RESUMEN
INTRODUCTION: Artisanal diving fishermen in Yucatán, Mexico have high rates of decompression sickness as a result of frequently unsafe diving practices with surface supplied compressed air. In this study, we investigated the prevalence of dysbaric osteonecrosis (DON), a type of avascular necrosis, in the most susceptible joints in a cohort of these fishermen. METHODS: We performed radiographs of bilateral shoulders, hips, and knees of 39 fishermen in Mexico and surveyed them about their medical and diving histories. We performed pairwise correlations to examine if the fishermen's diving behaviours affected the numbers of joints with DON. RESULTS: The radiographs revealed Grade II or higher DON in 30/39 (76.9%) of the fishermen. Twenty-two of 39 fishermen (56.4%) had at least two affected joints. The number of joints with DON positively correlates with the lifetime maximum diving depth and average bottom time. CONCLUSIONS: These findings represent among the highest prevalence rates of DON in divers and reflect the wide-spread scale of decompression sickness among these fishermen. Through this work, we hope to further educate the fishermen on the sequelae of their diving with the aim of improving their diving safety.
Asunto(s)
Enfermedad de Descompresión , Buceo , Enfermedades Profesionales , Osteonecrosis , Enfermedad de Descompresión/diagnóstico por imagen , Enfermedad de Descompresión/epidemiología , Enfermedad de Descompresión/etiología , Buceo/efectos adversos , Humanos , México/epidemiología , Enfermedades Profesionales/diagnóstico por imagen , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Osteonecrosis/diagnóstico por imagen , Osteonecrosis/epidemiología , Osteonecrosis/etiologíaRESUMEN
Introduction: 122,129 dives by 10,358 recreational divers were recorded by dive computers from 11 manufacturers in an exploratory study of how dive profile, breathing gas (air or nitrox [N2/O2] mixes), repetitive diving, gender, age, and dive site conditions influenced observed decompression sickness (DCSobs). Thirty-eight reports were judged as DCS. Overall DCSobs was 3.1 cases/104 dives. Methods: Three dive groups were studied: Basic (live-aboard and shore/dayboat), Cozumel Dive Guides, and Scapa Flow wreck divers. A probabilistic decompression model, BVM(3), controlled dive profile variability. Chi-squared test, t-test, logistic regression, and log-rank tests evaluated statistical associations. Results: (a) DCSobs was 0.7/104 (Basic), 7.6/104 (Guides), and 17.3/104 (Scapa) and differed after control for dive variability (p ⺠0.001). (b) DCSobs was greater for 22%-29% nitrox (12.6/104) than for 30%-50% nitrox (2.04/104) (p ≤ 0.0064) which did not differ from air (2.97/10104). (c) For daily repetitive dives (âº12-hour surface intervals (SI)), DCS occurred only following one or two dives (4.3/10104 DCSobs; p ⺠0.001) where SIs were shorter than after three or more dives. (d) For multiday repetitive dives (SIs ⺠48 hours), DCS was associated with high multiday repetitive dive counts only for Guides (p = 0.0018). (e) DCSobs decreased with age at 3%/year (p ≤ 0.0144). (f) Males dived deeper (p ⺠0.001) but for less time than females (p ⺠0.001). Conclusion: Collecting dive profiles with dive computers and controlling for profile variability by probabilistic modeling was feasible, but analytical results require independent confirmation due to limited observed DCS. Future studies appear promising if more DCS cases are gathered, stakeholders cooperate, and identified data collection problems are corrected.
Asunto(s)
Enfermedad de Descompresión/epidemiología , Buceo/estadística & datos numéricos , Adulto , Factores de Edad , Aire , Distribución de Chi-Cuadrado , Intervalos de Confianza , Enfermedad de Descompresión/complicaciones , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , México , Microcomputadores , Nitrógeno , Oxígeno , Estudios Prospectivos , Riesgo , Escocia , Factores Sexuales , Estadísticas no Paramétricas , Factores de TiempoRESUMEN
INTRODUCTION: Decompression sickness is endemic to small-scale fishermen-divers from coastal communities in southeast Mexico; overweight and obesity are also highly prevalent in the region. Existing literature suggests it is possible that fat tissue could play a role in decompression sickness pathophysiology. Our aim in this study is to describe the association between the number and severity of DCS events treated at the hyperbaric program and fishermen-diver body mass index. METHODS: In this cross-sectional study, we obtained anthropometric measurements of 105 fishermen-divers and reviewed clinical records of each participant at a hyperbaric program. RESULTS: Average BMI among participants was 34.5 ± 4.7, while 9.5% (n=10) were healthy-weighted, 28.6% (n=30) were overweight and 42.8% (n=65) were obese. Number of DCS events per diver was associated with BMI and severity of DCS in linear regression models. CONCLUSIONS: Overweight and obesity are highly preventable health problems; our results suggest that an association between these conditions and the frequency and the severity of DCS are an important topic to be further considered in longitudinal prospective studies.
