فهرست مطالب

Travel Medicine and Global Health - Volume:5 Issue: 4, Autumn 2017
  • Volume:5 Issue: 4, Autumn 2017
  • تاریخ انتشار: 1396/08/23
  • تعداد عناوین: 7
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  • Eugene Tan *, Kelly Cawcutt, Catherine Zomok, Ronald Go, Irene Sia Pages 107-112
    Introduction

    Nitazoxanide is an oral anti-parasitic agent that has been found to have broad antiviral activity. Its role in the treatment of viral gastroenteritis is not well-studied. Given the worldwide prevalence of viral gastroenteritis, particularly in developing nations, a systematic review of this topic would be valuable.

    Methods

    A formal literature search with the assistance of a reference librarian included randomized controlled trials, cohort studies, case-control studies, and case reports. Studies were included if they pertained to nitazoxanide use for viral gastroenteritis and excluded if nitazoxanide was used for parasitic or other viral illnesses.

    Results

    Based on inclusion and exclusion criteria, 5 randomized controlled trials (2 in Egypt and 1 each in Peru, India, and Bolivia) were included in the systematic review. Four of the studies enrolled children only; one study included adults. All studies noted a statistically significant reduction in time from the first dose of nitazoxanide to resolution of illness (approximately one to 2 days) in patients compared to the receiving placebos (approximately 3 days). There were 9 case series or reports on nitazoxanide use for viral gastroenteritis in immunocompromised hosts; of these, only one case reported a noticeable effect of nitazoxanide in reducing symptom duration and severity.

    Conclusion

    Despite the limited number of studies and the potential risk of bias introduced by the funding source, a benefit of nitazoxanide in reducing duration of illness from viral gastroenteritis was demonstrated for immunocompetent children. Randomized controlled trials are needed to elucidate the role of nitazoxanide for treating viral gastroenteritis in immunocompromised hosts.

    Keywords: Nitazoxanide, Gastroenteritis, Norovirus, Rotavirus
  • Peter Felkai *, Gabor Debrődi Pages 113-118

    The survival rate of medical emergencies depends highly on the intervention time and prompt medical care on the scene. The idea of “bring the doctor and medical equipment to the spot” was born in Hungary in the mid-1950s. The demand for advanced life support was a consequence of the fast growth of industry and traffic. It is worthwhile to review the development of the idea, the therapeutic methods, and the devices used by medical emergency and rescue services based on the example of the Hungarian model. What based on the highly trained medical team and the state-of-art medical devices respectively. In this study, the researchers collected and described the contemporary memorabilia of the Hungarian Emergency Services and compared them with the existing ideas and ambulance types in the world. The basic ideas and their adaptation into practice are also reviewed. The increasing demand for the soonest possible medical treatment can be claimed the reason for special ambulances with special teams and equipment. The all-purpose ambulance proved to be the most appropriate solution to the problem. The first ambulance of this kind was first used in Hungary.

    Keywords: ALS Ambulance, Rescue, Emergency Service, Patient Transport, history of medicine
  • Johis Ortega *, Juan González, Scott Sloane, Kenya Snowden, Lila De Tantillo Pages 119-124
    Introduction
    For the past 7 years, a nursing school has conducted biannual medical missions in a virtually inaccessible area in Haiti. Each medical mission team provides primary care, pediatric and gynecological examinations for up to 6 days in the impoverished island nation.
    Methods
    To improve the safety of participants engaged in this humanitarian travel medicine endeavor and enhance efficiency, the United States National Incident Management System (NIMS) has been implemented as a framework. This integrated system has 5 components: (1) Preparedness, (2) Communication/Information Management, (3) Resource Management, (4) Command and Management, and (5) Ongoing Management/Maintenance. This system was originally designed for government agencies and non-governmental organizations responding to disasters and other global health emergencies. A structural plan using the framework can be implemented as an effective model for future international missions.
    Results
    Implementation of the framework increased efficiency. While missions previously averaged approximately 100 patients daily, after incorporation of NIMS, this figure rose to 140 patients. Additionally, student feedback indicated increases in perceptions of safety and security.
    Conclusion
    The NIMS framework applied by the Haiti medical missions team provided organizational structure and leadership for this humanitarian effort in travel medicine. Integrating NIMS into the mission has extended the outreach of global medical systems to the most rural areas of Haiti and improved care for vulnerable populations with limited access to healthcare. This framework may be used to assist other academic institutions organize safe and effective travel medicine endeavors.
    Keywords: Haiti, Medical Mission, Primary Care, Travel Medicine
  • Oghenekaro Omodior *, Lori Pennington Gray, Brijesh Thapa Pages 125-134
    Introduction

    This study examined the relationship between specific psychosocial variables and the use of insect repellents on skin or clothing as a preventive behavior for Chikungunya fever among US travelers to Caribbean destinations.

    Methods

    A cross-sectional retrospective online survey method was adopted. US residents who travelled to one of 34 Caribbean destinations within the past 12 months and expressed an awareness of Chikungunya fever were invited to participate in this study. Sociodemographic variables, perceived response efficacy, perceived self-efficacy, perceived Chikungunya severity and susceptibility, and self-reported use of insect repellents were investigated.

