Claims were made by 153 males and 168 females with a mean and median age of 46 years. Trauma was the most frequent reason for a claim (113 cases, 35%), followed by DCI (109 cases, 34%). The ICR (per 104 member-years) was 39.8 (95% confidence interval 35.5 to 44.2) and the TCR was 14.0 (11.4 to 16.6). For every age group, the ICR and TCR were significantly higher for females than males. The DCR was 13.5 (11.0 to 16.1) and did not significantly differ between the sexes. CONCLUSIONS The incidence of trauma-related diving injuries exceeds that of claims related to DCI. Females appear to have a higher risk of injury than the general diving population.
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Affiliation(s)
- Yasushi Kojima
- Divers Alert Network Japan (DAN Japan) / Japan Marine Recreation Association, Yokohama, Japan.,Hyperbaric Medical Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan.,Tokio Marine & Nichido Medical Service Co. Ltd., Tokyo, Japan.,Corresponding author: Dr Yasushi Kojima, Divers Alert Network Japan (DAN Japan) / Japan Marine Recreation Association, 4-43 Honcho, Naka-ku, Yokohama-city, Kanagawa 231-0005, Japan,
| | - Akiko Kojima
- Divers Alert Network Japan (DAN Japan) / Japan Marine Recreation Association, Yokohama, Japan
| | - Yumi Niizeki
- Divers Alert Network Japan (DAN Japan) / Japan Marine Recreation Association, Yokohama, Japan.,Hyperbaric Medical Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan.,Department of Orthopaedic Surgery, Soka Municipal Hospital, Saitama, Japan
| | - Kazuyoshi Yagishita
- Divers Alert Network Japan (DAN Japan) / Japan Marine Recreation Association, Yokohama, Japan.,Hyperbaric Medical Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
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Guillén-Pino F, Morera-Fumero A, Henry-Benítez M, Alonso-Lasheras E, Abreu-González P, Medina-Arana V. Descriptive study of diving injuries in the Canary Islands from 2008 to 2017. Diving Hyperb Med 2019; 49:204-208. [PMID: 31523795 DOI: 10.28920/dhm49.3.204-208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 04/25/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION This research reports the epidemiology of diving injuries managed in the Hyperbaric Medicine Unit of the Canary Islands University Hospital. METHODS Data were extracted from the clinical records of all divers injured and admitted to the unit for treatment of dysbaric diving injuries between 2008 and 2017, inclusive. RESULTS One-hundred and thirty diving injuries were recorded. Most (71%) occurred in men and 43% were foreigners. Eighteen per cent either had no diving certification or that information was not recorded in the clinical chart. Only a third of the 40% of divers who had some form of on-site first aid treatment received oxygen and oral rehydration. Type 1 decompression sickness (DCS) was diagnosed in 56 divers (43%) and Type 2 in 67 (52%), whilst seven were treated for omitted decompression. At discharge, 122 (94%) were asymptomatic, whilst 5% experienced some residual sensory or other changes. One diver who presented late remained quadriparetic and one, admitted in a state of coma, died. Only 76% of the injured divers had specific diving accident insurance and, of those, 58% were foreign divers. CONCLUSIONS Over half of the injured divers did not receive any on-site first aid. The majority (94%) of treated injured divers were discharged without sequelae. Based on these data, several public health recommendations for the Canary Islands are made.
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Affiliation(s)
- Fernando Guillén-Pino
- Corresponding author: Fernando Guillén-Pino. Departamento de Medicina Interna, Dermatología y Psiquiatría (Unidad de Psiquiatría). Facultad de Ciencias de la Salud, Campus de Ofra, Universidad de La Laguna (ULL), 38071, Santa Cruz de Tenerife, Canary Islands, Spain, .,Department of Internal Medicine, Dermatology and Psychiatry, Facultad de Ciencias de la Salud, Universidad de La Laguna, Santa Cruz de Tenerife, Canary Islands, Spain
| | - Armando Morera-Fumero
- Department of Internal Medicine, Dermatology and Psychiatry, Facultad de Ciencias de la Salud, Universidad de La Laguna, Santa Cruz de Tenerife, Canary Islands, Spain
| | - Manuel Henry-Benítez
- Department of Internal Medicine, Dermatology and Psychiatry, Facultad de Ciencias de la Salud, Universidad de La Laguna, Santa Cruz de Tenerife, Canary Islands, Spain
| | - Emilio Alonso-Lasheras
- Hyperbaric Medicine Unit, Canary Islands University Hospital, Santa Cruz de Tenerife, Canary Islands, Spain
| | - Pedro Abreu-González
- Department of Medical Basic Science (Physiology Unit), Facultad de Ciencias de la Salud, Universidad de La Laguna, Santa Cruz de Tenerife, Canary Islands, Spain
| | - Vicente Medina-Arana
- Department of Surgery, Facultad de Ciencias de la Salud, Universidad de la Laguna, Santa Cruz de Tenerife, Canary Islands, Spain
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Marchitto N, Iannarelli N, Paparello PT, Cioeta E, Parisi F, Pirrone S, Raimondi G. Cardiovascular risk in scuba divers. J Sports Med Phys Fitness 2019; 59:1779-1782. [PMID: 31311237 DOI: 10.23736/s0022-4707.19.09358-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We evaluated the role of scuba diving on cardiovascular risk in a small group of divers. METHODS We have enrolled 14 subjects (12 males and 1 female, mean age 49±12.2 years) undergone to scuba diving (one patient did not complete the period of observation due to the b-blocker treatment). We evaluated electrocardiographyc trace and we have measured QT and RR interval to calculate the QTc index (Bazzet, Fridericia, Hodges and Framingam index) and the Tpeak to Tend index and heart rate variability index before and after scuba diving activity. RESULTS The results of our study confirm that there is a statistically significant improvement of the RR and QT index but there is not a statistically significant increase of the QTc index (QT interval normalized by heart rate) evaluated before and after scuba diving. In the same cohort of subjects, we have noted a not statistically significant improvement of Tpeak to Tend index. Our study has underlined a statistically significant modification of the SD1 and SD2 indices representative of parasympathetic and orthosympathic activity. Scuba diving activity seems to not be associated with a statistically significant variation of the cardiovascular risk. CONCLUSIONS Our data confirm that non-linear analysis is characterized by a statistically significant variation of the neurovegetative tone mainly linked to an increased parasympathetic activity. However, further studies are necessary to elucidate these preliminary findings.
