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Bhattacharya S, Agarwal S, Shrimali NM, Guchhait P. Interplay between hypoxia and inflammation contributes to the progression and severity of respiratory viral diseases. Mol Aspects Med 2021; 81:101000. [PMID: 34294412 PMCID: PMC8287505 DOI: 10.1016/j.mam.2021.101000] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/07/2021] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
History of pandemics is dominated by viral infections and specifically respiratory viral diseases like influenza and COVID-19. Lower respiratory tract infection is the fourth leading cause of death worldwide. Crosstalk between resultant inflammation and hypoxic microenvironment may impair ventilatory response of lungs. This reduces arterial partial pressure of oxygen, termed as hypoxemia, which is observed in a section of patients with respiratory virus infections including SARS-CoV-2 (COVID-19). In this review, we describe the interplay between inflammation and hypoxic microenvironment in respiratory viral infection and its contribution to disease pathogenesis.
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Affiliation(s)
- Sulagna Bhattacharya
- Regional Centre for Biotechnology, National Capital Region Biotech Science Cluster, Faridabad, India; School of Biotechnology, Kalinga Institute of Industrial Technology, Orissa, India
| | - Sakshi Agarwal
- Regional Centre for Biotechnology, National Capital Region Biotech Science Cluster, Faridabad, India
| | - Nishith M Shrimali
- Regional Centre for Biotechnology, National Capital Region Biotech Science Cluster, Faridabad, India
| | - Prasenjit Guchhait
- Regional Centre for Biotechnology, National Capital Region Biotech Science Cluster, Faridabad, India.
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2
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Point-of-Care Ultrasound Diagnosis of Acute High Altitude Illness: A Case Report. Wilderness Environ Med 2021; 32:204-209. [DOI: 10.1016/j.wem.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 02/04/2023]
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3
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Luenam A, Puttanapong N. Modelling and analyzing spatial clusters of leptospirosis based on satellite-generated measurements of environmental factors in Thailand during 2013-2015. GEOSPATIAL HEALTH 2020; 15. [PMID: 33461266 DOI: 10.4081/gh.2020.856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 08/22/2020] [Indexed: 06/12/2023]
Abstract
This study statistically identified the association of remotely sensed environmental factors, such as Land Surface Temperature (LST), Night Time Light (NTL), rainfall, the Normalised Difference Vegetation Index (NDVI) and elevation with the incidence of leptospirosis in Thailand based on the nationwide 7,495 confirmed cases reported during 2013-2015. This work also established prediction models based on empirical findings. Panel regression models with random-effect and fixed-effect specifications were used to investigate the association between the remotely sensed environmental factors and the leptospirosis incidence. The Local Indicators of Spatial Association (LISA) statistics were also applied to detect the spatial patterns of leptospirosis and similar results were found (the R2 values of the random-effect and fixed-effect models were 0.3686 and 0.3684, respectively). The outcome thus indicates that remotely sensed environmental factors possess statistically significant contribution in predicting this disease. The highest association in 3 years was observed in LST (random- effect coefficient = -9.787, P<0.001; fixed-effect coefficient = -10.340, P=0.005) followed by rainfall (random-effect coefficient = 1.353, P<0.001; fixed-effect coefficient = 1.347, P<0.001) and NTL density (random-effect coefficient = -0.569, P=0.004; fixed-effect coefficient = -0.564, P=0.001). All results obtained from the bivariate LISA statistics indicated the localised associations between remotely sensed environmental factors and the incidence of leptospirosis. Particularly, LISA's results showed that the border provinces in the northeast, the northern and the southern regions displayed clusters of high leptospirosis incidence. All obtained outcomes thus show that remotely sensed environmental factors can be applied to panel regression models for incidence prediction, and these indicators can also identify the spatial concentration of leptospirosis in Thailand.
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Affiliation(s)
- Amornrat Luenam
- Faculty of Public and Environmental Health, Huachiew Chalermprakiet University, Samut Prakan.
