The document provides information on travel health and pre-travel evaluation. It discusses that a family of four traveling to Chad for 2 years should vaccinate the entire family for meningitis as there is an ongoing epidemic in Chad. It also outlines key aspects of pre-travel risk assessment and highlights important considerations for various groups like pregnant travelers, those with medical conditions, and recommendations for reducing jet lag.
Rotary can take you many places. What can you do to stay
healthy while visiting other countries? A travel expert will
help you plan ahead. You’ll learn how to figure out which
immunizations you’ll need, and other measures you can take
to prevent disease.
Rotary can take you many places. What can you do to stay
healthy while visiting other countries? A travel expert will
help you plan ahead. You’ll learn how to figure out which
immunizations you’ll need, and other measures you can take
to prevent disease.
Elaborating the concepts of health determinants and disease prevention to the 3-year medical students by introducing an emerging field of Travel Medicine.
slides on emporiatrics for indian travellers,i was not able to find a decent slide so i compiled the epidemologicl data for various diseases hope u guys find it useful
This presentation provides an overview of the history of malaria reactive case detection in Zanzibar, including the use of mobile technology to facilitate and monitor the process. It also provides a brief look at the latest version of the Coconut Surveillance mobile software used in Zanzibar. Part of the work represented in this presentation was supported by Cooperative Agreement 621-A-00-10-00015-00, funded by the President’s Malaria Initiative (PMI). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of PMI or the U.S. Government.
Screening for diseases from community medicine. It explains the definition of screening, lead time, uses of screening, differences between screening and diagnostic test, criteria for a disease to be screened and criteria for a screening test, cut-off points, etc
Epidemiology of Non Communicable Diseases (NCDs)Prabesh Ghimire
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
This PowerPoint was prepared and presented in IAPSMCON-2022 as a part of Journal Club competition...
It was judged by eminent stalwarts Dr.Anand Krishnan sir, Dr. Sanjay Zodpey sir and Dr. Amarjeet Singh sir and bagged the first prize as well...!!!
It critically appraises a Mixed Method Research study...Dive in to explore...!!!
Elaborating the concepts of health determinants and disease prevention to the 3-year medical students by introducing an emerging field of Travel Medicine.
slides on emporiatrics for indian travellers,i was not able to find a decent slide so i compiled the epidemologicl data for various diseases hope u guys find it useful
This presentation provides an overview of the history of malaria reactive case detection in Zanzibar, including the use of mobile technology to facilitate and monitor the process. It also provides a brief look at the latest version of the Coconut Surveillance mobile software used in Zanzibar. Part of the work represented in this presentation was supported by Cooperative Agreement 621-A-00-10-00015-00, funded by the President’s Malaria Initiative (PMI). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of PMI or the U.S. Government.
Screening for diseases from community medicine. It explains the definition of screening, lead time, uses of screening, differences between screening and diagnostic test, criteria for a disease to be screened and criteria for a screening test, cut-off points, etc
Epidemiology of Non Communicable Diseases (NCDs)Prabesh Ghimire
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
This PowerPoint was prepared and presented in IAPSMCON-2022 as a part of Journal Club competition...
It was judged by eminent stalwarts Dr.Anand Krishnan sir, Dr. Sanjay Zodpey sir and Dr. Amarjeet Singh sir and bagged the first prize as well...!!!
It critically appraises a Mixed Method Research study...Dive in to explore...!!!
Nursing management of critically ill patient in intensive care unitsANILKUMAR BR
Critical care nursing: it is the field of nursing with a focus on the utmost care of the critically ill (or) unstable patients.
Critically ill patients : critically ill patients are those who are at risk for actual (or) potential life threatening health problems.
Admission QGeneral appearance (consciousness)
Airway: Patency Position of artificial airway (if present)
Breathing: Quantity and quality of respirations (rate, depth, pattern, symmetry, effort, use of accessory muscles) Breath sounds Presence of spontaneous breathing.
Circulation and Cerebral Perfusion: ECG (rate, rhythm, and presence of ectopy) Blood pressure Peripheral pulses and capillary refill Skin, color, temperature, moisture Presence of bleeding Level of consciousness, responsiveness.
quick Check Assessment in CCU.
