Tourism and emerging and re-emerging infectious diseases in the Americas: What physicians must remember for patient diagnosis and care

Emerging diseases are those which have shown an increased in humans over the last 20 years. Re-emerging diseases are those which have reappeared after a period of significant decrease in incidence. The etiological agents of these diseases in the Western Hemisphere are viroses (HIV, dengue, oroupuche, sabia, guanarito, or hanta), bacteria (Vibrio cholera, Borrellia burgdorferi, Legionella pneumofila, Escherichia coli O157:H7, or other bacteria with a new pattern of antibiotic resistence), or parasites (Cryptosporidia, Cyclosporidia or drug resistant Plasmodium falciparum). Due to the widespread geographical distribution of these infectious diseases in the Americas, and an increasing number of travellers (more than 87 milion persons within the region in 1997), there are many opportunities to contract an infection when travelling in developed or undeveloped countries. The infections may present with symptoms during the trip, or following the traveler's return to his or her place of origin. However, too often practicing physicians do not inquire about the travel history of their patients and, when they do, they often lack the information about diseases relevant to travelers. From the regional perspective, the emerging or reemerging agents that pose a higher risk to tourists or travelers are: 1) those that cause enteric infections; 2) sexually transmitted diseases; and 3) vector-borne diseases, including those present in ecotourism areas. Emerging and re-emerging diseases that physicians may encounter in their clinical practice while caring for travelers returning from different countries of the Western Hemisphere are briefly described (Lyme diseases, legionellosis, dengue, yellow fever, P. falciparum malaria, cyclosporidiosis and cryptosporidiosis). This report attempts to draw attention to the fact that new clinical and etiological entities are present in several geographical areas of the Americas; to place each of the these entities into an epidemiological context; and to end the misconception that only travel to poor coutries carries a risk of acquiring an infection. By knowing which infectious agents occur in each area and the incubation period of each disease, the treating physician can often patients sucessfully. Health care professionals must be aware of the organisms circulating in the region so that they have them in mind during their clinical practice.

Suporte médico em viagens aéreas / Advanced life support during air travel

Säo abordados aspectos médicos da aviaçäo e ocorrências das emergências näo-cardiológicas durante um vôo; alteraçäo da pressäo barométrica, diminuiçäo da tensäo de oxigênio, turbulência, alteraçäo circadiana, ortostase, exposiçäo à radiaçäo cósmica, estresse psicológico, envenenamentos, a gestante e viagens aéreas. Analisa-se o tratamento das seguintes situaçöes cardiológicas: doença coronariama, arritmias, ressuscitaçäo cardiopulmonar, utilizaçäo de marcapasso, e outras rotinas cardiológicas.

Aspectos cardiológicos relacionados à viagem / Cardiology problems and aviation

Os aspectos cardiológicos säo de importância vital para a Medicina da Aviaçäo. Tanto os profissionais do vôo - os aeronautas - como os passageiros säo objetos eventuais da atençäo dos cardiologistas. Estes devem estar familiarizados com o ambiente específico do transporte aéreo de forma a minimizar as consequências que impöem ao organismo humano, em particular ao indivíduo doente, evitando consequências danosas para o indivíduo e mesmo para a sociedade. A doença coronariana, as arritmias cardíacas e as patologias orovalvares säo condiçöes que afetam diretamente a vida do piloto e sua capacidade para o vôo seguro. O ambiente de hipoxia e a baixa umidade relativa ao ar que ocorre nas cabines de aviöes comerciais devem ser do conhecimento daqueles que aconselham seus pacientes antes de viagens aéreas. O cardiologista, que, por força de sua atividade de atualizaçäo, torna-se um viajante frequente, deve estar preparado para lidar com emergências cardiológicas a bordo, sem os recursos disponíveis no ambiente hospitalar.

Medicina del viajero / Traveller's medicine

La facilidad con que se viaja actualmente ha incrementado el número hasta hace poco inimaginable de los viajes fuera de las propias fronteras. El poder llegar en 24 horas a países y continentes que antes parecían tan lejanos, ha hecho realidad la aseveración de que el mundo en que vivimos es una "aldea global". El desplazamiento de millones de personas cada día a medios físicos y culturales tan distintos al de su residencia habitual, ha multiplicado la aparición en los viajeros de patologías no existentes en sus lugares de origen y para los cuales no estaban preparados, además de los problemas de salud causados por el estrés del viaje en sí mismo. El volumen de la morbilidad producida por este fenómeno contemporáneo catapultó el surgimiento de una nueva "especialidad", la emporiatría o "ciencia de la salud del viajero". Los médicos de familia están en condiciones inmejorables para proveer atención, consejo y prevención a los pacientes que viajan