This article presents a severe cerebral malaria patient in shock with a close contact of COVID-19 that was successfully cured in a negative pressure ward during the global pandemic of COVID-19. The patient experienced a sudden onset of high fever and coma in a designated isolation hotel after returning from Africa, and was transferred to a designated hospital. Following antimalarial therapy, blood pressure elevation, increase of blood volume, bedside hemodialysis, mechanical ventilation, plasma and platelet transfusions, the case gradual recovered.
Humans ; COVID-19 ; Malaria/drug therapy* ; Antimalarials/therapeutic use* ; Africa ; Travel

Monkeypox is a global health emergency. Prior to 2022, there were few reports of monkeypox outside of endemic countries, which were mostly travel-related. Since May 2022, an exponential increase in monkeypox infections in previously non-endemic countries has been reported. Unlike previous outbreaks of monkeypox, which were zoonotically transmitted and presented with generalised vesicular eruptions after prodromal symptoms, cases of the current outbreak feature significant travel and sexual history, and atypical localised genital eruptions with unpredictable onset relative to viral prodrome-like symptoms. We summarise the 15 Singapore cases reported to date as of August 2022, and highlight salient clinical clues that may aid physicians in narrowing the broad differential diagnosis of an acute vesicular genital eruption. Although research into vaccination and antiviral strategies is ongoing, monkeypox is currently conservatively managed. Clinical vigilance and a high index of suspicion are required to facilitate early detection and isolation of cases to contain transmission in Singapore.
Disease Outbreaks ; Humans ; Monkeypox/epidemiology* ; Singapore/epidemiology* ; Travel-Related Illness

Economy class syndrome (ECS) refers to a series of symptoms, such as lower limb swelling, chest pain, dyspnea, and sudden death, that occur during or after a long-distance flight. Its essence is venous thromboembolism. ECS, as a preventable syndrome, is one of the causes of sudden death in long-distance travelers. Medical assistance to the African region is a very important diplomatic matter of China. It often takes medical workers more than 10 hours of long-distance flight to reach the recipient country. Therefore, it is essential to improve the understanding of ECS and corresponding prevention strategies among the long-distance traveling people including medical workers assisting Africa, which could guarantee their health and ensure the smooth implementation of the work of assisting Africa.
Africa ; China ; Death, Sudden ; Humans ; Syndrome ; Travel

China ; epidemiology ; Coronavirus Infections ; epidemiology ; prevention & control ; Guidelines as Topic ; Humans ; Pandemics ; prevention & control ; Pneumonia, Viral ; epidemiology ; prevention & control ; Travel

Introduction: Massive open online courses (MOOCs) are designed to accommodate large numbers of geographically dispersed learners. Few healthcare students receive exposure in travel medicine. We aimed as partner medical universities to develop a novel introductory MOOC in travel medicine suitable for undergraduate healthcare students, and to evaluate it among a cohort of learners. Methods: A course development team, comprising a senior travel medicine academic from National University of Ireland Galway, local International Medical University faculty and instructional/graphic designers, was convened in November 2017. The MOOC proposal was subsequently refined. Course construction commenced in December 2017 and involved communication between team members based in Malaysia and Ireland. Lectures were recorded in January-July 2018. Development of learning and assessment material and the pilot phase were completed in December 2019. Course evaluation was based on the results of a questionnaire and qualitative free text comments from users. Results: The MOOC is being delivered to a multinational cohort on a rolling basis. It is organised into five four-themed units: travel health risk assessment; pre-travel health advice; tropical infectious diseases; specialised travellers; and illness in returned travellers. Pedagogical methods include short video lectures, journal articles, a discussion forum, and self-assessment quizzes. Learners have the option of completing an online test to receive a certificate of achievement. Participant evaluation from the first run of the MOOC has revealed very high levels of satisfaction with content and mode of delivery. Conclusions This is the first MOOC in travel medicine and it may provide a model for development of other collaborative international e-learning courses. It will address a significant deficit in undergraduate health professional education.
Travel Medicine ; Global Health ; Education, Medical

