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.

SARS-CoV-2 detection among international air travellers to Ghana during mandatory quarantine

Objectives: To determine the prevalence of SARS-CoV-2 detection among international travellers to Ghana during mandatory quarantine. Design: A retrospective cross-sectional study. Setting: Air travellers to Ghana on 21st and 22nd March 2020. Participants: On 21st and 22nd March 2020, a total of 1,030 returning international travellers were mandatorily quarantined in 15 different hotels in Accra and tested for SARS-CoV-2. All of these persons were included in the study. Main outcome measure: Positivity for SARS-CoV-2 by polymerase chain reaction. Results: The initial testing at the beginning of quarantine found 79 (7.7%) individuals to be positive for SARS-CoV2. In the exit screening after 12 to 13 days of quarantine, it was discovered that 26 of those who tested negative for SARS-CoV-2 in the initial screening subsequently tested positive. Conclusions: Ghana likely averted an early community spread of COVID-19 through the proactive approach to quarantine international travellers during the early phase of the pandemic

Reanudación de los viajes internacionales no esenciales en el contexto de la pandemia de COVID-19: orientación sobre el uso de pruebas para la COVID-19 / Resumption of International Non-Essential Travel in the Context of the COVID-19 Pandemic: Guidance on the Use of COVID-19 Tests

Este documento fue elaborado por la Oficina Sanitaria Panamericana en cumplimiento de la resolución La pandemia de COVID-19 en la Región de las Américas, aprobada por el 58.o Consejo Directivo de la OPS en septiembre del 2020. En el documento se resumen las consideraciones relativas al proceso de toma de decisiones para reanudar los viajes internacionales no esenciales en el contexto de la pandemia de COVID-19 y, en vista de que este riesgo no puede eliminarse, se incluyen las medidas clave que deberían implementarse para aceptar y mitigar el riesgo de propagación internacional del SARS-CoV-2. Además se brindan más detalles sobre el posible uso de pruebas para la COVID-19 y se hace hincapié tanto en los desafíos primarios (biológicos, técnicos y epidemiológicos) como en las limitaciones secundarias (jurídicas, operativas y en relación con los recursos).

Los viajes en avión y las enfermedades respiratorias / Air travel and respiratory diseases

Los aviones son medios de transporte habitual, y de uso cada vez más frecuente hasta el inicio de la pandemia COVID-19. La trasmisión del virus SARS-CoV2 se ve favorecida por el ambiente cerrado durante las horas del vuelo. A causa de esta pandemia se espera una disminución de entre el 58 y el 78% de los aproximadamente 3000 millones de pasajeros anuales, con una recuperación que también será variable según la evolución de dicha pandemia .

Oxigenoterapia en vuelos en Argentina. Encuesta diez años después / Oxygen Therapy During Air Travel in Argentina. A Survey Ten Years Later

En el año 2007, realizamos un estudio descriptivo sobre la prestación de oxigenoterapia en vuelo (OV) en nuestro país (Medicina BA 2008; 68:433-36). En este trabajo evaluamos el servicio de prestación actual de OV, tanto en aerolíneas de cabotaje (N) como en internacionales (I). Realizamos una encuesta telefónica usando la metodología del trabajo previo. Nos comunicamos con 29 aerolíneas (4 N y 25 I). Se consultó sobre los requisitos necesarios, costos y posibilidad de información en página web y se comparó con resultados del estudio anterior. Se evaluaron 25 aerolíneas (4 se descartaron por falta de información, 16% de I). Sólo una (4%) no permitía el uso de OV. Tres aerolíneas (12%) tienen un costo adicional. La encuesta se resolvió con un llamado en la mayoría de las aerolíneas (2 llamados en I) con tiempo promedio de 5:53 min (± 1:31min) para las N, y 8:42 min (± 3:45mim) para las I. Todas solicitan informe médico previo y 19 (79%) un formulario especial. El 32% de las aerolíneas provee la interfase. El 29% exige que el modelo de fuente de oxígeno figure dentro de la lista de la Federal Aviation Administration (FAA). El 80,5% cuenta con información en página web. Como conclusión, se ha observado menor dificultad en la información, agregando la versión en páginas web. Se ha evidenciado mejoría en las prestaciones de vuelos I, mayor exigencia en cuanto a tiempo de aviso, controles y requisitos necesarios y menor número de aerolíneas con costo adicional por la prestación.

