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24th Annual Meeting of the German Society for Travel Medicine (DFR), Bremerhaven, Germany, 16–18 September 2021

100%

Küpper T.

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nr 3

40-51

EN

About the MeetingThis year the Annual Meeting off the German Society of Travel Medicine took place in Bremerhaven, September 16th to 18th. This traditional harbour town where thousands of Germans were embarking hundred years ago facing an uncertain future, the so-called “climate house” (an exihibtion about several aspects of the world’s climate) and the Alfred-Wegener Institute for Arctic Research were a fantastic setting for the meeting’s motto “traveling under extreme conditions”. After a brillant introduction by Stefan Kröpelin about research in the Sahara two weeks away from the next pharmacy and a fascinating lecture by Eberhard Kohlberg how to organize expeditions to Antarctica and how to work and to live there several lecturers illuminated a wide field of travel medicine in more or less extreme conditions.

2

22nd Annual Meeting of the German Society for Travel Medicine (DFR) Aachen, Germany, 21.-22.9.2019

100%

Küpper T.

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tom 10

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nr 1

28-41

EN

The scientific management and organization: Prof. Dr. Thomas Küpper, Vice President of the Deutsche Fachgesellschaft für Reisemedizin (DFR)

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Tropical infections as occupational diseases – labor inspectorate physicians’ aspects of a complex problem

51%

Jansing P. J. , Morrison A. , Heggie T. W. , Küpper T.

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nr 2

21-28

EN

Background: Occupational physicians work directly with individual employees regarding diseases that has been caused or exacerbated by workplace factors. However, employees are increasingly required to travel for their work, including to tropical countries where they risk exposure to diseases they would not normally encounter at home (i.e., malaria). Such disease/s may also take days to months to incubate before becoming symptomatic, even after their return home, thus delaying and complicating the diagnosis. Proving this was an occupational disease with respective sick leave entitlement or compensation can be challenging. There is a lack of data concerning occupational diseases caused by tropical infections.Material and methods: Employee case records for the period 2003-2008 from the State Institute for Occupational Health and Safety of North-Rhine Westphalia in Germany were analysed and assessed within Germany’s regulatory framework. These records included Germany’s largest industrial zone.Results: From 2003-2008the suspected cases of “tropical diseases and typhus”, categorized as occupational disease “Bk 3104” in Germany, have decreased significantly. A high percentage of the suspected cases was accepted as occupational disease, but persistent or permanent sequelae which conferred an entitlement to compensation were rare.Conclusion: There is scope to improve diagnosis and acceptance of tropical diseases as occupational diseases. The most important diseases reported were malaria, amoebiasis, and dengue fever. Comprehensive pre-travel advice and post-travel follow-ups by physicians trained in travel and occupational health medicine should be mandatory. Data indicate that there is a lack of knowledge on how to prevent infectious disease abroad.

4

Performance of a new recuperative Heat and Moisture Exchange Mask

51%

Wehrle M. P. , Küpper T. , Muth C.-M.

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tom 14

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nr 1

9-16

EN

Aim of the study: The purpose of this work is to show the possibility to use a recuperative design of a heat and moisture exchange face mask (HME). Such HME are used as cold weather face masks for Arctic expeditions and conditioning of air for long-term intubated patients. Common regenerative HME have the disadvantage of increasing airway resistance and airway volume (dead space). In recuperative devices, the separation of inspired and expired airflow could reduce dead space and resistance. Materials and methods: Prototype HMEs were built using two concentric ducts of aluminium or cotton. A valve ensures that expired and inspired air are led through either the inner or the outer tube. The inner tube’s wall transmits heat and water. The HMEs were tested in a simulated Arctic environment using a breathing simulator and characterized in terms of heat and moisture exchange efficiency. The new design was also tested at room temperature in order to simulate the conditions of long-term intubation. To compare the results, the relative difference in temperature (Performance Coefficient PC) between the expired and the inspired air was calculated. Results: During the experiments, the ambient temperature was −37°C and therefore the absolute water content was about zero. The recuperative HME conditioned the air to 21°C and 10.7 mg/l water (61% relative humidity), giving a PC of 82%. At room temperature the recuperative mask showed a PC of 62%.Conclusion: The recuperative HME shows great potential. It might be of use in clinical conditions and Arctic expeditions.

