TREMOR
T
GUIDELINES FOR TRAVEL IMMUNIZATION
Immunization
Reason for Immunization
Effectiveness
Yellow fever
Compulsory for entry to some countries and
advisable for visits to others within yellow fever
zones in Africa and South America. May also be
needed when travelling from yellow fever zones
to some Asian countries.
Almost 100 per cent
protection for at least
10 years.
Certificate provided.
Cholera
No longer recommended for routine preventive
use. No vaccine is available in the UK. Anyone
intending to travel and asked to provide a
vaccination certificate is given instead a certificate
explaining that the vaccine is not recommended.
Poor.
Typhoid fever
Recommended when travelling anywhere outside
several countries, including Europe, the US,
Canada, Australia, New Zealand, and Japan for
anyone who has not received immunization or
a booster within the past three years.
Gives moderate
protection for about
three years, after which
a booster is needed.
Tetanus
Advisable for anyone who has not received
childhood immunization or a booster within
the past 10 years.
Highly effective, with
booster needed every 10
years. Usually no more
than five doses needed.
Poliomyelitis
Advisable for anyone who has not received
childhood immunization or a booster within
the last 10 years.
Highly effective, with
booster needed every
10 years in some areas.
Hepatitis A
Recommended for protection against viral
hepatitis type A when travelling to any country
where hygiene and sanitary standards are low.
Highly effective. Booster
needed every 10 years.
Diphtheria
Advisable for anyone who has not received
childhood immunization.
Highly effective.
Hepatitis B;
rabies
Recommended only for people who are special
riskbecause oftheir occupation or the nature of
their visit abroad.
Highly effective.
Meningitis A
and C
May be recommended when travelling to most of
Africa, Brazil, and Nepal and some other areas.
An immunization certificate is needed for travel
to Mecca.
Highly effective.
Japanese B
encephalitis;
tick-borne
encephalitis
May sometimes be recommended when travelling
Moderately effective.
tre m o r
A n
i n v o l u n t a r y ,
r h y t h m i c ,
o s c i l l a t i n g
m o v e m e n t i n t h e
m u s c le s
o f p a r t o f t h e
b o d y ;
t h e
m o s t
c o m m o n l y
a f f e c t e d
m u s c l e s
a r e
t h o s e
o f t h e
h a n d s ,
f e e t ,
j a w ,
t o n g u e ,
o r
h e a d . T r e m o r
i s
t h e
r e s u l t o f r a p i d l y a l t e r n a t i n g m u s c l e c o n -
t r a c t i o n
a n d
r e l a x a t i o n .
O c c a s i o n a l
t r e m o r s a r e e x p e r i e n c e d b y t h e m a j o r i t y
o f p e o p l e a n d a r e d u e t o i n c r e a s e d p r o -
d u c t i o n
o f
t h e
h o r m o n e
a d re n a lin e
( e p i n e p h r i n e ) . A s l i g h t ,
p e r s i s t e n t t r e -
m o r i s c o m
m o n i n e l d e r l y p e o p l e .
E s s e n t i a l t r e m o r , a t y p e t h a t r u n s i n
f a m i l i e s ,
i s a f i n e - t o - m o d e r a t e
t r e m o r
( a b o u t s i x t o t e n m o v e m e n t s p e r s e c -
o n d )
t h a t m a y b e t e m p o r a r i l y r e l i e v e d
b y c o n s u m i n g a s m a l l a m o u n t o f a l c o -
h o l o r b y t a k i n g
b e t a - b lo c k e r d ru g s .
C o a r s e
t r e m o r
( a b o u t
f o u r
t o
f i v e
m o v e m e n t s
p e r
s e c o n d )
i s
p r e s e n t
a t
r e s t b u t r e d u c e d d u r i n g m o v e m e n t , a n d
i s o f t e n a s i g n o f t h e m o v e m e n t d i s o r -
d e r
P a rk in s o n ’s d is e a s e .
