Meias elásticas de compressão graduada como medida profilática de tromboembolismo venoso e edema de membros inferiores desencadeados por viagens aéreas: uma revisão sistemática de ensaios clínicos / Graduated compression stockings as a prophylactic measure in venous thromboembolism and edema of lower limbs triggered by air travel: a systematic review of clinical trials

Resumo Com o aumento da duração e frequência das viagens aéreas, observou-se um aumento da prevalência de tromboembolismo venoso nos passageiros. Este estudo avaliou a eficácia do uso de meias elásticas de compressão graduada para a prevenção de tromboembolismo venoso desencadeado por viagens aéreas com duração maior que 3 horas de voo. Trata-se de uma revisão sistemática de ensaios clínicos. A qualidade metodológica dos estudos e o nível de evidência científica foram avaliados pelo Consolidated Standards of Reporting Trials e Grading of Recommendations Assessment, Development and Evaluation. Foram identificados 34 artigos, entretanto apenas oito atenderam aos critérios de elegibilidade. Os desfechos incidência de tromboembolismo venoso e edema foram avaliados em 2.022 e 1.311 passageiros, respectivamente. Os estudos demonstraram evidências de alta qualidade para a prevenção de edema e de moderada qualidade para a redução da incidência de tromboembolismo venoso com o uso de meias elásticas de compressão graduada durante viagens aéreas.

Abstract The increase in duration and frequency of flights has led to an increase in the prevalence of venous thromboembolism among airline passengers. This study assesses the efficacy of graduated compression stockings for prevention of venous thromboembolism triggered by flights lasting more than 3 hours. The design is a systematic review of clinical trials. The methodological quality of studies and the level of scientific evidence were evaluated using the Consolidated Standards of Reporting Trials and Grading of Recommendations Assessment, Development and Evaluation standards. A total of 34 articles were identified, but only eight met the eligibility criteria. The outcomes incidence of venous thromboembolism and edema were assessed in 2,022 and 1,311 passengers, respectively. The studies presented high quality evidence demonstrating prevention of edema and moderate quality evidence of reduced incidence of venous thromboembolism associated with wearing graduated compression stockings during flights.

Hematoma subperiosteal orbitário secundário a barotrauma em aviação civil / Orbital subperiosteal hematoma secondary to barotrauma in civil aviation

RESUMO Os diagnósticos diferenciais que compõem as proptoses agudas são, muitas vezes, desafiadores. A anamnese e o exame clínico exigem do oftalmologista atenção especial aos detalhes que permitem diferenciar quadros relativamente benignos e autolimitados de quadros que evoluirão com incapacidades permanentes. Relatamos o caso de uma paciente de 49 anos que, durante viagem de avião, apresentou dor ocular, hematoma periorbitário e proptose do olho esquerdo súbitos. Referia diplopia aguda incapacitante. Exames de tomografia e angiorressonância magnética confirmaram diagnóstico de sinusopatia do seio etmoidal esquerdo e hematoma subperiosteal da órbita esquerda, associado ao barotrauma. Apesar de raro, o diagnóstico de hematoma subperiosteal não traumático deve ser considerado diferencial em relação a proptoses agudas, sendo a anamnese fundamental para essa elucidação diagnóstica.

ABSTRACT Differential diagnoses of acute proptosis are often challenging. History and clinical examination require from ophthalmologists special attention to details, which make it possible to differentiate relatively benign and self-limited conditions from those that will progress to permanent disabilities. We report a 49-year-old female patient who had sudden eye pain, periorbital hematoma and proptosis of the left eye during a commercial flight. She also complained of disabling acute diplopia. Computed tomography and magnetic resonance angiography imaging confirmed the diagnosis of subperiosteal hematoma of the left orbit, associated with left ethmoid sinus disease. Although rare, non-traumatic subperiosteal hematoma should be considered in differential diagnoses of acute proptosis, and history taking is fundamental to elucidate the picture.

