WELCOME TO THE TROPIC "First Aid Kit for your boat

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WELCOME TO THE TROPIC / "First Aid Kit (for your
boat) Common Medical Needs in Mexico",

• Dr. Luis Suarez-López
• Internist, Immigrants Travelers Health
  Specialist.

www.healthylivinginmexico.com www.boatmexico.com
Certificate of knowledge Travel Health By The
International Society of Travel Medicine.
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Disclaimer

• Medicine is a constantly changing science. Almost
  every day there are newer diagnostic/treatment/scr
  eening modalities and controversies.
• I encourage attendants to obtain more information
  and discuss every theme with them attending
  physicians.

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The tropics

• the tropics plural the hottest part of the
  world, which is between the two tropics
• 2 C one of the two imaginary lines around the
  world, either the Tropic of Cancer which is 23½
  north of the EQUATOR, or the Tropic of Capricorn
  which is 23½ south of the EQUATOR

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Tropical diseases

• Are infectious diseases that either occur
  uniquely in tropical and subtropical regions
  (which is rare) or, more commonly, are either
  more widespread in the tropics or more difficult
  to prevent or control.
• African trypanosomiasis Dengue fever
  Leishmaniasis
• Malaria Schistosomiasis Tuberculosis
• Chagas disease Leprosy
• Lymphatic filariasis Onchocerciasis

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What is Travel Medicine?

• A new Medical Specialty.
• Focus on
• Travelers, Expatriates, Migrants, People
  traveling with Specials Needing
• (Medical Problems).
• Worldwide Epidemiology aware of infectious
  disease risks and their magnitude, patterns of
  drug resistance, current outbreaks of illness,
• immunization, prevention of Tropical Diseases,
  management of the ill-returned traveler.

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Travel Medicine

• The discipline devoted to the maintenance of the
  health of international travelers immigrants
  through health promotion and disease prevention
• Biannual Certification by The International
  Society of Travel Medicine. www.istm.org

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800,000,000 of travelers in 2008
MEXICO, 8º PAIS MAS VISITADO EN EL MUNDO.
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After injuries and accidents, respiratory
infection is the leading cause of morbidity in
sailors.

• According to V J Neville, et al, (1) upper
  respiratory tract infections also caused the most
  days of absence from sailing and modification of
  training.
• Can you imagine having the flu in the middle of
  the ocean? What about the rest of the crews? In a
  closed environment, contagious risk is extremely
  high! 
•  (1) V J Neville, J Molloy, J H M Brooks, D B
  Speedy, G Atkinson Br J Sports Med
  200640304312. doi 10.1136/bjsm.2005.021477

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People coming from Abroad

• 500,000 Living in Mexico.
• 11-15 Jalisco/Nayarit.
• 69 Coming from U.S.A.
• 56.2 Retired worker.
• This could mean
• 5 deaths/month in Mexico.
• 250 Evacuations.
• 1500 Hospitalizations here or in USA.

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General recommendations

• Healthy Eating Habits.
• Use sunscreen,
• minimize sun exposure.
• Avoid tobacco
• excess alcohol.
• Avoid mosquito bites.

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General recommendations

• Healthy Eating Habits.
• Avoid raw or undercook fish Poultry e.g.
  Ceviche in Mexico, Sashimi in Japan,
• SUM-FAK in Thailand. Gnasthostomiasis
• Anisakiasis

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Gnatostomiasis / Gnathostomiasis
Parasitol Int. 2005 Mar54(1)51-3. Epub 2004 Dec
19.
Parasitol Int. 2003 Jun52(2)133-40.
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ANISAKIASIS

• Geographic DistributionWorldwide, with higher
  incidence in areas where raw fish is eaten (e.g.,
  Japan, Pacific coast of South America, the
  Netherlands).
• Clinical FeaturesWithin hours after ingestion
  of infected larvae, violent abdominal pain,
  nausea, and vomiting may occur.  Occasionally the
  larvae are coughed up.  If the larvae pass into
  the bowel, a severe eosinophilic granulomatous
  response may also occur 1 to 2 weeks following
  infection, causing symptoms mimicking Crohn's
  disease.

