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van Veelen MJ, Likar R, Tannheimer M, Bloch KE, Ulrich S, Philadelphy M, Teuchner B, Hochholzer T, Pichler Hefti J, Hefti U, Paal P, Burtscher M. Emergency Care for High-Altitude Trekking and Climbing. High Alt Med Biol 2024. [PMID: 39073038 DOI: 10.1089/ham.2024.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Introduction: High altitude regions are characterized by harsh conditions (environmental, rough terrain, natural hazards, and limited hygiene and health care), which all may contribute to the risk of accidents/emergencies when trekking or climbing. Exposure to hypoxia, cold, wind, and solar radiation are typical features of the high altitude environment. Emergencies in these remote areas place high demands on the diagnostic and treatment skills of doctors and first-aiders. The aim of this review is to give insights on providing the best possible care for victims of emergencies at high altitude. Methods: Authors provide clinical recommendations based on their real-world experience, complemented by appropriate recent studies and internationally reputable guidelines. Results and Discussion: This review covers most of the emergencies/health issues that can occur when trekking or during high altitude climbing, that is, high altitude illnesses and hypothermia, freezing cold injuries, accidents, for example, with severe injuries due to falling, cardiovascular and respiratory illnesses, abdominal, musculoskeletal, eye, dental, and skin issues. We give a summary of current recommendations for emergency care and pain relief in case of these various incidents.
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Affiliation(s)
- Michiel J van Veelen
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Rudolf Likar
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, SFU Vienna, Klagenfurt, Austria
| | - Markus Tannheimer
- Department of Sport and Rehabilitation Medicine, University of Ulm, Ulm, Germany
- Department of General and Visceral Surgery, ADK-Klinik Blaubeuren, Ulm, Germany
| | - Konrad E Bloch
- Department of Pulmonology, University Hospital of Zürich, Zürich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital of Zürich, Zürich, Switzerland
| | | | - Barbara Teuchner
- Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | - Urs Hefti
- Swiss Sportclinic, Bern, Switzerland
- Medical Commission, International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Peter Paal
- Medical Commission, International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St John of God Hospital, Paracelsus Medical University, Salzburg, Austria
- Austrian Society for Alpine- and High-Altitude Medicine, Innsbruck, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Austrian Society for Alpine- and High-Altitude Medicine, Innsbruck, Austria
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Fuenmayor-González L, Vera-Ormaza J, Shen H, Corella-Ortega B, Fajardo-Loaiza T, Borja-Pérez C, Ochoa-Godoy N, Vásquez-Barzallo S, Díaz-Rodríguez J, Díaz AM, García F, Ramírez V, Sánchez H, Barberán JL, Paredes JP, Cevallos M, Montenegro F, Puertas S, Briones K, Martínez M, Vélez-Páez J, Montalvo-Villagómez M, Herrera L, Garrido S, Sisa I, Jibaja M. Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A retrospective cohort multicentric study. Medicine (Baltimore) 2024; 103:e38776. [PMID: 39058801 PMCID: PMC11272232 DOI: 10.1097/md.0000000000038776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/17/2024] [Indexed: 07/28/2024] Open
Abstract
Several risk factors were associated with mortality in patients with coronavirus disease 2019 (COVID-19) infection in intensive care units (ICU). We assessed the effect of risk factors related to the characteristics and clinical history of the population, laboratory test results, drug management, and type of ventilation on the probability of survival/discharge from the ICU. A retrospective cohort multicentric study of adults with COVID-19 admitted to the ICU between March 2020 and December 2021. Data were collected from 6 hospitals in 5 cities in Ecuador. The primary outcome was ICU survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Of those admitted to the ICU with COVID-19, (n = 991), mean age was 56.76 ± 13.14, and 65.9% were male. Regarding the primary outcome, 51.1% (n = 506) died and 48.9% (n = 485) survived. Of the group that died, their mean age was higher than the survivors (60.7 vs 52.60 years, respectively), and they had a higher prevalence of comorbidities such as arterial hypertension (37.2% vs 20.4%, respectively) and diabetes mellitus (26.9% vs 15.7%, respectively), with P < .001. In ventilatory management, 32.7% of patients used noninvasive ventilation and high-flow nasal cannula, and 67.3% required invasive ventilatory support. After adjusting for confounders, Cox regression analysis showed that patients were less likely to be discharged alive from the ICU if they met the following conditions: arterial hypertension (hazard ratio [HR] = 0.83 95% CI 0.723-0.964), diabetes mellitus (HR = 0.80 95% CI 0.696-0.938), older than 62 years (HR = 0.86 95% CI 0.790-0.956), obese (body mass index ≥ 30) (HR = 0.78 95% CI 0.697-0.887), 1 unit increase in SOFA score (HR = 0.94 95% CI 0.937-0.961), PaO2/FiO2 ratio <100 mm Hg (HR = 0.84 95% CI 0.786-0.914), and the use of invasive mechanical ventilation (HR = 0.68 95% CI 0.614-0.769). Risk factors associated with increased mortality were older age, obesity, arterial hypertension, and diabetes. Factors such as male gender, chronic obstructive pulmonary disease, acute kidney injury, and cancer reported in other investigations did not have the same effect on mortality in our study.
