Dislocated Shoulder Reduction in Wilderness

The Medicine for the Outdoors blog by Paul Auerbach has produced yet another great article! This tip on a technique for reducing a dislocated shoulder comes courtesy of Dr. Jeremy Joslin.

The technique he describes is called the Milch technique and his advice and descriptions of the procedure are very well written. Anybody who ventures off a paved road should have a read through the tips on this blog.

Thanks for a great article!


Family Medicine Resident Conference: Global Health

A great new conference is on the horizon. The American Academy of Family Physicians annual resident and medical student conference, July 30th-August 2nd in Kansas City, is about Global Health. Check out their site about the conference here: AAFP.org/nc

Yet another conference to attend, but it should be pretty good!
Adventure Doc

DEET in Pregnancy

I ran accross a good question about someone concerned with DEET use in pregnancy.  This is a very good question and a pregnant woman should always be aware of what she is doing and taking, with respect to the health of her baby. By the way, the article was over at BootsnAll Travel Health Forum.

DEET is safe for use by pregnant and breast feeding women, following manufacturer guidelines. CMAJ • August 5, 2003; 169 (3) “DEET-based insect repellents: safety implications for children and pregnant and lactating women” by: Gideon Koren, Doreen Matsui and Benoit Bailey.

Another fantastic article on Mosquito Bite prevention can be found here: Mosquitoes and Mosquito Repellents: A Clinician’s Guide by Mark S. Fradin, MD. This article is in Annals of Internal Medicine, 1 June 1998 | Volume 128 Issue 11 | Pages 931-940.

These are my two main sources when I need to refer about safety of mosquito repellents.

There are a few other options, as well. Avon Skin-so-soft lotion has some anti-mozzi effects and is well tolerated in children and adults. The downside to this is that it requires more frequent applications for decent protection. The anti-mosquito properties are believed to come from either fragrance of the cream or the chemicals it contains, benzophenone and diisopropyl adipate. Citronella oil should aslo be mentioned, although it is not proven to be as effective as DEET.

DEET is a very well know compound and has a wide safety profile. The few reported adverse events associated with DEET have largely been in pediatric populations and associated with improper use (using far too much and too often). For more information you can visit another post on mosquito bite prevention.

Adventure doc

Water Purification Bag

There is a interesting new article over at Outdoorsmagic.com. A company called Pure Hydration has released their “Thirst Aid Bag”.

The bag, made from Armour Weave Technology, makes use of the company’s Aquapure Traveller filter. About the size of a water bottle, the filter has already been approved by London School of Tropical Medicine and claims to kill viruses and bacteria.

Chiefly designed for emergency use in disaster areas, the bag will have obvious uses in the hiking world, as well.

I am always interested in a small and effective water filter.
Adventure Doc Water Purification

DesertUSA.com Survival Article

I grew up in Southern Arizona, the center of the Sonoran Desert. For people not used to the heat down there, it can be overwhelming. A really cool website, called DesertUSA.com, has an article by Felice Prage about “Surviving in the Sonoran Desert“.

The article contains loads of good information from sun protection and safe desert travel to special survival gear for deserts. I really liked it!

I have a page on Hot Climates over at AdventureDoc.org

Cholera Updates: Iraq and Vietnam

Iraq and Vietnam seem to have the unfortunate position of “top cholera hotspots” according to ProMed’s new diarrheal and cholera updates.

I was just asked a question, from a traveler going to Vietnam, about advice and safety. For knowledge of traveler’s diarrhea, you can visit the Adventure Doc Traveler’s Diarrhea Page.

ProMed stated that Iraq is facing a “Health Catastrophe” in Baghdad. Cholera cases continue to soar, mostly in the eastern part of the city. Poor sanitation is cited as the biggest factor to overcoming this outbreak. A November report form the UN stated 4569 new cases for the year and 22 deaths, all from cholera. Sanitation, clean drinking water, hand washing and prompt recognition of diarrhea followed by copius oral rehydration are the cornerstones to combating cholera.