5

Femoral neck stress fracture during sport climbing

51%

Küpper T. , Rutten S. , Morrison A. , Schöffl V.

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tom 17

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nr 4

1-5

EN

While the epiphyseal stress fracture of the finger’s middle phalanx is a known sport-specific injury occurring only in adolescent climbers, and in other locations it’s rare, no femoral neck stress fracture (FNSF) in sports climbing has yet been reported. An experienced female sport climber (37y, 160 cm, 45 kg, BMI 17.5) suffered from pain in the left inguinal region while climbing, and later, also required a stick to walk. Routine radiography missed the FNSF and it was many weeks before a MRI accurately provided that diagnosis. The time between the X-ray and MRI should have been minimized as it resulted in a delayed diagnosis, unnecessary pain and delayed healing. In this situation the initial clinical investigation, the patient’s history and the X-ray did not lead to a clear diagnosis, and the initial treatment was ineffective. Further investigation by MRI and / or CT scans should have taken place sooner and would have been essential.

6

Sportspecific performance diagnosis in ski mountaineering - comparison of a sportspecific cardiopulmonary exercise test on a treadmill versus outdoors and at altitude, a pilot study

51%

Schöffl I. , Bliemsrieder B. , Küpper T. , Schöffl V.

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nr 3

16-25

EN

Background: Ski mountaineering is a competitive sport that has gained popularity during the last years. As most competitions are held in altitudes between 1500 m and 3500 m, a considerable amount of training occurs at various hypobaric hypoxia degrees. It was establishing a sport-specific cardiopulmonary exercise protocol using standard ski mountaineering equipment on a treadmill. This study investigated altitude’s effects on a self-regulated incremental exercise field test at 3100 m with this protocol.Methods: Six athletes were tested (24.2 ± 4.2 years) from the German Ski Mountaineering National Team with a portable telemetric cardiopulmonary exercise test equipment. First, an incremental indoor step test with skis on a treadmill (altitude 310 m) and four days later outdoor on glacier snow (3085 m) after three days of acclimatization. All athletes were exposed to repetitive intermittent hypoxia during the weeks before the test. Standard cardiopulmonary exercise parameters were recorded while individual training zones were defined according to ventilatory thresholds.Results: In highly trained athletes, mean V̇O2peak (72/ml kg KG/min) was reduced by 25% or 9% per 1000 m altitude gain and by 18% and 23% at the first and second ventilatory thresholds, respectively. Mean maximum heart rate and the heart rate at the ventilatory thresholds were reduced at altitude compared to sea-level, as was the O2pulse.Conclusion: Due to distinctive individual reactions to hypoxia, cold, etc., an individual and sport-specific field performance analysis, representing the daily training environment, is highly useful in world-class athletes for precise training control. Our self-regulated cardiopulmonary field protocol could well prove to serve in such a way.

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Water disinfection in the mountains – an update of the recommendation of the Medical Commission of the Union Internationale des Associations d’Alpinisme (UIAA)

38%

Albanus C. , Timmermann L. , Schoeffl V. , Hillebrandt D. , Milledge J. , Küpper T.

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nr 2

40-55

EN

Safe water is still a major problem for travellers in many countries worldwide. In the last decade several new technical developments were made and more data exist about traditional procedures to produce safe water. This update includes such data with special regard to UV-C and held devices and SODIS.

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Extreme sleep fragmentation for 11 consecutive days and nights does not significantly alter total sleep time, and sleep stage distribution, during the continuous alpine downhill skiing world record

38%

Gindulis M. , Netzer N. , Burtscher M. , Gatterer H. , Schmidt C. , Morrison A. , Küpper T.