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4
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Kumar M, Nishad DK, Kumar A, Bhatnagar A, Karwasra R, Khanna K, S K, Sharma D, Dua K, Mudaliyar V, Sharma N. Enhancement in brain uptake of vitamin D 3 nanoemulsion for treatment of cerebral ischemia: formulation, gamma scintigraphy and efficacy study in transient middle cerebral artery occlusion rat models. J Microencapsul 2020; 37:492-501. [PMID: 32715833 DOI: 10.1080/02652048.2020.1801870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM For the treatment of cerebral ischaemia, vitamin-D3 loaded nanoemulsions were developed. METHOD Tween 20 and polyethylene glycol were chosen as surfactant/co-surfactant, while oleic acid as the oil phase. The formulation was characterised for various in-vitro parameters. Targeting efficiency was investigated through radiometry, gamma scintigraphy and efficacy was studied in transient middle cerebral artery occlusion (MCAo) rat model. RESULT Vitamin D3-nanoemulsion showed a mean size range of 49.29 ± 10.28 nm with polydispersity index 0.17 ± 0.04 and zeta potential 13.77 mV. The formulation was found stable during thermodynamic stability study and permeated within 180 min through sheep nasal mucosa (permeation coefficient 7.873 ± 0.884 cm/h). Gamma scintigraphy and radiometry assay confirmed better percentage deposition (2.53 ± 0.17%) of 99mTc-vitamin D3-nanoemulsion through nasal route compared to IV administered 99mTc-vitamin D3 solution (0.79 ± 0.03%). Magnetic Resonance Imaging (MRI) of the ischaemic model confirmed better efficacy of vitamin D3-nanoemulsion. CONCLUSION This work demonstrated better permeation, deposition, and efficacy of vitaminD3-nanoemulsion through the intranasal route.
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Affiliation(s)
- Mukesh Kumar
- Department of Pharmaceutical Technology, Meerut Institute of Engineering & Technology, Meerut, India.,Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Dhruv Kumar Nishad
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Anoop Kumar
- Department of Pharmaceutical Technology, Meerut Institute of Engineering & Technology, Meerut, India
| | - Aseem Bhatnagar
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Ritu Karwasra
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Kushagra Khanna
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Keerthana S
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Deeksha Sharma
- Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia.,Centre for Inflammation, Centenary Institute, Royal Prince Alfred Hospital, Sydney, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI) & School of Biomedical Sciences and Pharmacy, The University of Newcastle (UoN), Callaghan, Australia
| | - Vijaybabu Mudaliyar
- Department of Pharmaceutical Technology, Meerut Institute of Engineering & Technology, Meerut, India
| | - Nitin Sharma
- Department of Pharmaceutical Technology, Meerut Institute of Engineering & Technology, Meerut, India.,Department of Drug Development, Institute of Nuclear Medicine & Allied Sciences, DRDO (Ministry of Defence), New Delhi, India
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5
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Joyce KE, Weaver SR, Lucas SJE. Geographic components of SARS-CoV-2 expansion: a hypothesis. J Appl Physiol (1985) 2020; 129:257-262. [PMID: 32702272 PMCID: PMC7414234 DOI: 10.1152/japplphysiol.00362.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
The emergence of COVID-19 infection (caused by the SARS-CoV-2 virus) in Wuhan, China in the latter part of 2019 has, within a relatively short time, led to a global pandemic. Amidst the initial spread of SARS-CoV-2 across Asia, an epidemiologic trend emerged in relation to high altitude (HA) populations. Compared with the rest of Asia, SARS-CoV-2 exhibited attenuated rates of expansion with limited COVID-19 infection severity along the Tibetan plateau. These characteristics were soon evident in additional HA regions across Bolivia, central Ecuador, Nepal, Bhutan, and the Sichuan province of mainland China. This mini-review presents a discussion surrounding attributes of the HA environment, aspects of HA physiology, as well as, genetic variations among HA populations which may provide clues for this pattern of SARS-CoV-2 expansion and COVID-19 infection severity. Explanations are provided in the hypothetical, albeit relevant historical evidence is provided to create a foundation for future research.
