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Alison Sonnex was texting her neighbour about feeding her cats, but died hours later. A man's claim that his wife died on holiday in Egypt as a result of food poisoning is 'entirely speculative', a coroner has concluded. She became violently ill on their last night and died in hospital hours later. Delivering a narrative verdict, coroner James Dillon apologised to her family for not providing 'more answers'. A UK pathologist concluded Ms Sonnex, 54, had gastroenteritis and Mr Eversfield blamed her illness on food from the hotel. Mr Dillon said he could not be certain food poisoning responsible for Ms Sonnex's death. The evidence doesn't allow me to do so. While both Mrs Sonnex and Mr Eversfield, from Ramsgate, fell ill at the same time, her symptoms presented as more acute. An undiagnosed, unknown medical condition may have also contributed to her death, the court heard. Dr Kareem Aboualfa, a pathologist from the William Harvey Hospital in Ashford, performed the autopsy and concluded Ms Sonnex's cause of death was 'most likely to be gastroenteritis'. After the inquest Mr Eversfield said: 'It's not really what I wanted. I really wanted to have an open verdict. Had we not been ill she wouldn't have died and she'd be here today. It's now 15 months after she died and we're really not any clearer than we were 15 months ago The court heard they had been on a Thomas Cook holiday. The hotel said other guests ate similar meals without any symptoms. A Thomas Cook spokeswoman said it: 'Provided immediate support to the family at the time. Our head of customer welfare stayed in touch with Mr Eversfield and continued to offer support in the months following. Egypt holidaymaker 'died of gastroenteritis'. Diarrhoea and vomiting - NHS. Image source, Facebook. More on this story. Related internet links. Thomas Cook.
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Official websites use. Share sensitive information only on official, secure websites. Hypertension is a common condition, which is highly prevalent amongst scuba divers. In this article, we review available literature on the possible risks of diving in the presence of hypertension and antihypertensive drugs. Guidelines are presented for the diving physician for the selection of divers with hypertension suitable for diving, along with advice on antihypertensive treatment best compatible with scuba diving. Of the total divers, 4. In this perspective paper, we review available literature on the medical relevance of hypertension and antihypertensive drugs for scuba diving and provide practical advice for counselling divers with hypertension. This is based on best available evidence and expert opinions. From this, a literature summary was composed, and recommendations were drafted. This was limited to recreational scuba diving, thus excluding occupational and breath-hold diving. The findings were presented at an international educational meeting on diving medicine with various attending experts in May mini-congress on diving medicine by Capita Selecta Duikgeneeskunde in Marsa Alam, Egypt. A revised draft including practical recommendations was then submitted for review by members from the Dutch Society for Diving Medicine and a final set of recommendations was adopted as a national recommendation for diving with hypertension and antihypertensive drugs at the Society meeting of 09 December For the current paper, the search was repeated on 30 May In PubMed, hits were assessed for an applicability based on the abstract. In the Rubicon Research Repository, 43 hits were reviewed for applicability. Various observations have been published only in abstract form after presentation at scientific conferences, without having been published as a full article. These were included in this overview and designated as 'abstract' in the reference list. In cases of suspected situational hypertension, also known as 'white coat hypertension', the use of home blood pressure measurement or and hour ambulatory blood pressure measurement may be more reliable. Of note, subjects with situational hypertension are at increased vascular risk compared to true normotensives. Hypertension is a highly relevant risk factor for cardiovascular CV disease. The central aim of antihypertensive treatment is to prevent CV events. In low-risk individuals, the absolute risk reduction may be too small to justify treatment. Therefore, the indication for antihypertensive treatment depends not only on the grade of hypertension, but also on the overall absolute risk for a CV event. According to current ESC guidelines, all patients with hypertension grade 2 or higher should receive antihypertensive drug intervention irrespective of cardiovascular risk. If their CV risk is high, drug treatment should be initiated. If their risk is low to moderate, the effect of life style interventions may first be observed. More rarely used antihypertensive drugs are alpha-blockers, renin inhibitors, endothelin-inhibitors, alpha-2 adrenergic receptor agonists and direct-acting vasodilators. These will be considered beyond the scope of this article. Appropriate lifestyle changes may prevent or help treat hypertension. The following lifestyle measures are recommended:. Increased consumption of vegetables, fresh fruits, fish, nuts, unsaturated fatty acids olive oil , low consumption of red meat, and consumption of low-fat dairy products;. Lifestyle