Crimean Congo Hemorrhagic Fever (CCHF) by Wazhma HakimiDr. Wazhma Hakimi
Crimean Congo Hemorrhagic Fever (CCHF) is a highly fatal viral zoonotic disease caused by a tickborne virus (Nairovirus). It is primarily transmitted to humans either by the bite of the Hyaloma ticks or by direct contact with blood or tissues, secretions, organs or other bodily fluids of an infected animal during and immediately after slaughter. Human to human transmission can also occur resulting from close contact with bodily fluids of infected persons. Hospital acquired infections can also occur due to improper sterilization of medical equipment, reuse of needles and contamination of medical supplies. The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats. A case with sudden onset of high grade fever over 38.5OC for more than 72 hours and less than 10 days, especially in CCHF endemic area and among those in contact with sheep or other livestock (shepherds, butchers, and animal handlers including exposed family members) is defined as CCHF. The fever is usually associated with headache and muscle pain and does not respond to antibiotic or anti malarial treatment. Other signs and symptoms include malaise, weakness, irritability, and marked anorexia. There may be bleeding from gums, nose, lungs, uterus and intestine, but only in serious cases associated with severe liver damage. A single case of CCHF is considered by DEWS Plus as an outbreak and is investigated. The number of outbreaks of CCHF shows significant increase in Afghanistan. Similarly the number of deaths and provinces has tripled in 2016 (18 deaths, 24 provinces) compared to 2013 (6 deaths, 8 provinces). The data since 2007 shows that the number of CCHF cases and outbreaks has increased from 2 provinces (Herat and Helmand) to other 26 provinces. The sudden increase of CCHF cases also typically corresponded with the post exposure animal sacrifice during Eid Al Adha. Outbreaks of CCHF are a major public health concern n Afghanistan. Though the majority of the cases are reported from Herat province, the spread of the disease to 24 provinces is concerning. This pattern in the spread of the disease is a potential public health emergency of international concern (PHEIC). Risk of infection to health staff is high and the importance of IPC in hospitals also needs to be emphasized. Transboundary and internal movement of livestock need to be continuously monitored along with effective use of appropriate acaricide to reduce the tick population.
generalized anxiety disorder is very common in primary health care settings .patients usually have somatic complaints and they do not attribute these symptoms to anxiety.the doctor needs to have a high index of suspicion to be able help the patients.
Depression is the leading cause of disability world wide and is a major contributor to the overall global burden of diseases .At its worst depression can cause suicide .
There are effective psychological and pharmacological treatments for depression
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. TRAVEL HEALTH
PRE – TRAVEL EVALUATION
DR OGECHUKWU MBANU
FAMILY MEDICINE
DEPARTMENT AKTH
2. PRETEST
• 1…. A family of four is leaving in January for a 2-
year stay in Chad. The family consists of a 46-
year-old father, a 34-year-old mother who is 5
months pregnant, a 4-year-old boy, and a 2-
year-old girl. A meningitis epidemic has just
begun in Chad. Assuming that the epidemic
strain is covered by an available vaccine, which
members of the family should be vaccinated?
A. Father and mother only
B. Father, mother, and 4-year-old boy
C. Father and the two children
D. The entire family
3. 2…Regarding Key elements of pre-
travel risk assessment which is
false
A.Pre-travel health status of the
traveler is important
B.Mode of transport is important
C.Destination(s) is important
D.Duration and season of travel is
of no consequence
4. 3….A traveller to Mexico develops
sudden onset of severe, watery
diarrhea, with four bowel
movements in the first hour and a
fever of 38.5 Cï‚° (101.3ï‚° F). The
best treatment at this time is
• A. metronidazole
• B. ciprofloxacin
• C. oral rehydration solution
• D. bismuth subsalicylate tablets
5. • 4... Which of the following vaccinations is
contraindicated for a traveller who has the
Acquired Immunodeficiency Syndrome (AIDS)
and a CD4 count of 200/mm (normal range
400/mm - 1500/mm )?
A. Japanese B encephalitis
B. Hepatitis A
C. Pneumococcal
D. Varicella
6. 5…Which of the following is the most
appropriate advice for preventing acute
mountain sickness?
(A) Take acetazolamide beginning with onset of
symptoms.
(B) Keep fluid intake low enough to prevent
pulmonary and cerebral edema.
(C) Spend two to three nights at 1500 to 2500
meters before going higher.
(D) Rest in place at onset of symptoms and
breathe emergency oxygen, if available
7. OUTLINE
1. Introduction
2. Epidemiology
3. Risks/health risk assessment
4. Medical consultation before travel
5. Special situations
6. Travel related problems
7. Immunization
8. Globally targeted travelers diseases
9. Travel health kit
10.Conclusion
11.Refrences
8. INTRODUCTION
• Also called Emporiatic Medicine is the science of the
health of travelers.
• safety of travellers ,prevention and management of
health problems before, during and after the travel.
• It includes the specialties such as:-
1 .Tropical medicine
2.Aviation medicine
3.Immunization medicine
4.Accident medicine
5.Behavioral medicine
6.Infectious diseases
• Categories travellers include Businessmen ,Tourists,
Immigrants going home (VFR’s),Students ,Missionaries
Military ,pilots,etc
• MEANS OF TRANSPORT : by air, sea, train or land
9. The Continuum of Travel health
During Travel
Preventive health
Contingency Planning
Treatment & Rehabilitation
VisitorsPre-Travel
Post-Travel
10. AIMS OF TRAVEL HEALTH
• Prevention of illnesses and injuries amongst
travelers
• Management of health related problems
• Advocates for improved health and safety
services
• Refugee and migrant health
• Health Risk Assessment for travelers
• Impact of travel on ecosystem e.g. the
introduction and spread of disease and
disease resistance e.g. spread of the Ebola
virus.
