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D n n*; d"; MARINEMEDICAL SOCIETY (RegdF-361l) presiclent Surg V Adm Yogendra Singh VSM Vice presiclents Surg R Adm VS Dixit VSM Surg R Adm VK SaxenaVSM Executive Conmittee Surg Cmde SK Mohanty SM VSM Surg Cmde BS Rathore VSM Surg Cmde MJ John Surg Cmde SK Satsangi Surg Capt S Nangpal Surg Capt YP Monga Surg Cdr G Verghese Surg Capt PK Singh Secretary Surg Cdr R Chopra Treasurer Surg Cdr VK Goyle Arldress for Corre sportdenc. e Secretary Marine Medical Society INHSAsvini Colaba,Murnbai 400 005.India Website: http://www.mmsindia. net Printed,p Bhavan,l JOURNAL OF MARINEMEDICAL PublishedBiannually Editor-in-Chief Surg R Adm VS Dixit VSM Editor Surg Capt AA Pawar Addres s fo r Corre sp ondenc e Secretary Marine Medical Society INHS Asvini Colaba.Mumbai 400 005. India Website: http://www.mmsindia.net published I Printed, andowned by DirectorGeneral of Medical Services(Navy), Sena i Bhavan,New Delhi 110011. Printed on hisbehalf atTypo Graphics, Mumbai 400 103. JOURNAL OF MARINE MEDICAL SOCIBTY CONTENTS I I I i DITORIAL I OccupationalStress 59 lr Surg Capt AA Pawar I Thermal Physiologyin HyperbaricEnvironment I Dr Brinda Venkatraman SubmarineEscape and RescueWorking Group Meeting2006 - lstanbul,Turkey 65 SurgCdr HBS Chaudhry BiochemicalDecompression 72 Fig.5 : Rer SurgCdr CVSNRao ins FacilitiesOnboard USNS Mercy 14 on Surg Cdr Diviya Gautant Respiri PsychologicalEffects ofLong Sailingon Submariners 80 capeof bc SurB Capt AA Pawar Surg Cdr DK Ghosh, SurgLt B Sotti, Surg Cdr A Tripathi, Ms J Ratlrcd, Col S Chaudhuri is cooler. - The EustachianTube in Diving: Ear Barotraumaand Middle Ear Auto-inflationTechniques in Naval Divers 84 enduranc( Original ResearchPaper It is si Surg Cdr Padma Ramesh including 93 Evaluationof IDA 59(M) ',vhichwc Surg lt Cdr Kamal Mishra t expiredgi The Importanceof Effective and PromisingBehavioul Change Interventions to PreventHIV Infections l0l gas.In de Surg Cdr Saugat Ray I ratorygas A Clinical Trial Evaluatinga New Method of Fore-headPulse-oximetry with ConventionalLimb Pulse-oximetry 108 blockseri in Term Neonates feet, breat Surg Capt G Gupta, Surg Cdr S Narayan, Surg Cdr A K Yadav,A Bableshwar havea res ' ShipboardDermatology l13 WEIGHT Surg Cdr J Sridhar Inexpl; Multislice CT Imaging of SinonasalInflammatory Diseases in the Era of Fess I l8 comfortat Surg Cdr Pradipta C Hande, Surg Capt J D'Souzq Surg Capt E Janres couldbe - Intra Ocular Tension Recording Is Latest the Best? t20 in divers' Surg Cdr Tarun Choudhary concomit Hematological Changesin Alcohol Dependence t22 In the S Chaudhury,M Pawar, D Bahattacharyya, D Saldanha gas feels sensedas CASEREFORTS daysand During Report 127 DecompressionSickness SaturationDiving: A Case that therr Vivek Verma T Surg Lt Cdr bolic hee Lessonsfor Mental Health From 26 July Deluge : Mumbai 130 out shiv( Surg Cdr AI Ahmed PROGR] Management of Partial Anodontia -A ProsthodonticApproach IJJ TIYPOTI Surg Cdr (D) Archana Khanna Deve -58 Jour Marinc Medical Society,2406, Vol.8, No. 2 Jour.Mat pothermiain cold hyperbaricconditions is of in- creasingconcern now. It involvesvarying degrees of unconsciousnessor mental incompetenceal- though respilatorydifficulties, unsteadinessand weaknessare also common. Insensible respiratory I heatloss is the main factorin suchoccurrences. I Variousstudies have shown that subjective ther- mal comfortis relatedto fall in coretemperature. ),et. the diver's respiratoryheat lossesand the conse- 60 quent inceptionof hypothermia,a diver's assessmentof comfort is notalways related to physr- 65 trnrro ologicaltemperature changes. c^{cn|t ourrttt (ri.l.0) 72 DTVBRITYPERTITERMIA Fig. : Respiratoryheat loss mildactivity while 5 during Respiratorygas heatingcan lead to hyperther- inspiringgases at severaltemperatures. Based 1t mia in divers,which could be alarming. Respiratory onTaubcr et al.15and Webb and Annis.rT burnsare seen very commonly.Use of gasheaters Respiratoryheat loss is a sizableavenue for es- with hot water suit technologycan result in heat 80 capeofbody heatespecially when the environment stressin waterexposures and divers will encounter is cooler.It is a major factorlimiting survivaland heatsyncope on re-enteringa bell. Faintingoccurs 8,1 endurancein cold hyperbaricchamber. due to heat syncope.Blood pooling in the lorver It is simple to reducerespiratory heat loss by regionsof the body can leadto unconsciousness. includingin breathingequipment; a heatexchanger, 93 PREVENTIONOF TTIER,\4ALEFFECTS IN rvhichwould retainsome of the heatin the warm HYPERBARICCONDITIONS expiredgas and deliver it backto the cold inspired l: Divermonitoring: This is very importantin bounce l0r gas.In deepdives, it is necessaryto heatthe respi- diving.It ensuresdiver safety by determiningif the t ratory gas.Around 250 watts would be neededto