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Affiliation(s)
- Kelsey E Joyce
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Samuel R Weaver
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Samuel J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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6
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Dawadi S, Basnyat B, Adhikari S. A Review of Medical Problems in Himalayan Porters. High Alt Med Biol 2020; 21:109-113. [DOI: 10.1089/ham.2020.0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Suvash Dawadi
- Mountain Medicine Society of Nepal (MMSN), Kathmandu, Nepal
- CIWEC Hospital Pvt. Ltd., Kathmandu, Nepal
| | - Buddha Basnyat
- Mountain Medicine Society of Nepal (MMSN), Kathmandu, Nepal
- Oxford University Clinical Research Unit (OUCRU)-Kathmandu, Nepal
- Nepal International Clinic, Kathmandu, Nepal
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7
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Kühn C, Apel C, Bertsch D, Grass M, Gschwandtl C, Hundt N, Müller-Ost M, Risse J, Schmitz S, Sherpa K, Timmermann L, van der Giet M, van der Giet S, Wernitz K, Morrison A, Küpper T. Inpatient treatment of trekkers and Nepalese workers in the high-altitude environment of Mt. Everest Region 1996-2011: A retrospective analysis. Travel Med Infect Dis 2018; 31:101356. [PMID: 30502547 DOI: 10.1016/j.tmaid.2018.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/23/2018] [Accepted: 11/27/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The study investigates the diagnoses of inpatients (tourists and Nepali workers) of Kunde Hospital (Mt.Everest region) over 15 years. METHODS Records from January 1996 to September 2011 were analyzed concerning date, gender, age group, nationality, purpose of visit, diagnosis, length of treatment, and condition at discharge. Diagnoses were coded according to ICD-10-WHO 2010. Data were analyzed using descriptive statistics and non-parametric tests. P < 0.05 was defined as significant. RESULTS 479 inpatients were included: 363 (75.8%) males (202 trekkers (42.2%), 277 Nepalese workers (57.8%)). Most suffered from altitude sickness (45.5%), acute gastroenteritis (10.4%) or acute respiratory infection (8.4%). Severe cases of altitude sickness amongst trekkers decreased but increased amongst workers. Severe cases of acute gastroenteritis amongst trekkers increased. Mean length of inpatient treatment was 4.6 days ±2.7 days. 573/2030 days of treatment were caused by altitude sickness. 70 patients were evacuated, 9 died. CONCLUSION Altitude illness caused the majority of inpatient treatment and acute gastroenteritis may be an underestimated risk for both groups. Other severe problems were mostly illnesses, not trauma. Improved prevention strategies are needed for both groups. For tourists who often show pre-existing diseases this includes an individual pre-travel expert advice. Nepali workers should be instructed concerning acclimatization.
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Affiliation(s)
- Christian Kühn
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Christian Apel
- Department of Biohybrid and Medical Textiles, Institute of Applied Medical Engineering, Helmholtz Institute of Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Daniela Bertsch
- Department of Cardiology, Catholic Hospital Marienhof, Koblenz-Montabaur, Germany
| | - Maren Grass
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Carina Gschwandtl
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Nina Hundt
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Miriam Müller-Ost
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Julia Risse
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Sonja Schmitz
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Kami Sherpa
- Kunde Hospital, Solo Khumbu / Sagarmata National Park, Nepal
| | - Lisa Timmermann
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Michsel van der Giet
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Simone van der Giet
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Knut Wernitz
- Department of Dental Preservation, Parodontology& Preventive Dentistry, RWTH Aachen Technical University, Aachen, Germany
| | - Audry Morrison
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland; Royal Free London NHS Foundation Trust Royal Free London, UK
| | - Thomas Küpper
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany; Department of Dental Preservation, Parodontology& Preventive Dentistry, RWTH Aachen Technical University, Aachen, Germany.
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8
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Khanna K, Mishra KP, Ganju L, Kumar B, Singh SB. High-Altitude-Induced alterations in Gut-Immune Axis: A review. Int Rev Immunol 2017; 37:119-126. [PMID: 29231767 DOI: 10.1080/08830185.2017.1407763] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
High-altitude sojourn above 8000 ft is increasing day by day either for pilgrimage, mountaineering, holidaying or for strategic reasons. In India, soldiers are deployed to these high mountains for their duty or pilgrims visit to the holy places, which are located at very high altitude. A large population also resides permanently in high altitude regions. Every year thousands of pilgrims visit Holy cave of Shri Amarnath ji, which is above 15 000 ft. The poor acclimatization to high altitude may cause alteration in immunity. The low oxygen partial pressure may cause alterations in gut microbiota, which may cause changes in gut immunity. Effect of high altitude on gut-associated mucosal system is new area of research. Many studies have been carried out to understand the physiology and immunology behind the high-altitude-induced gut problems. Few interventions have also been discovered to circumvent the problems caused due to high-altitude conditions. In this review, we have discussed the effects of high-altitude-induced changes in gut immunity particularly peyer's patches, NK cells and inflammatory cytokines, secretary immunoglobulins and gut microbiota. The published articles from PubMed and Google scholar from year 1975 to 2017 on high-altitude hypoxia and gut immunity are cited in this review.
