RESUMO
Severe frostbite occurs frequently at extreme altitude in the Himalayas, often resulting in amputations. Recent advances in treatment of frostbite injuries with either intravenous or intra-arterial tissue plasminogen activator, or with iloprost, have improved outcomes in frostbite injuries, but only if the patient has access to these within 24 to 48 h postinjury, and ideally even sooner. Frostbitten Himalayan climbers are seldom able to reach medical care in this time frame. We wished to see if delayed iloprost use (up to 72 h) would help reduce tissue loss in grade 3 to 4 frostbite. In a series of 5 consecutive climbers with severe frostbite in whom we used iloprost, 4 of whom received treatment between 48 and 72 h from injury, 2 had excellent results with minimal tissue loss, and 2 had good results with tissue loss less than expected. The 1 patient with a poor outcome likely experienced a freeze-thaw-refreeze injury. This small series suggests that iloprost can be beneficial for severe frostbite, even after the standard 48-h window and perhaps for up to 72 h.
Assuntos
Congelamento das Extremidades/tratamento farmacológico , Iloprosta/uso terapêutico , Montanhismo/lesões , Inibidores da Agregação Plaquetária/uso terapêutico , Adulto , Altitude , Amputação Cirúrgica , Humanos , Masculino , Pessoa de Meia-Idade , Nepal , Fatores de Tempo , Dedos do Pé/lesões , Resultado do Tratamento , Adulto JovemRESUMO
Measles remains a risk for travelers, with 94 measles diagnoses reported to the GeoSentinel network from 2000 to 2014, two-thirds since 2010. Asia was the most common exposure region, then Africa and Europe. Efforts to reduce travel-associated measles should target all vaccine-eligible travelers, including catch-up vaccination of susceptible adults.
Assuntos
Sarampo/epidemiologia , Viagem , Adolescente , Adulto , Criança , Pré-Escolar , Transmissão de Doença Infecciosa/prevenção & controle , Saúde Global , Humanos , Lactente , Masculino , Sarampo/prevenção & controle , Vacina contra Sarampo/administração & dosagem , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
While altitude illness is common in the Himalayas, conditions unrelated to altitude illness also occur. High altitude cerebral oedema HACE is a global phenomenon of gradual onset affecting both cerebral hemispheres. We outline two cases of cervical artery dissection presenting with sudden onset of focal neurological symptoms at high altitude.