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Biomedical subjects

David R Shlim

Publications and source records attributed to David R Shlim.

9 recordsLinked to original sources
PubMed2005

Looking for evidence that personal hygiene precautions prevent traveler's diarrhea.

In the 50 years during which traveler's diarrhea has been studied, it has always been assumed that personal hygiene precautions can prevent or reduce the likelihood of developing traveler's diarrhea. However, 7 of 8 studies that specifically addressed this issue showed no correlation between the types of food selected and the risk of acquiring traveler's diarrhea. The eighth study showed a correlation between a few dietary mistakes and a decreased risk of acquiring traveler's diarrhea. A further increase in the number of dietary mistakes, however, did not continue to increase the risk of acquiring traveler's diarrhea. Personal hygiene precautions, when performed under the direct supervision of an expatriate operating his or her own kitchen, can prevent traveler's diarrhea, but poor restaurant hygiene in most developing countries continues to create an insurmountable risk of acquiring traveler's diarrhea.

Diarrhea↗
PubMed2005

Update in traveler's diarrhea.

TD has not proved as preventable as hoped, despite knowing that it is transmitted mainly through food. Travelers have little ability to select restaurants based on the kitchen hygiene. The rates of TD in travelers to developing countries have not changed in the past 50 years, either because the dietary precautions they are taught are not effective or they cannot be adhered to in the course of a pleasurable vacation. Nonantibiotic prophylaxis with bismuth subsalicylate has the potential to prevent 40% to 60% of TD episodes in short-term travelers, and is probably underused. Antibiotic prophylaxis can prevent up to 90% of infections, but is not routinely recommended. Empiric treatment of TD has been the best approach to dealing with this problem, but its usefulness is being undermined by growing antibiotic resistance in many parts of the world. Fluoroquinolones are still the most useful agents where Campylobacter is not a predominant pathogen. Rifaximin may prove to be a useful addition to the options for treatment and prophylaxis. If used for treatment, it may require a backup antibiotic in areas where Campylobacter and Shigella are prominent pathogens.

Anti-Bacterial Agents↗
PubMed2002

Japanese encephalitis vaccine for travelers: exploring the limits of risk.

The prevention of Japanese encephalitis in travelers presents the juxtaposition of 4 factors: a disease that is widespread throughout Asia, a disease with a low incidence in travelers, a vaccine about which there are safety concerns, and a clinical course that can result in death or permanent disability in two-thirds of symptomatic cases. Travel medicine practitioners often seem to be polarized into 2 groups: a group that gives more weight to the severity of the disease (and therefore often recommend vaccination) and another group that is more persuaded by the low occurrence of cases in travelers (and therefore rarely recommend vaccination). This review assesses the known risks of contracting Japanese encephalitis and the risks associated with the vaccine and tries to develop an appropriate way to recommend this vaccine to travelers who may be at significant risk.

Asia↗
PubMed2002

Cyclospora cayetanesis.

The novelty of C cayetanensis has led to some misconceptions about how best to detect its presence in stool examinations. Some reports have implied that the organism can only be seen on stained specimens, which is not true. The unstained organism can easily be identified by its characteristic size and internal structures. However, not doing a concentration procedure can reduce the chances of detecting C cayentanensis by up to 40%. Finally, there have been false positive reports of C cayetanensis when stained artifacts were mistaken for the real organism. The best way to become comfortable with the laboratory diagnosis of C cayentanensis is to obtain some known positive samples and practice identifying the oocysts using a variety of methods. The clinical syndrome associated with C cayentanensis is recognizable. The patient will usually have prominent anorexia, fatigue, nausea, and gas. Diarrhea, after the initial severe bout, is often intermittent, and submitted specimens may be formed despite a persistent feeling of being unwell.

Animals↗
PubMedDate not supplied

Risk of possible exposure to rabies among tourists and foreign residents in Nepal.