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Affiliation(s)
- Nicola Marchitto
- Department of Internal Medicine, Alfredo Fiorini Hospital, Terracina, Latina, Italy -
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11
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Hubbard M, Davis FM, Malcolm K, Mitchell SJ. Decompression illness and other injuries in a recreational dive charter operation. Diving Hyperb Med 2019; 48:218-223. [PMID: 30517953 DOI: 10.28920/dhm48.4.218-223] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/10/2018] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Health and safety within the recreational diving industry are poorly described. We aimed to obtain the true prevalence of decompression illness (DCI) and other diving and non-diving injuries, including occupational injuries, in a large recreational diving charter operation. METHODS A New Zealand recreational diving operator keeps detailed records of diving activity and event/incident reports. We extracted passenger and crew numbers, dive numbers and incident statistics from all boat trips and associated work-related injuries between 01 January 2008 and 31 December 2014. The records of divers referred to the regional hyperbaric unit for suspected DCI were reviewed retrospectively. Using these data the prevalence of DCI and non-diving injuries were calculated. RESULTS There were 65,536 person-trips to sea and 57,072 divers undertook 97,144 dives. Fifty-five injury events were documented over seven years, 31 in customers and 24 in staff. Four divers (including one staff member) diagnosed with DCI underwent recompression therapy, giving a prevalence of 0.41 cases requiring recompression per 10,000 dives, or one case per 24,386 dives, whilst five other divers were assessed as not having DCI. There was one cardiac-related fatality. Thirty-five non-diving injuries (mainly lacerations and minor musculoskeletal injuries) were documented in 30 people resulting in 10 consulting a general practitioner and seven presenting to the local regional hospital emergency department. CONCLUSIONS DCI requiring recompression was relatively rare in this supervised recreational diving operation. Minor non-diving injuries were the most common adverse event. Compared to other adventure sports, the prevalence of injury in recreational scuba diving is low.
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Affiliation(s)
- Marion Hubbard
- School of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - F Michael Davis
- Formerly Hyperbaric Medicine Unit, Christchurch Hospital, Christchurch, New Zealand
| | - Kate Malcolm
- Dive! Tutukaka, Tutukaka, Northland, New Zealand
| | - Scott J Mitchell
- Department of Anaesthesiology, Faculty of Medicine and Health Sciences, University of Auckland.,Corresponding author: Department of Anaesthesiology, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand,
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Buzzacott P, Edelson C, Bennett CM, Denoble PJ. Risk factors for cardiovascular disease among active adult US scuba divers. Eur J Prev Cardiol 2018; 25:1406-1408. [PMID: 30045634 DOI: 10.1177/2047487318790290] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiovascular factors among uninjured active adult recreational scuba divers in the USA are described. Scuba diving as an activity was included in 2011, 2013, and 2015 Behavioral Risk Factor Surveillance System data. One-third of active US scuba divers were aged ≥50 years and/or reported prior high cholesterol, around half were overweight, more than half reported having smoked cigarettes, and 32% reported hypertension or borderline hypertension. High cholesterol, hypertension, high body mass index, and smoking status should all be addressed during routine diving fitness physician assessments, to reduce the risk of mortality while diving.
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Affiliation(s)
- Peter Buzzacott
- 1 Divers Alert Network, Durham, USA.,2 School of Sports Science Exercise and Health, University of Western Australia, Crawley, Australia
| | - Charles Edelson
- 1 Divers Alert Network, Durham, USA.,3 New College of Florida, Sarasota, USA
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