Gianmarco D'Alessio

INFORMATION services in Telemedicine are available daily by requesting :
– Online consultations before travelling;
– advice on infectious diarrhoeas: how to prevent them, how to treat them, what to do when travelling;
– INFO on Chemoprophylaxis for malaria online;
– Online consultations for INFO on COVID19 and LONG COVID;
– Online consultations Infectious and Tropical Diseases.
These services can be requested (CLICK HERE) or by writing a request to seg.cesmet@gmail.com , or by sending a WhatsApp message to +39 346 6000899.

Comparing drugs for Traveller’s Diarrhoea – Bassado and Normix a winning combination

Information and advice, examinations and tests. Book at Cesmet

Diarrhoea, traveller’s diarrhoea, dysentery, abdominal discomfort, gastro enteritis, enterocolitis. First symptoms, immediate use of drugs such as Bassado (doxycycline) and Normix (rifaximin). From the classic bellyache with lots of air inside, to unbearable colic with very high fever. Antibacterial drugs are of first choice. Bimixin, now a second-rate drug. Imodium a symptomatic drug to watch out for.

Traveller’s diarrhoea: more than 60% of all travellers worldwide are affected by this problem. The World Health Organisation (WHO) provides us with accurate data and descriptions of what happens worldwide. Countries most affected, favourable environments, risk behaviour.  Traveller’s diarrhoea can affect any of us, anywhere, in any city or country. We have to prevent it, first and foremost, and if necessary, nullify the symptoms right from the start. Bassado as prevention or treatment, normix to be added in case of symptoms. Bimixin used less and less and imodium, locked in the drawer.  Of each drug we have put the package leaflets.
But reality is experienced in the field. And on the basis of years of experience I want to give you a few pointers.

DIARRHEA according to WHO

Some rules before travelling: to protect our health.

• Think about fair and correct information. Know the risks, the characteristics of the environment where you are travelling, the weather situation and the occurrence of illnesses, and how to behave to maintain good health. Then ask for specialised and direct advice that answers your doubts and questions.
• Go to an international vaccination centre and request, wherever you go, the 3 basic vaccinations to protect your gut from even serious infections.
  Vaccinate against Hepatitis A, a ubiquitous and aggressive virus; vaccinate also against Typhoid Fever, i.e. Salmonella, a ubiquitous, dangerous and particularly drug-resistant bacterium; vaccinate especially against Traveller’s Diarrhoea, i.e. against those bacteria that are enemies of our intestines, i.e. pathogenic E. Coli, as well as against the Vibrio cholerae, i.e. (Dukoral), an oral vaccine that is particularly effective and useful at all ages.
• Then prepare your ‘Travel Pharmacy’ by including some ‘drugs to prevent or treat’ diarrhoea, and its worsening to the presence of blood and mucus (dysentery) with fevers and particularly severe symptoms.
  Doxycycline 100 mg, an old tetracycline, widely used in the prevention of many bacterial forms, especially intestinal aggression by enterobacteria; but also in the treatment of particularly aggressive forms, up to the treatment of Cholera.  You can find it in pharmacies under the trade name Bassado or Miraclin

Normix 200 mg, is a strong intestinal antiseptic and therefore anti-diarrhoeal drug. Both for prevention of bacterial attacks and also as a treatment for diarrhoea. You can find it in pharmacies under the trade name Normix; Rifaximin has a broad spectrum of action on both aerobic and anaerobic gram-positive and gram-negative species. It is poorly absorbed in the body and therefore carries out bactericidal activity exclusively in the intestinal canal, avoiding toxic problems in the body resulting from absorption.
Doxycycline is preferred to Rifaximin, during travel, because of its multiple covers; from efficacy on skin infections, to prevention and treatment for tick bite infections and many other infections. Among the most effective drugs as an antimalarial.
Neomycin and Bacitracin, a combination drug, Bimixin, has become obsolete since bacteria no longer respond to the action of Neomycin; it is still in high demand and prescribed, but is really not very effective; in the past it had a broad spectrum of action, which has now almost disappeared;

