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Emergency sterile medical kit for travellers
HEALTHY TRAVEL INFORMATION
on their own. Your GP or Practice Nurse wil advise you if anti-malarial tablets are needed (i.e.
Being wel prepared before you travel wil ensure
in high-risk areas) and which tablets are
that you minimise the risk of preventable il health
appropriate. Again you wil find clear advice about
whilst abroad. Exposure to these risks wil
depend on where you are travel ing, how long you
are travelling for and your living conditions. Below you wil find advice on how to deal with the most
Depending on where you are travel ing different
common problems you are likely to encounter,
anti-malaria tablets can be necessary. In some
how best to prepare yourself for travel and how to
areas resistance is a major problem and a
ensure you return home in good health.
prescription for anti-malarials from a doctor will be necessary. More detail is given at the end of this
The advice is of necessity quite general and
applies to healthy adults. Children's needs
Even if you have taken the most appropriate tablets none of these anti-malarial precautions
can give absolute protection. So if you develop
Make sure you are up to date with all necessary
influenza-like symptoms, especial y associated
immunisations. Most of these can usual y be
with shivering/shaking attacks (rigors) while
done by making an appointment at your local GP
abroad, or even within a year of returning from a
surgery. It is important you do this as soon as you
malarial area, or after discontinuing prophylaxis,
know you are travelling. Some vaccinations need
you should seek medical attention urgently. You
several weeks to be ful y active or a course of
should tell the doctor of your recent travel to a
injections may be required. A good source of
independent travel advice tel ing you likely vaccination requirement on the web is
Rapid long haul flights of more than 5 hours time difference result in appreciable jet lag,
characterised by various symptoms including
Malaria is widespread in tropical and sub-tropical
fatigue and inability to sleep at the new night time,
areas of the world and is spread by the bite of an
headache, irritability, loss of concentration and
infected mosquito. Infection produces fever and,
gastrointestinal problems (indigestion, loss of
in some cases, complications affecting the
appetite and bowel irregularities). The body will
kidneys, liver, brain and blood. Malaria can be
take longer to adjust if the flight is eastwards
fatal. Precautions should be taken if you are
rather than westwards and adjustment is slowed
going to visit, travel through, or even just stop
by lack of sleep during the actual travel ing, the
stress of travel ing and alcohol. It is clear that work performances after arrival can be affected
Avoidance of mosquito bites is the single most
and since it may take 5 days to ful y adjust, any
important preventive measure, particularly with
measures that will help prevent jet lag are
increasing resistance of the disease to drug
treatment. This can be simply achieved by taking the following precautions:
use insect repel ent, preferably one containing
counteract the dry cabin atmosphere that leads to dehydration which is further
• keep your arms and legs covered with
appropriate clothing (long trousers, sleeves
stretch and exercise by walking frequently
and dresses) especial y when out walking and
during the flight in order to aid circulation and
after sunset when the infecting mosquitoes
sleep on the plane is recommended especially if you can sleep during the night
sleep in properly screened rooms and employ
time of your destination. If necessary a mild
a “knockdown” spray to kil any mosquitoes in
the room. Ideal y use a mosquito net (which
may be impregnated with insecticide) around
• for trips of less than seventy two hours, you
the bed at night, ensuring that it has no holes
should try to sleep at your normal night time, if
at al possible. Taking brief (1-2 hours) naps are advised since longer periods of sleep wil
Malaria Prevention tablets
are vital in areas
tend to move your body clock onto local time.
where the above measures, although still
For longer trips, you should aim to move to
essential, are unlikely to give adequate protection
local time immediately upon arrival.
be wary of salads, coleslaw, shel fish and
Exposure to sun leads not only to premature
ageing of the skin, but also increases the risk of
melanoma and other skin cancers. This risk is
greater in those who are fair skinned, or on certain
avoid unpasteurised milk often used in local
medications such as diuretics or tetracycline
antibiotics commonly used to treat acne. Sunscreen preparations containing agents
is a very common
protecting against the harmful effects of both UVA
and troublesome complaint. If the diarrhoea is
and UVB irradiation should be used at al times.
accompanied by persistent vomiting, high fever or
Eye protection is advised by wearing sunglasses
the passage of blood in the stools, then prompt
with ultraviolet light filters to reduce the long term
medical advice should be sought. Otherwise,
ensure that you remain wel hydrated by drinking plenty of fluids and avoiding milk. Anti diarrhoeals
Two common problems associated with excessive
such as Imodium are useful to reduce the
sun are detailed below, with advice on how to deal
frequency of diarrhoea in the short term, but if
symptoms persist beyond 3-4 days, again seek medical advice. Research has shown that most
– overexposure to the sun can cause
cases of travel er’s diarrhoea respond to two
redness, tenderness and blistering of the affected
doses of Ciprofloxacin 500mg taken at an interval
area of skin. Further exposure should be avoided
of twelve hours. Your GP may be prepared to
until the symptoms have settled remembering that
prescribe this as a private prescription if your trip
UV light can stil cause damage by penetrating
is 'high risk' and you discuss this with him before
thin clothes, clouds, water and even shade.
