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Query: UMLS:C0018681 (headache)
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We report a case of intestinal capillariasis in a 32-year-old Italian man. After he made a trip to Indonesia that lasted approximately one month, he developed heartburn, abdominal pain, irregular bowel movements, headache, fatigue, weight loss, low-grade fever, and severe itching. The diagnosis was provided by the recovery of Capillaria philippinensis eggs in the stool. Treatment with oral albendazole, 200 mg twice a day for 21 days, resulted in clinical and parasitologic cure. This is the first report of C. philippinensis infection acquired in Indonesia.
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PMID:Intestinal capillariasis (Capillaria philippinensis) acquired in Indonesia: a case report. 163 74

A nurse followed 50 patients at the outpatient unit of Ipswich Hospital in Ipswich, England for 3 weeks. They underwent either laparoscopy, laparoscopy/hydrotubation, or laparoscopic sterilizations. She wanted to determine whether the women felt a need to take analgesics for pain and discomfort after discharge. Only 37 women completed the questionnaire. Anesthetists found 82% of the women exhibited some degree of anxiety. Further women who had a sterilization were less anxious than the other 2 groups. No significant association existed between preoperative anxiety and postoperative headache or nausea, however. 19 women experienced nausea upon the return home or at bedtime. The man distance between the hospital and home was 10.3 miles. 7 women still felt nauseous 3 days after leaving the hospital. Further 2 patients had nausea for 2 weeks. 1 woman stayed in the hospital overnight since she was nauseous and dizzy. 3 women had headaches right after laparoscopy. The next day, 11 patients had headaches. 5 women wanted to spend 1 night in the hospital. 24 (65%) women needed analgesics for up to 3 days after laparoscopy, 20 of whom had pain in 1 location (head, back, shoulders, and abdomen). The analgesics included omnopon, fentanyl, cocodaprin, and alfentanil. 13 women who experienced pain, but did not use any analgesics. The study did not consider several factors, e.g., whether the women had a headache before laparoscopy. Neither did it take into account the home environment or the number of children to tend to when they returned home. Further the study did not look at patient mobility and activity at home, reasons for talking the analgesics (specific pain or generalized discomfort), or use of nitrous oxide which has an emetic effect. The researcher ended with recommendations such as further research on the effects of the trip home on pain, nausea, or headaches.
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PMID:Are analgesics necessary for women at home following laparoscopic gynaecological day surgery? 183 69

In all, 2665 Finns chosen at random who had made short visits to Spain and her islands, to North Africa or to Thailand, or who had taken an around-the-world tour or a West African cruise were asked to answer a questionnaire concerning the state of their health while abroad. One-third (33%) reported they were ill or had been ill; 48% had had some health complaint during the trip which in 93% lasted for 2 weeks or less. The most common health problems were diarrhoea (18%), sunburn (10%), upper respiratory symptoms with or without headache or fever (10%), insect stings (3%), and problems related to excessive consumption of alcohol (1.5%). 7% deemed it possible that they had contracted a venereal disease. The incidence of the complaints varied with the geographical area visited. It is concluded that mass tourism is accompanied by a morbidity whose dimensions are far from fully recognized.
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PMID:Trips to the South--a health hazard. Morbidity of Finnish travellers. 668 17

We report a 44-year-old Japanese man with chronic meningitis due to coccidoiodomycosis. He was admitted to our hospital because of pneumonia after the business trip to Phoenix, Arizona. Coccidioid immitis was cultured from periathric abscess on the sternoclavicular joint. He became asymptomatic by 5-FC administration. One year later, however, he complained of headache and fever. Coccidiodial meningitis was diagnosed by cerebrospinal fluid (CSF) examination. Both systemic and intrathecal administration of miconazole and oral itraconazole were ineffective. While meningitis was not cured for three years, normal pressure hydrocephalus (NPH) developed. CSF cell count fell into normal range after administration of fluconazole (800 mg/day) for thirteen months, but NPH continued. This is the first report of coccidiodimycosis with CNS involvement in Japan.
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PMID:[A case of coccidioidomycosis with central nervous system involvement]. 812 79

Acute mountain sickness (AMS) affects, to varying degrees, all travelers to high altitudes (elevations greater than 5280 feet). In a small percentage of patients, AMS can lead to high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE). Symptoms of AMS range from a combination of headache, insomnia, anorexia, nausea, and dizziness, to more serious manifestations, such as vomiting, dyspnea, muscle weakness, oliguria, peripheral edema, and retinal hemorrhage. Although the primary cause of these symptoms is related to the reduced oxygen content and humidity of the ambient air at high altitudes, the physiologic pathway relating hypoxemia to AMS and its sequelae remains unclear. Tips on self-diagnosis and symptom recognition are critical elements to be included in educating patients who are contemplating a trip to high altitudes. Preventive strategies include allowing 2 days of acclimatization before engaging in strenuous exercise at high altitudes, avoiding alcohol, and increasing fluid intake. Conditioning exercise for patients older than 35 years is also recommended before departure. A high-carbohydrate, low-fat, low-salt diet can also aid in preventing the onset of AMS. Acetazolamide (125 mg two or three times daily, or once at bedtime) has also been shown to reduce susceptibility to AMS and the incidence of HAPE and HACE. Although effective in treating cerebral symptoms of AMS, dexamethasone is not routinely recommended as a prophylactic agent for AMS.
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PMID:A trek to the top: a review of acute mountain sickness. 855 56

