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Altitude sickness

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https://www.readbyqxmd.com/read/29136449/does-this-patient-have-acute-mountain-sickness-the-rational-clinical-examination-systematic-review
#1
David Meier, Tinh-Hai Collet, Isabella Locatelli, Jacques Cornuz, Bengt Kayser, David L Simel, Claudio Sartori
Importance: Acute mountain sickness (AMS) affects more than 25% of individuals ascending to 3500 m (11 500 ft) and more than 50% of those above 6000 m (19 700 ft). AMS may progress from nonspecific symptoms to life-threatening high-altitude cerebral edema in less than 1% of patients. It is not clear how to best diagnose AMS. Objective: To systematically review studies assessing the accuracy of AMS diagnostic instruments, including the visual analog scale (VAS) score, which quantifies the overall feeling of sickness at altitude (VAS[O]; various thresholds), Acute Mountain Sickness-Cerebral score (AMS-C; ≥0...
November 14, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29130390/investigation-of-the-differences-between-the-tibetan-and-han-populations-in-the-hemoglobin-oxygen-affinity-of-red-blood-cells-and-in-the-adaptation-to-high-altitude-environments
#2
Cuiying Li, Xiaowei Li, Juan Liu, Xiu Fan, Guoxing You, Lian Zhao, Hong Zhou, Jingqi Li, Huifen Lei
OBJECTIVE: High altitude is characterized by low oxygen pressure, resulting in multiple adaptive responses. Tibetans who have lived in the plateau for thousands of years have developed unique phenotypes, such as downregulation of the HIF pathway through EPAS1 and EGLN1 gene mutation. However, the changes of hemoglobin-oxygen affinity under hypoxia environment remain elusive. METHODS: A blood cell analyzer and a blood oxygen analyzer were used to conduct routine blood tests and measure the oxygen affinity P50 in in the Han population that rapidly entered the plateau (for 3-7 days), the plateau-acclimatized Han population (residing for 30 days on the plateau), the plateau Han population (more than 10 years on the plateau), and the Tibetan population...
November 12, 2017: Hematology (Amsterdam, Netherlands)
https://www.readbyqxmd.com/read/29100088/natural-selection-on-genes-related-to-cardiovascular-health-in-high-altitude-adapted-andeans
#3
Jacob E Crawford, Ricardo Amaru, Jihyun Song, Colleen G Julian, Fernando Racimo, Jade Yu Cheng, Xiuqing Guo, Jie Yao, Bharath Ambale-Venkatesh, João A Lima, Jerome I Rotter, Josef Stehlik, Lorna G Moore, Josef T Prchal, Rasmus Nielsen
The increase in red blood cell mass (polycythemia) due to the reduced oxygen availability (hypoxia) of residence at high altitude or other conditions is generally thought to be beneficial in terms of increasing tissue oxygen supply. However, the extreme polycythemia and accompanying increased mortality due to heart failure in chronic mountain sickness most likely reduces fitness. Tibetan highlanders have adapted to high altitude, possibly in part via the selection of genetic variants associated with reduced polycythemic response to hypoxia...
November 2, 2017: American Journal of Human Genetics
https://www.readbyqxmd.com/read/29042272/effects-of-dietary-nitrate-on-respiratory-physiology-at-high-altitude-results-from-the-xtreme-alps-study
#4
Andrew F Cumpstey, Philip J Hennis, Edward T Gilbert-Kawai, Bernadette O Fernandez, Matthieu Poudevigne, Alexandra Cobb, Paula Meale, Kay Mitchell, Helen Moyses, Helmut Pöhnl, Monty G Mythen, Michael P W Grocott, Martin Feelisch, Daniel S Martin
Nitric oxide (NO) production plays a central role in conferring tolerance to hypoxia. Tibetan highlanders, successful high-altitude dwellers for millennia, have higher circulating nitrate and exhaled NO (ENO) levels than native lowlanders. Since nitrate itself can reduce the oxygen cost of exercise in normoxia it may confer additional benefits at high altitude. Xtreme Alps was a double-blinded randomised placebo-controlled trial to investigate how dietary nitrate supplementation affects physiological responses to hypoxia in 28 healthy adult volunteers resident at 4559 m for 1 week; 14 receiving a beetroot-based high-nitrate supplement and 14 receiving a low-nitrate 'placebo' of matching appearance/taste...