Cool showers and ‘after sun’ creams provide soothing relief. Avoid bursting blisters as this can
Any diarrhoeal illness will result in significant loss
of body fluids – partly from the diarrhoea itself as wel as from the tendency to stop eating and
– this is a common, intensely
drinking. It is vital to prevent dehydration by
itchy rash that occurs in hot climates, when the
taking frequent smal drinks of mineral water or by
skin becomes red with smal spots. The key to
using oral rehydration salts (e.g. Dioralyte).
treatment is preventing sweating by reduced exertion, taking cool showers, dusting with talcum
powder and wearing loose, cotton clothing.
The prevalence of many sexual y transmitted
Calamine lotion and antihistamine tablets such as
infections is greater in most parts of the world
Clarityn or Zirtek, available over the counter at
than in the U K. You should regard casual sexual
chemists, wil help relieve the itching. If you are
relationships as risky and take great care to avoid
prone to this problem you are advised to
the potential for acquiring infection.
In particular most parts of Africa have extremely
SAFE EATING AND DRINKING
high levels of HIV AIDS infection. This remains
Wherever you are in the world you need to be
an incurable illness. It isn't worth it!
careful what you eat and drink. Food and water can be contaminated in a variety of ways and this
Condoms are an absolute necessity and whilst
includes the water in swimming pools. Travel ers’
substantially reducing the risk of sexually
diarrhoea, typhoid and hepatitis A can al be
transmitted infection, do not offer complete
caught by eating contaminated food or water.
always wash your hands after going to the lavatory, before handling food and before eating;
if you have any doubts about the water available for drinking, washing food or cleaning teeth, boil it or sterilise it with disinfectant tablets (boiling for five minutes is best) or use bottled water – preferably carbonated with gas in sealed containers;
avoid ice unless you are certain it is made from safe water;
eat freshly prepared food and ensure meat is cooked through;
DEEP VEIN THROMBOSIS AND TRAVEL
gas! Allow some room for this expansion with
Following the recent publicity on the effects of air travel
on health, many people are concerned about their personal risk of Deep Vein Thrombosis
• Even though DVT is often referred to as "Economy
Class Syndrome", passengers in first and
A Deep Vein Thrombosis (DVT) is a clotting of the
business class are equally at risk.
The risk also
blood in a deep
vein of the lower leg. If a clot develops
applies to other forms of travel, such as coach or
in the veins, it usually makes its presence known by
bus travel where you stay seated for hours at a
increasing pain and usually pronounced swelling in the
affected calf. Medical attention should be sought immediately if this
Avoid crossing your legs for more than brief
occurs, especially after a long air flight or other journey.
periods. It restricts blood flow. Remove your shoes,
In some cases a DVT can be fatal if the clot breaks off
and makes its way to the lungs where it can then affect the lung’s ability to take in oxygen.
Some simple exercises are described below.
It is hard to establish just how many people are affected by DVT after a long flight as no official records are kept.
Certainly doctors have been aware of this increased
These exercises are designed to encourage a safe and
risk for many years. This is not therefore new
convenient way to enjoy movement and stretch certain
information simply that public awareness has recently
muscle groups that can become stiff as a result of long
increased due to the publicity surrounding recent
It is recommended that you do these exercises for three
Those in a higher risk category should see their
or four minutes every hour and occasionally get out of
doctor before they travel and discuss prevention.
This includes people with a personal or strong family history of thrombosis, smokers, older
Please try to perform these exercises with minimal
travellers and individuals who have undergone
disturbance to other passengers. Avoid a particular
recent surgery (especially to lower limbs or
exercise if it causes pain or cannot be done with ease.
abdomen). A history of cancer or heart disease may also be important. Also travellers who are
1. Ankle Circles
obese, pregnant women and women taking oral
Lift feet off the floor. Draw a circle with the toes,
contraceptives (particularly those who smoke)
simultaneously moving one foot clockwise and the other
foot counter clockwise. Reverse circles. Do each direction for 15 seconds. Repeat if desired.
Some people in these "higher risk" categories mentioned above should discuss with their doctor
2. Foot Pumps
whether taking a small dose of aspirin before they
fly (75mg) and perhaps wearing firm support
Start with both heels on the floor and point feet upward
stockings to reduce their risk is advisable.
as high as you can Put both feet flat on the floor
• These days, the personal entertainment available
Lift heels high, keeping balls of feet on the floor.
on many aeroplanes encourages us to stay rooted
Continue these three stages with continuous motion in
to our seats. However, try to exercise for three or
four minutes every hour on long flights to exercise the muscles pumping blood back to the heart. A list
3. Knee Lifts
of suitable exercises you may like to try is given in
Lift leg with knee bent while contracting your thigh
muscle. Alternate legs. Repeat 20-30 times for each leg.
• If you suffer from poor circulation, try wearing some
4. Neck Roll
supportive stockings to encourage circulation.