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.

Dispersion of a new coronavirus SARS-COV-2 by airlines in 2020: temporal estimates of the outbreak in Mexico

ABSTRACT Background: On January 23, 2020, China imposed a quarantine on the city of Wuhan to contain the SARS-CoV-2 outbreak. Regardless of this measure, the new infection has spread to several countries around the world. Objective: We developed a method to study the dissemination of this infection by airline routes and provide estimations of the time of arrival of the outbreak to different cities. Methods: Using the Kermack and McKendrick model complemented with diffusion on a graph composed of nodes and edges, we made an analysis of COVID-19 dispersion to other cities by air travel. Results: The estimation was accurate in that it was possible to predict in the middle of February 2020 the arrival of the first outbreak in Mexico, which eventually occurred between March 20 and 30. This estimation was robust with respect to small changes in epidemiological parameters at the other nodes. Conclusions: The estimation of the time of arrival of the outbreak from its epicenter, allows for a time period to implement and strengthen preventive measures aimed at the general population as well as to strengthen hospital infrastructure and training of human resources. In the present study, this estimation was accurate, as observed from the real data of the beginning of the outbreak in Mexico City up to April 6, 2020.

Embolismo cerebral durante vuelo comercial: reporte de caso / Cerebral embolism during commercial flight: case report

RESUMEN Presentamos el caso de un varón de 25 años con antecedentes de consumo de marihuana y tabaco, que durante viaje en vuelo comercial a Cusco presentó disnea, pérdida de conciencia y estado epiléptico. Arribó a esta ciudad presentando hipotensión arterial, murmullo pulmonar abolido, sin recuperación de conciencia. La tomografía de tórax reveló bullas pulmonares y la tomografía mostró neumoencéfalo, diagnosticándose embolia gaseosa cerebral. La hipoxemia asociada a convulsiones y pérdida de conciencia en una persona joven durante el vuelo no es un evento común. La pérdida de la presión en la cabina durante el ascenso parece ser el evento desencadenante en pacientes con enfermedad pulmonar.

ABSTRACT We present the case of a 25-year old man with a history of marijuana and tobacco consumption who, during a commercial flight to Cusco, presented dyspnea, loss of consciousness, and epileptic condition. He arrived in this city presenting arterial hypotension, abolished pulmonary murmur, with no recovery of consciousness. The thorax tomography revealed lung bullae and the tomography showed pneumocephalus. He was diagnosed with cerebral gas embolism. Hypoxemia associated with seizures and loss of consciousness in a young person during a flight is not a common event. Loss of cabin pressure during climb appears to be the triggering event in patients with lung disease.

Profilaxia do tromboembolismo venoso em viagens aéreas / Venous thromboembolism prophylaxis on flights

A aviação civil vem apresentando aumento progressivo do número de voos regulares nos últimos 10 anos e, em função disso, mais passageiros estão sendo transportados em viagens aéreas (VAs). Associado a isso, há um aumento das doenças relacionadas às VAs, especialmente naquelas de longa duração. Uma das complicações mais temidas dos voos é o tromboembolismo venoso (TEV), mas a sua real incidência é de difícil mensuração devido à falta de consenso sobre, por exemplo, quanto tempo após o pouso podemos considerar que o TEV possa estar relacionado à VA realizada ou mesmo quanto tempo de voo pode ser considerado como de longa duração. Muito tem se discutido sobre os mecanismos fisiopatológicos do TEV relacionado às VAs, quais passageiros são os de maior risco e quais medidas profiláticas podemos adotar com segurança e eficácia. O objetivo desta revisão é esclarecer esses pontos e as condutas consensuais atuais