11. EPIDEMIOLOGY
• international tourist arrivals worldwide in 2010 940
million(world tourism organization)
• Leisure , recreation and holidays accounted for 51% or
446 million
• 15% for business and professional purposes
• 27% for other purposes, sush as visiting friends and
relatives (VFR), religion, health treatment, etc.
• 51% travelled by air
• 49% travelled by surface eg road (41%), rail (2%) or sea
(6%)
• Increase in air transport arrivals
• International arrivals expected to reach 1.6 billion by
2020.
12. Epidemiology in travel health cont’d
• Per 100,000 travelers to a developing country
for 1 month:
• 50,000 will develop some health problem
• 8,000 will see a physician
• 5,000 will be confined to bed
• 1,100 will be incapacitated in their work
• 300 will be admitted to hospital
• 50 will be air evacuated
• 1 will die
13. Epidemiology cont’d
• Per 100,000 travellers that have travel insurance …..
• 8000 will make a claim (8%)
• 2000 will use emergency assistance (2%)
• 400 emergency or clinic referrals (0.4%)
• 200 Hospital admissions (0.2%)
• Note that :
• Cardiovascular Disease -50 to 70%
• Accidents/Trauma -20-25%
• Infectious diseases -2.8-4%
• Traveler’s diarrhea -20-60%
• Respiratory infection- 5-20%
• Malaria (without prophylaxis)- 2%
• Hepatitis A- 0.03-0.3%
• Animal bites with rabies risk 0.3%
14. RISKS TO TRAVELERS
• Changes in altitude, humidity, temperature
• exposure to infectious diseases
• Poor quality accomodation,hygiene and
sanitation
• Inadequate medical services
• Lack of availability of clean drinking water
• Road traffic Accidents
• Unforeseen natural or man-made disasters
• exposure to atmospheric pollution
• outbreaks of known/ newly emerging infectious
15. Fog caused by air pollution in one of the urban citties
16. Air polution at mexico and lanzhou ,
china respectively
•Total suspended
particulates
(in mcg/cubic meter)
•Stockholm(sweden)
is 9
•Mexico City is 279
•Lanzhou,China 732
17.
18. HEALTH RISKS ASSESSMENT
• Key elements of risk assessment are
1. Pre-travel health status of the traveler
2. Mode of transport
3. Destination(s)
4. Duration and season of travel
5. Purpose of travel
6. Standards of accommodation, food hygiene
and sanitation
7. Behavior and lifestyle of the traveler
8. Epidemiology of infectious diseases, road
traffic accidents (RTA)etc in the region
19. HEALTH RISKS ASSESSMENT CONT’D
• For those with underlying health problems, an
assessment is also made of:
1. Availability of appropriate medical services
in the destination,
2. Emergency treatment packs,
3. Self-treatment kits (e.g. a travellers’
diarrhoea kit);
4. Any associated public health risks (e.g. the
risk of infecting others)
20. MEDICAL CONSULTATION BEFORE TRAVEL
• 4–8 weeks before the journey
• preferably earlier if long-term travel or
overseas work
• For last-minute travelers as late as the day of
travel can be beneficial
• information about health risks (including traffic
accidents)
• Evaluation of need for any vaccinations
• Evaluation /advice on existing medical
problems
• malaria prophylaxis if needed
21. consultation before travel cont’d
• The travelers budget
• Comprehensive travel insurance.
• Medical items , the traveler may require
• A model checklist , protocol or Pre -
departure questionnaire
• All relevant information is obtained and
recorded
• provision of a basic medical kit
• Post travel consultation appointment
22. consultation before travel cont’d
Evaluation of patient ;
• Bio-data
• Any presenting complaints
• Past medical and surgical history
• Existing medical issues: Pregnancy ,disability
Breastfeeding ,Immunocompromise ,
Psychiatric condition , Seizure disorder
,cardiopulmonary events
• Drug history
23. Evaluation of patient cont’d
• Immunization history : Routine/travel vaccines
• Previous travel experience
• Trip Details
• Itinerary: : Countries and specific regions, order
of countries if >1 country ,Rural or urban
• Timing: Trip duration ,Season of travel, Time to
departure
• Reason for travel : Tourism ,Bussiness, VFR etc
• Travel style: Independent or package tour,
Modes of transportation and accommodations
24. Evaluation of patient cont’d
• Comprehensive physical examination
• Investigations: determined by
patients specific need and the
country of destination
• May include ;chest x- ray, mantoux
test , serology for hepatitis B,C, RVS,
VDRL , ECG, EEG etc
25. SPECIAL SITUATIONS; AGE
• New born: No limitations’ except babies less
than 7 days old.