October 16, 2017: Nitric Oxide: Biology and Chemistry
https://www.readbyqxmd.com/read/29029226/new-insights-into-the-genetic-basis-of-monge-s-disease-and-adaptation-to-high-altitude
#5
Tsering Stobdan, Ali Akbari, Priti Azad, Dan Zhou, Orit Poulsen, Otto Appenzeller, Gustavo F Gonzales, Amalio Telenti, Emily H M Wong, Shubham Saini, Ewen F Kirkness, J Craig Venter, Vineet Bafna, Gabriel G Haddad
Human high-altitude (HA) adaptation or mal-adaptation is explored to understand the physiology, pathophysiology and molecular mechanisms that underlie long-term exposure to hypoxia. Here we report the results of an analysis of the largest whole-genome-sequencing of Chronic Mountain Sickness (CMS) and non-CMS individuals, identified candidate genes and functionally validated these candidates in a genetic model system (Drosophila). We used PreCIOSS algorithm that uses Haplotype Allele Frequency score to separate haplotypes carrying the favored allele from the non-carriers and accordingly prioritize genes associated with the CMS or non-CMS phenotype...
September 19, 2017: Molecular Biology and Evolution
https://www.readbyqxmd.com/read/29021909/managing-diabetes-at-high-altitude-personal-experience-with-support-from-a-multidisciplinary-physical-activity-and-diabetes-clinic
#6
Gary Malcolm, Sian Rilstone, Sivasujan Sivasubramaniyam, Carol Jairam, Stephen Chew, Nick Oliver, Neil E Hill
OBJECTIVE: Physical activity is important for well-being but can be challenging for people with diabetes. Data informing support of specialist activities such as climbing and high-altitude trekking are limited. A 42-year-old man with type 1 diabetes (duration 30 years) attended a Multidisciplinary Physical Activity and Diabetes Clinic planning to climb Mont Blanc during the summer and trek to Everest Base Camp in the autumn. His aims were to complete these adventures without his diabetes impacting on their success...
2017: BMJ Open Sport & Exercise Medicine
https://www.readbyqxmd.com/read/28986453/reduced-cardiac-calcineurin-expression-mimics-long-term-hypoxia-induced-heart-defects-in-drosophila
#7
Rachel Zarndt, Stanley M Walls, Karen Ocorr, Rolf Bodmer
BACKGROUND: Hypoxia is often associated with cardiopulmonary diseases, which represent some of the leading causes of mortality worldwide. Long-term hypoxia exposures, whether from disease or environmental condition, can cause cardiomyopathy and lead to heart failure. Indeed, hypoxia-induced heart failure is a hallmark feature of chronic mountain sickness in maladapted populations living at high altitude. In a previously established Drosophila heart model for long-term hypoxia exposure, we found that hypoxia caused heart dysfunction...
October 2017: Circulation. Cardiovascular Genetics
https://www.readbyqxmd.com/read/28951950/high-altitude-adaptation-in-humans-from-genomics-to-integrative-physiology
#8
REVIEW
Priti Azad, Tsering Stobdan, Dan Zhou, Iain Hartley, Ali Akbari, Vineet Bafna, Gabriel G Haddad
About 1.2 to 33% of high-altitude populations suffer from Monge's disease or chronic mountain sickness (CMS). Number of factors such as age, sex, and population of origin (older, male, Andean) contribute to the percentage reported from a variety of samples. It is estimated that there are around 83 million people who live at altitudes > 2500 m worldwide and are at risk for CMS. In this review, we focus on a human "experiment in nature" in various high-altitude locations in the world-namely, Andean, Tibetan, and Ethiopian populations that have lived under chronic hypoxia conditions for thousands of years...
December 2017: Journal of Molecular Medicine: Official Organ of the "Gesellschaft Deutscher Naturforscher und Ärzte"
https://www.readbyqxmd.com/read/28949829/performance-mood-and-anxiety-during-a-climb-of-mount-everest
#9
Heikki M Karinen, Martti T Tuomisto
Karinen, Heikki M., and Martti T. Tuomisto. Performance, mood, and anxiety during a climb of Mount Everest. High Alt Med Biol. 16:000-000, 2017. BACKGROUND: Various studies have shown the deleterious effects of high-altitude hypoxia on visual, motor, somatosensory, cognitive, and emotional function and also in intelligence tests, reaction time, speech comprehension, hand steadiness, visual contrast discrimination, and word association tests. Because optimal cognitive abilities may be crucial for mountain climbers' safety, this study was intended to evaluate the changes in cognitive performance, mood, and anxiety during an Everest expedition lasting almost 3 months...