BACKGROUND: Pre-travel medical consultation is essential to reduce health impairment during travel. Yellow fever vaccination (YFV) is mandatory to enter some endemic countries. In this study, we evaluated the factors that affect compliance with appropriate prevention of infectious diseases in travelers who visited clinic for YFV. METHODS: For this retrospective study, chart reviews for 658 patients who visited a travel clinic for YFV before travel were conducted. The period of this study was from January 2016 to September 2018. The associations between appropriate vaccination and factors such as travel duration, destination, time of visiting clinic before departure, and purpose of travel were analyzed. RESULTS: Among 658 patients who got YFV during the study period, 344 patients (52.3%) received additional vaccination or malaria prophylaxis following a physician's recommendation. Travelers who visited the clinic more than 21 days before departure were more compliant than those who visited 14 days or fewer before departure (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.23–2.93; P = 0.004). Travelers visiting Africa were more compliant than were those traveling to South and Central America (OR, 1.97; 95% CI, 1.34–2.90; P = 0.001). Travelers in age groups of 40-49 years and over 70 years were less compliant than the 18–29 years old population (OR, 0.51; 95% CI, 0.28–0.93; P = 0.027 and OR, 0.19; 95% CI, 0.04–0.84; P = 0.03, respectively). Also, those who traveled for tour or to visit friends or relatives were more compliant than those who departed for business (OR, 0.77; 95% CI, 1.03–3.56; P = 0.04). CONCLUSION: For appropriate vaccination, pre-travel consultation at least 3 weeks before departure is crucial. Travelers should be aware of required vaccination and malaria prophylaxis before visiting South and Central America and Asia. Plans to enhance compliance of the elderly and business travelers should be contrived.
Africa ; Aged ; Asia ; Central America ; Commerce ; Communicable Diseases ; Compliance ; Friends ; Humans ; Malaria ; Patient Compliance ; Retrospective Studies ; Travel Medicine ; Vaccination ; Yellow Fever ; Yellow Fever Vaccine

Scuba diving is a popular sports activity, even though it is associated with potential hazards. When a diver enters the water for an underwater expedition, he/she needs a series of diving gear, including a regulator, buoyancy compensator, diving suit, and weight belt, among others. Here, the author encountered a fatal diving accident wherein autopsy showed the evidence of death by drowning. The witness stated that the diver requested more weight to descend into the water, and the diver wore one more weight belt, totalling 26 kg. After a second trial of diving, he did not grab the regulator and disappeared into the water suddenly, and bubbles did not appear at the surface. Based on the witness statement and autopsy findings, the original cause of accident was concluded as an overweighted belt for descent into the water.
Autopsy ; Diving ; Drowning ; Expeditions ; Overweight ; Sports ; Water

OBJECTIVES: The 2017 guideline for the prevention of travelers' diarrhea (TD) by the International Society of Travel Medicine suggested that ‘there is insufficient evidence to recommend the use of commercially available prebiotics or probiotics to prevent or treat TD.’ However, a meta-analysis published in 2007 reported significant efficacy of probiotics in the prevention of TD (summary relative risk [sRR], 0.85, 95% confidence interval [CI], 0.79 to 0.91). This study aimed to synthesize the efficacy of probiotics on TD by updating the meta-analysis of double-blind, placebo-controlled, randomized human trials. METHODS: The search process was conducted by the adaptive meta-analysis method using the ‘cited by’ and ‘similar articles’ options provided by PubMed. The inclusion criteria were double-blind, placebo-controlled, randomized human trials with hypotheses of probiotics as intervention and TD as an outcome. The adaptive meta-analysis was conducted using Stata software using the csi, metan, metafunnel, and metabias options. RESULTS: Eleven articles were selected for the meta-analysis. The sRR was 0.85 (95% CI, 0.79 to 0.91) and showed statistical significance. There was no heterogeneity (I-squared=28.4%) and no publication bias. CONCLUSIONS: Probiotics showed statistically significant efficacy in the prevention of TD.
Diarrhea* ; Humans ; Methods ; Population Characteristics ; Prebiotics ; Probiotics* ; Publication Bias ; Travel Medicine

OBJECTIVES: The 2017 guideline for the prevention of travelers' diarrhea (TD) by the International Society of Travel Medicine suggested that ‘there is insufficient evidence to recommend the use of commercially available prebiotics or probiotics to prevent or treat TD.’ However, a meta-analysis published in 2007 reported significant efficacy of probiotics in the prevention of TD (summary relative risk [sRR], 0.85, 95% confidence interval [CI], 0.79 to 0.91). This study aimed to synthesize the efficacy of probiotics on TD by updating the meta-analysis of double-blind, placebo-controlled, randomized human trials.METHODS: The search process was conducted by the adaptive meta-analysis method using the ‘cited by’ and ‘similar articles’ options provided by PubMed. The inclusion criteria were double-blind, placebo-controlled, randomized human trials with hypotheses of probiotics as intervention and TD as an outcome. The adaptive meta-analysis was conducted using Stata software using the csi, metan, metafunnel, and metabias options.RESULTS: Eleven articles were selected for the meta-analysis. The sRR was 0.85 (95% CI, 0.79 to 0.91) and showed statistical significance. There was no heterogeneity (I-squared=28.4%) and no publication bias.CONCLUSIONS: Probiotics showed statistically significant efficacy in the prevention of TD.
Diarrhea ; Humans ; Methods ; Population Characteristics ; Prebiotics ; Probiotics ; Publication Bias ; Travel Medicine

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.
Aedes ; virology ; Air Travel ; Airports ; Animals ; Cross-Sectional Studies ; Dengue ; transmission ; virology ; Dengue Virus ; classification ; isolation & purification ; Female ; Indonesia ; Mosquito Vectors ; virology ; Ovum ; virology ; Serotyping