Journal of travel medicine
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Acute mountain sickness (AMS), High altitude pulmonary edema (HAPE) and High Altitude Cerebral Edema (HACE) are well known problems in the high altitude region of the Nepal Himalayas. To assess the proportion of AMS, HAPE, and HACE from 1983 to 1995 in the Himalaya Rescue Association (HRA) aid posts' patients at the Everest (Pheriche 4,243 m) and Annapurna (Manang 3,499 m) regions, the two most popular trekking areas in the Himalayas. A retrospective study was conducted at the HRA medical aid posts in Manang (3,499 m) and Pheriche (4,243 m) in the Himalayas, where 4,655 trekkers (tourists, mostly Caucasians) and 4,792 Nepalis (mostly porters and villagers) were seen at the two high-altitude clinics from 1983 to 1995, for a variety of medical problems, including AMS. ⋯ HAPE and HACE are the life-threatening forms of AMS and although there is a linear increase of trekkers entering the Himalayas in Nepal, the findings revealed that HAPE and HACE have not increased over time. One possible explanation may be that awareness drives by organizations like the Himalayan Rescue Association may be effective in preventing the severe forms of AMS.
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Diving is a high-risk sport. There are approximately between 1 to 3 million recreational scuba divers in the USA (with over a quarter-million learning scuba annually); there are about 1 million in Europe and over 50,000 in the United Kingdom. In this population 3-9 deaths/100,000 occur annually in the US alone, and those surviving diving injuries far exceeds this. ⋯ Greater than 90% of the human body is either water or bone, which is incompressible; the areas directly affected by pressure changes thus are those that are filled with air or gas. These sites include the middle ear, the eustachian tube, the sinuses, the thorax, and the gastrointestinal tract. Air in these cavities is compressed when the ambient pressure rises because the pressure of inhaled air must equilibrate with the ambient pressure.
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Envenomation by marine creatures is more common than is often realized, and regularly accounts for both death and severe morbidity in humans. Worldwide marine envenomation morbidity and mortality result from two main animal groups: (1) jellyfish, and (2) "other" marine animals. Venomous jellyfish are discussed in part I of this article, with relevant information on their distribution and appearance, and on symptoms of envenomation; first aid and medical treatment are also suggested.
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Although tens of thousands of Salmonella infections occur annually in this country, most involve the gastrointestinal tract with involvement of the urinary tract being quite infrequent.1-3 I would like to report a case of urosepsis due to Salmonella with eventual development of metastatic osteomyelitis of a rib that proved refractory to treatment. A 59-year-old Latin American male who resided in the Texas Rio Grande Valley presented to an emergency room with inability to void, having first noted a decreased urinary stream and dribbling a few months earlier. In-and-out bladder catheterization yielded 700 cc of urine, and he was sent out on co-trimoxazole one double-strength tablet twice daily. ⋯ Forty-eight hours postoperatively, the patient suffered an acute myocardial infarction and expired. Postmortem revealed severe coronary artery disease. No additional focus of Salmonella infection was found.