diverbecomes hypothermic or if hisperformance is r08 block seriousrespiratory tract drain in a diver at 650 gettingimpaired. Parameters for monitoringare sub- feet, breathingHe-O, and working hard enoughto jective verbal measurement havea respiratoryminute volume of 25 l/min. comments, of deepbody temperatureand skin temperature,heart rate meas- I 13 WEIGHTLOSS INDIVERS urement,direct heat flow measurementetc. No one Inexplicableweight loss in parameteralone is an accurateand a completelyre- lr8 occurs diversduring comfortabledeep hyperbaric chamber exposures. It liableindicator of a decrementin diver performance could be due to an increasedheat loss that occurs or a developmentof a thermalproblem. The single t20 in divers with no decreasein body temperatureor a mostuseful and easily implemented diver-monitor- concomitantincrease in metabolism. ing parameteris direct verbalcontact. t22 In the hyperbaricenvironment, where the warm Giving rigorousattention to automaticregula- gas feels comfortable,the high heat loss is not tion of respiratoryheating and hot water suit entry sensedas cold. When the extra drain continuesfor temperaturescan preventhypothermia. daysand weeks,it would seementirely reasonable Hyperthermiacan be alleviatedby the useof ad- t27 l that there should be a matching increasein meta- equatecooling measures involving shadeor spray bolic heatproduction. This can occurwith or with cooling. r30 out shivering. CONCLUSION PROGRESSIVESYMPTOMLESS IJJ Men who spenddays in underseahyperbaric TIYPOTIIERMIA environmentrequire warm gas temperature, typically Developmentof progressivesymptomless hy- above29'C(85'F). il.8.No.2 Jour.Marine Medical Societv, 2006. Vol. 8. No.2 63 Editorial OCCUPATIONALSTRESS Surg CaptAAPawar. is associated.withmodern life. Qtress However,rn youngerpeople are more stressed.This emphasises tJthe Armed Forces setting,stress is usually as- the need of targeting the young population by sociatedwith combatignoring the fact that service educatingand imparting stress inoculation personnelare not different in their mentalmake up techniques.Carrier battle groups of the US Navy from their civilian counterpartsand are equally vul- usually carry a psychologist and psychiatric nerableto stressesof modernliving. techniciansto monitor mentalhealth among the crew. A survey of occupational stressesundertaken Suchdeployments have been found to be effective by Department of Psychiatry,INHS Asvini in [4]. In our setting,the task could be performedby WesternNaval Command three years earlier had havinga seniorsailor who is qualifiedas a clinical revealedthat29Vo of the personnelhad significant psychologistafier doing the proposedBachelor of occupationalstress [1]. Stresswas more common in MedicalTechnology (Clinical Psychology) course junior sailorscompared to seniorsailors and officers. underthe aegisof MaharashtraUniversity of Health Personnelat shorereported greaterstress compared Sciences. to their counterpartsin ship or submarine.Issues Experienceof developedcountries thus brings suchas role conflict, role ambiguity,powerlessness to us the need to update our services in keeping were significant. Also younger people reported with the timesas well asthe needto regularly monitor greatermarital stress. stressparameters in thesechanging times. Institute of Naval Medicine United Kingdom has REFERENCES publisheda recent study in which they have I . Bridger R, Kilminster S, Slaven G. Occupational str.ess comparedthe results of a surveys carried out by and strain in the naval service: 1999 and 2004. Ocruu themin 1999and repeated in 2004 [2]. They measured Med 200'7 57 (2\ : 92-7. a factor called as occupationalstrain. As per the 2. Pawar AA, Rathod J. A survey of occupationalstless study more femalesthan men were stressed.Also, in naval personnel.Article accepted for publication stresswas more in people serving afloat which is by Medical JournalArmed ForcesIndia. contradictory to our study. Factors noted were 3. Ikin Jfl McKenzie DP, Creamer MC. War zone stress without direct combat: the Australian naval experience reducedorganizational commitment, dissatisfaction 'Nar. of the Gulf J Traunta Stress 20!5:1 8 (3) : with the physical work environment,role conflict 193-204. andwork-family conflict which wasassociated with 4. Wood DP, Walker E, Moses K, Gilleran L. Treatment strain in males.The strain prevalencewas 32Voin of psychiatric disorders onboard an aircraft carrier 1999and33Vo in2OO4. Findings from theAusrrahan assistedwith psychotropic medicaton : a retrospective review describing one aspect Navy [3] also indicatethat in times of conflict, of Navy Force Health Protection.Mil Med 20O6: 17l (4\ : 3t6-20. 'Senior Adviser (Psychiatry), INHS Asvini, Colaba, Mumbai Jour. Marirc Medical Society, 2006, Vol. 8, No.
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