September 26, 2017: High Altitude Medicine & Biology
https://www.readbyqxmd.com/read/28947454/relationship-of-altitude-mountain-sickness-and-smoking-a-catalan-traveller-s-cohort-study
#10
Alba Sánchez-Mascuñano, Cristina Masuet-Aumatell, Sergio Morchón-Ramos, Josep M Ramon
OBJECTIVES: The aim of this study is to analyse the relationship between smoking and altitude mountain sickness in a cohort of travellers to 2500 metres above sea level (masl) or higher. SETTING: Travel Health Clinic at the Hospital Universitari de Bellvitge, in Barcelona, Spain. PARTICIPANTS: A total of 302 adults seeking medical advice at the travel clinic, between July 2012 and August 2014, before travelling to 2500 masl or above, who agreed to participate in the study and to be contacted after the trip were included...
September 24, 2017: BMJ Open
https://www.readbyqxmd.com/read/28919307/a-journey-between-high-altitude-hypoxia-and-critical-patient-hypoxia-what-can-it-teach-us-about-compression-and-the-management-of-critical-disease
#11
M L Avellanas Chavala
High altitude sickness (hypobaric hypoxia) is a form of cellular hypoxia similar to that suffered by critically ill patients. The study of mountaineers exposed to extreme hypoxia offers the advantage of involving a relatively homogeneous and healthy population compared to those typically found in Intensive Care Units (ICUs), which are heterogeneous and generally less healthy. Knowledge of altitude physiology and pathology allows us to understanding how hypoxia affects critical patients. Comparable changes in mitochondrial biogenesis between both groups may reflect similar adaptive responses and suggest therapeutic interventions based on the protection or stimulation of such mitochondrial biogenesis...
September 14, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28870508/inappropriate-dexamethasone-use-by-a-trekker-in-nepal-a-case-report
#12
Nicholas R Haslam, Rachel Garth, Nicola Kelly
We present a case of inappropriate dexamethasone use in a trekker in the Everest region of Nepal. We aim to increase awareness among health professionals of the possible use of this medication by trekkers and promote knowledge of potential complications. In this case, a previously altitude-naive trekker was prescribed prophylactic dexamethasone by physicians in a Western travel clinic before high-altitude trekking in Nepal. There were no indications for prophylactic medication nor for the use of dexamethasone...
September 1, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28860167/measuring-high-altitude-adaptation
#13
Lorna G Moore
High altitudes (>8000 ft or 2500 m) provide an experiment of nature for measuring adaptation and the physiological processes involved. Studies conducted over the past ~25 years in Andeans, Tibetans, and less often Ethiopians show varied but distinct O2 transport traits from those of acclimatized newcomers, providing indirect evidence for genetic adaptation to high altitude. Short-term (acclimatization, developmental) and long-term (genetic) responses to high altitude exhibit a temporal gradient such that, while all influence O2 content, the latter also improve O2 delivery and metabolism...
August 31, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28857147/safety-and-ergogenic-properties-of-combined-aminophylline-and-ambrisentan-in-hypoxia
#14
Thies Schroeder, Claude A Piantadosi, Michael J Natoli, Julie Autmizguine, Michael Cohen-Wolkowieczs, Karyn L Hamilton, Christopher Bell, Jelena Klawitter, Uwe Christians, David C Irwin, Robert J Noveck
We hypothesized that concomitant pharmacological inhibition of the endothelin and adenosine pathway is safe and improves exercise performance in hypoxic humans, via a mechanism that does not involve augmentation of blood oxygenation. To test this hypothesis, we established safety and drug interactions for aminophylline (500mg) plus ambrisentan (5mg) in normoxic volunteers. Subsequently, a placebo-controlled study was employed to test the combination in healthy resting and exercising volunteers at simulated altitude (4,267m)...