Another on-going epidemic with 1941 cases of acute diarrhea in northern provinces of Vietnam, of which 261 tested positive for cholera.

“According to Nguyen Tran Hien, director of the National Institute of Hygiene and Epidemiology, the results from tests on vegetables and water from areas where cases of cholera were identified found no sign of the cholera bacterium.” Source: Promed Mail.

Ha Tay and Ha Noi provinces are hardest hit.  Ha Tay, being a large producer of food products for the country, is in a prime spot for transmitting the disease all over the country.

Government inspectors are currently assesing the sitituation and giving out hand sanitizer and latex gloves to citizens in the hardest hit provinces.

The cholera vaccine is currently marketed by:
Dukoral ®
SBL Vaccin AB,
SE-105 21 Stockholm, Sweden
telephone +46-8-7351000,
e-mail: info@sblvaccines.se
website: http://www.sblvaccines.se

Although the CDC does not advise the vaccine for routine travelers. See more on the CDC cholera page. Previous vaccines have been notorious for causing intussusception in children. Intussusception is a cause for abdominal pain and bowel obstruction. This occurs, most commonly, when the bowel/intestine “telescopes” into itself, similiar to closing a spyglass. E-medicine has a great article about it.


Fatal Trypanosomiasis in Serengeti

The ISTM/Geo Sentinel has a news release about a fatal case of African Trypanosomiasis in a tourist traveling through the Serengeti. The victim was dead 6 days after being bitten by the notorious Tse Tse Fly, carrier of “African Sleeping Sickness”.

Apparently, she was initially diagnosed, by blood smear, as a case of malaria. This delay in correct diagnosis cost valuable time and the patient died in an Intensive Care Unit in a Niarobi hospital. This is the first case of African Trypanosomiasis, in a Serengeti Tourist, since 2001.

She was reported to acquire the infection while traveling through Tanzania.

The causative agent in Sleeping Sickness is Trypanosoma Brucei Gambiense, found is Western Africa, in areas where Glossinia (tsetse) species live. T.B. Rhodsiense is found in scattered spots of Eastern Africa and more associate with sylvatic cycles involving wild deer and range animals.

Nicknamed “Sleeping Sickness”, mental status changes are common. The acute nature of the disease suggest the East African form, T.B. Rhodiense.

Adventure Doc

Paul Auerbach’s Wilderness Medicine Blog

Dr. Paul Auerbach, a co-author of one of my favorite books: A Field Guide to Wilderness Medicine also runs a blog. His site, found here: http://www.healthline.com/blogs/outdoor_health/ contains an amazing amount of information and current events involving wilderness and expedition medicine. I also like the fact the he includes some personal comments and information, adding a human side to a lot of strong medical information.

An opportunity to follow current wilderness medicine news and material with one of the leaders in the field, this blog deserves a visit!

Adventure Doc

Sri Lanka Viral Fever Spreading

TamilNet has an article about a febrile illness that is spreading accross Sri Lanka. The Jaffna Hospital has been overwhelmed with nearly 700 patients.

Sri Lanka has a history of Chikungunya virus outbreaks, especially this rainy time of year. Chikungunya is a viral illness spread from the bite of an infected mosquito. Similiar to Dengue fever, chikungunya is considered less severe and self-limiting.

Dominican Leptospirosis Outbreak

In the wake of flooding from Tropical Storm Noel,  last month, there is a outbreak of leptospirosis in the Dominican Republic. The article, from Reuter’s also went to to say that there has been 25 deaths and almost 200 illnesses.

Leptospirosis is a spirocheate that is most commonly acquired through skin contact with infected fresh water. Animals such as rats carry the disease and shed the infective organism in their urine. The usual method of infection is the hiker or forest walker, with a few cuts on their legs, gets splashed or wades in standing fresh water and acquires the infection. Symptoms include fever, headache, jaundice and leg pains. This infection may progress to a fatal meningitis/encephalopathy, if untreated. Treatment is with an antibiotic (penicillin) and there is some literature to suggest prophylaxis with weekly doses of doxycycline.

