Diving accidents treated at a military hospital-based recompression chamber facility in Peninsular Malaysia.

This paper describes the pattern of diving accidents treated in a military hospital-based recompression chamber facility in Peninsular Malaysia. A retrospective study was carried out to utilize secondary data from the respective hospital medical records from 1st January 1996 to 31st December 2004. A total of 179 cases categorized as diving accidents received treatment with an average of 20 cases per year. Out of 179 cases, 96.3% (n = 173) received recompression treatment. Majority were males (93.3%), civilians (87.2%) and non-Malaysian citizens (59.2%). Commercial diving activities contributed the highest percentage of diving accidents (48.0%), followed by recreational (39.2%) and military (12.8%). Diving accidents due to commercial diving (n = 86) were mainly contributed by underwater logging activities (87.2%). The most common cases sustained were decompression illness (DCI) (96.1%). Underwater logging and recreational diving activities which contribute to a significant number of diving accidents must be closely monitored. Notification, centralised data registration, medical surveillance as well as legislations related to diving activities in Malaysia are essential to ensure adequate monitoring of diving accidents in the future.

Decompression illness secondary to occupational diving: recommended management based current legistation and practice in Malaysia.

Occupational divers are exposed to hazards which contribute to the risk of developing decompression illnesses (DCI). DCI consists of Type I decompression sickness (DCS), Type II DCS and arterial gas embolism (AGE), developed from formation of bubbles in the tissues or circulation as a result of inadequate elimination of inert gas (nitrogen) after a dive. In Malaysia, DCI is one of the significant contributions to mortality and permanent residual morbidity in diving accidents. This is a case of a diver who suffered from Type II DCS with neurological complications due to an occupational diving activity. This article mentions the clinical management of the case and makes several recommendations based on current legislations and practise implemented in Malaysia in order to educate medical and health practitioners on the current management of DCI from the occupational perspective. By following these recommendations, hopefully diving accidents mainly DCI and its sequalae among occupational divers can be minimized and prevented, while divers who become injured receive the proper compensation for their disabilities.

Development of underwater and hyperbaric medicine in Malaysia.

Underwater and Hyperbaric Medicine is a treatment modality gaining recognition in Malaysia. It uses the hyperbaric oxygen therapy (HBOT) approach where patients are placed in recompression chambers and subjected to oxygen therapy under pressure. In Malaysia it was introduced as early as the 1960's by the Royal Malaysian Navy to treat their divers for decompression illness (DCI), arterial gas embolism (AGE) and barotraumas. Other sectors in the armed forces, universities and private health centres began developing this approach too in the late 1990's, for similar purposes. In 1996, Underwater and Hyperbaric Medicine began gaining its popularity when the Institute of Underwater and Hyperbaric Medicine at the Armed Forces Hospital in Lumut started treating specific clinical diseases such as diabetic foot ulcers, osteomyelitis, and carbon monoxide poisoning and other diseases using HBOT. This paper discusses the development of this interesting treatment modality, giving a brief historical overview to its current development, as well as provides some thought for its future development in Malaysia.

Pulmonary overinflation syndrome in an underwater logger.

Pulmonary overinflation syndrome (POIS) is a group of barotrauma-related diseases caused by the expansion of gas trapped in the lung, or over-pressurization of the lung with subsequent over-expansion and rupture of the alveolar air sacs. This group of disorders includes arterial gas embolism, tension pneumothorax, mediastinal emphysema, subcutaneous emphysema and rarely pneumopericardium. In the case of diving activities, POIS is rarely reported and is frequently related to unsafe diving techniques. We report a classical case of POIS in an underwater logger while cutting trees for logs in Tasik Kenyir, Terengganu. The patient, a 24-year-old worker, made a rapid free ascent to the surface after his breathing equipment malfunctioned while he was working underwater. He suffered from bilateral tension pneumothoraces, arterial gas embolism giving rise to multiple cerebral and cerebellar infarcts, mediastinal and subcutaneous emphysema as well as pneumopericardium. He was treated in a recompression chamber with hyperbaric oxygen therapy and discharged with residual weakness in his right leg.

Rapid solid-phase immunoassay for detection of methicillin-resistant Staphylococcus aureus using cycling probe technology.

A Cycling Probe Technology (CPT) assay with a lateral-flow device (strip) was developed for the detection of the mecA gene from methicillin-resistant Staphylococcus aureus (MRSA) cultures. The assay uses a mecA probe (DNA-RNA-DNA) labeled with fluorescein at the 5' terminus and biotin at the 3' terminus. The CPT reaction occurs at a constant temperature, which allows the probe to anneal to the target DNA. RNase H cuts the RNA portion of the probe, allowing the cleaved fragments to dissociate from the target DNA, making the target available for further cycling. The strip detection step uses a nitrocellulose membrane with streptavidin and immunoglobulin G antibody impregnated on the surface. In the absence of the mecA gene, the uncut probe is bound to an antifluorescein-gold conjugate and is then captured by the streptavidin to form a test line. In the presence of the mecA gene, the probe is cut and no test line is formed on the strip. A screen of 324 S. aureus clinical isolates by the CPT-strip assay showed a 99.4% sensitivity and a 100% specificity compared to the results of PCR for the detection of the mecA gene. Specificity testing showed that the CPT-strip assay did not exhibit any cross-reactivity with a panel of mecA-negative non-S. aureus isolates. The CPT-strip assay is simple and does not require sophisticated equipment. Furthermore, the assay takes 1.5 h starting from a primary culture to the time to detection of the mecA gene in S. aureus isolates.