Nevin Manimala

Diving Hyperb Med. 2025 Dec 20;55(4):384-390. doi: 10.28920/dhm55.4.384-390.

ABSTRACT

INTRODUCTION: Breath-hold divers can surface with neurological symptoms consistent with nitrogen buildup in tissues or gas entry into the arterial circulation, collectively termed decompression illness (DCI). While DCI has historically been attributed to diving with compressed air, breath-hold divers have reported similar syndromes. The causes, diagnosis, and management of DCI in breath-hold divers is poorly understood.

METHODS: We developed an online survey that queried breath-hold divers on the symptoms they experienced during decompression illness events and the medical management of each event.

RESULTS: A total of 36 (31 M, 5 F) breath-hold divers filled out the survey. A majority identified as recreational freedivers, competitive freedivers, and/or spearfishers with an average age of 45 years and 18 years of breath-hold diving experience. Of those surveyed, 33 (92%) held a certification from an accredited training agency. A total of 18 (50%) reported experiencing DCI, with 21 DCI incidents reported by 13 individuals from 1999-2024. Sixteen (76%) of DCI incidents occurred during training, with an average depth of 83.4 m and average speed of 1.0 m∙s-1. Thirteen (62%) percent of DCI incidents occurred while diving to depths shallower than a previous personal best. The most common symptoms were weakness, numbness, slurred speech, and fatigue. The most common treatment modalities were surface oxygen, in-water recompression, and hyperbaric oxygen therapy. Sixteen divers (76%) had partial or complete resolution of their symptoms. The top cited contributors to the DCI incidents were depth, short surface interval between dives, and pulmonary barotrauma.

CONCLUSIONS: Breath-hold divers can experience DCI even when diving within their limits. The most cited contributors to DCI were depth, short surface interval between dives, and pulmonary barotrauma. Most divers’ symptoms resolved after treatment with surface oxygen, in-water recompression, and/or hyperbaric oxygen therapy.

PMID:41364862 | DOI:10.28920/dhm55.4.384-390

Diving Hyperb Med. 2025 Dec 20;55(4):369-375. doi: 10.28920/dhm55.4.369-375.

ABSTRACT

INTRODUCTION: Rebreather diving carries a high fatality rate (estimated 1.8-3.8 deaths per 100,000 dives), yet its popularity is growing. Among 54 French military divers who lost consciousness underwater, none died when using a mouthpiece retaining strap (MRS) in a team diving setup. Despite this, MRS use remains limited among recreational divers for whom drowning is a major cause of death. This study assessed knowledge, perceptions, and training regarding MRS use within the rebreather diving community.

METHODS: An international online survey targeting certified rebreather divers was disseminated via social media. The survey gathered demographic information, diving experience, MRS usage, and details on related training.

RESULTS: A total of 563 responses were collected. Of these, 133 (23.6%) were instructors, and 210 (37.3%) had received MRS training. On a 0 to 100 scale, divers trained on MRS use rated MRS importance higher (median score: 74 [IQR 33-90]) than divers with no MRS training (median: 49 [IQR 16-67]). Barriers to MRS adoption included negative past experiences, poor training, misuse, and concerns about complications during bailout procedures.

CONCLUSIONS: While not widely adopted among recreational divers, the MRS is supported by strong safety data. Formal training significantly improves its perceived value and acceptance. Greater involvement from manufacturers, training agencies, and instructors is essential to promote education and encourage MRS adoption as a key safety measure in rebreather diving.

PMID:41364860 | DOI:10.28920/dhm55.4.369-375

Diving Hyperb Med. 2025 Dec 20;55(4):352-368. doi: 10.28920/dhm55.4.352-368.

ABSTRACT

INTRODUCTION: Research in hyperbaric oxygen (HBO) medicine is growing, but the quality of HBO studies is variable. Low study quality may compromise evidence-based decision-making and clinical translation.

METHODS: This cross-sectional study examined the adherence of 50 randomly selected HBO clinical trials (25 randomised controlled trials [RCTs] and 25 observational studies) to relevant core reporting guidelines: consolidated standards of reporting trials (CONSORT), non-pharmacologic treatments (NPT), and strengthening the reporting of observational studies in epidemiology (STROBE). Studies published in peer-reviewed journals between January 2018 and May 2023 and indexed on PubMed were analysed. Reporting quality was classified as ‘excellent’ (> 85% of guideline items adequately reported), ‘good’ (50-85%), or ‘poor’ (< 50%).