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General recommendations

• Avoid mosquito bug bites.
• Use repellent, Products containing
  diethyltoluamide (DEET) are considered to be most
  effective.
• protective clothing,
• use pyrethrin insecticides.

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Insect Born Diseases.

• Today 1 person in 6 is infected with an
  insect-borne disease.
• Dengue, Ricketsias, Allergic reactions, Skin
  Infectious,

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October 2008
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HOW TO PROTECT YOURSELF AGAINST DENGUE

• What are some approaches that do not work?
• Thiamine (vitamin B1). Ultrasound
  devices. Electronic buzzers. Insect
  electrocution traps. Eating garlic Wearing
  perfume.

http//www.healthylivinginmexico.com/dengue.htm
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Immunization for Mexico

• Hepatitis A all those staying more than one
  month.
• Hepatitis B those staying for longer periods
  especially with pre-existing medical conditions
  who may need medical attention or surgical
  procedures while abroad.
• Typhoid Fever every 3 years.
• Tetanus/ Diphtheria booster every ten years
  after primary course

www.healthylivinginmexico.com
Department of Health and Human Service, Centers
for Disease Control and Prevention. HEALTH
INFORMATION FOR INTERNATIONAL TRAVEL
http//www.cdc.gov/travel/camerica.htm
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Hepatitis A
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Immunization for Mexico

• Rabies If you might have extensive unprotected
  outdoor exposure in rural areas, such as might
  occur during camping, hiking, or bicycling, or
  engaging in certain occupational activities.
• Influenza annual
• Pneumoccocus every 5 years
• Tuberculosis. A tuberculin skin test is
  recommended before departure and after one year.

Department of Health and Human Service, Centers
for Disease Control and Prevention. HEALTH
INFORMATION FOR INTERNATIONAL TRAVEL
http//www.cdc.gov/travel/camerica.htm
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Immunizations!

• Preventative Medicine - The Best (and the
  Cheapest) Medicine.
• "Good doctors think about how to cure diseases,
  whereas supreme doctors focused on how to prevent
  them."
• - Chinese saying.

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Are you sure?

• "I have been so far so good for a long time
  without immunizations, (touching the table,
  knocking on wood)) why do I need them?" "I have
  never had a shot and I never get sick
• "I know how to eat and I never go to crowded
  places, so I do not need a flu shot."

Up to them!
www.vallartatribune.com
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MALARIA IN MEXICO
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Living Healthy in The Tropics.

• Diarrhea and infections are the most common
  complains abroad.
• Accident and cardiovascular events, the most
  common causes of death

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Traveler's Diarrhea

• Consume safe water and food. Eat foods that are
  freshly cooked and served piping hot and to avoid
  water and beverages diluted with water
  (reconstituted fruit juices, ice, milk) and foods
  washed in water, such as salads. BOIL IT, COOK
  IT, PEEL IT OR FORGET IT!
• Hand washing after the toilet and before eating.
• Keep Hydrated /
• Oral Rehydration Therapy

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Traveler's Diarrhea

• Prophylaxis For travelers to third world
  countries, with special conditions like
• AIDS/HIV or Immunocompromise (e.g. Transplant
  recipient).
• Insulin-dependent DIABETES MELLITUS.
• INFLAMMATORY BOWEL DISEASE.
• A History of stomach surgery or if you are taking
  medication that reduces stomach acid (e.g.
  achloridia, or in reflux, heartburn or ulcers).
• Essential business or activities that cannot be
  compromised by illness (E.G. Special diplomatic
  missions, elite sport person)
• Heart disease and taking diuretics.
• Psychiatric problem taking LITHIUM.

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Traveler's Diarrhea

• Prophylaxis
• It is recommended taking ANTIMICROBIAL
  PROPHYLAXIS like PEPTO BISMOL 2 tablets or 60ml
  four times a day for this purpose or RIFAXIMIN
  200mg (Flonorm) three times a day, one
  non-absorbable antibioticnot minimizing care
  with food and beverages!