Oxygen Therapy During Air Travel in Argentina. A Survey Ten Years Later

In 2007, we carried out a descriptive study about the use of oxygen therapy during air travel (OAT) in our country (Medicina BA 2008; 68:433-36). In this study we evaluate the current OAT service, both in domestic airlines (D) and international airlines (I). We conducted a telephone survey using the same methodology of the previous study. We communicated with 29 airlines (4 D and 25 I). We consulted them about the necessary requirements, costs and the possibility of obtaining information through their website, and then compared the results with the previous study. 25 airlines were evaluated (4 were discarded for lack of information, 16% of I airlines). Only one of them (4%) didn't allow the use of OAT. Three airlines (12%) have an additional cost. The survey was resolved with only one phone call in most cases (2 calls for I) with an average duration of 5:53 minutes (± 1:31 min) for the D airlines and 8:42 minutes (± 3:45 min) for the I airlines. In order to provide the service, all the airlines request a previous medical report and 19 (79%) need a special form. 32% of the airlines provide the interface. 29% of the companies demand that the oxygen supply model should be part of the list of the Federal Aviation Administration (FAA). 80.5% has information available through the website. In conclusion, the information has been more easily provided with the website version. An improvement has been observed in services rendered by I flights, which have more demands in relation to the period of notice, controls and necessary requirements; also, a lower number of airlines imposes an additional cost for the service.

Rutas aerocomerciales y distribución internacional de Covid-19 / Commercial airline routes and international distribution of COVID-19

Resumen La novel enfermedad COVID-19 ha tenido una rápida diseminación. Desde China, el virus viajó por todo el mundo. El potencial de la propagación global de COVID-19 fue anticipado y calculado mediante el uso de modelos matemáticos precisos. A estos modelos predictores se puede agregar información obtenida mediante la comparación de mapas gratuitos que representan la propagación internacional de la enfermedad y la densidad de las rutas aerocomerciales. Este análisis proporciona información de lo que parece ser una relación directa entre la distribución mundial inicial desigual de la enfermedad y la densidad del flujo aerocomercial. Esta comparación también puede estar sugiriendo la presencia de centros internacionales de distribución secundaria fuera de China. Con esta información de rápido acceso se puede contribuir a la mejor comprensión del derrame internacional de COVID-19 y orientar los esfuerzos de las políticas de salud para el control de esta y otras enfermedades infecciosas respiratorias agresivas.

Abstract COVID-19 has had a rapid dissemination. Departing from China, the virus has traveled all around the world. With the use of accurate mathematical models, the global spread of the disease was anticipated. Some additional information to these predictive models could be provided by the comparison of freely available maps depicting commercial air travel routes and disease spread. This analysis informs on what seems to be a direct relationship between the initially unequal worldwide distribution of the disease and the density of the commercial air traffic. This comparison may also help to identify international distributional hubs of the disease out of China. The observation of this easily accessible information may contribute to the understanding of COVID-19 spill over and help health control policies to better focus on the spread of this and other aggressively spreading respiratory infectious diseases.

Transporte aéreo e passageiros com deficiência auditiva: barreiras e facilitadores / Air transport and passengers with hearing impairments: barriers and facilitators

Este estudo teve como objetivo compreender as barreiras e facilitadores para a participação das pessoas com deficiência auditiva em viagens aéreas. Fundamentou-se na abordagem da ergonomia da atividade. Os dados foram coletados por meio de questionário, observações diretas durante as viagens e entrevistas de autoconfrontação com passageiros com deficiência auditiva. Constatou-se a existência de barreiras relacionadas a fatores sociais, como comunicação, e ambientais, como sinalização nos aeroportos. Entre os facilitadores das viagens destacaram-se a comunicação com trabalhadores que têm conhecimento da língua de sinais e legendas nos conteúdos de entretenimento a bordo. Este estudo espera dar visibilidade às experiências de viagens de passageiros com deficiência auditiva e, a partir disso, contribuir para a melhoria das condições e procedimentos do transporte aéreo e orientar a formação de pessoal visando prestar serviços adequados aos diversos passageiros

This study aims to understand the barriers and facilitators to the participation of persons with hearing disability in air travel. This study was based on the assumptions of activity-centered ergonomics. Data was collected by means of a questionnaire, direct observations during trips and self-confrontation interviews with passengers with hearing disability. The study findings include barriers related to social factors, such as communication, and environmental factors, such as airport signage. Air travel facilitators included communication in sign language with workers and closed-captioned in-flight entertainment for passengers. This study hopes to give visibility to travel experiences of passengers with hearing disability, and from that to contribute to the improvement of air transport conditions and procedures and to guide staff training aiming to provide adequate services to diverse passengers

Economy class syndrome: what is it and who are the individuals at risk?