• Elderly: no contraindication, should be advised
to ensure:
comfortable seating,
Adequate fluids,
small meals
move around and preferable to sit at the aisle.
• Adolescents: Risky behaviour – eg engaging
prostitutes, drug related issues
26. UNUSUALLY HIGH ALTITUDES
• Altitudes greater than 8000ft(2450m) can lead to
HIGH ALTITUDE ILLNESS.
• These includes;
Acute mountain sickness(AMS);- starts from 14000ft
• Non specific, Headache, nausea, vomiting, insomnia,
fatigue ,malaise ,like alcohol intoxication
High altitude cerebral oedema(HACE);-AMS with
AMS ,AMS +obvious weakness, ataxic gait, mental
function, level of consciousness , coma
High altitude pulmonary oedema(HAPE);- cough –
initially non productive ,then frothy sputum, SOB
,tachycardia , haemoptysis , loss of consciousness
26
27. PRECAUTIONS
• Gradual acclimatization over 2- 4 days
• Begin exertion at <8000ft , 2 to3 nights between
8000-10,000ft before ascending >10,000
• Sleep no more than 1500ft higher each day
• Avoid alcohol or sedatives
• Avoid dehydration or hypothermia
• Consider acetazolamide 250mg bid – start the day
before ascent ,1) when climbing >11,400ft , 2)if hx of
altitude sickness, or3) when acclimatization is not
possible
• Don't go higher if altitude sickness is present;
descend, if symptoms don’t improve in 12hours, get
supplemental oxygen & dexamethasone
27
28. Travellers with chronic problems
• chronic illnesses : diagnosis ,drug doses on their
persons e.g a hand band
• A medical report
• Medicines in hand luggage with prescriptions
• For the disabled-
Inform airline ahead
Specify required assistance
Arrange for companion
Request seat near toilet
• For HIV patients - avoid live vaccine if
CD4<200iu/L patients with CD4>500iu/L fare
better
29. DIBETES MELLITUS
• Have some snacks, crackers, nuts or sugar
cubes.
• Early signs of hypoglycemia
• Well equipped with supplies eg insulin
• Diabetic I.D tags or bracelets is worn
• A card with the insulin dose should be
carried.
• Maintain the departure timing throughout
the journey, for meals and medication
• Adjust to arrival/local time after arrival at
the final destination
30. HEART DISEASES
• Persons with stable heart disease can
travel
• Not recommended if recent heart attack
, unstable angina or uncontrolled CCF.
• Recent ECG and a medical report
• Pacemakers may activate metal detectors
• Mefloquine not to be given concurrently
with antiarrhythmics or B-blockers.
• Tailor activities to their physical
capabilities.
31. PREGNANT TRAVELLERS
• Second trimester preferable
• Most airlines will not carry passengers after
35weeks of pregnancy on international flights or
36weeks on domestic flights. For twin pregnancies ,
32 weeks is the limit.
• If unstable e.g PIH postpone travel
• Avoid Long hours of immobilization
• Use seatbelts continuously, belted low
• Avoid gaseous meal : causes expansion in the
bowel during travel with resultant pain
• Avoid live vaccine except polio vaccine when
indicated
32. POST OPERATIVE FLIGHT PERMIT
• 24 hours after keyhole surgery
• 10 days after simple abdominal surgery
• 10 to 14 days after chest surgery or a coronary
artery bypass graft
• One day after simple cataract or corneal laser
surgery
• Seven days after more complicated eye
surgery
• two to six weeks after surgery for retinal
detachment
32
33. POST OPERATIVE FLIGHT PERMIT
• Seven days after brain surgery
• One day after a colonoscopy
• One day after surgery where a plaster cast
is applied, for flights that are less than two
hours long, or two days for longer flights
Three months if:
• Lung resection
• Joint replacement, such as a hip or knee
replacement
33
34. TRAVEL RELATED PROBLEMS
• Motion sickness; occurs in all means of travel,
chemoprophylaxis can be helful
• Jet Lag
• Altitude Illness
• Barometric changes
• Claustrophobia
• Stress & anxiety
• Motion sickness
35. Travel related problems cont’d
Barometric changes ;
• cabin air pressure gases to expand as the
air craft ascends .
• On descent,there is in air pressure gases
contract.
• Air escapes the middle ear and sinuses on
accent and flows back on descent.
• altitude of about 2,100 m (7,000 feet)
above sea level , causes in oxygen
saturation of Hb.
36. travel related problems cont’d
Barotraumas (decompression sickness)
• Physical damage to body tissue due to
difference in pressure between a gas space
inside or in contact with the body and the
surrounding gas or fluids
• Causes Tissue rupture
• Introduction of gas circulationair embolism
Damage to :-
Middle ear – barotitis / aerotitis/ aero plane ear
paranasal sinuses – aero sinusitis
teeth – barodontalgia,
37. Travel related problems cont’d
Effect of barotrauma
• symptoms includes clogging of the ear ,
ear pain, hearing loss ,dizziness , tinnitus
,bleeding from the ear etc
• If ear ,nose,or sinus infections are
present flying should be postponed.