Loperamide, is the active ingredient in the famous Imodium, a drug found in most travellers’ luggage. It is frequently used at the first diarrhoeal discharge. Nothing could be more negative. Imodium should not be taken alone, but always in combination with antibacterial drugs. It decreases intestinal muscle motility, slows down the transit of food and water and liquids, facilitates absorption at the level of the villi, decreasing the frequency of discharges. It decreases colon movements by reducing the gastrocolic reflex and thus the urge to evacuate. But all this facilitates the stagnation of liquids and thus of bacteria that increase in number, to the point of worsening the infection.

When you travel, whether to Italy or to any country in the world, take your ‘little travel pharmacy’ first of all with you your packet of Doxycycline 100 mg, for all the coverage and efficacy in many infections; supplement this drug with Normix (Rifaximin) to increase its efficacy in treating diarrhoea; Bimixin I no longer recommend because of its reduced efficacy; never use Imodium alone to treat infectious type diarrhoea as it can have the unwanted effect of strengthening enteropathogenic bacteria causing a worsening of the already delicate intestinal situation. If it is really necessary, and this is rare, add it to Doxycycline or Rifaximin.

Read also Normix- Package Leaflet
Read also Bimixin leaflet
Read also Imodium – Package Leaflet
Read also Rifacol – Package Leaflet

INTRODUCTION

Malaria is an acute infectious disease caused by infection with a parasite, Plasmodium, transmitted by the bite of a mosquito called Anopheles. This is widespread in most equatorial tropical territories, where the humid, warm environment and the presence of water, especially stagnant water, favor its reproduction and growth.

Many different symptoms of malaria occur with increasing gradations and levels. After the bite of the infected mosquito, most individuals, especially those who have always lived in at-risk areas, remain asymptomatic, that is, although infected, they do not manifest any symptoms. Other individuals, however, manifest the disease with a crescendo of symptoms and increasingly strong and severe manifestations. Delay in diagnosis and treatment can cause symptoms to worsen to the point of death. This may be due to “brain” forms, kidney failure, or other internal deficits. Speed in dealing with this disease can be vital. Waiting and letting time pass unnecessarily can be lethal, as is often the case.

MALARIA IN RESIDENTS OF ENDEMIC AREAS AND TRAVELERS

Living in endemic areas, where infected Anopheles coexist with humans, sting to feed on their blood, and inoculate Plasmodium frequently, means fostering a mechanism for eliciting the cellular immune or antibody response, a protective factor against the parasite. Repeated and symptomless infections are typical situations for those living in malarial areas. In contrast, in these areas, infants and young children, who have not yet developed full immunity against malaria, are at serious risk of disease and are the age groups with the greatest deaths.

In travelers coming from areas where the malarial parasite is absent, the bite of an infected mosquito can cause an infection that, without immune coverage, allows Plasmodium to develop and invade with the “erythrocyte cycle the blood cells,” with gradually exponential growth.

The presence or absence of symptoms and their “degree” of manifestation is greatly conditioned by the response of the immune system.

THE VARIETY OF SYMPTOMS

Worsening malaise; a sense of dizziness; increasing headaches; fatigue and muscle aches; these may be the first symptoms that occur after a few days to those who have been bitten by an infected mosquito. After a few days, heaviness and soreness in the nape of the neck and neck may appear; dull, severe pain in the muscles of the legs and arms; initial sensation of moist skin, particularly noticeable in the abdomen and back. Approximately one week after the first Plasmodium infestation a fever may begin, not always, to present first, accompanied by mild chills; increased sweating and fronto-occipital headache; these symptoms in the following hours or days tend to increase, with an asthenia that does not allow arms and legs to move. Lightheadedness increases and fever may begin to disappear and to reappear with an undulating characteristic every three to four days. Over the next few days, if no action is taken, the sufferer may present with a heavy, reddish, sometimes dark urine; a feeling of heaviness and swelling in the upper abdomen, spleen and liver; worsening mental confusion to a semi-comatose state and eventually irreversible coma and death due to blockage of cerebral circulation by encephalic microthrombosis.

