Health Tips

Self-Treatment of Traveler’s Diarrhea

The traveler’s diarrhea is diarrhea which is seen among traveler’s (mainly from developed country to a developing country, but can occur during travel from anywhere to other country and in on study the rate of traveler’s diarrhea was, as low as 8% per 2-week stay in industrialized countries and as high as 55% in parts of Africa, Central and South America, and Southeast Asia), that is generally short lived and self limited. Though short lived about 40% of affected individuals need to alter their scheduled activities and another 20% become bedridden for few days. The causative organisms of traveler’s diarrhea are entero-toxigenic Escherichia coli and entero-aggregative E. coli. Sometimes it may be due to Campylobacter infections, Salmonella, Shigella or rotavirus.

Traveler’s diarrhea can occur despite rigorous precautions regarding food and water during travel to a developing country, all the traveler’s should carry some medication for self-treatment with them (preferably traveler’s medical kit). Antibiotic therapy will generally reduce the duration and severity (reduce frequency of stools) of traveler’s diarrhea in moderate to severe cases. The standard antibiotic regimen for traveler’s diarrhea is 3-day course of quinolone like ciprofloxacin (single double dose of quinolone is equally effective regimen). But if you are traveling to Thailand quinolone like ciprofloxacin will not work due to resistance (in Thailand more then 90% of traveler’s diarrhea is due to Campylobacter infections which are resistant to quinolone like ciprofloxacin) and azithromycin is a better alternative in such cases. Rifaximin (a poorly absorbed rifampin derivative) is also highly effective (especially against noninvasive bacterial pathogens such as entero-toxigenic and entero-aggregative E. coli) alternative to quinolone.

The present recommendation of self-treatment of travelers’ diarrhea is for the traveler to carry three once-daily doses of an antibiotic (azithromycin or ciprofloxacin) and to use as many doses as necessary to correct the diarrhea. If there is no fever or blood in stool, loperamide can be taken in combination with the antibiotic (but never take loperamide if you have fever or blood in stool as it may prolong diarrhea).

Prevention of Traveler’s Diarrhea

Traveler’s diarrhea can be prevented if precautions are observed properly during international travel. The main preventive measures of traveler’s diarrhea are related to food and water precautions. But studies indicate that indiscretion in eating and drinking water is done by approximately 98% of traveler’s upon arrival of their destination within 72 hours. That means only a handful of cautious travelers follow the precautions for prevention of traveler’s diarrhea. No wonder that such a large percentage of travelers suffer from traveler’s diarrhea. There is a popular slogan for travelers “Boil it, cook it, peel it, or forget it!” and it is easier to remember than following it as the studies indicate.

In general a traveler should follow some precautions for prevention of traveler’s diarrhea. The food precautions are eating food when it is still hot, avoid foods that are raw, poorly cooked, or sold by street vendors etc. Water precautions include drinking only boiled or commercially bottled beverages (preferably those that are carbonated). Heating can kill organisms that cause traveler’s diarrhea (entero-toxigenic Escherichia coli, entero-aggregative E. coli, Campylobacter, Salmonella, Shigella, rotavirus, norovirus etc.), but freezing can not kill them and due to this reason ice cubes made from unpurified water should be avoided.

Prophylaxis of traveler’s diarrhea:

The most commonly used prophylaxis for traveler’s diarrhea is bismuth subsalicylate, but it is only 60% effective. In special cases (athletes, persons with a repeated history of travelers’ diarrhea, and persons with chronic diseases) a single daily dose of a quinolone or azithromycin or a once-daily rifaximin regimen during travel of more than 1 month’s duration is effective in preventing travelers’ diarrhea in 75% to 90% of cases.

Self treatment of traveler’s diarrhea:

Ideally all travelers should carry some medication for traveler’s diarrhea for self-treatment, as it can occur despite rigorous food and water precautions. An antibiotic can reduce the frequency of stools and duration of illness in moderate to severe diarrhea. The standard regimen for traveler’s diarrhea is a single daily dose of quinolone (ofloxacin, ciprofloxacin etc.) for 3 successive days. Rifaximin, a poorly absorbed rifampin derivative and is highly effective against noninvasive bacterial pathogens like entero-toxigenic E. coli and entero-aggregative E. coli. But if you acquire traveler’s diarrhea, in Thailand, where more than 90% of Campylobacter infections are quinolone resistant, azithromycin can be a good choice.