    Results

    Results of direct logistic regression analysis revealed a significant association between higher levels of education and the odds of self-reported use of insect repellent on skin or clothing among study participants. Among the proximal Chikungunya-related variables, hierarchical binary logistic regression revealed a significant association between scores on perceived response efficacy, perceived self-efficacy, and perceived severity of self-reported use of insect repellents. These results support the existence of a hierarchical relationship between the more proximal Chikungunya-related variables and self-reported use of insect repellents as a personal protective measure (PPM).

    Conclusion

    The findings of the current study have important implications for health communication messaging aimed at reducing the spread of Chikungunya among US travelers to Caribbean destinations. It seems essential to establish the use of insect repellent on skin and clothing as a personal preventive measure against Chikungunya disease within an educational context, framed along the lines of Chikungunya severity, response efficacy, and self-efficacy, for US travelers to destinations with a high risk of exposure to Chikungunya disease-carrying mosquitoes.

    Keywords: Chikungunya Fever, Personal Protective Measure, Protection motivation theory, Caribbean
  • Inam Danish Khan *, Syed Bahavuddin Hussaini, Shazia Khan, Faiz MH Ahmad, Faisal Ahmad Faisal, Muhammad Arif Salim, Razzakur Rehman, Syed Asif Hashmi, Bushra Asima, Muhammad Shaikhoo Mustafa Pages 135-139
    Introduction
    Extreme heat claims more lives than all other weather-related exposures combined. Hajj rituals at Mina, Arafat, and Muzdalifah involve a minimally-clothed, moving assemblage of 3.5 million pilgrims who are exposed to a harsh, hot, desert climate during physically challenging outdoor rituals and unsheltered night stays, rendering them prone to heat illness, dehydration, and sunburn. This cross-sectional study assessed the emergency response of the Indian Hajj Medical Mission to overwhelming heat illnesses in Mina and Arafat among Indian pilgrims during Hajj, 2016.
    Methods
    In 2016, 88 patients affected by the heat were brought to central tent-clinics at 36 maktabs in Mina and Arafat that were established by the Indian Hajj Medical Mission. Patients were offered rapid external evaporative cooling (wet towels) and cold intravenous saline infusion on patient couches and wheelchairs.
    Results
    The incidence of heat illness among Indian pilgrims in 2016 was 0.62/1000. The ratio of males to females was 1.8:1. Mean ages of males and females were 62.2 ± 7.43 and 52.6 ± 9.3, respectively. Pre-existing conditions, such as diabetes mellitus and hypertension, were present in 93.2% of the patients. The most common presentations included hyperthermia, fatigue, and restlessness. Heatstroke presented in five patients and resulted in one fatality. Twenty-eight patients were referred to Saudi hospitals, and 12 of them were institutionalized. Exertion related to the stoning of Satan ritual during late morning and afternoon hours was the leading cause of heat illness.
    Conclusion
    The overwhelming incidence of heat illness among Indian pilgrims in the critical five-day period of the Hajj represents the tip of the iceberg as the Hajj attracts over 3.5 million pilgrims from 200 countries annually. Heat illness is difficult to manage in the presence of pre-existing comorbidities and mandates clientele education and outreach warning systems to enhance resilience capital amongst Hajj pilgrims, sportspersons, outdoor enthusiasts, and military personnel.
    Keywords: Hajj, Heat Illness, Heat Exhaustion, Heat Stroke, Mass Gathering Medicine
  • Hadi Khoshmohabat, HamidReza Rasouli, MohammadJavad Forozanmehr, MohammadHosein Kalantar Motamedi, Masoud Saghafinia * Pages 140-143
    Introduction

    In recent years, the prevalence of attacks perpetrated by humans against other humans has increased worldwide. The injuries suffered by attack victims are severe and multi-organ. Iran’s neighboring countries have been the scenes of attacks in the recent past. This study assessed the type and severity of injuries sustained by victims transferred to Iran during the time period 2005-2007.

    Methods

    This study was conducted on injured civilians transferred to hospitals in Iran. Data regarding cause of injury, type and severity of injuries, diagnostic-therapeutic interventions, and patient outcomes was collected and statistically analyzed using SPSS version 14 software.

    Results

    In the studied time period, 214 attack victims were transferred to 3 Level 1 trauma centers in Iran. The mechanisms of injury were explosion in 130 cases, gunshot in 48, and other causes in the remaining victims. The mean Injury Severity Score (ISS) was 5.91 ± 4.54 (range = 1-34), and the median was 4; 109 cases (51%) had an ISS between 1 and 8, 73 cases (34%) were scored between 9 and 14, 15 cases (7%) were scored from 16 to 24, and 17 cases (8%) had an ISS ≥25. In terms of the number of injured organs, 42 patients (20%) had one, 124 (58%) had 2, 36 (17%) had 3, and 12 patients (5%) had 4 or more injured organs. Procedures included 86 orthopedic, 25 general surgical, 21 ear, nose, and throat (ENT), 18 plastic, 15 neurosurgical, and 10 ophthalmic operations; 25 patients received psychiatric counseling. The mean (±SD) hospital stay was 13.43 (±19.76) days (range = 1-230).

    Conclusion

    The injury pattern in attacks is more severe and differs from other traumas. The medical team should have adequate knowledge in this respect to provide comprehensive healthcare.

    Keywords: Trauma, Pattern of Injury, Severity of Injury
  • Beuy Joob *, Viroj Wiwanitkit Page 144