Abstract The term 'economy class syndrome' refers to the occurrence of thrombotic events during long-haul flights that mainly occur in passengers in the economy class of the aircraft. This syndrome results from several factors related to the aircraft cabin (immobilization, hypobaric hypoxia and low humidity) and the passenger (body mass index, thrombophilia, oral contraceptives or hormone replacement therapy, cancer), acting together to predispose to excessive blood coagulation, which can result in venous thromboembolism. Several risk factors, both genetic and acquired, are associated with venous thromboembolism. The most important genetic risk factors are natural anticoagulant deficiencies (antithrombin, protein C and protein S), factor V Leiden, prothrombin and fibrinogen gene mutations and non-O blood group individuals. Acquired risk factors include age, pregnancy, surgery, obesity, cancer, hormonal contraceptives and hormone replacement therapy, antiphospholipid syndrome, infections, immobilization and smoking. People who have these risk factors are predisposed to hypercoagulability and are more susceptible to suffer venous thromboembolism during air travel. For these individuals, a suitable outfit for the trip, frequent walks, calf muscle exercises, elastic compression stockings and hydration are important preventive measures. Hence, it is essential to inform about economic class syndrome in an attempt to encourage Brazilian health and transport authorities to adopt measures, in partnership with the pharmaceutical industry, to prevent venous thromboembolism.

Barotrauma-Induced Pneumocephalus Experienced by a High Risk Patient after Commercial Air Travel

A 49-year-old female with a history of several neurosurgical and otolaryngologic procedures for occipital meningioma and cerebrospinal fluid leaks was diagnosed with pneumocephalus after a one hour flight on a domestic jet airliner. Despite multiple operations, the air appeared to enter the cranium through a weak portion of the skull base due to the low atmospheric pressure in the cabin. The intracranial air was absorbed with conservative management. The patient was recommended not to fly before a definite diagnostic work up and a sealing procedure for the cerebrospinal fluid leak site had been performed. Recent advances in aviation technology have enabled many people to travel by air, including individuals with medical conditions. Low cabin pressure is not dangerous to healthy individuals; however, practicing consultant neurosurgeons should understand the cabin environment and prepare high risk patients for safe air travel.

Tromboembolismo pulmonar crônico assintomático: uma condição infrequente? / Asymptomatic chronic pulmonary thromboembolism: is it an infrequent condition?

Relata-se um caso de tromboembolismo pulmonar crônico em homem asintomático de 72 anos, com antecedente de trombose venosa profunda após viagem aérea prolongada. O controle clínico e de imagem durante aproximadamente cinco anos revelaram a evolução dos trombos na artéria pulmonar direita, com extensão para o tronco arterial. Exceto pela trombose venosa profunda no membro inferior, nenhum fator de risco pessoal ou familiar pode ser evidenciado. A anticoagulação oral foi utilizada após uso de heparina, que contribuiu para a recanalização do vaso, com prognóstico favorável. O objetivo desse relato é ressaltar o papel da trombose venosa profunda devido à imobilização,na origem das embolias pulmonares crônicas, e enfatizar que esta condição pode evoluir não detectada clinicamente, podendo causar hipertensão pulmonar com elevada taxa de mortalidade se não tratada.

A case of chronic pulmonary thromboembolism in asymptomatic 72-year-old male, with previous deep-vein thrombosis after a prolonged air-travel is reported. Clinical and imaging surveillance for about five years revealed the thrombus in the right pulmonary artery, extending to the arterial trunk. Except for deep-vein thrombosis in his lower limb, no personal or familial predisposing risk factor could be detected. Longstanding oral anticoagulation after heparin use resulted in vessel recanalization, and good outcome. The aim is to highlight the role of deep-vein thrombosisdue to immobilization in the origin of chronic pulmonary embolism, and emphasize that this condition may evolve clinically undetected. Furthermore, it can cause pulmonary artery hypertension with high mortality rate if untreated.