Irritative abdominal symptoms such as even watery diarrhea and feeling of nausea and vomiting are common at the onset of the disease.

 

All of these symptoms can rarely occur simultaneously. It is more common for a few, the less severe, to occur with a widely varying degree of intensity. Fever, considered a pathognomonic symptom, often does not appear or occurs late. The typical symptom and almost always present is the generalized feeling of malaise and headache, in the early stage with that sense of head muffling.

Malaria is called the “great deceiver” precisely because of this variety of such different symptoms and unpredictable gradations.

As mentioned earlier, fever, mild or very high, is considered the typical symptom of malaria, accompanied by chills and sweating. This set of symptoms result from the body’s response to the lysis of blood cells, the release of endotoxins, catabolites and the release of parasites into the circulatory stream with a defensive reaction of the body’s systems. But this set of symptoms, regularly taken as the only clinical evidence of the presence of plasmodium, is to be considered unreliable in diagnosing the disease because it is often not present. That is, the absence of these symptoms does not rule out diagnostic doubt. “Algid malarias,” i.e., those without fever, are very common, especially in individuals who have had malaria, in those who live for long periods in risk areas, and in those who have developed specific immunity.

The life of the different types of Plasmodium within the organism; their presence and long cohabitation in blood cells and in those within the “liver acini,” which are cell formations that constitute the internal structure of the liver; the presence within certain families of lymphatic cells; all these events affecting the presence of the parasite in the human organism is strongly conditioned by the immune response of each individual.

The reproductive cycles of Plasmodium in the liver and blood cells occur with well-timed and well-timed but conditioned by the response and modulation of the immune system, which also regulates the occurrence of symptoms.

Native populations, living in areas densely populated by Anopheles, due to the constant bites of infected mosquitoes and the constant presence of the malarial parasite in the “red and white” blood cells and also in the lymphocyte organs, constantly reinforce their defensive capacity against Plasmodium. This situation, typical of malarial territories, of “attack” (Plasmodium) and defense (immunity), permanent, allows to arrive at a coexistence between the two

organisms (parasite and host).

Individuals then coexist in malarial environments with mosquitoes and parasites in a form of “commensalism” (peaceful living) but which should not be considered long-lasting. It only takes a decrease in defense systems due to other infections, or traveling to areas where Anopheles and Plasmodium are not present, to lose immunity and defense. This is a typical phenomenon of those living in infected areas: (1) suffering from periodic states of fatigue; (2) experiencing generalized malaise; (3) losing muscle strength; (4) losing work capacity; and (5) slowing down body activities.

In this period of climate change, long dry spells condition the presence of Anopheles in the environment for long periods. The arid climate prevents mosquito life. Then sudden floods, a frequent phenomenon after long periods of drought, induce new reproductive waves of insects. All this favors the disappearance and presence of Plasmodium in these countries with multiple, periodic infections that, due to the periodic loss of defenses, produce serious and often fatal malaria in the population, especially children, which is unforeseen and unpredictable.

This is the same phenomenon that happens to people who expatriate for medium to long periods from their countries and lose their resistance to Plasmodium. Back home they are just as likely to get sick, even with severe forms as any traveler from areas free of the Malaria Plasmodium.

“The great deception of malaria,” with the most diverse symptoms in type and gradation thus stems from the relationship between the immune system and the parasite and explains the onset of different symptoms, and the progression of the disease to increasingly aggressive situations.

 

From the above it is good to reflect on the following:

– Anyone traveling to malarial areas, coming from countries with this disease, is subject to infection. The manifestation of the disease and symptoms depends on his or her immune response;

– The most important defense against malaria is definitely the use of natural (Neem) or chemical (DEET) repellents that ward off the risk of mosquito bites;

– Prophylaxis with suitable and effective drugs helps decrease the incidence of the disease by chemically attacking Plasmodium. But it is important to know that a weak “natural and innate immune response of the individual” increases the chance of manifesting symptoms after Plasmodium inoculation; (The Covid example is emblematic. During the pandemic, the induced reduction of immune defenses caused a sharp increase in malaria symptoms and even deaths in indigenous populations – WHO statistics 2022). This demonstrates the defensive power of the immune system.

