Migraine headache confounding the diagnosis of acute mountain sickness

Recommendations for traveling to altitude with neurological disorders

BACKGROUND

Several neurological conditions might worsen with the exposure to high altitude (HA). The aim of this review was to summarize the available knowledge on the neurological HA illnesses and the risk for people with neurological disorders to attend HA locations.

METHODS

A search of literature was conducted for several neurological disorders in PubMed and other databases since 1970. The neurological conditions searched were migraine, different cerebrovascular disease, intracranial space occupying mass, multiple sclerosis, peripheral neuropathies, neuromuscular disorders, epileptic seizures, delirium, dementia, and Parkinson's disease (PD).

RESULTS

Attempts were made to classify the risk posed by each condition and to provide recommendations regarding medical evaluation and advice for or against traveling to altitude. Individual cases should be advised after careful examination and risk evaluation performed either in an outpatient mountain medicine service or by a physician with knowledge of HA risks. Preliminary diagnostic methods and anticipation of neurological complications are needed.

CONCLUSIONS

Our recommendations suggest absolute contraindications to HA exposure for the following neurological conditions: (1) Unstable conditions-such as recent strokes, (2) Diabetic neuropathy, (3) Transient ischemic attack in the last month, (4) Brain tumors, and 5. Neuromuscular disorders with a decrease of forced vital capacity >60%. We consider the following relative contraindications where decision has to be made case by case: (1) Epilepsy based on recurrence of seizure and stabilization with the therapy, (2) PD (± obstructive sleep apnea syndrome-OSAS), (3) Mild Cognitive Impairment (± OSAS), and (4) Patent foramen ovale and migraine have to be considered risk factors for acute mountain sickness.

Magnetic cobalt-embedded carbon nitride composite derived from one-dimensional coordination polymer as an efficient catalyst for activating oxone to degrade methyltheobromine in water

As methyltheobromine (MTB) has been increasingly detected in wastewater, it would be necessary to develop more intensive and effective approaches to remove MTB. As Co species immobilized on carbonaceous materials appears as a promising catalyst, doping carbon with nitrogen has been also validated to significantly enhance catalytic activities for Oxone activation. Therefore, it is desired to develop a composite of immobilizing Co species on N-doped carbonaceous supports for activating Oxone to degrade MTB. Unfortunately, very few studies have demonstrated such composites for activating Oxone to degrade MTB as this type of composites are conventionally prepared via complex procedures. Alternatively, this study aims to develop such a composite conveniently by using a cobaltic coordination polymer (CP) as a precursor. Specifically Co²⁺ and 4,4-bipyridine (BIPY) are selected for formulating a special one-dimensional CP, which is then carbonized to convert Co to Co nanoparticles (NPs) and transform BIPY to carbon nitride (CN) matrices. Because of 1-D coordinated structure of CoBIPY, the resulting magnetic Co NPs are well-distributed and protected within CN to form a magnetic Co-embedded carbon nitride composite (MCoCN). In comparison to pristine CN and Co₃O_4, MCoCN exhibits much higher catalytic activities to activate Oxone for degrading MTB completely within 7 min. MCoCN also shows a much lower activation energy of 24.6 kJ/mol than other reported catalysts for activating Oxone to degrade MTB. The findings of this study validate that the 1-D coordination polymer of CoBIPY is a useful precursor to prepare MCoCN for effectively activating Oxone to degrade MTB.

Characteristics of Headache and Relationship to Acute Mountain Sickness at 4559 Meters

The goals of this study were to characterize headache at high altitude in relation to the severity of acute mountain sickness (AMS), to investigate whether a history of migraine or nonmigrainous headache at low altitude is a risk factor for AMS and to estimate its effect size in relation to established major risk factors. We performed a secondary, extended analysis of data obtained from 1320 mountaineers staying overnight at the Capanna Margherita (4559 m). Headache at low and high altitude was classified according to the criteria of the International Headache Society. About 45% of the mountaineers suffered from headache in the evening of the arrival day at 4559 m. In those with headache, tension type headache decreased from 62% to 29% and 13% with no AMS (AMS-C <0.70), moderate AMS, and more severe AMS (AMS-C ≥1.5), while headache fulfilling the criteria of migraine increased correspondingly from 14% to 34% and 69%. A history of migraine or any type of headache at low altitude is a minor predictor of AMS that does not significantly contribute to AMS risk in a multivariate analysis including the major risk factors such as history of AMS, rate of ascent, and degree of preacclimatization in this population of alpine mountaineers. The association between more severe AMS and migrainous headache may be due to common nonspecific symptoms but a common underlying pathophysiology of AMS and migraine cannot be excluded. Despite this association a history of migraine or other headache at low altitude is not a major risk factor for AMS.

Efficient elimination of caffeine from water using Oxone activated by a magnetic and recyclable cobalt/carbon nanocomposite derived from ZIF-67

To eliminate caffeine, one of the most common pharmaceuticals and personal care products, from water, Oxone (peroxymonosulfate salt) was proposed to degrade it.

Wilderness medicine at high altitude: recent developments in the field

Travel to high altitude is increasingly popular. With this comes an increased incidence of high-altitude illness and therefore an increased need to improve our strategies to prevent and accurately diagnose these. In this review, we provide a summary of recent advances of relevance to practitioners who may be advising travelers to altitude. Although the Lake Louise Score is now widely used as a diagnostic tool for acute mountain sickness (AMS), increasing evidence questions the validity of doing so, and of considering AMS as a single condition. Biomarkers, such as brain natriuretic peptide, are likely correlating with pulmonary artery systolic pressure, thus potential markers of the development of altitude illness. Established drug treatments include acetazolamide, nifedipine, and dexamethasone. Drugs with a potential to reduce the risk of developing AMS include nitrate supplements, propagators of nitric oxide, and supplemental iron. The role of exercise in the development of altitude illness remains hotly debated, and it appears that the intensity of exercise is more important than the exercise itself. Finally, despite copious studies demonstrating the value of preacclimatization in reducing the risk of altitude illness and improving performance, an optimal protocol to preacclimatize an individual remains elusive.

General Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure

Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.