A n
i n t e n t i o n
t r e m o r ( t r e m o r t h a t i s w o r s e o n m o v e -
m
e n t o f t h e a f f e c t e d p a r t ) m a y b e a s i g n
o f
c e r e b e lla r a ta xia.
T r e m o r m a y a l s o b e c a u s e d b y
m u lt i-
p le s c le r o s is ,
W ils o n ’s d is e a s e ,
m e rc u ry
p o is o n in g , th y ro to x ic o s is ,
o r
h e p a t i c
e n -
c e p h a lo p a th y ;
d r u g s ,
s u c h
a s
a m p h e t-
a m in e s
a n d
c a ffe in e ;
a n d
w i t h d r a w a l
f r o m d r u g s , i n c l u d i n g
a lc o h o l
.
tre n c h fe v e r
A n i n f e c t i o u s d i s e a s e t h a t i s n o w r a r e o r
u n k n o w n i n m o s t p a r t s o f t h e w o r l d .
T h e d i s e a s e i s c a u s e d b y
ric k e ttsia e
( m i c r o -
o r g a n i s m s t h a t a r e s i m i l a r t o b a c t e r i a )
s p r e a d b y b o d y
lic e .
S y m p t o m s i n c l u d e
h e a d a c h e ,
m u s c l e
p a i n s ,
a n d
f e v e r ,
w h i c h m a y o c c u r i n b o u t s . T r e a t m e n t i s
w i t h
a n tib io tic d ru g s .
tre n c h fo o t
S e e
im m e rs io n f o o t
.
tre n c h m o u th
S e e
g in g iv it is , a c u te u lc e ra tiv e .
T re n d e le n b u rg ’s te st
A t e s t t h a t i s u s e d t o a s s e s s t h e f u n c t i o n
o f e a c h h i p i n t u r n . I t i n v o l v e s s t a n d i n g
o n
o n e
l e g
a n d
l i f t i n g
t h e
o t h e r
l e g
w h i l e k e e p i n g t h e s p i n e s t r a i g h t . N o r -
m a l l y , a s t h e l e g i s r a i s e d t h e p e l v i s o n
t h e s a m e s i d e s h o u l d l i f t . D r o o p i n g o f
t h e p e l v i s o n t h e s i d e o f t h e r a i s e d l e g
i n d i c a t e s t h a t t h e r e m a y b e a p r o b l e m ,
s u c h a s a h i p d i s l o c a t i o n o r w e a k n e s s o f
t h e b u t t o c k m u s c l e s .
tre p h in e
A h o l l o w , c y l i n d r i c a l i n s t r u m e n t w i t h a
s a w - t o o t h e d e d g e u s e d f o r c u t t i n g a c i r -
c u l a r h o l e , u s u a l l y i n b o n e .
Treponema pallidum
T h e s p e c i e s o f b a c t e r i a r e s p o n s i b l e f o r
c a u s i n g
s y p h ilis
.
tre tin o in
A
t o p ic a l
d r u g t h a t i s c h e m i c a l l y r e l a t e d
t o
v ita m in A
a n d t h a t i s u s e d t o t r e a t
a cn e
a n d
c e r t a i n
s k i n
d i s o r d e r s
s u c h
a s
ic h th y o s is .
T r e t i n o i n m a y a g g r a v a t e a c n e
a t
t h e
s t a r t
o f t r e a t m e n t
b u t
u s u a l l y
i m p r o v e s t h e c o n d i t i o n w i t h i n t h r e e t o
f o u r m o n t h s .
P o s s i b l e
s i d e
e f f e c t s
a r e
i r r i t a t i o n ,
p e e l i n g , a n d s k i n d i s c o l o r a t i o n . E x p o s -
i n g
t h e
s k i n
t o
s u n l i g h t
w h i l e
u s i n g
t r e t i n o i n
m a y
a g g r a v a t e
i r r i t a t i o n
a n d
c a n c a u s e
s u n b u r n
.
758
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