Civil aviation has seen a steady increase in the number of scheduled flights over the last ten years and, as a result, more passengers are traveling by air. This has been associated with an increase in flight-related diseases, especially on long-haul flights. One of the most feared complications during flights is venous thromboembolism (VTE), but its true incidence is difficult to measure because of a lack of consensus on elements such as the definition of how long after landing a VTE can be considered to be related to a flight and even how long a flight must last to be considered of long duration. There has been much discussion of the pathophysiological mechanisms of flight-related VTE, of which passengers are at greatest risk, and of what prophylactic measures can be adopted safely and effectively. The purpose of this review is to clarify these points and describe current consensual conduct

traveler to Holland with a benign killer: a case report of a sickle cell trait male with splenic infarction

Sickle cell trait is highly prevalent in Saudi Arabia. However, most of the patient are asymptomatic, only few present with symptoms of the complications of the disease. We report a case of 24-year-old male who presented to the hospital with history of dull left upper quadrant, nausea and vomiting while he was on the airplane. Investigation showed a picture of sickle cell trait with hemoglobin S of 40%. Peripheral blood smear was within normal. CT scan of the abdomen confirmed the presence of splenic infraction. This case emphasized on the need to increase the level of threshold to recognize the rare complications of sickle cell trait and how to manage them appropriately

Vertical transmission of dengue virus in the Yogyakarta airport area

BACKGROUND@#International Health Regulations controls international travel including human movement, disease vector, and imported items to prevent the spread of dengue, especially in seaports, airports, and border crossing posts. This study aimed to determine dengue Transovarial Transmission Index (TTI) and distribution of dengue virus in the areas around Adisucipto Airport of Yogyakarta, Indonesia.@*METHODS@#The study was a descriptive analytic study with cross sectional design, conducted by mapping the spread of the dengue virus and identifying TTI in Adisucipto Airport. A total of 145 ovitraps were installed in both perimeter and buffer areas of the airport. Positive Ovitrap Index (OI), TTI, and serotype of dengue virus were examined. The TTI was identified using immunocytochemistry immunoperoxidase streptavidin biotin complex (IISBC) method in mosquito head squash preparations.@*RESULTS@#OI in the buffer area was 32 (45.1%), whereas OI in the perimeter area was 24 (32.4%). The TTI in the buffer and perimeter areas were 21 (18.3%) and 11 (18.9%), respectively. The TTI was found greater in the Aedes aegypti population compared to the Aedes albopictus population, both in the perimeter area (20% versus 16.7%) and the buffer area (20.3% versus 16.1%). Dengue virus serotype-2 (DENV-2) and dengue virus serotype-3 (DENV-3) were predominantly found in Ae. aegypti and Ae. albopictus.@*CONCLUSIONS@#Buffer areas of Adisucipto Airport of Yogyakarta have higher risk as breeding sites for Aedes spp., predominantly DENV-2 and DENV-3 serotypes. High OI shows that the areas are likely to have higher risk of developing dengue outbreak.

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.

Parálisis facial recidivante en vuelos comerciales: reporte de un caso / Recurrent facial paralysis during comercial flights / Case report

La parálisis facial asociada a cambios bruscos de presión en el oído medio es un fenómeno poco común que ha sido reportado tanto en actividades de buceo como en aviación. Se produciría una incapacidad, por parte de la tuba auditiva, de equilibrar las presiones entre el oído medio y el ambiente, lo que generaría una neuropraxia del facial en presencia de ciertas condiciones. Presentamos el caso de un paciente que desarrolló un cuadro de parálisis facial recidivante durante vuelos comerciales, se describe la evaluación realizada y la probable fisiopatología involucrada.

Facial paralysis, associated with sudden changes in pressure in the middle ear, is a rare phenomenon that has been reported in both diving and aviation. It occurs because the Eustachian tube is unable to compensate middle ear pressure changes which would lead to a facial neuropraxia in the presence of certain conditions. A case of a patient who developed recurrent facial paralysis during comercial flights. The possible involved pathophysiology is described.