To learn more about leptospirosis visit the adventure doc leptopsirosis page

Pet Related Infections Article

A very good article on Pet Related Infections can be found at the American Family Physician website (Am Fam Physician 2007;76:1314-22). The article, written by an MD and two vets, covers zoonosis very well. Most of the illness are not specific to household pets and have application to wild animals and travelers, as well.  This is a very informative and well written piece that deserves to be read by any person who treats people in contact with animals.


Adventure Doc

Angola Mystery Illness Update

The WHO released a statement of findings about the mysterious illness in Angloa. According to WHO, there are high levels of Bromide in patients plasma samples. As of 19 November 2007, over 390 cases had been reported, with over half in children under age 15. The Municipal Hospital in Cacuaco, Angola seems to have the largest collection of cases.

WHO officers are currently working to find the source of the contamination and prevent further damage or illness.

Antarctic Cruise Ship Rescue

A cruise ship in the antarctic ran into some trouble and is sinking according to this article from the AP.

Apparently, there is a hole the size of a fist and some hull damage, causing the passangers to have to be evacuated. All passengers are safe and accounted for, according to the coast guard.

The incident took place near the South Shetland Islands, on the vessel named “Explorer”. Rescue teams from Norfolk, Virgina and Argentina responded to the call for help.

The saga is over, hopefully. MSNBC has a good article covering the evacuation and safe recovery of cruisers. MSNBC Article.

Read more about cruise ships and health at sea on the Cruise Ship Medicine page over at AdventureDoc.org

Yellow Fever Vaccine Recalls in South America

I received an e-mail today from one of the many, many travel and tropical medicine listserves I am following. There has been recall of the YF vaccine manufactured by BioMaguinos, headquartered in Brazil. The recall is in response to the 4 Peruvian deaths associated with recent vaccinization, all from the same lot, of this implicated vaccine. Of note, there are 9 lots in total that are being recalled, at present. This larger recall, involving other lots, makes you wonder how widespread the problem vaccines are? This vaccine is widely used in South America.

According to the WHO/PAHO statement, 3 of the 4 deaths have been classified as “acute viscerotropic disease following yellow fever vaccination” after autopsy, with the 4th case pending. There have only been 37 cased of confirmed or suspected acute viscerotropic disease following yellow fever vaccination, since the disease was first recognized in 2001.

From that same WHO/PAHO statement: “The estimated risk for viscerotropic disease following YF vaccination ranges from 0.1 to 0.3 per 100,000 vaccinated persons overall; a higher risk has been documented in persons older than 60 years.”

The vaccine used in the USA is from a different company: Sanofi Pasteur.

The Yellow Fever vaccine is a live virus vaccine. This means you are actually getting a bit of the virus, that is alive, injected into you. There are other vaccines that make use of killed bacteria or viruses and inject them, letting your body develop immunity without risk of infection. The ubiquitus MMR (measles, mumps, rubella) vaccine is a live virus vaccine. Commonly given to children in developed nations, it is never to be given to people with weakened immune systems or pregnant women.

The Yellow Fever vaccine is given as a one shot dose and offers protection from YF for 10 years, according to WHO re-imminuzation requirements. I have commonly heard that the YF vaccine is believed to provide immunity for up to 30 years, although there is limited formal data to this.

Contraindications to receiving the YF vaccine include an altered or weak immune system (because you cannot fight off the live virus used to immunize you), pregnancy (the live virus can harm the fetus), allergy to eggs (the vaccine is produced by injecting the virus into eggs, allowing it to multiply) and age less than 9 months old (immune system might not be able to fight off the live virus).

Check out more about Yellow Fever over at AdventureDoc.org and my original post about this, a few days ago.


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