• decongestant nasal drops shortly before
flight and before descent may be helpful
if flight cannot be postponed
38. Travel related problems cont’d
Control of the effect of
barotrauma
• Chewing of gums
• Frequent swallowing
• Use of pacifiers in babies
• Valsalva manoeuvre
39. Travel related problems cont’ d
JET LAG : Desynchronosis or circadian dysrhythmia,
• Caused by alterations to the body's circadian
rhythms (CR)due to rapid long-distance trans-
meridian (east–west or west–east) travel.
• North–south flights that do not cross time zones do
not cause jet lag
• CR goes out of synchronisation with the destination
time, as it experiences daylight and darkness contrary
to the rhythms to which it has grown accustomed
• It may last several days
• Recovery period of one day per time zone crossed is
a suggested
40. JET LAG CONT’D
• Adjustment to the new time zone is faster for
east–west travel than for west–east.
• Westward adjustment = in days , about half the
number of time zones crossed;
• Eastward adjustment= takes about two-thirds the
number of time zones crossed
• Affects the physical /mental performance e.g
athletes
• Ship or train is slower thus not much jet lag
• Different from travel fatigue which does not
involve a shift in CR
41. JET LAG CONT’D
common symptoms of jet lag:-
• Anxiety
• Dehydration
• Disorientation
• Exhaustion
• Headache
• Indigestion, and
• Impaired Coordination
42. JET LAG CONT’D -- PREVENTION
BEFORE FLIGHT
• Reduce stress , Eat light healthy meals
• Maintain exercise routine
• Go to bed earlier for a couple of nights before leaving if
you are traveling east
• Go to bed later for a couple of nights if you are traveling
west
DURING FLIGHT
• Arrive at the airport early and wear comfortable clothes
• Use flight time as time zone transition time
• Sleep as much as you can on the plane
• Get up and stretch or walk the aisle , drink plenty of water
42
43. JET LAG CONT’D -- PREVENTION
DURING FLIGHT
• Avoid alcohol before and during the flight
Slows down your circadian rhythm
Increases dehydration
• Avoid Beverages with caffeine
• Avoid Sleeping pills
AFTER FLIGHT
• Carefully control exposure to light or avoid bright lights
• Try to sleep and eat on new time zone schedule
• Stick to established daily routines
• Expose yourself to sunlight
• Keep naps to less than 45 min. or to more than 2 hours
44. JET LAG CONT’D
After flight :-
Other measures include:
• Timed light exposure
• Light therapy , used by professional athleths
• Special glasses, usually battery-driven, provide
light to the eyes, inhibiting the production of
melatonin
• Timed melatonin administration
• Timing of exercise and food consumption
• Short-acting sleep medications
45. travel related problems cont’d
MOTION SICKNESS :
• Disturbance in the inner ear due to repeated
motion e.g. swell of the sea, plane in turbulent air
• Affects the organs of balance and equilibrium in
the inner ear.
• Motion is sensed by the brain through :
the inner ear (sensing motion, acceleration, and
gravity),
the eyes (vision), and the deeper tissues of the
body
surface (proprioceptors)
46. Motion sickness cont’d
• For Intentional movement eg. when we walk,
the input from all three pathways is
coordinated by our brain.
• During unintentional movement eg.when
driving in a car, there may be dis-coordination
among the inputs from the three pathways
• Symptoms includes – nausea, vomiting ,
dizzyness, sweating, malaise,
• Drugs used for management includes –
meclizine ,diphenhydramine .prometazine
,dimenhydrinate
47. Motion sickness cont’d – prevention :-
• Ride where eyes will see the same motion that body
and inner ears feel.
• In a car, sit in front seat , look at the distant scenery.
• On a boat, go up on the deck and watch the motion of
the horizon.
• In an airplane, sit by the window and look outside,
choose a seat over the wings
• Do not read while traveling and do not sit in a seat
facing backward.
• Do not watch or talk to another traveler who is having
motion sickness.
• Avoid strong odors and spicy food
48. IMMUNIZATION
• Immunization is the administration of a vaccine to
stimulate a protective immune response if there is
subsequent contact with the infectious agent.