August 31, 2017: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28832689/incidence-and-severity-of-acute-mountain-sickness-and-associated-symptoms-in-children-trekking-on-xue-mountain-taiwan
#15
Fei-Ying Cheng, Mei-Jy Jeng, Yin-Chou Lin, Shih-Hao Wang, Shih-Hao Wu, Wen-Cheng Li, Kuo-Feng Huang, Te-Fa Chiu
BACKGROUND: Acute mountain sickness (AMS) occurs in non-acclimatized people after an acute ascent to an altitude of 2,500 m or higher. The aim of this study was to examine the incidence and severity of AMS and associated symptoms in children. METHODS: The prospective observational study included 197 healthy, non-acclimatized 11 and 12-year-old children trekking the round-trip from the trailhead to the summit of Xue Mountain, Taiwan (2,179 m to 3,886 m) over 3 days...
2017: PloS One
https://www.readbyqxmd.com/read/28828048/initial-evaluation-and-key-principles-of-critically-ill-pediatric-patient-aerial-transport
#16
Constanta Pick
Recent advances in more efficient communications, modern telemedicine systems, medical progress, better training of the medical professionals with the possibility of sub-specialisation has led to shorter transfer times in safer conditions of this and overall affording a better chance of survival. High altitude air transport has considerable implications on the respiratory system's efficiency. Caregiver selection is key in avoiding the dangers of debilitating altitude sickness on the medical team. Minimizing physiological or anatomical derangements and minimizing potential complications in the very small critically ill patients while achieving short transfer times are major objectives...
December 2016: Mædica
https://www.readbyqxmd.com/read/28810963/treating-decompression-sickness-military-flight-simulation-site-community-hospital-partnership
#17
Whitney C Rhodes, George Hertner, Robert Price, Lani Finck, Claudia Temmer, Tracy Cushing, Kathleen Flarity
BACKGROUND: High-altitude flight simulation familiarizes military trainees with the symptoms of hypoxia to prepare them for emergency situations. Decompression sickness (DCS) can occur as a result of these simulations. In cases when ground-level supplemental oxygen does not resolve symptoms, hyperbaric oxygen (HBO) therapy is indicated. Many military hyperbaric chambers have been closed because of cost reductions, necessitating partnerships with community hospitals to ensure access to treatment...
July 2017: Military Medicine
https://www.readbyqxmd.com/read/28810235/obesity-as-a-conditioning-factor-for-high-altitude-diseases
#18
Rocío San Martin, Julio Brito, Patricia Siques, Fabiola León-Velarde
Obesity, a worldwide epidemic, has become a major health burden because it is usually accompanied by an increased risk for insulin resistance, diabetes, hypertension, cardiovascular diseases, and even some kinds of cancer. It also results in associated increases in healthcare expenditures and labor and economic consequences. There are also other fields of medicine and biology where obesity or being overweight play a major role, such as high-altitude illnesses (acute mountain sickness, hypoxic pulmonary hypertension, and chronic mountain sickness), where an increasing relationship among these two morbid statuses has been demonstrated...
2017: Obesity Facts
https://www.readbyqxmd.com/read/28798201/remote-ischemic-preconditioning-does-not-prevent-acute-mountain-sickness-after-rapid-ascent-to-3450-m
#19
Marc M Berger, Franziska Macholz, Lukas Lehmann, Daniel Dankl, Marcel Hochreiter, Bernhard Bacher, Peter Bärtsch, Heimo Mairbäurl
Remote ischemic preconditioning (RIPC) has been shown to protect remote organs, such as the brain and the lung, from damage induced by subsequent hypoxia or ischemia. Acute mountain sickness (AMS) is a syndrome of non-specific neurologic symptoms and in high altitude pulmonary edema excessive hypoxic pulmonary vasoconstriction (HPV) plays a pivotal role. We hypothesized that RIPC protects the brain from AMS and attenuates the magnitude of HPV after rapid ascent to 3450 m. Forty non-acclimatized volunteers were randomized into 2 groups...
August 10, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28781177/impact-of-a-newly-constructed-motor-vehicle-road-on-altitude-illness-in-the-nepal-himalayas
#20
Jonathan Reisman, Dinesh Deonarain, Buddha Basnyat
OBJECTIVE: This study investigated the impact that motor vehicle travel along a newly constructed road has on altitude illness (including acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema). The new road from Besisahar (760 m) to Manang (3540 m) in Nepal was completed in December 2014. METHODS: We enrolled all patients diagnosed with altitude illness at the Himalayan Rescue Association Manang clinic in fall 2016. Phi coefficients were calculated to test for an association between Nepali ethnicity and rapid ascent by motor vehicle...
August 3, 2017: Wilderness & Environmental Medicine
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