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Vol. 4 July 1997 .,afu- -*fu#* ' " ,.-muqs@t** .i- / Vol. 4 1\O. I July 1997 1I JULY T997 ."' -t .*' i |"tl' MARINE MEDICAL SOCIETY : (RegdF-3611) a tlt" President SurgVADM JC SHARMA VSM t;, I DGMS(NAVY) ,tr Vice Presidents I Surg RADM VK PAHWA SurgRADM HPMUKHERJEEVSM t. CMO WesternNaval Command CommandingOfficer,INHS Asvini I ExecutiveCommittee Surg Cmde NR RAHA VSM Surg Cmde SP MALHOTRA Director INM DMS (P & M) Naval Headquarters Surg Cmde WP THERGAONKAR Surg Cmde BPS RAWAT VSM CMO EasternNaval Command CMO SouthernNaval Command Surg Cmde ML GUPTA EXO INHS Asvini Dental Advisor (Navy) DMS (H&S) Surg Cdr S NANGPAL Naval Headquarters Officer-in-Charge, Schoolof Naval Medicine Surg Cdr AM JOGLEKAR BMO INS Vajrabahu Secretary Surg Cdr MJ JOHN Treasurer Surg Cdr KKDUTTA GUPTA -J Address for Correspondence Secretary MARINE MEDICAL SOCIETY Instituteof Naval Medicine,INHS Asvini Campus, Colaba,Mumbai 400 005. India. Printed,published and owned by Director GeneralMedical Services(Navy). SenaBhavan, New Delhi I l0 0ll. Printedon his behalfat Typo Graphics,Mumbai 400 103. Editor Surg Cdr S Nangpal,Institute of Naval Medicine, Mumbai 400 005. JOURNAL OF MARINE MEDICAL SOCIETY VOLUME 4 NUMBER1 tuLY 1997 PublishedBiannually Chief Editor Surg RADM VK PAHWA Editor Surg Cdr S NANGPAL Co-Editors Surg Cdr AC PRAVEEN KUMAR Surg Cdr GIRISH GUPTA Sub Editors Naval Headquarters Surg Cdr A AHUJA NM Western Naval Command Surg Lt Cdr VRG PATNAIK EasternNaval Command Surg Cdr D D'COSTA Southern Naval Command Surg Cdr(Mrs) N KANAN VSM Editorial Advisory Board Surg Cmde (D) ML GUPTA Brig DINESH PRASAD Surg Capt RAMESH KUMAR Surg Capt RT AWASTHI i -r Surg Cdr MJ JOHN I Surg Cdr KK DUTTA GUPTA Addressfor Correspondence Editor JOURNAL OF MARINE MEDICAL SOCIETY Instituteof Naval Medicine,INHS Asvini Campus, Colaba.Mumbai 400 005. JOURNAL OF MARINE MEDICAL SOCIETY CONTENTS President's Message From the Editor's Desk Surg Cdr S Nangpal REVIEWARTICLE Drugs and Therapy in Hyperbaric Environment Surg Cdr S NANGPAL, Surg Cdr MJ JOHN, Surg Cdr KK DUTTA GUPTA a n UPDATE ARTICLE s HumanImmuno Deficiency Virus (HIV) andTubercular Infection - A SeriousChallenge to HealthCare System 9 il Surg CmdeNR RAHA, VSM,Surg Cdr KK DUTTA GUPTA tl ORIGINAL ARTICLES n Evaluationof HyperbaricOxygen as Adjunctive Therapy in DiabeticFoot 12 p Surg Lt Cdr VRGPATNAIK, Surg Cdr PSLAMBA, Surg Cdr S IIIANGPAL,Surg Cdr MJ JOHN, Surg 1 CdTKK DUTTA GUPTA I lr Developmentof IndigenousCompressor Driven Atomizer for CockroachControl on BoardShips l6 ir Surg Lt J SNDHAR, SurgLt Cdr A CHATTEMEE,Surg Cdr KK DUTTA GUPTA tl MicrocoolingSystem for NavalApplication 20 r DT KRISHNAS HEGDE, HANSH S RAO,KOTRESH RM, DTI-IIZAR MATHEW S u ProblemWounds and Hyperbaric Oxygen (HBO) Therapy 26 F Dr SURESHPUROHIT, Surg Lt Cdr GD BHANOT,Surg Lt HBSCHAUDHRY, Surg Lt G KRISHNAN p PsychologicalAspects of UnderwaterEndeavors 29 li Surg Cdr MJ JOHN, Surg Cdr S NANGPAL,Surg Cdr VSSRRYALI, Surg Cdr KK DUTTA GUPTA v CarcinomaProstate : Profilesof Presentationand Modalities of Management 32 n Surg Cdr B FANTHOME,Surg Lt Cdr S MNJAN, Surg Cdr YK SAXENA,VSM h AccidentalPoisonings in Children 35 t( SSMATHAI, KS BAWA,G GUPTA,SR DAS, RN