Traveler’s Diarrhea

Diarrhea (also known as traveler’s diarrhea) is the leading cause of illness in travelers but it is usually self limiting and short-lived. Approximately 40% of affected travelers need to change their scheduled activities and approximately 20% are confined to bed. For travelers diarrhea, the most important which determines the risk is the destination of the traveler. The rate of incidence of diarrhea among travelers is about 8% in developed countries and as high as 55% or higher in parts of Africa, Central and South America, and Southeast Asia for a 2-week stay. Young people and infants are most vulnerable to get diarrhea. A recent study suggests that there is little correlation between dietary indiscretions (eating what traveler like without thinking of health problems) and the occurrence of travelers’ diarrhea.

The commonest identified pathogens for traveler’s diarrhea are entero-toxigenic Escherichia coli (ETEC) and entero-aggregative E. coli. But in some parts of the world traveler’s diarrhea like northern Africa and Southeast Asia, is due to Campylobacter infections. Other organisms found to cause traveler’s diarrhea are Salmonella, Shigella, rotavirus, and norovirus (this virus has caused numerous outbreaks on cruise ships) etc. Parasitic infections like giardiasis may cause traveler’s diarrhea some times, but other parasitic infections are uncommon causes of travelers’ diarrhea. A huge problem that is emerging in case of travelers’ diarrhea is development of antibiotic resistance among many bacterial pathogens (strains of Campylobacter are resistant to quinolones like ciprofloxacin and strains of E. coli, Shigella, and Salmonella resistant to trimethoprim + sulfamethoxazole combination).

The clinical features of traveler’s diarrhea include frequent stool and some times abdominal pain, but these symptoms disappear within few days (self limiting) even without any treatment. Treatment of traveler’s diarrhea is usually not required in maximum number of patients as it goes off by itself with a few days. The dehydration is usually mild and no aggressive rehydration is not required. If it persists or as a precaution oral rehydration salts (ORS) can be taken as required.

Prevention of Malaria and other Insect Borne Diseases during Travel

Malaria and other infectious diseases are a huge health problem among travelers. In many developed countries the cases of malaria are mainly of travelers returning from an malaria endemic area. The risk of contracting malaria depends on factors like area of travel, whether chemoprophylaxis is taken or not and the endemicity of malaria in the particular area.

The risk of contracting malaria vary if different parts of the world. Highest risk in sub-Saharan Africa and Oceania regions where it is estimated that the chance of contracting malaria is as high as 1 in 5 (1:5) to 1 in 50 (1:50) per month of stay, if chemoprophylaxis is not taken. The intermediate (malarious) areas are Indian subcontinent and in Southeast Asia where chance of contracting malaria is 1:250–1:1000 per month of stay. Low risk areas are South and Central America where the chance of contracting malaria is 1:2500–1:10,000 per month of stay.

In US more than 1000 cases of malaria are reported annually and out of these more than 90% are due to Plasmodium falciparum (most serious form of malaria and can involve brain and develop cerebral malaria). Almost all the cases are seen among travelers returning from or immigrating from Africa and Oceania.

There is worldwide increase in chloroquine- and multi drug-resistant falciparum malaria and the decision on chemoprophylaxis has become complicated. Recently there is spread of malaria due to primaquine- and chloroquine-resistant strains of Plasmodium vivax. This also has med the treatment of malaria more complicated. The case-fatality rate of falciparum malaria in the United States is 4% but the fact is only about one third of these fatal cases of malaria are diagnosed or thought of diagnosis of malaria before death.

Many studies indicate that less than 50% of the travelers follow the basic recommendations for malaria prevention. The main protective measure of malaria during travel are personal protection measures against mosquito bites (especially between dusk and dawn) and malaria chemoprophylaxis. The personal protection measures against mosquito bites include use of DEET-containing insect repellents, permethrin-impregnated bed-nets and clothing, screened sleeping accommodations, and protective clothing (the important motto of this is “sun down sleeves down” and for this traveler should use full sleeve dress). Personal protection measures against mosquito also help prevent other insect-transmitted illnesses, like dengue fever.