interventions are recommended for all subjects with hypertension. The presence of hypertension is likely to be aggravated during recreational diving through several mechanisms:. Immersion, as this leads to a fluid shift from the extremities to the central core. This fluid shift has been estimated to comprise approximately — ml;\[ 8 \]. Peripheral vasoconstriction, particularly when diving in cold water conditions, which will exacerbate the central pooling of blood and thereby the increase in central blood pressure;\[ 9 \]. Exercise, which may temporarily increase arterial blood pressure substantially. As a consequence, a significantly elevated blood pressure prior to a dive may accumulate to a cardiovascular strain that could elicit a cardiovascular event. After a dive, systemic blood pressure is unchanged compared to the pre-dive values. In addition to the above, there is also the effect of activity related stress psychological , which is significant among novice divers and directly proportionate to the level of general physical fitness. Environmental conditions will also affect the conditions of exercise and stress levels thus potentially affecting blood pressure levels. Of note, this implies that there may be subjects with a low CV risk and a systolic blood pressure between and mmHg that are not receiving drug treatment, but therefore should not dive. Alternatively, these subjects could consider taking antihypertensive drugs to be allowed to dive. There is substantial evidence suggesting that hypertensive subjects may be more prone to develop immersion pulmonary oedema IPO. Hypertension was found to be relatively prevalent in a study of underlying predisposing factors in patients with IPO. In an animal experiment, decompression sickness was found to occur more than twice as often in spontaneous hypertensive rats than in control rats. A substantial proportion of scuba-diving related incidents and fatalities are related to cardiovascular events. In some cases of diving fatalities, hypertensive cardiomyopathy or hypertensive atherosclerotic vascular disease were indeed specifically identified as the suspected cause of death. Pulmonary symptoms, particularly a dry cough, may occur as a side effect for this drug class, which should be carefully evaluated. Otherwise, few specific diving-related risks are expected from this drug class, if well tolerated by the diver. Few specific diving-related risks are expected from this drug class, if well tolerated by the diver. Ca-A are vasodilators that act on smooth muscle cells in the arterial wall. A common side effect is orthostatic hypotension. A specific diving-related risk may involve a sudden drop in blood pressure when exiting the water as the central blood pooling effect of immersion is reversed at a time when the circulating blood volume has been reduced during the dive. Divers using Ca-A may be needed to take specific care to gradually exit the water to allow for blood pressure adaption during emersion. Otherwise, there are no specific diving-related risks. In the treatment of hypertension, the most commonly used diuretics are thiazide diuretics. These have a modest effect on water clearance and plasma volume contraction. Dehydration is commonly thought to be a risk factor for decompression sickness. Of note, although there is a strong theoretical basis for this notion, the scientific evidence is very limited with conflicting results in animal models\[ 19 - 21 \] and only small supportive human studies. In the hypovolemic state, thiazide-induced electrolyte disturbances may also become more likely to occur. Beta-blockers may adversely affect diving safety through multiple mechanisms. First, beta blockers may cause chronotropic incompetence of the heart by limiting heart rate modulation during exercise. This may impair exercise capacity. It is recommended that certain antihypertensive drugs may be preferred to others in the context of scuba diving, and participation in scuba diving may be of consequence for antihypertensive treatment choices. It is recommended that divers with hypertension should dive with an increased margin of safety to lower the risk of decompression sickness. It is recommended that divers with hypertension be informed about the symptoms of IPO and receive specific instructions to immediately abort a dive in case of these symptoms. Treatment of first choice for divers, if well-tolerated with specific attention to pulmonary symptoms. Emphasize the importance of hydrating properly before and after diving. Hypertension is prevalent amongst scuba divers and many divers use antihypertensive drugs. Hypertension may be aggravated by immersion and is associated with endothelial dysfunction and increased cardiovascular risk. This may increase the susceptibility to diving related illnesses and this is indeed observed in accident statistics. A specific concern is an increased risk for immersion pulmonary oedema. Antihypertensive drugs could influence diving safety. Less preferred are beta-blockers and diuretics. As a library, NLM provides access to scientific literature. Diving Hyperb Med. Find articles by Peter E Westerweel. Find articles by Rienk Rienks. Find articles by Ahmed Sakr. Find articles by Adel Taher. This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms. Conflict of interest and funding: nil. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.
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