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WARNING SIGNS OF DIARRHEA

• Should any of the following signs and/or
  symptoms develop, medical care should be sought
  immediately
• Vomiting of blood, black bowel movements,
• blood or mucous in the bowel movement,
• Signs of dehydration
• (dizziness, weakness, dry skin, sunken eyes,
  parched lips, deep yellow urine, reduction of
  tears and urine).
• If diarrhoea does not resolve within 3 days.
• If high fever (gt101F, 38C) continues after 1
  day of beginning antibiotics.
• If you have persistent diarrhoea after returning
  home.

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Skin Parasites

• Gnathostomiasis
• Dietary/occupational exposure or ingestion
• Larva Migrans / Creeping eruption
• this parasite is found in dog and cat faeces
  and are able to penetrate the outer layers of the
  skin and creep around underneath the skin.

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dengue
Seabather rash
Bedbug bites
Myasis
tungiasis
Swimmers itch
Leishmania
Loa Loa
Ecthyma
Tick Typhus
Larva Migrans
Phytophotodermatitis
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PHYTOPHOTODERMATITIS / POSION OAK/IVY
QUEMADOR
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PHYTOPHOTODERMATITIS Contact Dermatitis

• CONTACT WITH Urushiol Oil toxicodendron POISON
  IVY,
• POISON OAK
• A CITRIC FRUIT PLUS SUN EXPOSICION
• Lime, lemon, pineapple,

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Accident.

• Seatbelt restrain for all passengers in the car.
• No cellular phone while driving, (included
  hands-free phones).
• When driving in a foreign country travelers avoid
  alcohol, fatigue, jet-lag, all night-driving.
• Never drive or ride on a moped or motorbike in a
  foreign country
• Avoid overcrowded public transport.
• Never swim at an unmarked or unguarded beach
• Have your car and you with a Insurance Company

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SAM SPLINT
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Dangerous Animals in Jalisco-Nayarit

• African Bee (Africanized)
• Scorpions
• Elegans, noxius, infamatus, tecomanus
• Spider
• Black-Widow and Brown-Recluse
• Snakes
• Crotalus, Rattlesnake - Marine Serpent
• Agkistrodon Zolcuate Moccasins ,Coralillo
• Lizard
• Heloderma horridum
• Gila Monsters cousin

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Africanized Bee

• Local reaction
• Allergic Serious
• Anaphylactic Reaction.

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Africanized Honeybees"Killer bee"

• Apis mellifica adansoni
• An Africanized honeybee (AHB) is a honeybee
  hybrid strain, originated in Brazil, that is a
  cross-breed between a European honeybee and an
  African honeybee subspecies, apis mellifera
  scutellata, a.m. adonsonii, or a.m.

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Africanized Bee

• Treatment of Bee Stings
• Remove the stinger

• Use your clean fingernail or the blunt edge of a
  knife, avoid squeezing, it may expels more venom.
• Apply cold water pad or an ice cub.

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Africanized Bee

• Treatment of Bee Stings
• Taking an antihistamine such as Benadryl
  (diphenhydramine) in tablet form and/or
  nonprescription pain relievers such as ibuprofen
  or acetaminophen can also provide relief of
  symptoms.

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Africanized Bee

• Treatment of Bee Stings
• In a systemic allergic reaction, the entire body
  is affected. The victim may develop hives,
  redness, or swelling at sites on the body distant
  from the site of the sting. Symptoms can also
  include
• vomiting, nausea , diarrhea, and dizziness.
• In anaphylactic reactions, victims experience
  wheezing, difficulty breathing, and a drop in
  blood pressure that leads to shock if not treated
  promptly.
• 50 deaths/year in USA.

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Scorpions.

• mild pain with localized tenderness followed by
  restlessness and random head and neck
• movements. Roving eye movements, nystagmus, and
  oculogyric movements
• commonly are described.
• An exaggerated startle response may be seen and
  tachycardia and hypertension precede the
  excessive salivation and
• respiratoryfailure that may occur

Antivenom
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Black Widow.

• Their bites typically are pinprick like, with
  subsequent aching pains of the large muscle
  groups.
• Fasciculations can be seen within 30 minutes.
  Rigidity of the abdomen, hyperreflexia, headache,
  dizziness, and high frequency tremor also can be
  seen. Severe hypertension may require the use of
  intravenous antihypertensive agents.