A new insect repellent with picaridin as active ingredient is quite efficacious and is available in the United States, but only in low-concentration formulations that require frequent reapplications. So, in regions where infections like malaria are transmitted (very high chance of transmission), DEET products (25–50%) are recommended, even for children and infants who are above 2 months of age.

CDC recommends the following anti malarial drugs for chemoprophylaxis according to region:

• Chloroquine: For Central America (north of Panama), Haiti, Dominican Republic, Iraq, Egypt, Turkey, northern Argentina, and Paraguay. Mefloquine, Doxycycline, Atovaquone + proguanil are the alternatives to Chloroquine.
• Mefloquine, Doxycycline, Atovaquone + proguanil (Malarone): Recommended for South America including Panama (except northern Argentina and Paraguay); Asia (including Southeast Asia), Africa and Oceania. Primaquine is an alternative to all the above.
• Doxycycline, Atovaquone + proguanil (Malarone): For Thai-Myanmar and Thai-Cambodian borders.

General Health Advice for International Travel

According to World Tourism Organization the number of international tourist arrivals is approximately one billion every year at present and the number is increasing steadily every year. Not only are more people traveling; these days travelers are seeking more exotic and remote destinations and studies show that 50% to 75% of short-term travelers to the tropics or subtropics report some health problem during or immediately after the travel. Most of these health problems are minor and only about 5% of them require some medical attention and less than 1% require hospitalization. Among these travelers infection is a major contributor of illness but only approximately 1% of the deaths among travelers is due to infection.

The most frequent causes of death among travelers from the United States and other western countries are cardiovascular disease (49% deaths among travelers) and injuries (22% deaths) due to accidents. The age specific death rates due to cardiovascular disease are similar among travelers and non travelers but for injuries (motor vehicle, drowning, aircraft accidents etc.) it is much higher among travelers.

The health advice and recommendations for international travel are based on traveler’s destination, health status of the traveler (pregnancy, old age, any specific diseases like cardiovascular diseases, respiratory disease etc.), specific itinerary, and lifestyle during travel. Most commercial aircrafts are pressurized to 2500 m (8000 ft) above sea level (corresponding to a Pa_O2 of ~55 mmHg), travelers with serious cardiopulmonary problems, severe anemia should be evaluated before travel. those who have recently had surgery, a myocardial infarction, a cerebrovascular accident, or a deep-vein thrombosis are at high risk during flight.

Fitness of traveler is an important issue and a growing concern due to increased numbers of elderly and chronically ill individuals journeying to exotic destinations. A pre-travel health assessment is highly recommended for travelers particularly for those who are considering adventurous recreational activities, such as mountain climbing and scuba diving.

From the Centers for Disease Control and Prevention (CDC) publication Health Information for International Travel you can get detailed information regarding country-specific risks and recommendations for international travel.

The Travelers Medical Kit

A traveler should always carry travelers medical kit along with him/her (especially while traveling from a developed country to a developing country or an underdeveloped country) and it is strongly recommended by all the authorities in the field. The travelers medical kit is very much helpful in times of need.

There are many medications available in many countries of travel (often over the counter), directions for their use may not be there with the medicine or if present it is in a foreign language, the medicine may be outdated or counterfeit. For example, a recent multi-country study in Southeast Asia showed that an average of 53% (range, 21–92%) of anti-malarial drugs were counterfeit or contained inadequate amounts of active drug and can not be relied upon.

The contents of travelers medical kit may very depending on many factors and situations. The contents of travelers medical kit vary depending on the itinerary of travel, duration of stay, style of travel, and local medical facilities where you are going etc. For a short term traveler the travelers medical kit should contain an analgesic or painkiller like ibuprofen; an anti-diarrhea agent and an antibiotic for self-treatment of travelers’ diarrhea like azithromycin; a laxative, ORS or oral re-hydration salts; antihistamines (allegro or fexofanadine, cetirizine etc.); sunscreen with a SPF (skin-protection factor) of at least 30; an insecticide for clothing like permethrin; a DEET containing insect repellent (for mosquito and other insects) for the skin and some anti-malarial drugs like artesunate (acts in case of falciparum malaria which can cause cerebral malaria).