Medical Guidelines for Air Travel Patients to Physicians

With a steady economic growth and the advancement of aircraft design, the demand to travel by air has constantly been on the rise. So much to the fact that there are more than 10 billion people traveling all over the world by aircraft. This demand will continue to rise so long as air travel continues to surpass other methods of transportation in aspects such as speed, comfort, safety, etc. There are about seven million tourists who travel abroad annually in our nation, thus airline travel has become one of the most popular forms of public transport. However, some people travel on flights without considering their state of health and risk suffering from a health ailment while on board. The cabin environment of a modernized aircraft preserves conditions similar to that on the ground, thereby making the travelers feel comfortable. But sometimes people with chronic diseases can make their health condition worse due to long distance flight travel. Traveling overseas among the elder generation has increased, and cases involving patients traveling abroad to receive better medical treatment has increased as well. In advanced countries, the air ambulance system is well prepared, but in Korea we can only transfer patients by commercial airlines based on the destination. This is especially typical in Jeju where there are no alternative ways. Helping an emergency patient inside the cabin is not a simple matter, and therefore it is best to avoid the situation. To be prepared for emergencies, each aircraft has an Emergency Medical Kit, First Aid Kit and Automated External Defibrillator (AED) inside the cabin. Each airline is also developing curriculums for teaching First Aid and training their flight attendants to properly use the Kit, AED and how to give First Aid. If there is a patient with a critical illness, generally the aircraft would land at the closest airport instead of the destination in an attempt to save the precious life. But, it would be more effective to be prepared with a contingency plan beforehand, instead of thereafter. If physicians and patients take more concerns regarding airline travel and kept in close communication with the airlines, some inflight medical emergencies in the cabin can be prevented. A patient who is planning to travel by air would want to receive some aero-medical information from their physicians. It is necessary to understand the cabin environment and to receive information on airline travel myths, the maximum amount of safe time for traveling, and steps to prepare before they leave. In this article, as a physician, I will review the medical guidelines to prevent unexpected accidents or inflight emergencies, and also to have some aviation medicine knowledge to help those on board.

Medical Guidelines for Air Travel Patients to Physicians

With a steady economic growth and the advancement of aircraft design, the demand to travel by air has constantly been on the rise. So much to the fact that there are more than 10 billion people traveling all over the world by aircraft. This demand will continue to rise so long as air travel continues to surpass other methods of transportation in aspects such as speed, comfort, safety, etc. There are about seven million tourists who travel abroad annually in our nation, thus airline travel has become one of the most popular forms of public transport. However, some people travel on flights without considering their state of health and risk suffering from a health ailment while on board. The cabin environment of a modernized aircraft preserves conditions similar to that on the ground, thereby making the travelers feel comfortable. But sometimes people with chronic diseases can make their health condition worse due to long distance flight travel. Traveling overseas among the elder generation has increased, and cases involving patients traveling abroad to receive better medical treatment has increased as well. In advanced countries, the air ambulance system is well prepared, but in Korea we can only transfer patients by commercial airlines based on the destination. This is especially typical in Jeju where there are no alternative ways. Helping an emergency patient inside the cabin is not a simple matter, and therefore it is best to avoid the situation. To be prepared for emergencies, each aircraft has an Emergency Medical Kit, First Aid Kit and Automated External Defibrillator (AED) inside the cabin. Each airline is also developing curriculums for teaching First Aid and training their flight attendants to properly use the Kit, AED and how to give First Aid. If there is a patient with a critical illness, generally the aircraft would land at the closest airport instead of the destination in an attempt to save the precious life. But, it would be more effective to be prepared with a contingency plan beforehand, instead of thereafter. If physicians and patients take more concerns regarding airline travel and kept in close communication with the airlines, some inflight medical emergencies in the cabin can be prevented. A patient who is planning to travel by air would want to receive some aero-medical information from their physicians. It is necessary to understand the cabin environment and to receive information on airline travel myths, the maximum amount of safe time for traveling, and steps to prepare before they leave. In this article, as a physician, I will review the medical guidelines to prevent unexpected accidents or inflight emergencies, and also to have some aviation medicine knowledge to help those on board.