• Vaccines rarely protect 100% of the recipients
• So precautions against infection should still be
followed
• Schedule for vaccination must be personalized and
tailored to the individual traveller’s
1. Immunization history
2. The countries to be visited
3. The type and duration of travel
4. And the amount of time available before departure
49. IMMUNIZATION cont’d
• Routine ,Required ,Recommended
• Non-immunized or incompletely immunized
should :-
1. Get routine vaccinations recommended in
national immunization schedules, and
2. Those needed for travel
• Inactivated vaccines can be given at any time or
with any live vaccine with no interference of
immunity
• Most live vaccines can be given simultaneously
with each other
49
50. IMMUNIZATION cont’d
• If two live-virus vaccines are not administered
on the same day, then allow a 4 weeks
interval between administration
• Time intervals for vaccines requiring more
than one dose should be followed
• Slight variation can be made to accommodate
the needs of travellers who may not be able
to complete the schedule
• Significant shortening of the intervals
however is not recommended
51. IMMUNIZATION cont’d -- Routine immunization :
• Routine vaccinations can be boosters to standard
immunizations of childhood especially tetanus and
diphtheria
1. Diphtheria, tetanus, and pertussis
2. Hepatitis B
3. Haemophilus influenzae type b
4. Human papillomavirus
5. Measles, mumps and rubella
6. Poliomyelitis
7. Rotavirus
8. Tuberculosis (BCG) ,Pneumococcal vaccine
9. Yellow fever etc
51
52. Immunization cont’d -- Required vaccination :-
• Those required by WHO or some ministries of health
of some countries
• Yellow fever is required by WHO for all travelers
• Meningitis vaccine mandatory for all pilgrim to Saudi
Arabia
• Administered by authorized center & the
international immunization certificate (Yellow card)
issued ,they include;
• Hepatitis A
• Japanese encephalitis
• Meningococcal infection
• Tick-borne encephalitis ,others are typhoid fever
,rabies ,yellow fever, cholera etc
52
53. Immunization cont ’d -- Recommended vaccine
• Given on the basis of risk of exposure as assessed
from the traveller's
1. itinerary and
2. immune status
They include:
• Hepatitis A, hepatitis B, or Twinrix
• Rabies, Typhoid, cholera
• Chicken pox, Influenza,
• Japanese encephalitis, meningococcal,
• Pneumococcal and tick-borne encephalitis
53
54. Table 1: Travelers' Common Immunisation Schedule, Side Effects and
Precautions
Vaccine
Nigeria
n
Childho
od
Schedul
e
Standa
rd
Regim
en
Booster
s
Age
Minimu
m
interval
before
travel
Adverse
Effects
Remarks
Yellow
Fever
(YF-Vax)
0.5 mls
SC at 9
months
0.5 mls
SC
0.5 mls
every 10
years
>9
months
> 10
days
Headache,
myalgia,
fever,
encephalitis
especially in
the elderly
Contraindicated in pregnancy,
patients with egg allergy and
immunocompromised
patients. Avoid concurrent
administration with other live
virus vaccines (MMR, Oral
Polio, varicella, Oral ty21a)
Meningoc
occal
(Menomu
ne)
0.5 mls
SC at 2
years
0.5 mls
SC
0.5 mls
every 3
to 5
years
>2 years > 10
days
injection site
soreness
Safe in pregnancy
Hepatitis
B
(Recombi
vax;
Engerix
B)
0.5 mls
at birth,
6 weeks
and 14
weeks
1 ml im
at 0, 1,
and 6
months
1 ml
every 10
years
>20
years
> 10
days
injection site
soreness,
headache
Safety in pregnancy not
determined. Contraindicated
in yeast hypersensitivity. Age
20 yrs is used here only if
childhood doses have been
administered 54
55. Typhoid
(Vivotif
Berna
Oral
Ty21a)
Not
applicab
le
4
capsul
es-one
given
alternat
e days.
4
capsule
regimen
every 5
years
>6 years immedia
tely
Nausea,
vomiting,
cramping
pain.
The capsule most be
refrigerated; each capsule
should be taken whole (do not
chew) with cool liguid 1 hour
before a meal. It is
contraindicated in pregnancy
and immunocompromised
patients. Start mefloquine or
chloroquine at least 3 days
after completion of the
vaccine.
Typhoid
(Typhim
VI)
Not
applicab
le
0.5 mls
im
0.5 mls
im every
2 years
2 years immedia
tely
Nausea,
vomiting,
cramping
pain.
Safety in pregnancy not
determined.
Rabies
(HDCV)
Not
applicab
le
1 ml im
at the
deltoid
area
0, 7,
21or
28
days.
(three
doses)
same
dosage
every 2-
5 years
all ages immedia
tely
Myalgia,
lymphadeno
pathy
Pregnancy not a
contraindication to pre-
exposure therapy. After
animal bite rabies vaccine is
needed on day 0 and 3 if pre-
exposure vaccination has
been given. Mefloquine and
chloroquine may interfere with
intradermal Imovax if
administered concurrently.
55
56. Rabies
(Imovax,
Rabivax)
Not
applicabl
e
1 ml im
at 0, 7,
21, 28
days.
same
dosage
every 2-5
years
all ages immediat
ely
Myalgia,
lymphadeno
pathy
Pregnancy not a contraindication
to pre-exposure therapy. After
animal bite rabies vaccine is
needed on day 0 and 3 if pre-
exposure vaccination has been
given. Mefloquine and
chloroquine may interfere with
intradermal Imovax if
administered concurrently.