We report a patient aged 41 years with fever of unknown origin. Notable aspects of his travel history were a trip to the Philippines and a sailing trip around Sicily. The patient presented with fever up to 40 degrees C since 4 weeks, weakness, headache, hepatosplenomegaly and night sweat. No specific cause could be found. Based on clinical findings tuberculosis was suspected and empirical tuberculostatic treatment was started. However, during the following 6 weeks the patient's condition deteriorated. A bone marrow biopsy performed to exclude a haematological malignancy revealed Leishmania sp. in macrophages. This histological diagnosis was confirmed retrospectively by re-examination of a previously performed liver biopsy and by an increased anti-leishmania serum antibody titer of 1:1280. The patient was treated with sodium stibogluconate (pentostam, 850 mg) for 30 days and recovered slowly.
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PMID:A case of visceral leishmaniasis in Austria. 962 27

We monitored 74 crewmembers before, during, and after 3-4-d commercial short-haul trips crossing no more than one time zone per 24 h. The average duty day lasted 10.6 duty hours, with 4.5 flight hours and 5.5 flights. On trips, crewmembers slept less, woke earlier, and reported having more difficulty falling asleep, with lighter, less restful sleep than pretrip. The consumption of caffeine, alcohol, and snacks increased on trip days, as did reports of headaches, congested nose, and back pain. The study suggests the following ways of reducing fatigue during these operations: base the duration of rest periods on duty hours as well as flight hours; avoid scheduling rest periods progressively earlier across a trip; minimize early duty report times; and inform crewmembers about strategic use of caffeine and alternatives to alcohol for relaxing before sleep.
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PMID:Flight crew fatigue II: short-haul fixed-wing air transport operations. 974 36

We studied 32 helicopter pilots before, during, and after 4-5 d trips from Aberdeen, Scotland, to service North Sea oil rigs. On duty days, subjects awoke 1.5 h earlier than pretrip or posttrip, after having slept nearly an hour less. Subjective fatigue was greater posttrip than pretrip. By the end of trip days, fatigue was greater and mood more negative than by the end of pretrip days. During trips, daily caffeine consumption increased 42%, reports of headache doubled, reports of back pain increased 12-fold, and reports of burning eyes quadrupled. In the cockpits studied, thermal discomfort and high vibration levels were common. Subjective workload during preflight, taxi, climb, and cruise was related to the crewmembers' ratings of the quality of the aircraft systems. During descent and approach, workload was affected by weather at the landing site. During landing, it was influenced by the quality of the landing site and air traffic control. Beginning duty later, and greater attention to aircraft comfort and maintenance, should reduce fatigue in these operations.
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PMID:Flight crew fatigue III: North Sea helicopter air transport operations. 974 37

We monitored 34 B-727 crewmembers before, during, and after 8-d commercial overnight cargo trips crossing no more than one time zone per 24 h. Daytime sleep episodes were 41% shorter and were rated as poorer than nighttime sleep episodes. When the layover was long enough, crewmembers usually slept again in the evening before going back on night duty. Nevertheless, the total sleep per 24 h on duty days averaged 1.2 h less than pretrip. The circadian temperature rhythm did not adapt completely to night duty, delaying by about 3 h. Self-rated fatigue was highest around the time of the temperature minimum, which occurred near the end of the nighttime duty period. On trip days, crewmembers ate more snacks and there was a marked increase in reports of headaches, congested noses, and burning eyes. Comparisons with daytime short-haul operations confirm that a daytime rest period does not represent the same sleep opportunity as a nighttime rest period of the same duration. We examine regulatory and scheduling options, and personal countermeasure strategies, that could help to reduce sleep loss during overnight cargo operations.
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PMID:Flight crew fatigue IV: overnight cargo operations. 974 38

We monitored 32 flight crewmembers before, during, and after 4-9 d commercial long-haul trips crossing up to 8 time zones per 24 h. The average duty day lasted 9.8 h, and the average layover 24.8 h. Layover sleep episodes averaged 105 min shorter than pretrip sleep episodes. However, in two-thirds of layovers, crewmembers slept twice so that their total sleep per 24 h on trips averaged 49 min less than pretrip. Greater sleep loss was associated with nighttime flights than with daytime flights. The organization of layover sleep depended on prior flight direction, local time, and the circadian cycle. The circadian temperature rhythm did not synchronize to the erratic environmental time cues. Consequently, the circadian low point in alertness and performance sometimes occurred in flight. On trip days, by comparison with pretrip, crewmembers reported higher fatigue and lower activation; drank more caffeine; ate more snacks and fewer meals; and there were marked increases in reports of headaches, congested nose, and back pain. Scheduling strategies and countermeasures to improve layover sleep, cockpit alertness, and performance, are discussed.
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PMID:Flight crew fatigue V: long-haul air transport operations. 974 39


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