الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
 |  | from | 107 |  |  |
| | | from | 107 | | |
Abstract
Professoional divers industry includes inshore, offshore, inland, scientific diving,militrayand fishermen diving are known tasks from the ancient histroy. Professional divers are exposed to unique hazards in their working environment, these hazards are multifactorial and cardiovascular effects are tremendius. So, cardiovascular related events founded in one quarter of the diving related deaths. Meanwhile cardiovascular diseases still the most common cause of morbidity and mortality worldwide.
Indeed, CVR assessment is helpful in the prevention and management of CVDs. Many guidelines recommend that comprehensive evaluation of individual global CVR profile should be performed in all adult individuals. Manytoolsare relatively easy, inexpensive, friendly for users and reproducible over time. ASCVD risk estimator for the vascular CVR is one of these important electronic web based tools based on the traditional risk factors. Using traditional risk factors alone is insufficient and adding newbiomarkers for the CVR assessment is recommeded as it improves the sensitivity and specifity of estimators and provide new clues for risk straification.
The electorphsyiological changes of the cardiac activties detected by ECG are amongthe specific and sensitive CVD biomarkers. More particularly, the corrected QT interval whiich was found a good biomarker in for assessing the electrophysiological changes in
CVR assessment in divers. Furthermore, OS and trace metal levels werelinked to the pathophysiology ofCVDsalthough their use as routine biomarkers is non specific and need further controlled research to prove their role in CVR assessment.
The aim of this study was to evaluate some novel biomarkers in CVR assessment in professional divers and their effect on the performance of the established ASCVDR estimator.
The study was carried on a total of50 of professional divers an equal number of age and sex matched seafarers as controls. All enrolled participants were subjected to detailedhistory taking, physical examinations,laboratory investigtions [OSBMs, trace metal, electrolytes, FBS, lipid profile, liver and kidney function test) and ECG.,
Estimationof CVR by the ASCVD risk estimator for all subjects was done to infer the optimal, 10 years and life time risks. Results were tabulated and analysed using the appropriate statistical tests.
Divers were found at significant higher risk of CVD compared to seafares.Adding some predictor biomarkers to the established ASCVDR calculator resulted in increased its sensitivity in CVR assessment. Significant predictor included ECG changes particulary the corrected QT interval, disturbed OSBMs (MDA, GSH, GPx, SOD),serum electrolytes (Na+ and K+)and trace metals (Fe+, Zn+, and Cu+).
IN CONCLUSION: The risk of CVD in professional divers is alarmingly high and including CVRA in divers’ periodic examinations is of utmost importance. Adding selected biomarkers particularly ECG changes and some OSBMs with elements of the ASCVD risk estimator improves its accuracy in CVRA.
Conclusion and Recommendations
• Professional divers are at higher risk of cardiovascular diseases as measured by ASCVD estimator in term of increased 10 years riskscore as well as life time compared to the same levels reported among the control group.
• Cardiovascular risk assessment of professional divers is recommended in the periodicmedical examinations and during fitness examinations.
• Oxidative stressand trace metals are possibly involved inthe pathogenesisofcardiovascular diseases.
• Corrected QT interval of the resting ECGis a marker of the electrophysiological changes. Itshowed significant prolongation in divers more than the control with increased risk at a cutoff point of 402 mses.
• Professional divers showedsignificantOSas measured by related OSBMs(MDA, GSH,GPx,SOD) and TAS levels. The SOD was the most predictive biomarker in relation to ASCVD estimator score of risk both in 10 years and life time risk values.
• Trace metals showed imbalancemanifiested as increased Cu/Zn ratio among divers in relation toCVD risk score when compared to the control.
• Somking and SBP kept an independent effect in contributing to the CV risk after controlling of the confounders among divers.
• During the periodic examination of the divers and seafares for fitness the following should be emphazied:
o Careful monitoring of the arterial SBP
o ASCVD estimator for assessing CV risk. Analysis of the results should be done considering cutoff points of ≤46 and ≤2.6 for the life time and 10 years risk detection respectively. Training of medical staff on the use of ASCVD should be enforced and encourged.
o Calculation of the corrected QT wave intervalin the resting ECG with a cut off point of ≤402 msc should b consided for further assessment and investigation by specilalized cardiologist for diving fitness.
• Although highly predictive, OSBMsparticularly SOD and trace metals levels (Cu+/Zn+) should not be done as routine unless their their role in CVR assessment is reproduced and validated in further research on larger sample sizes.
• Preventive measures for CVR factors and promoting better quality of life should be advised for prfessional divers and seafarersby emphasizing and not limited to :
o Tight smoking prevention and control program.
o Nutritional health education engcourging antioxidants and Zn supplements.
o Health education for CV diseases prevention and control measures.