The article presents a dermatosis that occurs in tropical and subtropical countries. Though the definitive hosts of the cutaneous larva migrans parasite are animals, humans can become accidental hosts and they are infected when their skin comes into contact with damp soil, most frequently sand. The disease is only present in the epidermis where an itch is brought about by the mining activity of the larva. Sunbathers and divers who put on their gear on a beach, on account of the epidermis maceration caused by a prolonged exposure to water, are particularly susceptible to the penetrative activities of the larva. In Poland the cutaneous larva migrans is in most cases mistaken for nettle rash or eczema.
Research shows a potential threat from external environmental factors which might be the cause of upper and lower gastrointestinal diseases in tourists, or soldiers engaged in tropical peacekeeping missions. The research includes infections which due to their spread are also present in their home countries such as Helicobacter pylori infections, viral hepatitis as well as infections which might cause symptoms of upper and lower gastrointestinal tract diseases as a result of poor sanitary and unhygienic conditions. Contact with diseases typical of the tropical climate, especially during longer stays, increases the chances of bringing some tropical diseases back to Poland, which can be problematic for the domestic health care service.
The paper discusses the treatment results of ten patients with severe atopic dermatitis (AD) who did not respond to standard pharmacotherapy and underwent hyperbaric oxygen therapy (HBOT). Each patient was subject to 10 oxygen exposures at pO2 2.5 ATA (~ 250 kPa) with the duration time of 60 minutes. In the period of implementation of the hyperbaric procedures the general treatment plan was suspended for all patients while maintaining typical local treatment. Clinical evaluation was performed in the study group as well as determination of levels of immunoglobulins: IgA, IgG, IgM and IgE and C3 and C4 complement. All patients indicated clinical improvement and a decreased IgE immunoglobulin and complement C3 level upon the completion of the exposure cycle. Taking into account the authors’ own observations and data from literature, an overall improvement in the clinical status and a decrease in the level of immunoglobulin E and C3 complement following a cycle of exposures may be indicative of an immunomodulating HBOT effect on AD, whereas hyperbaric oxygenation may constitute a therapeutic option for some patients with AD, especially those exhibiting a poor response to standard treatment.
Allergic rhinitis occurs in various regions of the world and affects from 10 to 40% of the population. The skin prick test is the “gold standard” for the detection of type I allergic diseases according to the Gella and Coombs classification, which is mediated by IgE. For our experiment, skin prick tests were performed on 60 divers aged between 30 and 40 years of age. The following tests for airborne allergens were used: tests for pollen from trees, grasses, cereals, weeds, proteins from house dust mites, animal hair and epidermis, and moulds. On the basis of an interview and a positive skin prick test allergic rhinitis was diagnosed in 17 divers.
Allergic rhinitis can cause health problems in divers and be the cause of diving accidents.
The application of the skin prick test during the health qualification in the Military Maritime Health Commission, would allow the exclusion of diver candidates suffering from allergies.
The authors conducted the preliminary clinical investigation on 16 multiple sclerosis (Sclerosis multiplex) patients of median disease duration 9.33 years and symptoms evaluated on Kurtzke’s scale. The patients underwent between 25 and 30 hyperbaric oxygen exposures at a pressure of 2 ata in intervals spread over a few days. The patients were qualified and classified to the treatment symptomatologically according to Fisher but the obtained results were evaluated according to the standardised Disability Status Scale by Kurtzke. During the investigations the authors carried out additional quantitative immunoglobulin and complement activity determination, lymphocyte T and B determinations as well as the usually applied clinical and laboratory investigations. Evident clinical improvement was observed in 14 patients, but in the case of one patient a deterioration was observed after 15 hyperbaric expositions (resulting in the hyperbaric oxygen treatment being stopped), whilst in another case no curative effect could be observed. By utilising the 50% haemolysis method, within the examined immunological parameters the authors observed an increase of complement fractions and its activity, white lymphocytes T and B examined qualitatively did not maintain the characteristic shift. The authors are still discussing the obtained results.
The most hazardous adverse reactions following hyaluronic acid injections in aesthetic medicine involve vascular complications, known as the Nicolau Syndrome. This article presents a vascular complication in the area of the upper part of the nasolabial fold following subcutaneous administration of 0.5 ml of hyaluronic acid. At the time of the injection, paling occurred, which was followed by livedo racemosa appearing an hour later. Upon the lapse of a week, an ulceration appeared. It was not until the tenth day after the hyaluronic acid injection that hyaluronidase was administered. After 15 hyperbaric oxygen exposures, the ulcer was completely healed
Cutaneous leishmaniasis in Poland is an imported disease mainly occurring in tourists who travelled to tropical countries. Cutaneous symptoms occur as late as between ten and twenty days following the return from the tropics. Lesions connected with cutaneous leishmaniasis were most commonly diagnosed by Polish doctors as furuncle, ecthyma or ulceration and ineffectively treated for several weeks with antibiotics.