Asunto(s)
Índice de Masa Corporal , Enfermedad de Descompresión/etiología , Buceo/efectos adversos , Enfermedades Profesionales/etiología , Sobrepeso/complicaciones , Adulto , Estudios Transversales , Enfermedad de Descompresión/epidemiología , Buceo/estadística & datos numéricos , Explotaciones Pesqueras , Humanos , Masculino , México/epidemiología , Obesidad/complicaciones , Enfermedades Profesionales/epidemiología , Estaciones del AñoRESUMEN
The probabilities of decompression sickness (DCS) among diving fishermen are higher than in any other group of divers. Diving behavior of artisanal fishermen has been directed mainly to target high-value species. The aim of this study was to learn about the occurrence of DCS derived from sea cucumber harvesting in the Yucatán Peninsula, Mexico. We conducted a retrospective chart review of diving fishermen treated at a multiplace hyperbaric chamber in Tizimín, Mexico. In total, 233 recompression therapies were rendered to 166 diving fishermen from 2014 to 2016. The average age was 36.7 ± 9.2 years (range: 20-59 years); 84.3% had experienced at least one DCS event previously. There was a correlation between age and DCS incidents (F: 8.3; R2: 0.07) and differences in the fishing depth between seasons (H: 9.99; p⟨0.05). Musculoskeletal pain was the most frequently reported symptom. Three divers, respectively, suffered permanent hearing loss, spinal cord injury and fatal outcome. Diving fishermen experience DCS at an alarmingly high rate, probably due to the type of species targeted, given the requirements in each case. Understanding divers' behaviors and their incentives while in pursuit of high-value species such as sea cucumber could help to find ways to mitigate health risks and help enforce regulation.
Asunto(s)
Enfermedad de Descompresión/epidemiología , Buceo/estadística & datos numéricos , Enfermedades Profesionales/epidemiología , Adulto , Animales , Enfermedad de Descompresión/etiología , Enfermedad de Descompresión/terapia , Buceo/efectos adversos , Humanos , Oxigenoterapia Hiperbárica/estadística & datos numéricos , Masculino , México/epidemiología , Persona de Mediana Edad , Dolor Musculoesquelético/epidemiología , Dolor Musculoesquelético/etiología , Enfermedades Profesionales/etiología , Enfermedades Profesionales/terapia , Análisis de Regresión , Estudios Retrospectivos , Pepinos de Mar , Estaciones del AñoRESUMEN
Diving conditions, dive profiles, vascular bubbles, and symptoms of decompression sickness (DCS) in a group of Galapagos commercial divers are described. They harvest sea cucumbers from small boats with surface supplied air (hookah). Dive profiles for 12 divers were recorded using dive loggers, and bubble formation was measured in the pulmonary artery. DCS symptoms were assessed by interview. A total of 380 immersions were recorded over a nine day period. The divers did on average 6.3 immersions per day, in a yo-yo pattern. Mean overall depth was 34.5 FSW. Maximum recorded depth was 107 FSW. Average bottom time per day per diver was 175 minutes. 82 % of all ascents exceeded the recommended maximum ascent rate of 30 FSW/ min. High bubble grades were observed on six occasions, but the test was unreliable. Muscle and joint pain was reported on five occasions, in three different divers. Symptoms were typically managed by analgesics, in-water recompression or not at all. The divers were extremely reluctant to seek professional help for DCS symptoms, mostly due to the high costs of treatment. We conclude that the fishermen dive beyond standard no-decompression limits, and that DCS symptoms are common.
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Enfermedad de Descompresión/epidemiología , Buceo , Adolescente , Adulto , Enfermedad de Descompresión/etiología , Enfermedad de Descompresión/psicología , Buceo/efectos adversos , Buceo/normas , Buceo/estadística & datos numéricos , Ecuador/epidemiología , Falla de Equipo , Equipos y Suministros/normas , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de TiempoRESUMEN
Self-Contained Underwater Breathing Apparatus (SCUBA) diving popularity is increasing tremendously, reaching a total of 9 million people in the US during 2001, and 50,000 in the UK in 1985. Over the past 10 years, new advances, equipment improvements, and improved diver education have made SCUBA diving safer and more enjoyable. Most diving injuries are related to the behaviour of the gases and pressure changes during descent and ascent. The four main pathologies in diving medicine include: barotrauma (sinus, otic, and pulmonary); decompression illness (DCI); pulmonary edema and pharmacological; and toxic effects of increased partial pressures of gases. The clinical manifestations of a diving injury may be seen during a dive or up to 24 h after it. Physicians living far away from diving places are not excluded from the possibility of encountering diver-injured patients and therefore need to be aware of these injuries. This article reviews some of the principles of diving and pathophysiology of diving injuries as well as the acute treatment, and further management of these patients.