BACKGROUND: There is little data available on the actual risk to travelers of being possibly exposed to rabies. This data would be useful in advising travelers who are considering rabies pre-exposure immunization. In addition, it is not known how many travelers are already pre-immunized when they are bitten by a possibly rabid animal. The current study was performed to determine the rate at which travelers to Nepal are possibly exposed to rabies, and to determine risk factors for possible rabies exposure. METHODS: A prospective 3-year study was carried out at the Canadian International Water and Energy Consultants (CIWEC) Clinic Travel Medicine Center in Kathmandu, Nepal, during the years 1996 through 1998. All non-Nepalese and non-Indian patients who presented with animal bites or scratches were eligible to be included in the study. RESULTS: Ninety-nine persons presented with possible rabies exposures to the CIWEC Clinic during the study period; 56 were tourists, and 43 were resident expatriates. The incidence of people presenting to the CIWEC clinic with possible rabies exposures was 1.9 per 1,000 persons/year for tourists, and 5.7 per 1,000 persons/year for resident expatriates (p <.0001). The incidence of possible exposure to rabies while trekking was 1.2 per 1,000 persons/year. Women were significantly more likely than men to present with a possible rabies exposure, accounting for 61% of patients (p =.0027). Younger people were more likely to have bite exposures to the face and head than older patients. The length of time between exposure and treatment averaged 1.6 to 5.0 days. Among patients presenting with animal bites, 56% of foreign residents, and 21% of tourists had been pre-immunized against rabies. CONCLUSIONS: Foreign residents of Nepal are significantly more likely to be exposed to rabies than tourists. Trekking does not increase the chances of being exposed to rabies. Children have a higher risk of being bitten on the face and head, and females are more likely than males to be bitten or scratched by a possibly rabid animal.

Adolescent↗
PubMedDate not supplied

Chemoprophylaxis use and the risk of malaria in travelers to Nepal.

BACKGROUND: Malaria transmission in Nepal is focal and seasonal. Based on data in returning travelers the risk of malaria is low. Sources of advice give contradictory information regarding the need for chemoprophylaxis. As a result, a degree of confusion exists among visitors. The aim of this study was to describe chemoprophylactic practices among travelers to Nepal and to document differences in advice according to its source and the country in which it was given. METHODS: A questionnaire survey of tourists attending the CIWEC Clinic Travel Medicine Center, Kathmandu between June 2000 and May 2001. Resident expatriates and indigenous Nepalese were excluded. RESULTS: Completed questionnaires were obtained from 1,303 respondents. Two hundred and eighty-eight respondents were taking chemoprophylaxis specifically for their trip to Nepal (22%), whereas 958 were not. Travelers from the United Kingdom and Denmark were significantly more likely, and those from the United States and Germany significantly less likely, to be taking chemoprophylaxis. Most travelers sought pretravel advice (71%), and all sources were more likely to advise them not to take chemoprophylaxis than to take it. However, travelers advised by a family practitioner were significantly more likely to be taking chemoprophylaxis than those advised by a travel medicine specialist. Of those taking chemoprophylaxis, 53% were doing so for a visit to the Terai alone, 33% for all areas of Nepal, and 6% for the Kathmandu Valley. Nine different chemoprophylactic regimes were in use. Six hundred and forty respondents who were not taking chemoprophylaxis had been advised that it was not necessary; 276 had made the choice themselves; and 131 had been taking chemoprophylaxis but had stopped while in Nepal. Twenty-eight of these respondents had stopped because of side effects. The most common reason for choosing not to take chemoprophylaxis was either the occurrence of side effects or the fear of them (31%). CONCLUSIONS: The variable and ultimately low risk of contracting malaria in Nepal has resulted in a lack of consensus and a wide range of opinion regarding the need for chemoprophylaxis. There is a need for clarification and tighter definition of the malaria risk faced by travelers to Nepal to avoid unnecessary chemoprophylaxis use while protecting those at significant risk.

Adolescent↗