The paper presents the case of leishmaniasis in a 30-year-old male with an ulceration of the left shank, ineffectively treated with antibiotics over a period of four months. The ulceration was healed completely only after leishmaniasis was diagnosed and following the application of a treatment based on antimony derivatives, followed by hyperbaric oxygenation performed in a hyperbaric chamber.
The lack of evidence for the tissue-factor dependent activation of the coagulation system and the release of thrombin on one hand, and a decreased concentration of factor XII after short term air, saturated air and heliox exposures, as well as an increased concentration of the plasmin-antiplasmin complex (PAP) after short dives indicate that diving and decompression possibly affect fibrinolysis. The aim of our research was to verify the assumption that diving and decompression activate the system of fibrinolysis and the clarification of the pathomechanism of this activation.
The study involved 50 healthy volunteers who were subjected to short-term, air hyperbaric exposures at 400 kPa and 700 kPa, which correspond to 30m and 60m dives. Decompression was applied in accordance with Naval tables of decompression. Before hyperbaric exposition and after decompression the following factors were determined: activity of factor XII, concentration and activity of t-PA, concentration and activity of PAI-1, concentration of alpha2- antiplasmin, concentration of PAP, concentration of neutrophil elastase.
The following observations have been made: a statistically significant increase in the factor XII activity, increase in the PAP complex concentration and a simultaneous significant decline in the α2-AP activity. No measurable t-PA activity or significant changes in t-PA concentration have been observed. In addition, a statistically significant decline in both the activity and concentration of PAI-1 has been observed, which was more pronounced after the expositions that corresponded to 60 m dives. The concentrations of granulocyte elastase did not differ significantly before and after decompression.
Conclusions: People qualified for diving should have the following risk factors examined: risk factors of increased fibrynolytic activity - haemostasis abnormalities that increase the risk of haemorrhage, possibility of parietal blood clots/thrombi.
Service on a submarine is the most stressful and psychologically challenging form of military service. It is characterised by specific living and sanitaryepidemiological conditions which are far from typical. This work is based on the analyses of reports formulated from research conducted by a working environment laboratory, and on the control protocols of the sanitary supervision and control team (WOMP) Gdynia, from the Kobben submersible vessels in the years 2014 and 2015. Military Centres of Preventive Medicine hold supervision over Military Units pursuant to generally applicable regulations in the civil environment and standardised NATO norms. Measurements concern the level of noise, mechanical vibrations, chemical agents, electromagnetic radiation, physiochemical and biological water and kitchenware tests. The objective of the research is to evaluate the service conditions on a submersible vessel with regard to sanitary-epidemiological aspects such as exposure to infectious and occupational diseases. In selected stations, the conducted measurements indicate an increased level of noise, electromagnetic radiation and excess quantities of bacteria colonies on kitchenware.
When working in chemical or biological environments, contamination is an extremely dangerous issue for the rescue services of the fire department, police and the army.
Modern protective overalls worn by fire fighters or dry “Viking” diving suits made from neoprene or nylon covered with polyurethane, have been proven to ensure sufficient protection. However, once the contaminated area is left, there is a need to perform decontamination of the external and internal surfaces of the protective overalls; in order to ensure the clothing continues to offer a high level of comfort and to retain the durability of said protective clothing, it is of course also necessary to perform a drying procedure.
Moreover, there is a risk of a transfer of pathogenic micro-organisms between persons utilising the same protective clothes, particularly in the case of expensive specialist suits. Micro-organisms which may potentially spread through clothing include intestinal bacteria, such as: Salmonella, Shigella, Campylobacter, E. coli (including E. coli O157), C. difficile, viruses inducing infections of the upper respiratory tract and alimentary tract (noraviruses, rotaviruses, adeno and astroviruses). The risk of infection also involves the presence of the flu viruses, herpesviruses and pathogens transferred through skin, such as S. aureus (including MRSA), yeast-like fungi (Candida albicans), fungal strains inducing Tinea pedis and Tinea corporis . Pathogenic micro-organisms can easily transfer from fabric surface onto the body of a person wearing protective clothing.
From the numerous available techniques of decontamination of surfaces, equipment and protective clothing we propose to use for this purpose gaseous hydrogen peroxide (H2O2), a very effective biocidal agent. In field conditions, typical for the activities of rescue crews of the fire department, police and army we assume utilisation of a portable decontamination chamber enabling performance of a complete decontamination process.
The process lasting approximately 3 hours encompasses 3 phases:
• Drying phase;
• Decontamination with gaseous hydrogen peroxide;
• Catalytic combustion phase of hydrogen peroxide residues to a level safe for the environment.
The integrated humidity and H2O2 level sensors ensure automatic control of the entire process and the unique distribution system of gaseous H2O2 secures full accessibility of the biocidal agent to the external surface of protective clothing as well as its interior. Moreover, the container allows for the conduction of the complete decontamination of the rescue equipment, night vision devices, binoculars, field telephones, radio stations, etc. Upon decontamination cycle completion, we obtain a completely dried suit which can be safely used by another crew member.