A long-stay traveler should have all the above mentioned medicines in the travelers medical kit and should add some more additional medications. A long-stay traveler should add a broad-spectrum general-purpose antibiotic like levofloxacin or azithromycin, a topical antifungal cream like miconazole, an antibacterial eye and skin ointment etc to the travelers medical kit.

A first aid kit should also be there with the travelers medical kit regardless of duration of stay. The travelers first aid kit should contain items like scissors, tweezers, a knife and bandages. Long-stay traveler should carry a once-daily dose of antibiotics is to use 3 tablets “below the waist” (bowel and bladder infections) and 6 tablets “above the waist” (skin and respiratory infections).

Prevention of Diseases During Travel

Travelers (especially traveler from a developed country to a developing or underdeveloped country) are at high risk of contacting many diseases compare to the local population. Many of the diseases are infectious diseases and many are not related to disease agents. All the risks are due to indulgent of travelers to different activities in the place of their travel.

Travelers are at high risk of contacting an STD (sexually transmitted disease). Recent studies show that large number of travelers engage in casual sex and they can get reluctant to use condom consistently and get infected with STDs. To prevent STD all travelers should use condom during casual sex and also carry condom with them. Use of condom can also prevent spread of HIV. In USA an increasing number of travelers are diagnosed with schistosomiasis. Travelers should avoid bathing, swimming or wading in freshwater lakes, streams, or rivers in parts of tropical South America, the Caribbean, Africa, and Southeast Asia.

Prevention of travel associated injuries or injury during travel is also very important as study shows that the chances of getting injury is much higher among travelers. Common-sense precautions should be taken during travel like not riding a motor cycle without a helmet, avoiding overcrowded public transport etc. A traveler should not travel in developing countries by road after dark (especially alone), particularly in rural areas. Traveler should not go out of his/her shelter after dark and alone. Travelers are cautioned to avoid walking barefoot because of the risk of hookworm infection and Strongyloides infection and snake bites. Excessive alcohol use has been a significant factor in drowning, assaults, injuries and not to mention the chances of increased motor vehicle accidents. Excess alcohol should be avoided during travel and also excessive “tasting” of local drinks, because travelers may get a bigger “kick” due to local alcoholic drinks.

Fungal Infection of Toenails & its Treatment

Fungal infection of toenails is a common problem we face. This is commonly seen if the hygiene level of feet is not as much as required. If the feet are kept wet and not kept dry this fungal infection of toenail is very common. The feet should be kept dry and proper aeration should be maintained. Toenail fungus attack the toenail when the nails are wet and unclean.

The toenail fungus treatment can be of different types. The medical treatment can be surgical removal of the affected part of the toenail or oral antifungal agents or topical application of antifungal antibiotics. But conventional treatment with topical application of antifungal antibiotic ointment is not always successful in eradicating the fungus from the toenail. So many doctors prefer the surgical removal of the affected part of the toenail up to the root of the toenail. The removal of root is important because the fungus attack the root also. If the root is not removed the infection can not be uprooted.

The antifungal agents can be taken orally as well as given as ointment. The treatment of toenail fungus is about 12 weeks for toenails and 6 weeks for fingernails. During this long treatment there are chances of side effects that are potentially serious like heart problems (if you take some medicines that react with antifungal antibiotics and cause serious heart trouble) and liver toxicity. That is why if the toenail fungal infection is mild you can get rid of it by using tea tree oil that can kill the fungus of your toenails. This is preferred because of the negligible side effects with this preparation. This tea tree oil is even prescribed by medical doctors for it efficacy in curing the toenail fungal infection and fewer side effects. It also has very good patient compliance and failure rate is less.

Unravelling Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia that makes people forget names, places and things and lose track of time and events irretrievably still remains a mystery. Science has so far failed to fully understand the exact cause of this brain disorder, let alone develop a cure. Alzheimer’s strike at old age and occasional memory lapse is the first symptom. The condition deteriorates rapidly and those suffering from its severest forms may not be able to recognize even their closest family members. Moreover, the patients often experience delusions and hallucinations.