– During the stay and also upon return from a trip from malaria-prone areas, the occurrence of discomfort, such as those described above, even nuanced, should kindle doubt that one has been infected with Plasmodium. The event should be considered possible and probable even for short or very short stays in areas with the presence of Anopheles. Even a few hours is enough to receive infected stings;

– Returning from a trip from malarial-risk areas, if there is discomfort, headache, fever, or other symptoms, first think of the malarial risk and rule out the disease, then think of any other disease you may have developed.

– The statement that in the presence of symptoms of suspected malaria, laboratory tests are always positive, including the highly sensitive PCR, is not true.

“If the slide read in the laboratory is negative, malaria is not there.” This statement is not true and is dangerous. Significant immunity present in an individual can make the presence of the parasite negative. A slide reading made by inexperienced or hasty eyes can give a negative answer even though the parasite is present.  The clinical diagnosis, derived from an evaluation of symptoms, cannot be erased by a negative test, the answer to which is not always true.

– A symptomatic individual, with symptoms that worsen over time and with typical manifestations, even with presumed negative tests, should be treated with effective medicine.

– “Intervening as early as possible saves and does no harm, waiting can kill.”

 

Update: January 2023                                                                         Book your vaccination here

Vaccination against Yellow Fever (or Anti-Amharillic Vaccine), an acute viral disease transmitted by mosquito bite, is the only preventive practice that can be mandatorily required by a country’s health authorities in order to enter through border crossings. This occurs irrespective of the presence of manifest cases or epidemic outbreaks of the disease, but is an international provision designed to prevent the spread of the disease when the vector insect (Aedes aegypti) is still present in the country. The example is the Asian countries where the virus is absent but the vector, i.e. the mosquito, is present. Remember that Yellow Fever is a zoonosis (disease of animals – monkeys) that can be transmitted to humans through the bite of the Aedes type mosquito.

This is why vaccination is made compulsory in some cases, and in any case is strongly recommended in countries where the virus is present with the vector. It is necessary, before leaving for a country considered to be at risk, to find out about the international regulations adopted in this regard. Regardless of this, however, it is a good idea to check with experts where there is a real risk of infection or where the presence of infected animals is likely, and therefore in which cases vaccination is recommended before travelling. Currently, the areas at risk of transmission are in Central and South America, as well as in many countries in Africa. In Asia, the presence of this virus is not reported.

Vaccination is risk-free; it rarely produces a fever after 24 hours at most, which is easily controlled with antipyretics
It is not recommended for individuals allergic to egg proteins.
Can be administered from the age of 6 months.
Use during pregnancy: not recommended.

Period of activity of the live attenuated virus once injected with the vaccine

During the first 48/72 hours, the live attenuated virus, which is harmless to the organism, reproduces and activates the defence system, simulating the disease. The immunological cellular part is activated and anti-virus antibodies (neutralising the virus) are formed. This fact serves to disprove the urban legend that the harmful action of the ‘live attenuated virus’ present in the vaccine is active for 3 or even 6 months (one cannot conceive for this length of time). It is reiterated that already after two to three days the virus is neutralised by the immune response, which reaches its maximum cellular response as early as the seventh day. Its action therefore on the product of conception is practically non-existent. Therefore, all women who think they might become pregnant in the immediate future can be vaccinated without any problem after vaccination.

To learn about the disease please visit our disease fact sheet on Yellow Fever.