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Affiliation(s)
- Kunjan Khanna
- a Immunomodulation Division , Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO , Delhi , India
| | - K P Mishra
- a Immunomodulation Division , Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO , Delhi , India
| | - Lilly Ganju
- a Immunomodulation Division , Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO , Delhi , India
| | - Bhuvnesh Kumar
- a Immunomodulation Division , Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO , Delhi , India
| | - Shashi Bala Singh
- a Immunomodulation Division , Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO , Delhi , India
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Nuñez D, Olavegoya P, Gonzales GF, Gonzales-Castañeda C. Red Maca (Lepidium meyenii), a Plant from the Peruvian Highlands, Promotes Skin Wound Healing at Sea Level and at High Altitude in Adult Male Mice. High Alt Med Biol 2017; 18:372-383. [PMID: 28846044 DOI: 10.1089/ham.2017.0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Nuñez, Denisse, Paola Olavegoya, Gustavo F. Gonzales, and Cynthia Gonzales-Castañeda. Red maca (Lepidium meyenii), a plant from the Peruvian highlands, promotes skin wound healing at sea level and at high altitude in adult male mice. High Alt Med Biol 18:373-383, 2017.-Wound healing consists of three simultaneous phases: inflammation, proliferation, and remodeling. Previous studies suggest that there is a delay in the healing process in high altitude, mainly due to alterations in the inflammatory phase. Maca (Lepidium meyenii) is a Peruvian plant with diverse biological properties, such as the ability to protect the skin from inflammatory lesions caused by ultraviolet radiation, as well as its antioxidant and immunomodulatory properties. The aim of this study was to determine the effect of high altitude on tissue repair and the effect of the topical administration of the spray-dried extract of red maca (RM) in tissue repair. Studies were conducted in male Balb/c mice at sea level and high altitude. Lesions were inflicted through a 10 mm-diameter excisional wound in the skin dorsal surface. Treatments consisted of either (1) spray-dried RM extract or (2) vehicle (VH). Animals wounded at high altitude had a delayed healing rate and an increased wound width compared with those at sea level. Moreover, wounding at high altitude was associated with an increase in inflammatory cells. Treatment with RM accelerated wound closure, decreased the level of epidermal hyperplasia, and decreased the number of inflammatory cells at the wound site. In conclusion, RM at high altitude generate a positive effect on wound healing, decreasing the number of neutrophils and increasing the number of macrophages in the wound healing at day 7 postwounding. This phenomenon is not observed at sea level.
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Affiliation(s)
- Denisse Nuñez
- 1 Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia , Lima, Peru .,2 Research Circle on Plants with Effects on Health , Lima, Peru
| | - Paola Olavegoya
- 1 Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia , Lima, Peru .,2 Research Circle on Plants with Effects on Health , Lima, Peru
| | - Gustavo F Gonzales
- 1 Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia , Lima, Peru .,2 Research Circle on Plants with Effects on Health , Lima, Peru .,3 Laboratory of Endocrinology and Reproduction, Instituto de Investigaciones de la Altura , Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cynthia Gonzales-Castañeda
- 1 Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia , Lima, Peru .,2 Research Circle on Plants with Effects on Health , Lima, Peru
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Abstract
Travel to elevations above 2,500 m is an increasingly common activity undertaken by a diverse population of individuals. These may be trekkers, climbers, miners in high-altitude sites in South America, and more recently, soldiers deployed for high-altitude duty in remote areas of the world. What is also being increasingly recognized is the plight of the millions of pilgrims, many with comorbidities, who annually ascend to high-altitude sacred areas. There are also 400 million people who reside permanently in high mountain ranges, which cover one-fifth of the Earth's surface. Many of these high-altitude areas are in developing countries, for example, the Himalayan range in South Asia. Although high-altitude areas may not harbor any specific infectious disease agents, it is important to know about the pathogens encountered in the mountains to be better able to help both the ill sojourner and the native high-altitude dweller. Often the same pathogens prevalent in the surrounding lowlands are found at high altitude, but various factors such as immunomodulation, hypoxia, poor physiological adaptation, and harsh environmental stressors at high altitude may enhance susceptibility to these pathogens. Against this background, various gastrointestinal, respiratory, dermatological, neurological, and other infections encountered at high altitude are discussed.