RESULTS: The sample represented 29% of RCTs and 16% of observational studies for the timeframe assessed. No study was rated as ‘excellent’ for completeness, 28 (56%) were rated as ‘good’, and 22 (44%) as ‘poor’. In RCTs, only one study (4%) adequately reported protocol adherence and eight studies (32%) reported blinding procedures. The NPT checklist showed that key items, including care provider adherence (0 studies) and participant adherence (one study; 4%), were frequently not reported. For observational studies, basic design elements were adequately reported, but with significant gaps in bias management (nine studies; 36%) and missing data handling (13 studies; 52%). Only six studies (12%) mentioned the use of reporting guidelines.

CONCLUSIONS: Our results showed that quality of reporting of HBO studies is suboptimal. These findings highlight the need for increased awareness and implementation of reporting guidelines, as well as the potential development of HBO-specific guidelines.

PMID:41364859 | DOI:10.28920/dhm55.4.352-368

Diving Hyperb Med. 2025 Dec 20;55(4):338-342. doi: 10.28920/dhm55.4.338-342.

ABSTRACT

INTRODUCTION: Cardiac arrest (CA) during hyperbaric oxygen treatment (HBOT) is exceedingly rare with only a few cases reported. It is unknown if in-chamber defibrillation of a patient has been performed in Australasia. In-chamber defibrillation is potentially dangerous with the risk of fire in an oxygen-rich environment. Australasian Standards prohibit the use of currently available defibrillators licensed for in-chamber use, as they contain lithium batteries. This study aimed to investigate how CA is managed in Australasian hyperbaric medicine units (HMUs) and to establish if there is a need to develop standardised protocols.

METHODS: A 10-part SurveyMonkey® questionnaire sent to all 15 Australasian HMUs. Questions aimed to ascertain if there were cases where defibrillation during HBOT was indicated and if it was performed. We asked about emergency treatment protocols, defibrillation capabilities and if regular training drills were conducted. We asked if colleagues felt the need to have a uniform treatment protocol across Australasia and invited them to share their emergency protocols.

RESULTS: Fourteen responses (93.3%) were received. No clinical cases of in-chamber CA or defibrillation were reported. Examples of emergency treatment protocols were provided by two respondents. Six respondents (43%) stated that regular emergency training drills for CA are performed in their HMU. Eleven respondents (79%) favoured standardised treatment protocols; however, comments suggested that this might be unachievable.

CONCLUSIONS: CA requiring defibrillation in the hyperbaric medicine context is rare and has not been performed in Australasia. Most HMUs have protocols in place, but they are not universally practiced regularly.

PMID:41364857 | DOI:10.28920/dhm55.4.338-342

AACN Adv Crit Care. 2025 Dec 15;36(4):317-324. doi: 10.4037/aacnacc2025924.

ABSTRACT

In-hospital strokes carry high long-term morbidity and mortality rates, but treatment pathways for inpatient strokes are not as well studied as those for community-onset strokes. This single-center, retrospective study of in-hospital Code Strokes extracted data from a database maintained by stroke nurse coordinators at an urban academic institution (January 2017 to March 2023). The objective was to explore the benefits of a rapid response team-driven Code Stroke model. Of 900 Code Stroke activations, 836 were driven by the rapid response team and 64 were not driven by the rapid response team. Patients with codes activated by the rapid response team received imaging faster than did those with codes not activated by the rapid response team (mean [SD] time, 15.7 [13.7] minutes vs 23.2 [23.1] minutes; P = .03). More Code Strokes were activated in the intensive care units and cardiovascular units than in other areas.

PMID:41364849 | DOI:10.4037/aacnacc2025924

Swiss Med Wkly. 2025 Nov 25;155:4453. doi: 10.57187/s.4453.

ABSTRACT

STUDY AIMS: Premature birth is the leading cause of neonatal morbidity and mortality. Tocolytics aim to temporarily inhibit preterm contractions, allowing time for lung maturation induction, which reduces neonatal complications. Guidelines recommend limiting tocolysis to 48 hours and avoiding its use beyond 34 weeks of gestation. However, international surveys indicate that clinical practice often deviates from guidelines, revealing a gap between evidence-based recommendations and real-world practice. We aimed to evaluate current practices in the use of tocolysis and antenatal corticosteroid treatment in Switzerland and their alignment with international and national guidelines for preterm birth management.