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Brown-Recluse Spider
Skin
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SNAKES.
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Serpientes venenosas y no venenosas
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CORAL SNAKES
Red on yellow- kill a fellow,  Red on black-
venom lack
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SNAKES

• Apply pressure to the bite or sting by placing a
  1-inch-thick gauze pad or cloth directly over the
  wound. The pressure bandage may be held in place
  with a hand or elastic bandage. When wrapping an
  elastic bandage around the pad, check for
  adequate circulation in the fingers or toes.
  (Fingers or toes with adequate circulation have
  normal color and feeling.)

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SNAKES

• The pressure should be firm enough to press
  the pad into the skin but not so tight that blood
  circulation is stopped. For example, do not wrap
  tape completely around the limb because this
  may hamper circulation. The pressure pack should
  be released within 8 hours or as soon as medical
  care is reached.

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Marine Snake -- Pelamis platurus

• Probably the most widely distributed snake in
  the world, inhabiting the Indian and Pacific
  Oceans, including the coasts of Africa, Asia,
  Australia, Mexico, including Baja California, and
  Central America.
• Habitat Warm ocean waters. Usually seen within a
  few miles of the shore, but also occurs far out
  to sea.
• More common along slicks where ocean currents
  converge creating quite waters with surface
  debris which attract the fish this snake preys
  upon.

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Lizards

• There are only two venomous lizard species
  identified the Gila monster,
• Heloderma suspectum, and the beaded lizard,
  Heloderma horridum.
• Their venom, containing high concentrations of
  serotonin, is transferred through saliva and is
  reported to cause hyperesthesia and dizziness
  without hypotension

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TARANTULA
VINAGRILLO
CIENPIES/ CENTIPEDES
SAPOS
SALAMANDRA
NO DANGEROUS, MILD VENOM
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HOW TO REMOVE A HOOK
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Water borne infection

• The genus Aeromonas consists of ubiquitous Gram
  negative rods that are widely distributed in
  freshwater, estuarine, and marine environments
  worldwide
• Vibrio vulnificus may infect skin that is injured
  in brackish water by scraping against rocks or
  stepping on organisms with hard shells.
• Erysipelothrix rhusiopathiae infection

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EMPIRIC TREATMENT

• Either a first generation cephalosporin
  (cephalexin 500 mg orally four times daily or
  cefazolin 1 g IV every eight hours) OR
  clindamycin (300 mg orally four times daily or
  600 mg IV every eight hours, in those patients
  with immediate hypersensitivity reactions to
  penicillin) PLUS
• Levofloxacin (750 mg once daily) PLUS either of
  the following if the epidemiologic risk is
  present
•       - Metronidazole (500 mg four times daily)
  if exposure to sewage-contaminated water or if
  soil-contaminated wound (not necessary to
  include if the regimen includes clindamycin) OR
•       - Doxycycline (100 mg twice daily) for
  coverage of Vibrio species If seawater exposure

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The globalization of Infectious Diseases
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The Globalization of Infectious Diseases

• Examples and threats
• SARS, West Nile VIRUS, Chikungunya
• AIDS, TUBERCULOSIS
• MONKEYPOX, HANTA VIRUS
• IN EE.UU. Hepatitis A.
• IN EUROPE Importation of Malaria (airport
  malaria), Leishmania, Typhoid,
• POTENTIAL AVIAN INFLUENZA

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LA GLOBALIZACION DE LAS ENFERMEDADES INFECCIOSAS

• CUANDO LA SALUD MUNDIAL SIGNIFICA LA SALUD LOCAL

AJN 20031275-79
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SARS
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Chikungunya Fever
Locally transmitted in Italy!!!
37 CONFIRMED PATIENTS
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Chikungunya Fever
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VIRUS DEL NILO
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2007 West Nile Virus Activity in the United
States(Reported to CDC as of September 18, 2007)
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Can other mosquitoes transmit West Nile Virus ?
YES

• Annals of the New York Academy of Sciences
  2001951317-24

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THANK YOUGRACIAS