With shoulders relaxed, drop ear to shoulder and gently
However it is important that you do not wear
roll neck forward and back, holding each position about
clothing that will cause any restriction of circulation.
This can happen with ‘pop soxs’ worn just under the knees, or socks which are tight around the
5. Knee To Chest
Bend forward slightly. Clasp hands around the left knee and hug it to your chest. Hold stretch for 15 seconds.
Too much alcohol, tea and coffee on flights causes
Keeping hands around the knee, slowly let it down.
dehydration which can also increase the risk of
DVT. Also the air in a plane is very dry and the temperature warmer than we might normally have
6. Forward Flex
at home. It is very important to remain well
With both feet on the floor and stomach held in, slowly
hydrated during a long flight by drinking plenty of
bend forward and walk your hands down the front of
your legs toward your ankles. Hold stretch for 15 seconds and slowly sit back.
Loose clothing is important on a long flight. Because of the reduced atmospheric pressure in a
7. Shoulder Roll
plane, parts of the body expand due to increased
Hunch shoulders forward, then upward, then backward, then downward, using a gentle circular motion.
TRAVELLING DURING PREGNANCY
in premature labour. Check that you have adequate medical insurance before you travel.
You should always discuss any travel plans with
Some policies exclude medical conditions
your doctor but you may find the following
VACCINATION DURING PREGNANCY
Flying itself is not harmful to your unborn child at
Some vaccines can be given during pregnancy.
any stage in pregnancy but the following points
The risk of contracting a serious il ness must be
weighed against the smal , theoretical risk to the pregnancy of the vaccine. In general, a live
vaccine such as yellow fever is not given during
thrombosis during pregnancy because of the
pregnancy. Hepatitis A vaccine should also
usual y be avoided during pregnancy unless the
Immobility and dehydration can increase this
risk of infection is high. If you are planning to
risk further. Try to get up and walk down the
conceive, you should inform your doctor prior to
aisle periodical y and “circle” your ankles from
time to time whilst sitting. Keep wel hydrated with non-alcoholic drinks;
The most important aspect of malarial
immobility can also cause ankle swelling.
prophylactics is mosquito bite precautions. This
area is covered in some detail elsewhere in this
reduce the chance of this developing. Ankle
information leaflet. Chloroquine and Proguanil
swel ing can also be a sign of a serious
have been used fairly extensively in pregnancy
medical condition and should be reported to a
with no known adverse effects. Folic Acid
doctor if severe. Ankle swel ing occurring in
supplements should be taken with the Proguanil.
one leg only could be a sign of deep vein
The benefit of disease prevention far outweighs
any smal theoretical risk. Like most drugs, malarial prophylaxis cannot be tested on pregnant
• there are limits imposed by most airlines
women. The information on safety is compiled
on flying in late pregnancy.
from anecdotal reports. Lariam (Mefloquine) has
for example wil not allow travel beyond 32
been shown to cause foetal abnormalities in
weeks on long haul flights. Many airlines wil
animal studies and should therefore be avoided.
expect a doctor’s letter confirming that the
Doxycycline, which is sometimes prescribed for
patients at risk of Chloroquine resistant malaria, should also be avoided in pregnancy.
You should take particular care with food and
appointments in your antenatal care whilst
water hygiene in developing countries. This topic
you are away. Some pre-natal screening tests
is also covered elsewhere. Gastro-intestinal
infections, such as salmonel a, can potential y be
a more severe il ness in pregnant women.
See your doctor or midwife for an antenatal
check just before departure. Check with them
You tire more easily during pregnancy and this
when you should have your next appointment.
should be taken into consideration in planning
Depending on the stage of pregnancy and the
your itinerary whilst you are away. The combined
length of your visit, you may need to make
effects of pregnancy and jet lag can be quite
arrangements for routine antenatal checks to
debilitating. You should make sure that you plan
• In developing countries, medical facilities
available wil usual y be more basic. This is particularly true in the case of the care of the severely pre-term infant. You should discuss this issue with your GP if you are planning to travel between 24-32 weeks. The risk of suffering an early delivery at this stage of pregnancy is approximately 1.5% for a normal 'single baby' pregnancy. An ultrasound scan of the cervix at 23 weeks can identify some of the pregnancies that are at high risk of ending
Consensus Document on the Management of Cellulitis in Lymphoedema Cellulitis is an acute spreading inflammation of the skin and subcutaneous tissues characterised by pain, warmth, swelling and erythema. In lymphoedema, attacks are variable in presentation and, because of differences from classical cellulitis, are often called acute inflammatory episodes. Cellulitis will be the term
PRASUGREL Resistencia al Clopidogrel en pacientes con angioplastia con stent (Informe para la Comisión de Farmacia y Terapéutica del Hospital El Cruce) 1. AUTORES DEL INFORME Autores: Servicio de Farmacología Clínica: 2. INFORMACION DEL SERVICIO SOLICITANTE Servicio : Cardiología Facultativo que efectuó la solicitud : DR Javier Mariani Indicación/es clínica/s sol