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Abstract
Religious pilgrims have been going to high altitude pilgrimages long before trekkers and climbers sojourned in high altitude regions, but the medical literature about high altitude pilgrimage is sparse. Gosainkunda Lake (4300 m) near Kathmandu, Nepal, and Shri Amarnath Yatra (3800 m) in Sri Nagar, Kashmir, India, are the two sites in the Himalayas from where the majority of published reports of high altitude pilgrimage have originated. Almost all travels to high altitude pilgrimages are characterized by very rapid ascents by large congregations, leading to high rates of acute mountain sickness (AMS). In addition, epidemiological studies of pilgrims from Gosainkunda Lake show that some of the important risk factors for AMS in pilgrims are female sex and older age group. Studies based on the Shri Amarnath Yatra pilgrims show that coronary artery disease, complications of diabetes, and peptic ulcer disease are some of the common, important reasons for admission to hospital during the trip. In this review, the studies that have reported these and other relevant findings will be discussed and appropriate suggestions made to improve pilgrims' safety at high altitude.
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Affiliation(s)
- Buddha Basnyat
- Oxford University Clinical Research Unit-Nepal and Nepal International Clinic , Himalayan Rescue Association, Kathmandu, Nepal
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Sakamoto R, Okumiya K, Ohno A, Ge RL, Matsubayashi K. Detection of Legionella pneumophila at high altitude in Tibetan plateau. High Alt Med Biol 2014; 15:209-10. [PMID: 24949648 DOI: 10.1089/ham.2013.1152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ryota Sakamoto
- 1 Hakubi Center for Advanced Research, Kyoto University , Kyoto, Japan
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13
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Oliver SJ, Sanders SJ, Williams CJ, Smith ZA, Lloyd-Davies E, Roberts R, Arthur C, Hardy L, Macdonald JH. Physiological and psychological illness symptoms at high altitude and their relationship with acute mountain sickness: a prospective cohort study. J Travel Med 2012; 19:210-9. [PMID: 22776381 DOI: 10.1111/j.1708-8305.2012.00609.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this prospective observational cohort study was to investigate relationships between acute mountain sickness (AMS) and physical and mental health during a high altitude expedition. METHODS Forty-four participants (mean age, 34 ± 13 y; body mass index, 23.6 ± 3.5 kg·m(2) ; 57% male) completed the Dhaulagiri base camp trek in Nepal, a 19-day expedition attaining 5,372 m. Participants self-reported the following daily physical and mental health: AMS (defined by Lake Louise diagnosis and individual and total symptom scores), upper respiratory symptoms, diarrhea, and anxiety, plus physiological and behavioral factors. RESULTS The rate of Lake Louise-defined AMS per 100 person days was 9.2 (95% CI: 7.2-11.7). All investigated illnesses except diarrhea increased with altitude (all p < 0.001 by analysis of variance). Total AMS symptom score was associated with a lower arterial oxygen saturation, higher resting heart rate, more upper respiratory and diarrhea symptoms, greater anxiety, and lower fluid intake (all p < 0.02 by longitudinal multiple regression analyses). However, only upper respiratory symptoms, heart rate, arterial oxygen saturation, and fluid intake predicted future AMS symptoms [eg, an increase in upper respiratory symptoms by 5 units predicted an increase in the following day's AMS total symptom score by 0.72 units (0.54-0.89)]. CONCLUSIONS Upper respiratory symptoms and anxiety increasingly contributed to symptom burden as altitude was gained. Data were consistent with increased heart rate, decreased arterial oxygen saturation, reduced fluid intake, and upper respiratory symptoms being causally associated with AMS. Upper respiratory symptoms and fluid intake are the simplest targets for intervention to reduce AMS during high altitude exposure.
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Affiliation(s)
- Samuel J Oliver
- Extremes Research Group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor, Gwynedd, UK
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14
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Ding H, Liu Q, Hua M, Ding M, Du H, Zhang W, Li Z, Zhang J. Polymorphisms of Hypoxia-Related Genes in Subjects Susceptible to Acute Mountain Sickness. Respiration 2011; 81:236-41. [DOI: 10.1159/000322850] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 11/16/2010] [Indexed: 01/01/2023] Open
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15
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Baze MM, Schlauch K, Hayes JP. Gene expression of the liver in response to chronic hypoxia. Physiol Genomics 2010; 41:275-88. [PMID: 20103700 DOI: 10.1152/physiolgenomics.00075.2009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Hypoxia is an important ecological, evolutionary, and biomedical stressor. While physiological acclimatization of mammals to hypoxia is well studied, the variation in gene expression that underlies acclimatization is not well studied. We acclimatized inbred mice for 32 days to hypoxic conditions that simulated altitudes of 1400, 3000, and 4500 m. We used oligonucleotide microarrays to measure changes in steady-state abundance of mRNA in the livers of these mice. Mice exposed to more severe hypoxia (simulated altitude of 4500 m) were smaller in mass and had higher hematocrit than mice exposed to less severe hypoxia. ANOVA and false discovery rate tests indicated that 580 genes were significantly differentially expressed in response to chronic hypoxia. Few of these 580 genes have previously been reported to respond to hypoxia. In contrast, many of these 580 genes belonged to same functional groups typically respond to acute hypoxia. That is, both chronic and acute hypoxia elicit changes in transcript abundance for genes involved in angiogenesis, glycolysis, lipid metabolism, carbohydrate metabolism, and protein amino acid phosphorylation, but the particular genes affected by the two types of hypoxia were mostly different. Numerous genes affecting the immune system were differentially expressed in response to chronic hypoxia, which supports recently proposed hypotheses that link immune function and hypoxia. Furthermore, our results discovered novel elevated mRNA abundance of genes involved in hematopoiesis and oxygen transport not reported previously, but consistent with extreme hematocrits found in hypoxic mice.