To find out about the vaccination please visit our Yellow Fever vaccination factsheet

If you would like further information, please contact us by e-mail at seg.cesmet@gmail.com or phone +39 06/39030481, or whatsapp +393466000899

IRELAND: The Health Protection Surveillance Centre has confirmed 4 recent cases of meningitis/meningococcal septicaemia reported in the last week of October in the country.
Three cases have already been confirmed and one is under investigation. The three confirmed cases are all caused by meningococcal serogroup B. The cases were reported from different regions of the country and have no known links to each other. Three of the cases concern young adults between 12 and 18 years of age and one case is less than ten years old. The public health authorities have identified close contacts, who will be placed under close surveillance and under preventive antibiotic treatment. The latest information gives 2 deaths from the cases reported.

Meningitis

Meningococcal meningitis and septicaemia are caused by various serogroups of Neisseria meningitidis (meningococcus), an encapsulated aerobic Gram-negative bacterium. There are at least 12 serotypes of meningococcus, of which groups A, B and C account for about 90% of meningococcal disease, together with strains Y and W135.
TRANSMISSION: Meningococcus is transmitted by aerosol or by direct contact with the respiratory secretions of infected persons and healthy carriers. The disease occurs mainly in children, adolescents and persons with risk factors.
INCUBATION: The incubation period is different for each organism and can vary from two to ten days for bacterial meningitis.
SYMPTOMS: Generally, signs and symptoms may include: severe headache, stiff or sore neck, high fever, photosensitivity, confusion, convulsions, rash, joint pain, vomiting.
In children, signs may include: difficult feeding, excessive tiredness, irritable state, difficulty breathing, fever, stiff neck, convulsions, vomiting, rash, pale or blotchy skin.
PREVENTION: Vaccination is, without doubt, the most effective tool for preventing bacterial meningitis.

Several types of anti-meningococcal vaccine are available in Italy:

the conjugate vaccine against meningococcal serogroup C (MenC): this is the most frequently used and only protects against serogroup C
the tetravalent conjugate vaccine: protects against serogroups A, C, W and Y
the serogroup B meningococcal vaccine: protects against this serogroup only.
The vaccination card currently in force provides for vaccination against meningococcus C or ACWY in children over one year of age, while a booster with tetravalent vaccine A, C, W, Y is recommended for adolescents. The tetravalent vaccine is also recommended for adults with risk factors and those travelling to countries endemic for these serogroups.

The vaccine against meningococcal B meningitis is especially recommended for children within the first year of age.
Meningococcal B disease is prevented by vaccination.
The MenB vaccine was introduced for all children born on or after 1 October 2016 because children under one year of age are at a higher risk of meningococcal B disease. All children are offered the MenB vaccine at 2 and 4 months of age with a booster dose of the MenB vaccine given at 12 months.

WHAT COP27 IS (watch video)

From RIO 1992 and Berlin 1995 to Glasgow 2021. The 26 Conferences on the Climate and Health of OUR ‘planet earth’ organised by the United Nations. Decades of reflections, studies, observations, joint efforts to mitigate the effects of climate change. Climate change is now a reality for all to see. Particularly in the year 2022, the earth was scorching hot with a dramatic shortage of water.
And in the year 2022, still with Europe in a heat vice, in Egypt in Sharm el Shake we seek new results, more inclusive, more concrete, based on clear rules; on concrete guidelines to be followed by all participating states. Results commensurate with the challenge, based on scientific research, the word and the work of researchers, and guided by actions based on ‘agreements, promises and commitments’. Agreements promises and commitments that have marked previous Conferences with growing interest but few concrete actions.

ITALY PRESENT WITH COUNCIL PRESIDENT GIORGIA MELONI

Goals and vision from the Conference in Egypt

On the part of all participants there is now an awareness of where we are, of environmental disasters, of the disruption of weather and seasons, and an awareness that only an acceleration on global and joint climate action, through (1) a reduction of carbon emissions, (2) an increase in adaptation efforts and (3) the enhancement of adequate funding streams towards renewable, green and less polluting energies, can bring about a change of course. The recognition that the ‘just transition’ remains a priority for all countries, from the advanced to the developing world.

