Summary Acute respiratory distress syndrome (ARDS) is a rare but life-threatening complication of diabetic ketoacidosis (DKA). We present the case of a young female, with no previous diagnosis of diabetes, presenting in DKA complicated by ARDS requiring extra corporeal membrane oxygenation (ECMO) ventilator support. This case report highlights the importance of early recognition of respiratory complications of severe DKA and their appropriate management. Learning points ARDS is a very rare but life-threatening complication in DKA. The incidence of ARDS remains unknown but less frequent than cerebral oedema in DKA. The mechanism of ARDS in DKA has multifactorial aetiology, including genetic predisposition. Early recognition and consideration of rare pulmonary complication of DKA can increase survival rate and provide very satisfactory outcomes. DKA patients who present with refractory ARDS can be successfully rescued by ECMO support.

Providing a tailored educational intervention can positively impact on hypertension knowledge, self-care management and control within community-based settings.

Background Older people represent a significant proportion of overseas travellers. The epidemiology of older international travellers is not well described in the literature. This study aims to identify demographics, travel characteristics and the medical profile of older travellers seeking pre-travel health advice in a specialist travel medicine clinic. Methods Records of travellers aged 60 years and older attending the Tropical Medical Bureau clinic in Galway, Ireland between 2014 and 2018 were examined. Descriptive and inferential analysis of data was performed. Results A total of 337 older travellers sought pre-travel health advice during the study period. The mean age of the cohort was 65.42 (±10) years. Most of the travellers (n = 267, 80%) had at least one travelling companion. Nearly half of older travellers (n = 155, 46.8%) were travelling with a single companion. Tourism was the main reason for travel for the majority (n = 260, 77.6%), followed by visiting friends and relatives (VFR) (n = 23, 6.9%) travellers. The mean interval remaining before the planned trip was 4.36 (±2) weeks, and the mean duration of travel was 3.16 (±1) weeks. The most popular single country of destination was India with 33 (9.8%) visitors, and South East Asia was the most popular region with 132 (39.2%) older travellers. The majority of travellers (n = 267, 79.2%) had a documented pre-existing medical condition. The most commonly reported medical conditions were hypertension (n = 26, 7.7%), dyslipidaemia (n = 18, 5.3%), diabetes mellitus (n = 12, 3.5%), insect bite sensitivity (n = 11, 3.3%), and hypothyroidism (n = 9, 2.6%). Antihypertensive agents (n = 32, 9.4%) and statins (n = 24, 7.1%) were the most frequently used medications. Typhoid (n = 112, 33.2%) and hepatitis A (n = 84, 24.9%) were the most common vaccinations administered to older travellers at the clinic. Conclusions This study provides an insight into the demographics, travel characteristics, and medical profile of elderly travellers seeking advice at a large travel clinic in Ireland. A wide range of travel destinations, diseases and medication use was reported among this group of travellers, which may enable travel medicine physicians to provide more tailored advice and to more appropriately counsel older travellers.

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Introduction: Primary care practitioners and travel medicine physicians are primarily responsible for identifying individuals who may be unfit for overseas travel and consulting with them pre-travel. Pre-existing medical conditions such as cardiovascular disease, chronic respiratory conditions and diabetes mellitus (DM) have the potential to complicate travel journeys. A considerable percentage of travel-associated illness may be due to the decompensation of a pre-existing medical condition. This review seeks to address the challenges faced by travellers with each of these conditions, including recently updated and evidence-based practical approaches for travel with comorbidities. Methods: Sources for this review were identified through searches of PubMed/Google Scholar for materials published between 1st January 2000 and 31st December 2019, using combinations of search terms. Results: The volume of literature on travelling with a pre-existing condition exploded with more than 865 associated articles indexed on the PubMed alone as of March 2020. After screening titles, abstracts and, in some cases, the full text version of indexed articles, 121 articles were deemed relevant to the subject matter of this review. Conclusion: Rational approaches to pre-planning for travel with a medical condition will contribute to the prevention of problems while in transit as well as when at the travel destination. It is imperative for health care providers to be aware of the preventative measures and current recommendations that should be taken before and during travel to protect individuals with a chronic illness. Further research and studies should be directed to protect this vulnerable group of travellers.

Living kidney donation from Gitelman’s syndrome (GS) patients remains very rare. Long-term renal prognosis of donor and recipient patients remains unknown. We report a 67-year-old man with GS, harbouring a mutation of the SLC12A3 gene, who donated his kidney for transplant. Five years post-transplantation, his clinical condition and biochemical parameters remained stable with close monitoring and follow-up. Patients with non-complicated GS can be considered eligible to donate their kidney for transplant.

Introduction: International travel is increasing, yet few studies have reported on country-level death rates among international travelers. The data regarding the death profiles of overseas Irish travelers are insufficient. The current study examined data obtained from the Irish Department of Foreign Affairs and Trade to profile these deaths. Methods: Data on Irish civilian citizen deaths occurring abroad were obtained from the Consular Division of the Irish Department of Foreign Affairs and Trade and analyzed based on age, gender, time of death, travel destination, and recorded cause of death. Results: Between January 2016 and April 2018, the Consular Division received 654 reports of Irish civilians dying abroad, of which 72% (n=469) were males and 23% (n=149) were females; in 6% (n=36) the sex was not recorded. The mean age at death was 58 ±5 years old (range from 1 to 110, median 62 years). Recorded causes of death were illness (25%; n=162), traumatic deaths including homicides and suicides (24%; n=151), and natural (age-related) (3%; n=19); the rest were classified as unidentified cause (47%; n=309). The majority of deaths (63%; n=309) occurred in European destinations followed by Asia (16%; n=102) and the Americas (12%; n=75). Conclusion: At least 25% of Irish deaths abroad can be considered preventable. More tailored pre-travel medical interventions may prevent further deaths. In the collection of data, consular services miss the opportunity to acquire valuable information for both travelers and healthcare professionals. The authors recommend the creation of a comprehensive database of international traveler deaths.

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