MEHNSHI tI tl EMERGING TRENDS n, Newer Prognostic Indicators in Breast Carcinoma 38 Lt Col S BHATTACHARYA (1 Emerging Trends in Alcohol RelatedDisorders and the Navy ' 40 p Surg Cdr VSSRRYALI, Surg Cdr MJ JOHN, Surg Lcdr A TNPATHI, Surg Lcdr KK MISHRA 'v t Recent Developnents in the Managementof Benign ProstaticHyperplasia 43 Surg Cdr VK SAXENA, VSM,Lt Col D BAWRq Current recommendation for prcventive ther- NGOs' assistancein achievingbetter drug compli- apy .' In USA, theCenter for DiseaseControl (CDC) ance and drug distribution through establishing a recommendsthat persons with HIV infectionshould propermachinery of co-operationand collaboration be given a fuberculinskin test with five tuberculin amongthe Govemmentand NGOs, as most of the units of purified protein derivative.In absenceof casesof tuberculosiswith HIV infection will have activetubercular infection, Isoniazid for 12 months to be treatedas outdoorpatients [8]. duration was recommendedfor all HIV infected person showing more than five mm induration. CONCLUSION WHO and IntemationalUnion againstTuberculosis There is a rapidly increasingincidence of TB- and Lung Disease(IUATLD) issuedsimilar guide- HIV co-infection. With the spread of HIV, the line for resourcepoor countries[6]. epidemiologicalsituation of tuberculosiswill dete- Management of cases riorate.With nearly halfof Indian population having focii oftubercular infection on one hand and a rapid Regimenscontaining Thiacetazoneare associ- rise in the incidenceof HIV infection on the other, ated with high rates of side effects, increasedtreat- complicatedby varioussocio economic factors such and relapse rate in HIV infected per- ment failure as poor quality of life, over crowding, illiteracy, sons.Similarly streptomycinshould be avoidedbe- largefamilies, lack of awareness,inadequate health cause of risk of transmission of blood bome 9 care facilities etc., the picture is gloomy unless infection. HIV positive patientswith tuberculosis adequatemeasures are taken at the earliest[9]. treatedwith Rifampicin containingshort course che- motherapyhave similar responseto HIV negative In a climate of economicrestraint and rampant t2 patientsand have similarly low early relapserate. HIV infection,intersectoral co-ordination, innova- The simplest regimen will be three times weekly tive ideas and further researchare essentialfor the Isoniazid,Rifampicin, Pyrazinamide and Ethambu- future developmentof Tuberculosiscontrol pro- lol. In USA, HIV infectedpatients taking supervised gramme. t6 intermittenttherapy had more favourablesurvival REFERENCES than those on daily self administeredmedication. Hencedirectly observed therapy (DOT) hasbeen the L World Health Organisation.Ninth General Programmeof 20 work covering the period 1996-2001. Geneva I 994 9. single most effective interventionand has contrib- ; uted to better tuberculosiscontrol in recentyears. 