Hepatitis A
(Havrix;
Vaqta)
Not
applicabl
e
1 ml im 1 ml im
6-12
months
after first
dose
>19 years immediat
ely
injection site
soreness,
headaches
Safety in pregnancy not
determined
Polio Oral
(live
vaccine)
2 drops
by mouth
at birth,
6wks,
10wks
and 14
wks
three
doses
of 2
drops at
weekly
interval
s
one dose
of 2
drops by
mouth
all ages immediat
ely
Nil Can be administered in
Pregnancy if the traveler is going
to a highly endemic area.
Cholera
(parenteral
)
Not
applicabl
e
0.5 mls
SC at 0
and 7
days
0.5 mls
after 6
months
>6
months
immediat
ely
Injection site
soreness
Safety in pregnancy not
determined
56
57. Cholera
(Live
Oral
CVD
103-Hgr)
Not
applica
ble
A dose
by
mouth
in an
empty
stoma
ch
A dose
by
mouth
after 6
months
> 2
years
immedi
ately
Nil Safety in pregnancy not
determined
Tetanus
toxoid
0.5 mls
im at 6,
10, 14
weeks
in the
combin
ation as
DPT
two
doses
of 0.5
mls im
at 0
and 4
weeks
single
dose of
0.5 mls
im at
least 6
months
from
2nd
dose
>6
weeks
immedi
ately
Fever,
injection
site
soreness
Very safe in pregnancy
Measles,
Mumps,
Rubella
(MMR)
Not
applica
ble
0.5
mls
SC
A dose
sc at 4-
6 years
old and
once in
adult life
.
>15
months
immedi
ately
Fever Not safe in pregnancy
57
59. GLOBALLY TARGETED TRAVELERS DISEASES
• Main diseases of global burden to travelers;
1)Malaria
2)Cholera
3)Travelers diarrhoea
• Advise on risk of HIV & other STDs, benefits
of safe sex, or preferably abstinence
• Some other diseases are country specific &
vaccinations are recommended eg ;
Africa - meningitis, typhoid, poliomyelitis,
yellow fever, etc
Asia - above plus Hepatitis A ,Japanese E
South America - as above +/- yellow fever
59
60. Globally targeted travelers diseases cont’d -- Malaria
• Big killer especially for travelers from non-endemic area
• Risk assessment based on(1) itinerary(2), species of
malaria at the destination(3) season(4) duration of travel
and (5)access to medical care should be made
• Travellers should be encouraged on
1. risk awareness,
2. avoidance of bites(nets, repellants—
DEET,permetrine) ,Wear clothing that reduces
exposure
3. Stay in screened or air conditioned rooms
4. Chemoprophylaxis
5. prompt diagnosis and treatment
60
61.
62. RISK ASSESSMENT AND PREVENTIONMalaria risk Type of prevention
Type I Very limited risk of malaria
transmission
Mosquito bite prevention
only
Type II Risk of P. vivax malaria only or
fully chloroquine-sensitive P.
falciparum
Mosquito bite prevention
plus chloroquine
chemoprophylaxis
Type III Risk of P. vivax and P. falciparum
malaria transmission, combined
with emerging chloroquine
resistance
Mosquito bite prevention
plus chloroquine +
proguanil
chemoprophylaxis
Type IV (1) High risk of P. falciparum
malaria, in combination with
reported antimalarial drug
resistance; or
(2) Moderate/low risk of P.
falciparum malaria, in
Mosquito bite prevention
plus atovaquone–
proguanil (malarone),
doxycycline or
mefloquine
chemoprophylaxis (select
63. Malaria prophylaxis
Mefloquine 250 mg (base) once wkly. Start 1-2 wks before entering malarious area and
continuing until 4 wks after leaving.
Sulfadoxine-pyrimethamine 500/25 mg wkly Start 1-2 wks before entering malarious area and
continuing until 4 wks after leaving.
Doxycycline 100 mg daily Start 1-2 day before entering malarious areas and
continues until 4 wks after leaving. Not suitable
for pregnant women and children below 8
years. The drug should be taken with food and
not used simultaneously with antacid or
bismuth-containing product.
Atovaquone/proguanil 250/100 mg tab, one tab
daily
Start 1-2 day before entering malarious area and
continuing until 7 days after leaving.
Proguanil 200 mg daily Start 1-2 day before entering malarious area and
continuing until 4 wks after leaving.
Chloroquine 300 mg (base) once wkly Start 1-2 wks before entering malarious area and
continuing until 4 wks after leaving.
Chloroquine/Proguanil As for Chloroquine and
Proguanil above
This combination has been safely used in pregnant
women.
Primaquine 30 mg base once daily Start 1-2 day before entering malarious areas and
continues until 4 wks after leaving. It very good
for areas with P-vivax and P-ovale infection.
