الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
The diver is a person who work, or explore underwater, practicing an activity called diving. Diving is from the very old activities along the human history. It was historically recognized as a job for gaining money since before 4500 BCE.The main diving activities include: Recreational or sport diving; Technical diving; Commercial diving; diving for research purposes; diving for financial gain by fishing, sponge, and pearl collection; Public safety diving; Military diving. Diving is recognized as activity included in variable occupational activities from the beginning of the twentineth century under the title of professional diving.
Professional divers are working in an exceptional unique environment, exposed to multiple unique multifactorial hazards; exposing them to many diseases.This fact affect their attendance in work which is strictly important for the diver’s economic, socio-professional integration, psychological state. On the other hand; the continuity of work is very important technically, and economically to the organization hiring the divers.
The investigations, clinical examinations for evaluation of the divers, fitness for diving, evaluate his present condition. While the diseases, and pathological conditions usually affecting the diver are results of cummulative predispositions not detected by this routine evaluation. Also, most of these medical problems predisposed by diving, were assumed to be mediated by inflammatory, and OS. The previous research studies for detection of OS in divers; were analyzing, and investigating a possibly late stage of OS.They was also neglecting the inflammatory status tightly related to OS.
These studies confirmed the correlation between scuba diving, and OS, but the role of SIRTs in OS at divers was not studied. The SIRTs, a group of proteins secreted by the human body, are recognized as early protective proteins from OS; when the person is subject of stressors.They are connected with lifespan, aging, and wellbeing; mediated by adjustement of homeostasis, and metabolism of the cell; particularly in the conditions of inflammation.
Oxidative stress can cause chronic inflammation, through activation of transcription factors, leading to the expression of genes included in the inflammatory process. High sensitivity CRP is a relevant, and respectable biomarker of inflammation, possibly referred to OS. This implicates on divers, especially as the divers show a very high prevelance of those diseases caused by inflammatory process triggered by OS.
Alkaline Plosphatase is not actualy from the investigations included in the medical fitness evaluation for divers. But many studies suggested it as a valuable test in this domain. We expected it to have an additive value in evaluating the fitness of the divers.
In the present study, these four biomarkers were selected as biomarkers of OS, inflammatory stress at divers, and its reflection on the divers, health. Musculo Skeletal score, heamodynamic measurements, together with laboratory investigations covering the main body systems, glucose, electrolytes were used to reflect the health condition of the divers, and the seafarers.
This study aimed to assess some biomarkers of OS, and inflammatory status among professional divers in Alexandria, create a new scope of early protective measures for the divers to ameliorate their performance, safety, and lifestyle.
The study was carried on 43 professional divers, a same number of seafarers as a control group. For proper diagnosis of inflammatory, and OS, all available tools was utilized in stepwise approach to reach this diagnosis. This was achieved in this study by detailed medical, and occupational history taking, physical examination, laboratory investigations including SIRT1, SIRT3, hsCRP, ALP, FBS, lipids, hepatocellular sufficiency, renal function tests, and serum electrolytes levels.
According to the results of this study, it was suggested that continuous exposure to the conditions related to diving cause oxidative and proinflammatory conditions in the exposed divers when compared with seafarers. Also, the current study is showing the importance of early detection of oxidative, and inflammatory changes by measuring the level of serum biomarkers like SIRT1, SIRT3, hsCRP, and ALP.
As a conclusion; effective diagnostic, and preventive measures will not eliminate the occurrence of oxidative, and proinflammatory conditions, but can prohibit the occurrence of chronic diseases, and stop its progress to impairments or disabilities. We can avoid these consequences by the use of those newly effective investigations to detect these conditions in asymptomatic patients, being a promising tool to achieve this goal, even with a higher cost. But the cost of health improvement, is less than the cost of illness; especially in divers as mentioned before.We concluded from this study results that the biomarkers used in this study are valuable biomarkers of OS, and inflammatory status, and the prevention of health conditions in divers.
Conclusion and Recommendations
- Professional divers are at high risk for many health effects, especially high SBP, and high uric acid levels, and a status of MS dicomfort.
- The association between diving, with SIRT1, SIRT3, and MS comfort; is revealed by univariant analysis, and multiple logistic regession analysis at the present study.
- The higher SIRT1, and lower SIRT3 level in divers group are predicting an active body protective mechanism against OS.
- There is undetermined association between diving, with hsCRP as inflammatory risk predictor in divers group.
- The proinflammatory status with OS biomarkers changes in divers may be independently related to serum ALP levels, as evidenced in multivariant analysis among the study population reflecting the possibility of tissue breakdown.
- Normal results of medical examination, and routine investigations of the divers, do not exclude liability to preclinical diseases, and pathological conditions.
- Professional divers are at a state of chronic OS, determined by the inverse pattern of SIRT1, to SIRT3 in the present study.
Therefore it is recommended to:
- Health surveillence of professional divers should include full clinical examination with emphesis on SBP, and MS score.
- Laboratory investigations are valuable approach for early detection of any health effect among professional divers.Both serum UA, ALP, and HDL cholesterol should be focussed on in the routine laboratory checkup analysis.
- The higher MS soreness score in young divers, not supposed to be suffering from this degree of soreness at this age, can be a predictor of OS, and proinflammatory stress.
- Sirtuin1, and SIRT3 can be possibility included in the tests for evaluation of the health status of the divers, even on wider scale of time in periodic examination.
- The other five members of SIRTs family must be studied in the future researchs on divers; to evaluate its role in the protection against OS.
- High sensitive CRP, and serum electrolytes levels should be restudied in larger studies among divers for assessment of pending inflammatory status.
- Some protective measures; as stopping the diving activity even temporarly, the use of antioxidants, and SIRT activators, are additive lines to exhibit OS.
- The significantly higher smoking index in divers, while this index not correlated to OS biomarkers, need to be revised in further researchs.
- Strict assessment of the diseases; known to be predisposed by OS in professional divers is recommended in the periodic medical examination, and fitness evaluation.
- The oxidant vs antioxidant profiles investigations ; should be applied on divers.
- The resurches focusing on the MS discomfort in divers must be intensified as its role as a reflection of OS, inflammatory status, is becoming more prominent.
- The examining hyperbaric doctor should advise the professional divers during their periodic medical examination for the following:
i. Emphasizing healthy quality of life, with healthy food rich in antioxidants, and no smoking.
ii. Respecting the rules, and guidelines of diving, to decrease the prevelance of MS soreness, and diving related diseases especially those associated with a proinflammatory status.
iii. Seaking the medical staff consultation on any complain. Especially those possibly requiring restriction of diving activities to avoid exacerbation of inflammatory, and oxidative stress .