2. Kevin M Decock,David Wilkinson. Tuberculosiscontrol in resourcepoor countries. Altemative approaches in the eraof 26 Peripheralhealth functionariessuch as multipur- HIV. Lancet 1995:364 : 6'/5-77. M poseworkers, anganwadi worker, traineddais, vil- 3. Cofram SR, Vinay Kumar, Stanley L Robbers.Robbins lage healthguide etc.,could be usedfor DOT 29 [7,8]. PathologicBasis of disease5'n edition.WB SaundersCom- Integration of services at district level .' Patients pany,USA lS94 I 325-30. with HIV associatedtuberculosis may requiretreat- 4. Philip C Hopewell.Pulmonary manifestations of HIV infec- ment for other complicationsof HIV diseasethat tion in Cecil text book ofmedicine ed. BennettCJ and PIum tuberculosis control programmes are not accus- F, WB SaundersCornpany, Philadelphia 1996; 1859-65. J) tomed to dealingwith. Thereforetuberculosis con- 5. Kevin M Decock. Screeningfor tuberculosisand HIV in trol programme will have to integrate activities at resourcepoor countdes.Lancet I 995 ;345 : 873. the district level into other servicescatering to the 6. Kevin M Decock,Alison Grant,John DH, Porter.Preventive needofthe population[8]. therapy for tuberculosisin HIV infected persons;intema- 38 tional recommendationsresearch and practice. Lancet I 995; Information, Education and Communication 345 : 833-35. (IEC) : IEC activities should be augmentedso that 7. Dale I Morse. Directly observedtherapy lbr Tuberculosis '40 proper messagesreach the targetgroups and to those BMJ 1996;312:719-20. who are put on treatmentso that they continue their 8. Rohit S, Dey LBS. IndianNational tuberculosis programme treatmentfor entireduration. 43 - Revisedstrategy Ind J Tub 1995;42 : 95-100. Co-operation of Non Governmental Organisa- 9. MukherjeeAK. Tuberculosiscontrol programmein India - tion (NGO) .' Effort should be made to harness Progressand prospects.Ind J Tub 1995;42 :75-85. Jour.Marine Medical Society, July 1997,Vol.4, No. I I] hasbe Original Articles such i EVALUATION OF HYPERBARICOXYGEN AS depen ADJUNCTIVETHERAPY IN DIABETIC HBO'I FOOT NOITNE healin Surg Lt CdR VRG PATNAIK *, SurgCdr PSLAMBA**, level Surg Cdr S NANGPAL***, SurgCdr MJ JOHN+, forma SurgCdr KKDUTTAGUPTA# bettet MAT ABSTRACT TT groul Diabetic foot is one of the most devastatinglong term complicationof diabetesmellitus. Hyperbaric oxygen therapy ([IBOT) is used in its treatment basedon physico-chemicaland haemodynamicconsiderations. To assessits role total a study was conducted at the Institute of Naval Medicine in an age matched group.30 patients were evaluated in the p a randomized study. Study group consistedof 13 males and two females(Mean age 63.1 + 8.74) . Control group TI consistedof three femalesand 12 males (mean age 67 + 9.81). Both groups were given standard antibiotic and fema surgical care. Diabetic foot was graded as per Wagener's classification.Study group was pressurisedto 2.8 ATA using 1007o oxygen for one hour. Controls were pressurisedto the samedepth but using 7.57ooxygen and 92.5 5l-7. 7o nitrogen asthe breathing mixture . The overall outcomewas significantly better in the study group as compared groul to controls (p < 0.01).86.67oin the study group either healedor improved comparedto 46.7Toin controls. 53.97o age! of Wagener's grade I-III in the control group either healedor improved. In comparison, significantly more (p to fe < 0.05) (92,3o/onumber of grade I-III caseseither healedor improved in the study group. In this study no patient 87: experiencedany complication of HBOT . the I KEY WORDS
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