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Affiliation(s)
- Monica M Baze
- Program in Ecology, Evolution and Conservation Biology and Department of Biology, and
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Cingi C, Erkan AN, Rettinger G. Ear, nose, and throat effects of high altitude. Eur Arch Otorhinolaryngol 2009; 267:467-71. [PMID: 19551397 DOI: 10.1007/s00405-009-1016-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 05/26/2009] [Indexed: 01/22/2023]
Abstract
High altitude changes human physiology and can result in illnesses such as acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema. The physiological impacts of high-altitude illnesses occur secondary to extravasation of fluid from the intravascular space into the extravascular space during a rapid ascent. Headache, hearing disturbances, vestibular disturbances, epistaxis, sleep apnea, coughing, respiratory tract infections, and nasal obstruction are main ear, nose, and throat complaints of individuals travelling to high altitude. These complaints can cause delays or cancelations in a person's climbing plans. In this article, we review the ear, nose, and throat effects of high altitude based on the relevant literature.
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Affiliation(s)
- Cemal Cingi
- Department of Otorhinolaryngology, Osmangazi University, Eskişehir, Turkey
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Abstract
Athletes, military personnel, fire fighters, mountaineers and astronauts may be required to perform in environmental extremes (e.g. heat, cold, high altitude and microgravity). Exercising in hot versus thermoneutral conditions (where core temperature is > or = 1 degrees C higher in hot conditions) augments circulating stress hormones, catecholamines and cytokines with associated increases in circulating leukocytes. Studies that have clamped the rise in core temperature during exercise (by exercising in cool water) demonstrate a large contribution of the rise in core temperature in the leukocytosis and cytokinaemia of exercise. However, with the exception of lowered stimulated lymphocyte responses after exercise in the heat, and in exertional heat illness patients (core temperature > 40 degrees C), recent laboratory studies show a limited effect of exercise in the heat on neutrophil function, monocyte function, natural killer cell activity and mucosal immunity. Therefore, most of the available evidence does not support the contention that exercising in the heat poses a greater threat to immune function (vs thermoneutral conditions). From a critical standpoint, due to ethical committee restrictions, most laboratory studies have evoked modest core temperature responses (< 39 degrees C). Given that core temperature during exercise in the field often exceeds levels associated with fever and hyperthermia (approximately 39.5 degrees C) field studies may provide an opportunity to determine the effects of severe heat stress on immunity. Field studies may also provide insight into the possible involvement of immune modulation in the aetiology of exertional heat stroke (core temperature > 40.6 degrees C) and identify the effects of acclimatisation on neuroendocrine and immune responses to exercise-heat stress. Laboratory studies can provide useful information by, for example, applying the thermal clamp model to examine the involvement of the rise in core temperature in the functional immune modifications associated with prolonged exercise. Studies investigating the effects of cold, high altitude and microgravity on immunity and infection incidence are often hindered by extraneous stressors (e.g. isolation). Nevertheless, the available evidence does not support the popular belief that short- or long-term cold exposure, with or without exercise, suppresses immunity and increases infection incidence. In fact, controlled laboratory studies indicate immuno-stimulatory effects of cold exposure. Although some evidence shows that ascent to high altitude increases infection incidence, clear conclusions are difficult to make because of some overlap with the symptoms of acute mountain sickness. Studies have reported suppressed cell-mediated immunity in mountaineers at high altitude and in astronauts after re-entering the normal gravity environment; however, the impact of this finding on resistance to infection remains unclear.
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Affiliation(s)
- Neil P Walsh
- School of Sport, Health and Exercise Sciences, University of Wales, Bangor, UK.
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