The name “Alzheimer’s disease” entered the medical lexicon in 1907 following a description of the condition by the German physician Dr Alois Alzheimer at a scientific meeting the year before. Dr Azlheimer happened to treat a female patient in 1901, who had some peculiar symptoms like problems with memory, unfunded suspicions about her husband’s fidelity and difficulty in speaking and understanding what was said to her. After her death, which was about five years later, he performed an autopsy on her. He found that her brain had shrunken dramatically, particularly in the cortex region, the outer layer involved in memory, thinking, judgement and speech.

We still do not know the cause of the disease, but recent advances in neuro-imaging techniques have shown that those suffering from it have two abnormal structures in their brain: plaques formed of deposits of a sticky protein fragment called beta-amyloid, and tangled or twisted fibres of another protein called tau inside the dying neurons.

Most people develop plaques as they age, but those with Alzheimer’s tend to form them on a much larger scale and earlier than others. Ever since the discovery of these unusual elements in the brain of Alzheimer’s patients, scientists have been trying to find out what causes the trigger for their formation.

Recently published in an article of Nature Medicine, came up with an interesting finding. The scientists first isolated beta-amyloid from the brains of Alzheimer’s patients, and separated them as monomers, oligomers and insoluble plaque. They then injected these separately into the brains of mice. They found that memory was impaired only when soluble beta-amylid oligomers were administered the hippocampus (brain region where memory is stored) of the animals.

In an study by researchers in the UK and Canada, which appeared last week in Nature Cell Biology, says that the best way to treat Alzheimer’s is to trick the brain into not producing the tau protein, which forms the aggregates called tangles. The scientists, who studied the chemistry and structure of the tau protein, designed an enzyme inhibitor which uses a sugar molecule to lower the production of the protein. With the new insights, scientists hope that the management of Alzheimer’s disease, which is estimated to cost more than $300 billion a year-may become easier. Perhaps here may soon be drugs that can treat the worst of neuro degenerative disorders.

Why Weight Sways After Losing it

Losing weight may be easy, but maintaining it is difficult. But scientists (so we) now have better understanding of long term weight maintenance.

A person may lose as much as more than 200 kg of weight in 15 to 20 years and gain more than 200 kg. How it is possible and why it happens? It is possible by losing weight and again gaining the lost weight. Why it happens is because the human body is designed to sabotage weight loss at every turn. Once a body is fatter, it wants to revert to what it used to be. Physiology gets changed in two ways, the body needs fewer calories to maintain itself but the craving of food becomes more intense. So, keeping the food away means pitting one’s willpower against several biological processes involving brain, metabolism, hormones, and fat storage. That is why most people can lose weight but only few can sustain it.

Human body is designed to protect against weight lose and starvation. After a period of obesity human body change permanently the way weight is regulated by stimulating the appetite more and protecting the fat stores. After the permanent change the metabolism also changes permanently. The body requires eight (8) calories per day less energy for every pound of weight lose. This difference in energy need before and after weight loss is called “energy gap”.

There are hormonal changes also. Appetite hormone leptin, for example, is appetite regulator. This leptin tells the body to stop eating and store fat after meal. But after weight loss leptin levels are lower than before weight lose. That means appetite is more difficult to suppress. Some people are genetically prone to have lower leptin level and prone to weight gain and obesity. Similarly, another hormone ghrelin, stimulate food intake. Its level in brain falls after meals. But after weight lose the levels of ghrelin increases, and fall after meal is not as marked.

If you lose 10% of your body’s weight all the above mechanisms come into play and try to keep you from losing weight. That is the reason losing 10% of body’s weight is very easy and it becomes very difficult after that. So the person who gains weight after losing it not directly responsible for his weight gain again, it is the biology which is responsible.

There have been some interesting facts about the people who could maintain weight after losing it. They follow certain things like, instead of trying to eat less lifelong to bridge the energy gap, these people exercise more. Exercise influences some biological systems that promote weight regain, encourage the body to be more sensitive to leptons and insulin. These persons also change what they eat. They keep their calories in careful balance with what they expend. They tend to eat low fat foods.

Scientists are trying to find out how to turn the physiological response in our favor and the day is not very far when we will be able to eat and not gain weight. If not what we want to eat, at least we can eat hearts content of food (may not be of our very liking) and not gain weight.