Take drug with food. Contraindicated in
pregnancy and persons with G6PD deficiency
63
64. Globally targeted travelers diseases cont’d -- Cholera :-
Two types of oral cholera vaccines are available:
1. Dukoral
2. Shanchol and mORCVAX
• Efficacy is 52% in the 1st year after being given and 62% in
the 2nd year, with minimal side effects.
• Available in > 60 countries
• Complete protection within 8 days
Parenteral (subcutaneos) cholera vaccine provides limited
brief protection against 01, may not provide any protection
against 0139,
• It has a high cost-benefit ratio; therefore, the vaccine is not
recommended for travellers
• Given on days 0 & 7, and booster at 6 months
64
65.
66. Cholera cont’d
• Preventive measures : drink clean water , cook
foods well & eat hot , avoid shell fish , peel instead
of wash fruits
• Antibiotic treatments for 1 to 3 days shortens the
course of the disease and reduces severity
• Doxycycline is firstline,Other antibiotics include
cotrimoxazole, erythromycin, tetracycline,
chloramphenicol, and furazolidone.
• NOTE
CDC – On Vaccination for Cholerae
• Cholera vaccine is no longer required, nor
recommended for the vast majority of travellers by
the Centres for Disease Control and Prevention
(CDC).
67. TRAVELLERS DIARRHOEA (TD)
• Most common illness affecting travelers
• Occurs within the 1st 14 days of travel, if caused by
enterotoxic E. coli
• Typically, self-limiting lasts 3-5 days
• Each year affects 20%–50% of international
travelers ( >10 million people)
• In 10% persistent diarrhoea,
• 30% are confined to bed
• 40%change itinery,
• 10%post infection IBS
• Commoner in the developing world ,rates > 60%
68. ETIOLOGY OF TRVELLERS DIARRHOEA
Bacteria (60%)
E.coli(ETEC ,EAEC)
Shigella
Salmonella
Campylobacter
Aeromonas
Plasiomonas
Unknown (20% - 30%)
Others – lactose intolorance ,
irritable bowel
Rifaximin is effective for E coli
Parasitic (3%)
Giadia
Cryptosporidium
Entamoeba histolytica
Cyclospora
Isospora
Dientamoeba
Viral (10%)
Norovirus
Rotavirus
Travellers diarrhoea affects
more of young adults
69.
70. TD – Treatment
• Usually no dehydration in adults, but should
fluid
• Self management is recommended
• Seek medical attention if it persists after 48 hours
Steps to take includes:
Rehydration(ORS - especially for young children)
symptom management
Fluoroquinolones are 1st line agent ,Azithromycin
in cases of resistance
• Loperamide is not recommended if gross blood in
the stool or a temperature > 38.50C, or in children
70
71. TD -- Prevention
• Eat at restaurants with a good reputation
for food safety
• Peel fruits and vegetables
• Eat steaming hot, thoroughly cooked
food
• Avoid tap water, ice cubes, fresh salads,
unpasteurized dairy products, cold sauces
and toppings, undercooked or reheated
food
71
73. YELLOW FEVER(YF) cont’d
• YF Vaccination certificate is the only compulsory
health certificate needed for international travel
• valid for 10 yrs
• WHO (2013) says it is valid for life
• Attenuated live vaccine
• Effective 10days after vaccination
• Vaccination may not be required if travelling to a
low risk or No risk region
• Those with waivers may still be denied entry
,quarantined or vaccinated at the point of entry
• There is an outbreak currently in brazil
74. TRAVEL HEALTH KIT
• Personal Prescriptions
• Condoms
• Antimalarial medications
• OTC antidiarrheals and antibiotic for diarrhea
• allergy meds
• laxative
• antacid
• Epi-Pen (with hx allergy)
• insect repellant (DEET)
• sunscreen
• oral re-hydration salts
• first aid items
• migraine regimen
• Any other standing instructions
• Travellers should carry a medical card or other document
showing their blood group
75. CONCLUSION
• There are common illnesses associated
with travelers and endemic areas
associated with some of the diseases
• Pre-travel evaluation ensures safety of
travelers, prevention and management of
health problems before and during travel
76.
77. REFERENCE
• Steffen R et al. J infect dis 1987; 156:84-916
• Leggat et al. Travel med inf dis 2005;3:9-17.
• Primer of travel medicine 3rdd ed
• Lecture on emporiatrics by dr Maqsood Hayat
• Emporiatrics by Dhanush Anand
• International travel and health– WHO 2012
• Travel health: immunization and chemoprophylaxis by Aboi J.K . Madaki
• The pre-travel consultation Gary W. Brunette, MD, MS
• Travelers’ health team division of global migration and quarantine
centercholera, malaria, tuberculosis
• (TB) and aidss for disease control and prevention
• INFECTIOUS DISEASE CHOLERA by: kamal Bahadur Budha
• Vibrio cholerae update dr.T.V.Rao
• MDMOTION SICKNESS dr Jignesh Vora
• Wikipedia