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Barotrauma/etiología , Barotrauma/terapia , Buceo/lesiones , Embolia Aérea/etiología , Embolia Aérea/terapia , Tratamiento de Urgencia/métodos , Corticoesteroides/uso terapéutico , Anticoagulantes/uso terapéutico , Barotrauma/epidemiología , Terapia Combinada , Enfermedad de Descompresión/epidemiología , Enfermedad de Descompresión/etiología , Enfermedad de Descompresión/terapia , Buceo/efectos adversos , Embolia Aérea/epidemiología , Femenino , Humanos , Masculino , Terapia por Inhalación de Oxígeno , Medición de Riesgo , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Diving conditions, dive profiles, and symptoms of decompression sickness (DCS) in a group of Miskito Indian underwater seafood harvesters are described. Dive profiles for 5 divers were recorded with dive computers, and DCS symptoms were assessed by neurological examination and interview. Divers averaged 10 dives a day over a 7-day period with a mean depth of 67 +/- 7 FSW (306 +/- 123 kPa) and average in-water time of 20.6 +/- 6.3 minutes. Limb pain was reported on 10 occasions during 35 man-days of diving. Symptoms were typically managed with analgesic medication rather than recompression. Indices of the decompression stress were estimated from the recorded profiles using a probabilistic model. We conclude that the dives were outside the limits of standard air decompression tables and that DCS symptoms were common. The high frequency of limb pain suggests the potential for dysbaric bone necrosis for these divers.
Asunto(s)
Enfermedad de Descompresión/etiología , Buceo/efectos adversos , Procesamiento Automatizado de Datos/métodos , Indígenas Centroamericanos , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/uso terapéutico , Recolección de Datos/métodos , Enfermedad de Descompresión/diagnóstico , Enfermedad de Descompresión/epidemiología , Honduras/epidemiología , Honduras/etnología , Humanos , Incidencia , Pierna , Masculino , Fumar Marihuana/epidemiología , Osteonecrosis/complicaciones , Dolor/diagnóstico , Dolor/epidemiología , Dolor/etiología , ProbabilidadRESUMEN
The compression chamber facility at the Barbados Defence Force has treated 150 SCUBA diving accidents, since it began operation in 1985. Nineteen women and 131 men were treated. The average age of the victims was 34 years. There were 67 sports diving accidents and 83 occupational or work-related accidents. Patients were referred from many of the islands of the Eastern Caribbean, from the Dominican Republic in the north to Trinidad and Tobago in the south. The majority of the sports accidents occurred amongst vacationing tourists and the majority of the work-related accidents were among commercial fishermen from Puerto Rico and St. Vincent and the Grenadines. All three major diving-related diseases, decompression sickness types 1 and 2 and arterial gas embolism, were seen, with the majority presenting with serious (type 2) decompression sickness. SCUBA-related diving accidents are seen in virtually all of the Caribbean Islands and represent a serious occupational and recreational disorder. Such accidents occur in young adults and may have devastating consequences with paralysis and disability leading to loss of income and consequent reduction in the standard of living of those affected (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Buceo/lesiones , Enfermedad de Descompresión/epidemiología , BarbadosRESUMEN
Se realiza un estudio descriptivo de todos los casos de Enfermedad por Descompresión Inadecuada (E.D.I.), desde el primero de abril de 1985 al 31 de marzo de 1991, clasificándolos según el modelo de Golging et.al y registrando los datos en las fichas elaboradas por el Dr. Alfredo Cea Egaña. Se analizaron 125 casos, destacando que el 41 por ciento de ellos corresponde a formas graves de E.D.I., los que junto al número total de casos se incrementó hasta 1988, fecha desde la cual ha disminuído su importancia, debido a varios factores. La etiopatogenia es multifactorial y a pesar de su polimorfismo clínico es fácilmente diagnosticable, radicando su importancia en que afecta a una población en edad reproductiva, es totalmente prevenible y de buen pronóstico, con un tratamiento adecuado y oportuno
Asunto(s)
Humanos , Masculino , Descompresión/efectos adversos , Enfermedad de Descompresión/epidemiología , Chile , Buceo/efectos adversosRESUMEN
Se realizó un estudio transversal en la Cámara Hiperbárica de Roatán, tomando como población al numero total de buceadores de origen misquito que sufrieron la enfermedad por descompresión, a fin de determinar factores predisponentes, manifestaciones clínicas mas frecuentes y respuesta al tratamiento con oxígeno hiperbárico. Los resultados revelaron que el 70% de todos los sujetos usaban bebidas alcohólicas, el 69% fueron fumadores y un 14% reconocíeron el uso de otro tipo de drogas. Los síntomas de aparición más frecuente fueron el dolor articular, disminución o pérdida de fuerza de miembros inferiores, pérdida de sensibilidad e incapacidad para miccionar respectivamente. El 64% de los pacientes recibieron tratamiento con oxígeno hiperbárico exclusivamente, el 33% combinó el uso de medicamentos con la terapia hiperbárica y un 3% se trató solo con medicamentos. La mayoría de los pacientes recibieron entre 1 y 5 sesiones de tratamiento hiperbárico, y la condición de egreso fue mejorada en 52.5%, y curado en 44.3%. Se concluye que la enfermedad por descompresión es un problema serio de salud en este tipo de población, y que la existência de la Cámara Hiperbárica de Oxígeno en Rotan, constituye una facilidad terapéutica muy importante en esta región del país