Coronary Heart Disease in Air Travelers / 항공우주의학회지

The air medical transport of coronary patients is a rapidly expanding practice. From time to time, the physician is called on to assess risk or advise coronary patients. Commericial aircraft flight presents a highly variable altitude exposure that may result in significant hypoxia for patients with coronary heart disease. When considering elective long-distance air travel of coronary patients, it is necessary to weigh the benefits against the potential risks of flight. Strong contraindications to air travel by coronary patients would appear to be new-onset angina and unstable angina. And myocardial infarction within several weeks or months constitutes a relative contraindication, with persistent angina, ventricular ectopy, and poor ventricular function. These patients and those coronary patients with obstructive lung disease maybe candidates for in-flight oxygen treatment.

Spread of Communicable Disease by Air Travel

International movement of individuals, population, and products is one of the major factors associated with the transmission of infectious diseases. Travel can be associated with disease transmission because diseases arise in an area of heavy tourism and tourists may be at heightened risk because of their activities, or because they can act as vectors to transport an agent to new areas. Rapid air travel, in particular, has increased the potential for international transmission of infectious diseases. Important aspects of this problem include the transmission of foodborne and waterborne illnesses, the translocation of insect vectors, the rapid transport of individuals with incubating illnesses, the direct transmission of diseases inside aircraft, the transmission of zoonosis through animal transport, and the transmission through human waste.

The Effect of Long Distance Air-travel on Serum Viscosity and Prothrombin Time

BACKGROUND: Economy class syndrome is medically described as deep vein thrombosis, it is worldwide issued that Long-Distance Air-Travel is a risk factor for venous thromboemborism. Some study provides evidence and theoretical explanations for the hypothesis that long-distance is a risk factor for venous thromboembolism. The purpose of this study is to provide the useful prevention of venous thromboembolism for long-distance travelers in comparison to the effect of long distance air-travel on serum viscosity and prothrombin time between flight level and ground level. METHODS: Subjects selected healthy volunteers that had no abnormal findings in evaluation (alpha2-plasmin inhibitor, plasminogen, anti-thrombin III, protein C, protein S) for hypercoagulability. 5subjects (1 male, 4 females) had a seat on economy class of ground training facility designed for flight attendant and their activities limited as possible during about 8 hours at Sep. 16, 2001. Also, 5 subjects had a seat on the economy class of Asiana Airlines (B-777) from Sydney in Australia to Seoul in Korea at Mar. 3, 2002. In the flight, Actual flight altitude was 31,000 feet, cabin altitude was 4,800 feet and cabin temperature was 25degrees C. We have investigated the serum viscosity used by viscometer and prothrombin time. These data were analyzed statistically by General linear model (spsswin ver. 10.0). RESULTS: The results showed that there were no differcence between Flight Group and Ground Group statistically. However, the serum viscosity of flight group by position was some higher than ground group but these defference was not statistically significance (P=0.419). Also, the serum viscosity of flight group by time had a decreased trend but these trend was not statistically significance (P=0.061). The prothrombin time of flight group by position was some lower than ground group but these defference was not statistically significance (P=0.472). Also, the prothrombin time of ground group by time had a decreased trend but these trend was not statistically significance (P=0.217). CONCLUSION: This study shows the prediction to venous thrombosis more closely relates to prothrombin time than serum viscosity under immobilization to healthy people on the ground environment. Exercise is more useful method than hydration to prevent venous thrombosis on the ground environment. In the flight environment, we think that hydration is also useful method to prevent venous thrombosis because of more dry environment inside flying aircraft. But, this study was decreased serum viscosity between samples according to time. I think serum viscosity can be reduced by vibration effect inside flying aircraft. Serum viscosity and prothrombin time between samples according to position were not statistically significant. I think that risk for the healthy people is poorly quantified and possibly overestimated that long-distance air-travel is a risk factor for venous thromboembolism.