Small bowel mucosal damage in familial Mediterranean fever: results of capsule endoscopy screening.

OBJECTIVE: Familial Mediterranean fever (FMF) is the most common form of autoinflammatory diseases. We aimed to evaluate the small bowel mucosa by capsule endoscopy (CE) in FMF patients for investigation of other possible causes of abdominal pain. MATERIAL AND METHODS: The study group consisted of 41 patients with FMF. A standard questionnaire was used to record the gastrointestinal symptoms, other clinical findings, Mediterranean fever gene (MEFV) mutations, and history of medications including non-steroidal anti-inflammatory drugs (NSAIDs). Gastroscopy, colonoscopy and small bowel CE were performed in all patients, and biopsies were taken from terminal ileum and duodenum. RESULTS: The mean age of the patients was 34 ± 11 years, 63% of them were female, and 76.5% of them were carrying MEFV exon 10 mutations. Only one patient used NSAIDs in addition to colchicine. In endoscopic investigations, gastric erosion was detected in only one patient, and no significant findings were detected in colonoscopy. CE showed small bowel mucosal defects in 44% (erosions in 26.8%, ulcer in 17.1%) and edema in 29.3% of the patients. Most (64%) of the ulcer and erosions were localized to jejunum, and only 24% were in ileum. Mitotic changes as an indirect finding of colchicine toxicity were not different from the changes observed in samples of independent group of patients with irritable bowel syndrome. CONCLUSION: Mucosal defect was observed in half of the FMF patients, which may be associated with underlying inflammation or chronic colchicine exposure. Detection of nonspecific chronic inflammation without mitotic changes supports that mucosal defects may be associated with the autoinflammatory process.

Hysteria as a Trigger for Epidemic Decompression Sickness Following Hypobaric Hypoxia Training.

INTRODUCTION: Although hypobaric hypoxia training (HHT) is an essential component of aviation physiology training, it poses a risk of decompression sickness (DCS). DCS can sometimes be observed as a cluster of cases, which is referred to as epidemic DCS. In this report, we aim to evaluate an epidemic DCS episode that occurred following two consecutive HHT sessions.METHODS: A total of 16 trainees, all of whom were medical doctors, attended the aviation medicine training course in the aeromedical research and training center. They went through HHT in two sessions, each with eight trainees.RESULTS: Following two HHT sessions, five Type 1 DCS cases occurred among 18 personnel (16 trainees and 2 inside observers). DCS incidence rate was found to be 27.77%. They were successfully treated with hyperbaric oxygen therapy (HBOT).DISCUSSION: Since the DCS incidence rate was found to be higher than the average in such a short period of time, this cluster of cases was labeled as epidemic DCS. We carried out a thorough investigation into all possible causes by following some templates that were developed to conduct comprehensive investigations into epidemic DCS episodes. According to the psychological arguments discussed here, we placed a special emphasis on hysterical and psychosocial components, among other probable factors. In cases where the possibility of hysteria and placebo-nocebo responses exist, it is appropriate to conduct the training and treatment processes with these factors in mind. No matter what the triggering factor is and how the symptoms manifest, HBOT remains crucial in the treatment of DCS.Demir AE, Ata N. Hysteria as a trigger for epidemic decompression sickness following hypobaric hypoxia training. Aerosp Med Hum Perform. 2022; 93(10):712-716.

A COVID-19 infection incidentally detected during hyperbaric oxygen treatment and preventive measures for COVID-19 transmission in a multiplace hyperbaric chamber.

INTRODUCTION: SARS-CoV-2 (COVID-19) was declared a global pandemic on 11 March 2020 and has become a serious threat to public health. As it can easily be transmitted through droplets and aerosols, there is an increased risk of transmission in enclosed environments such as hyperbaric oxygen treatment (HBOT) units if preventive measures are not taken. CASE REPORT: A 16-year-old female tested positive for SARS-CoV-2 during HBOT for idiopathic sudden sensorineural hearing loss. The other patients and the inside attendant who attended the sessions with her were regarded as contacts, tested for SARS-CoV-2, and quarantined until the test results were available. Ultimately, none of them tested positive. DISCUSSION: As HBOT in multiplace chambers entails a high risk of SARS-CoV-2 transmission, we strictly adapted our practice to consider that every patient could be a potential asymptomatic carrier. Therefore, the negative results of all contacts in this case and the fact that no confirmed cases of COVID-19 were reported suggests that these measures successfully prevented SARS-CoV-2 transmission in our HBOT clinic. SARS-CoV-2 transmission can be prevented if sufficient protective measures are taken.

Vestibular Illusions and Alterations in Aerospace Environment.

As the aerospace industry has grown rapidly over the years, aviators and astronauts have been exposed to some abnormal physiological changes arising from the dynamics of the aerospace environment. The vestibular system, encoding linear and angular movements of the head, is one of the main affected systems in which those abnormal changes can occur during flight. Despite the intricate and solid organization, vestibular units are such delicate structures that they can easily be deceived by aerial dynamics and gravity changes. Therefore, it is of vital importance for the continuity of flight safety to be aware of the detrimental alterations and impairments regarding the vestibular system and its reflex pathways. The aim of this paper was to present a review about how a healthy vestibular system is negatively affected within the aerospace environment and how some vestibular disorders become exaggerated or impaired during aviation and space activities.