METHODS: This national cross-sectional survey (15 February to 30 May 2024) used an anonymous online questionnaire distributed to 94 chief physicians of obstetric departments and 481 private-practice gynaecologists via e-mail, as well as through newsletters and social media channels of the Swiss Society of Gynaecology and Obstetrics in German, French and Italian. Chief physicians were contacted through the Chief Physicians’ Conference e-mail list and asked to share the survey with their medical teams. Private-practice gynaecologists were reached via practice e-mail addresses obtained through the authors’ personal networks and a clinic internal directory, as no centralised registry exists. Eligible participants were those actively involved in obstetrics or pregnancy care. The primary outcomes were duration and timing of tocolysis. Data is shown for the overall cohort and stratified by physician group (hospital, private-practice and attending physicians). The estimated response rate among specialists was 13% overall, with higher participation by hospital physicians (25%) and lower participation by private-practice physicians (8%).

RESULTS: A total of 319 obstetricians participated in the survey (201 hospital, 68 private-practice and 50 attending physicians). Maintenance tocolysis was still practiced by 54% of survey participants. While 80% of the respondents adhered to international/national guidelines by limiting tocolysis to 34 weeks of gestation, 20% reported administering tocolytics beyond this point. Tocolysis was primarily used in cases of preterm labour; in contrast, its use in premature preterm rupture of membranes without contractions was limited, with most physicians administering it only during antenatal corticosteroid treatment administration. Furthermore, similarities were observed among physician groups in prioritising indications and contraindications for tocolysis, but variations existed in the use of tocolytics in special situations (e.g. high-risk pregnancies or cervical cerclage).

CONCLUSION: Most participating Swiss obstetricians adhere to existing guidelines for preterm birth management, but discrepancies remain – particularly regarding tocolysis for longer than 48 hours and after 34 weeks of gestation. Enhanced education and improved implementation strategies are needed to bridge gaps and promote a more unified approach in line with current evidence.

PMID:41364824 | DOI:10.57187/s.4453

Swiss Med Wkly. 2025 Dec 9;155:5203. doi: 10.57187/s.5203.

ABSTRACT

Although the medical literature is flooded with case descriptions, it is difficult to dismiss the significant impact that a clinical observation limited to one or two patients can have. Case reports can also play a critical role in other areas such as drug safety by serving as early warning signals for adverse drug reactions. Unlike the aggregated data and statistical abstractions of clinical trials or meta-analyses, case reports reflect the real-world context of medical practice, where decisions are made patient by patient. This alignment with everyday clinical experience makes case reports particularly relatable and valuable to practicing clinicians, offering insights that resonate far beyond the confines of population-based evidence. The “Swiss Medical Weekly” wishes to participate in the dissemination of high-quality case reports. A new section entitled “Clinical reasoning” will provide a dedicated platform for well-structured case reports while upholding the journal’s high and very strict editorial standard and its Diamond Open Access model.

PMID:41364819 | DOI:10.57187/s.5203

Swiss Med Wkly. 2025 Nov 18;155:4546. doi: 10.57187/s.4546.

ABSTRACT

INTRODUCTION: Human childbirth remains a complex and risky process for both mothers and infants, even with modern advancements in medical care. This study investigated the prevalence of obstetric interventions, namely caesarean sections, episiotomies, and forceps deliveries, along with the role of maternal-foetal body size mismatch in influencing delivery outcomes.

METHODS: Utilising two datasets from similar archival sources in two Swiss cities (Basel and Lausanne) from the 1920s, we explored the relevance of a mismatch between the body size of the mother and the foetus as a risk factor for obstetrical interventions and the duration of the expulsion phase during delivery.

RESULTS: Over 91% of births (1290/1407 in Basel and 1062/1145 in Lausanne) featured the foetal head in a normal position (either the right or left occiput anterior position). Episiotomies were performed in 8-17% of cases (233/1407 in Basel and 98/1145 in Lausanne) and forceps deliveries in 1-5% (17/1407 in Basel and 54/1145 in Lausanne). Caesarean sections were rare (<1%, 19/1407 in Basel and 6/1145 in Lausanne). Key findings indicated that larger foetal head diameters and narrower pelvic measurements were linked to prolonged expulsion phases and an increased likelihood of intervention. Abnormal head positions and first-time births were also associated with obstetrical interventions. Additionally, rickets was documented in 2% of mothers (23/1145) in Lausanne, correlating with increased forceps use and caesarean section rates.

CONCLUSION: This research provides insights into obstetric practices and maternal health conditions over a century ago, emphasising the significant impact of maternal-foetal body size mismatches on childbirth complications in a historical context.

PMID:41364818 | DOI:10.57187/s.4546

J Med Internet Res. 2025 Dec 9;27:e80981. doi: 10.2196/80981.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) techniques, particularly those using machine learning and deep learning to analyze multimodal imaging data, have shown considerable promise in enhancing preoperative prediction of extraprostatic extension (EPE) in prostate cancer.