The key words of the COP 27 Conference: Mitigation; Adaptation; Financing; Collaboration;

The COP27 (Egyptian) chairmanship has as its determining objective the strengthening and facilitation of agreement in negotiations between states and representations to achieve tangible results in a balanced manner. The effort to forge partnerships and collaborations between states will help to achieve the four goals mentioned above and ensure that the world adopts a more resilient and sustainable economic model, in which the survival of human beings is at the heart of the climate negotiations.

As these UN-driven negotiations are based on consensus and reaching an agreement among all stakeholders, this will require the inclusive and active participation of all these stakeholders.

The Egyptian Presidency of COP27 is working hard to ensure adequate representation and participation of all stakeholders at COP27, particularly vulnerable communities and representatives of countries in the African region that are increasingly affected by the impacts of climate change. We need to transform the theoretical outcomes of Glasgow into concrete actions and start implementing them.

At this conference it is the organisers’ wish that human beings are at the centre of the climate talks.

The goal of COP 27 is that the governments present, big business and the private sector, and civil society must work together to transform the way we all interact with our planet. New solutions and innovations must be sought and introduced in our everyday lives. Innovations and solutions that help alleviate the negative impacts of climate change. It is a priority to rapidly replicate and disseminate all climate-friendly solutions in order to implement them also and especially in developing countries.

Italy will also be present at the International Climate Conference with Prime Minister Giorgia Meloni who will travel to Sharm El Shake on 7 and 8 November. (CLICK HERE – Giorgia Meloni in Sharm El Shake)

COP27: Italy is represented at the International Climate Conference by Prime Minister Giorgia Meloni.
Prime Minister Giorgia Meloni will attend the Cop27 Summit of Heads of State and Government in Sharm El Sheich on 7 and 8 November. Italy’s commitment will be full and active according to President Giorgia Meloni.

The issues on the ground discussed at the COP27 conference in Sharm El-Shaike.
Cop27 is the 27th annual UN climate conference, which began in Berlin in 1995. It will be held in Egypt from 6 to 18 November. More than 100 leaders including heads of state and government from around the world are expected to attend. This testifies to the delicacy and global involvement on an issue that is crucial for the maintenance of the planet’s natural balance, and for mankind’s very survival.

Climate and Coal

The COP 27 Conference will focus on the guidelines for combating climate change effectively. Glasgow 2021 marks the starting point. During the COP 26 in Glasgow, political choices were marked and many concrete actions to be taken. The start of the Sharm Conference is an opportunity to take stock of the commitments made at Cop26 in Glasgow. The first commitment was to keep global warming within 1.5° C. This goal is almost impossible to achieve as things stand, since average global temperatures have already risen by 1°C and global greenhouse gas emissions are not and are not falling. On the contrary, the trend is towards increasing emissions.
Compared to 2021, a year ago, the scenario has even worsened and serious issues have emerged that threaten to undermine climate change action in the short and long term. Among the events that held back the common effort to counter harmful emissions was the war in Ukraine, with the subsequent economic recession; the energy crisis with heavy investments and actions on fossil fuels such as gas and coal. All factors that contribute to producing greenhouse gases.

The UNFCCC UN climate agency and the Egyptian chairmanship of the conference have prepared a very broad agenda to address, discuss and find concrete solutions to most of the topics.
From 6 to 18 November, one topic is dedicated to each day: (1) finance; (2) agriculture; (3) water; (4) decarbonisation; (5) biodiversity; (6) energy.

The UNFCCC report that will be presented at COP 27, produced by dozens of research teams of specialists in the field, shows that the commitments made by the 193 signatory countries of the Paris Climate Agreement, almost all of the world’s countries, will lead to a predictable increase in global average temperatures of 2.5° C, compared to pre-industrial levels, by 2100. Instead, the Agreement should provide that global warming should be kept below 2°C, possibly within 1.5°. Yet, despite temperatures rising steadily and peaking in 2022, the trend shown by global emissions is growing further than the rapid decrease that science believes is needed this decade. Increasing the much hoped-for decarbonisation commitments of individual countries no longer seems to be a priority for states at this juncture but will remain one of the central themes at Cop27.