Eficacia de la detección sistemática de la gripe en las fronteras en los viajeros que llegan por vía aérea / Effectiveness of border screening for detecting Influenza in arriving airline travelers

OBJETIVOS: Se midieron los síntomas y la prevalencia de la gripe (también llamada influenza), así como la eficacia del mecanismo de detección sistemática basado en los síntomas y la temperatura para diagnosticar la gripe en viajeros internacionales que llegaban por vía aérea. MÉTODOS: El presente estudio transversal recopiló datos de viajeros que llegaron al aeropuerto internacional de Christchurch (Nueva Zelandia) en el invierno del 2008 mediante un cuestionario de salud, medición de la temperatura y toma de muestras de las vías respiratorias. RESULTADOS: De los viajeros, 15 976 (68%) entregaron los formularios completos. De ellos, 17% notificaron al menos un síntoma de gripe; los síntomas más comunes fueron rinorrea o congestión nasal (10%) y tos (8%). Se tomaron muestras de las vías respiratorias de 3 769 viajeros. La prevalencia estimada de la gripe fue de 1,1% (4% en las personas sintomáticas, 0,2% en las asintomáticas). La sensibilidad de los criterios de detección varió de 84% para "cualquier síntoma" a 3% para la fiebre de 37,8 ºC o mayor. El valor predictivo positivo fue bajo para todos los criterios. CONCLUSIONES: El método de detección sistemática en las fronteras mediante la autonotificación de síntomas y la toma de la temperatura presenta limitaciones para impedir que una gripe pandémica entre en un país. Basarse en criterios como "cualquier síntoma" o la tos haría que se investigara a varias personas no infectadas, mientras que algunas personas infectadas pasarían inadvertidas. Si se usaran criterios más específicos como la fiebre, la mayoría de las personas infectadas entrarían en el país a pesar del mecanismo de detección.

ABSTRACT OBJECTIVES: We measured symptom and influenza prevalence, and the effectiveness of symptom and temperature screening for identifying influenza, in arriving international airline travelers. METHODS: This cross-sectional study collected data from travelers to Christchurch International Airport, New Zealand, in winter 2008, via a health questionnaire, temperature testing, and respiratory sampling. RESULTS: Forms were returned by 15 976 (68%) travelers. Of these, 17% reported at least 1 influenza symptom, with runny or blocked nose (10%) and cough (8%) most common. Respiratory specimens were obtained from 3769 travelers. Estimated prevalence of influenza was 1.1% (4% among symptomatic, 0.2% among asymptomatic). The sensitivity of screening criteria ranged from 84% for "any symptom" to 3% for a fever of 37.8 ºC or greater. The positive predictive value was low for all criteria. CONCLUSIONS: Border screening using self-reported symptoms and temperature testing has limitations for preventing pandemic influenza from entering a country. Using "any symptom" or cough would lead to many uninfected people being investigated, yet some infected people would remain undetected. If more specific criteria such as fever were used, most infected people would enter the country despite screening.

[Approach to tuberculosis in air travelers]

Tuberculosis is one of the major health problems, especially in developing countries. This study aimed to further understanding of the medical community with this problem in domestic and international air travel, and ICAO has been predicted that by 2015 that is reached number of travel- air to more than 5 / 2 million per year. Ease and duration of air travel, with large numbers of international travelers- international, has increased the likelihood of contact with infectious TB. To access the resources of articles were used PubMed .nejm. Civil aviation, WHO and the papers published in reputable scientific journals of Iranian and foreign research data from 2000 to 2011 and the Ministry of Health and Medical Education. pulmonary tuberculosis is the most common type of tuberculosis in Iron and world and sputum smear-positive pulmonary TB, so that makes up 53 percent of all TB cases. Non pulmonary tuberculosis is 28% of all cases of tuberculosis. Considering that more tuberculosis in pulmonary tuberculosis is spread through the air, air travel time outlast 8 h is danger for travelers. Over 80 percent of the total number of people with TB annually is in developing country, regarding the transmission of tuberculosis, information is necessary required for reduced risk of transmission of TB on flights travelers