OBJECTIVE: This meta-analysis compares the diagnostic performance of AI-enabled imaging techniques with that of radiologists for predicting preoperative EPE in prostate cancer.

METHODS: We conducted a systematic literature search in PubMed, Embase, and Web of Science up to September 2025, following PRISMA-DTA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis of Diagnostic Test Accuracy) guidelines. Studies applying AI techniques to predict EPE using multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging were included. Sensitivity, specificity, and area under the curve (AUC) for both internal and external validation sets were extracted and pooled using a bivariate random effects model. Study quality was assessed using the modified Quality Assessment of Diagnostic Performance Studies (QUADAS-2) tool.

RESULTS: A total of 21 studies were included in the analysis. For internal validation sets in patient-based analyses, mpMRI-based AI demonstrated a pooled sensitivity of 0.77 (95% CI 0.71-0.82), specificity of 0.71 (95% CI 0.64-0.78), and AUC of 0.81 (95% CI 0.77-0.84). In external validation, mpMRI-based AI achieved a sensitivity of 0.66 (95% CI 0.43-0.84), specificity of 0.80 (95% CI 0.64-0.90), and AUC of 0.80 (95% CI 0.77-0.84). In comparison, radiologists achieved a pooled sensitivity of 0.69 (95% CI 0.60-0.76), specificity of 0.73 (95% CI 0.66-0.78), and AUC of 0.77 (95% CI 0.73-0.80). Statistical comparisons between mpMRI-based AI and radiologists showed no significant difference in sensitivity (Z=1.61; P=.10), specificity (Z=0.43; P=.67). Conversely, the AUC of mpMRI-based AI was significantly higher than that of PSMA PET-based (Z=2.77; P=.01). PSMA PET-based AI showed moderate performance with sensitivity of 0.73 (95% CI 0.65-0.80), specificity of 0.61 (95% CI 0.30-0.85), and AUC of 0.74 (95% CI 0.70-0.77) in internal validation, and in external validation, it demonstrated sensitivity of 0.77 (95% CI 0.57-0.89) and specificity of 0.50 (95% CI 0.22-0.78), demonstrating no significant advantage over radiologists.

CONCLUSIONS: mpMRI-based AI demonstrated improved diagnostic performance for preoperative prediction of EPE in prostate cancer compared to conventional radiological assessment, achieving higher AUC. However, PSMA PET-based AI models currently offer no significant advantage over either mpMRI-based AI or radiologists. Limitations include the retrospective design and high heterogeneity, which may introduce bias and affect generalizability. Larger, more diverse cohorts are essential for confirming these findings and optimizing the integration of AI in clinical practice.

PMID:41364797 | DOI:10.2196/80981

Medwave. 2025 Dec 9;25(11):e3154. doi: 10.5867/medwave.2025.11.3154.

ABSTRACT

INTRODUCTION: Bariatric and metabolic surgery is a safe and effective method for treating clinically severe obesity. In Argentina, Law 26 396 and its amendments establish the regulatory framework for its coverage. However, administrative, regulatory, and financial barriers limit effective access to it, with gaps remaining in its scope and understanding. This study aimed to explore surgeons’ and health insurance providers’ perceptions of the implementation of bariatric and metabolic surgery in Argentina, within the framework of Law 26 396, and to identify the barriers that impede effective, timely access.

METHODS: We conducted an exploratory qualitative study comprising 16 in-depth virtual interviews with eight surgeons specializing in bariatric and metabolic surgery and eight health insurance officers of the Argentine healthcare system, conducted between November and December 2024. The sampling was intentional. The interviews were recorded, transcribed, and coded. A thematic and recursive analysis was conducted, enabling us to identify emerging categories.

RESULTS: We identified multiple barriers and challenges to the effective implementation of bariatric and metabolic surgery in Argentina, including geographic inequalities, heterogeneity in surgical module agreements, administrative and bureaucratic restrictions related to variability in the interpretation of the law and its requirements, high costs, and the imposition of quotas that delay timely access, among others.

CONCLUSIONS: The implementation of bariatric and metabolic surgery presents structural and functional challenges that affect equitable and timely access. Although Law 26 396 and its subsequent regulations established a regulatory framework for its coverage, tensions among healthcare system actors and regional disparities have resulted in heterogeneous implementation. Administrative and financial barriers persist, affecting its effective and timely practice. We highlight the need to strengthen coordination between physicians and health insurance providers, promoting opportunities for dialogue that optimize authorization and funding processes.

PMID:41364794 | DOI:10.5867/medwave.2025.11.3154