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tom 17

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nr 4

18-24

EN

Introduction: Extreme levels of sleep deprivation, fragmentation and management, are major problems in many sportive disciplines, ultramarathons, polar or extreme altitude expeditions, and in space operations.Material and methods: Polysomnographic (PSG) data was continuously recorded (total sleep time and sleep stage distribution) in a 34-year-old male whilst performing the new world record in long-term downhill skiing. He napped only during the short ski lift rides for 11 days and nights. Results: After an initial period of complete sleep deprivation for 24 hours, total sleep time and the total times of non-REM and REM achieved during the lift rides returned to standard values on the second day. PSG data revealed an average sleep time per 24 hours of 6 hours and 6 minutes. During daylight sleep was rarely registered. The subject experienced only two minor falls without injury and immediately resumed skiing. Conclusion: In a healthy, trained, elite male athlete, sleep fragmentation over 11 consecutive days did not significantly impair the sleep, motor or cognitive skills required to perform a continuous downhill skiing world record after an initial adaptation phase

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The need for specific first aid and emergency knowledge whilst trekking in remote areas – results of the ADEMED (Aachen DEntal and MEDical) Expedition to the Annapurna region, Nepal

38%

Scharfenberg C. , Lechner K. , Giet S. v. d. , Hettlich M. , Schöffl V. , Morrison A. , Küpper T.

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tom 14

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nr 1

17-24

EN

Introduction: Fellow trekkers are often the first responders to their comrades in remote settings. Not everyone undertakes First Aid (FA) training when travelling to remote settings away from comprehensive healthcare, whether travelling independently or in a group. The syllabus of standard urbanised FA courses does not fully cover the needs of such trekkers (ie altitude illnesses). We evaluated the FA and emergency knowledge of trekkers en route in the remote Nepalese Himalayas.Material and methods: A questionnaire about FA, trekking emergencies and water hygiene knowledge was completed by a cohort of 453 trekkers passing through Manang (3,519 m), Nepal, who volunteered their participation. A previously validated questionnaire consisted of 20 multiple choice questions (each using a five-point Likert scale) was used, followed by a subjective self-assessment of 17 key topics using a 5-point rating scale from very good to unsatisfactory knowledge. Demographic data including FA and climbing experience was also collected.Results: The participants generally showed a poor knowledge in FA and trekking emergencies, even though 20.8% had some occupational medical training. In total 59.5% of possible answers were answered correctly. On average each participant managed to answer only one out of 20 questions (5.4%) completely correct. The most unsatisfactory results concerned the following topics, each with only 2.4% correct answers: hypothermia/resuscitation, rescue strategies and rip fractures. The best results were for HACE 33.8%, cranio-cerebral injury 33.6%, angina pectoris/heart attack 31.8% and hypovolemic shock 28.7%. The majority of participants had very limited experience of climbing mountains, rock climbing or ice climbing.Conclusions: This study provides essential data identifying deficiencies in standard FA courses that are targeted for urban settings, and not for trekkers in a remote setting far away from comprehensive health care and rescue. There is a need to develop readily accessible FA curriculums specific to trekkers that would provide education on preventative care prior to, during, and after treks, and to improve their knowledge of medical care of trekking injuries and emergencies.

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The Borg Scale at high altitude

32%

Küpper T. , Heussen N. , Morrison A. , Schöffl V. , Basnyat B. , Hillebrandt D. , Milledge J. , Steffgen J. , Meier B.

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nr 2

1-8

EN

Introduction: The Borg Scale for perceived exertion is well established in science and sport to keep an appropriate level of workload or to rate physical strain. Although it is also often used at moderate and high altitude, it was never validated for hypoxic conditions. Since pulse rate and minute breathing volume at rest are increased at altitude it may be expected that the rating of the same workload is higher at altitude compared to sea level.Material and methods: 16 mountaineers were included in a prospective randomized design trial. Standardized workload (ergometry) and rating of the perceived exertion (RPE) were performed at sea level, at 3,000 m, and at 4,560 m. For validation of the scale Maloney-Rastogi-test and Bland-Altmann-Plots were used to compare the Borg ratings at each intensity level at the three altitudes; p < 0.05 was defined as significant.Results: In Bland-Altmann-Plots more than 95% of all Borg ratings were within the interval of 1.96 x standard deviation. There was no significant deviation of the ratings at moderate or high altitude. The correlation between RPE and workload or oxygen uptake was weak.Conclusion: The Borg Scale for perceived exertion gives valid results at moderate and high altitude – at least up to about 5,000 m. Therefore it may be used at altitude without any modification. The weak correlation of RPE and workload or oxygen uptake indicates that there should be other factors indicating strain to the body. What is really measured by Borg’s Scale should be investigated by a specific study.