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Affiliation(s)
| | - Jair Vera-Ormaza
- Servicio de Emergencias, Hospital Pablo Arturo Suárez, Quito, Ecuador
| | - Hua Shen
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Nancy Ochoa-Godoy
- Servicio de Emergencias, Hospital Pablo Arturo Suárez, Quito, Ecuador
| | | | | | - Ana María Díaz
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Fernanda García
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Vanessa Ramírez
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Hernán Sánchez
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - José Luis Barberán
- Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador
| | - Juan Pablo Paredes
- Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador
| | - Mónica Cevallos
- Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador
| | - Francisco Montenegro
- Unidad de Cuidados Intensivos, Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador
| | - Soraya Puertas
- Unidad de Cuidados Intensivos, Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador
| | - Killen Briones
- Unidad de Cuidados Intensivos, Hospital del IESS, Babahoyo, Ecuador
| | - Marlon Martínez
- Unidad de Cuidados Intensivos, Hospital del IESS, Babahoyo, Ecuador
| | - Jorge Vélez-Páez
- Unidad de Cuidados Intensivos, Hospital General Pablo Arturo Suárez, Quito, Ecuador
| | | | - Luis Herrera
- Unidad de Cuidados Intensivos, Hospital del IESS, Ibarra, Ecuador
| | - Santiago Garrido
- Unidad de Cuidados Intensivos, Hospital del IESS, Ibarra, Ecuador
| | - Ivan Sisa
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
| | - Manuel Jibaja
- Unidad de Cuidados Intensivos, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador
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Ning Z, He S, Liao X, Ma C, Wu J. Cold waves and fine particulate matter in high-altitude Chinese cities: assessing their interactive impact on outpatient visits for respiratory disease. BMC Public Health 2024; 24:1377. [PMID: 38778299 PMCID: PMC11110372 DOI: 10.1186/s12889-024-18896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Extreme weather events like heatwaves and fine particulate matter (PM2.5) have a synergistic effect on mortality, but research on the synergistic effect of cold waves and PM2.5 on outpatient visits for respiratory disease, especially at high altitudes in climate change-sensitive areas, is lacking. METHODS we collected time-series data on meteorological, air pollution, and outpatient visits for respiratory disease in Xining. We examined the associations between cold waves, PM2.5, and outpatient visits for respiratory disease using a time-stratified case-crossover approach and distributional lag nonlinear modeling. Our analysis also calculated the relative excess odds due to interaction (REOI), proportion attributable to interaction (AP), and synergy index (S). We additionally analyzed cold waves over time to verify climate change. RESULTS Under different definitions of cold waves, the odds ratio for the correlation between cold waves and outpatient visits for respiratory disease ranged from 0.95 (95% CI: 0.86, 1.05) to 1.58 (1.47, 1.70). Exposure to PM2.5 was significantly associated with an increase in outpatient visits for respiratory disease. We found that cold waves can synergize with PM2.5 to increase outpatient visits for respiratory disease (REOI > 0, AP > 0, S > 1), decreasing with stricter definitions of cold waves and longer durations. Cold waves' independent effect decreased over time, but their interaction effect persisted. From 8.1 to 21.8% of outpatient visits were due to cold waves and high-level PM2.5. People aged 0-14 and ≥ 65 were more susceptible to cold waves and PM2.5, with a significant interaction for those aged 15-64 and ≥ 65. CONCLUSION Our study fills the gap on how extreme weather and PM2.5 synergistically affect respiratory disease outpatient visits in high-altitude regions. The synergy of cold waves and PM2.5 increases outpatient visits for respiratory disease, especially in the elderly. Cold wave warnings and PM2.5 reduction have major public health benefits.
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Affiliation(s)
- Zhenxu Ning
- Department of Public Health, Faculty of Medicine, Qinghai University, Xining, China
| | - Shuzhen He
- Xining Centre for Disease Control and Prevention, Xining, China.
| | - Xinghao Liao
- Department of Public Health, Faculty of Medicine, Qinghai University, Xining, China
| | - Chunguang Ma
- Xining Centre for Disease Control and Prevention, Xining, China
| | - Jing Wu
- Xining Centre for Disease Control and Prevention, Xining, China
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Ghatee MA, Kanannejad Z, Nikaein K, Fallah N, Sabz G. Geo-climatic risk factors for chronic rhinosinusitis in southwest Iran. PLoS One 2023; 18:e0288101. [PMID: 37406025 DOI: 10.1371/journal.pone.0288101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a prevalent and disabling paranasal sinus disease associated with some environmental factors. In this study, we evaluated the effect of geo-climatic factors on CRS in a region of southwest Iran. The study mapped the residency addresses of 232 patients with CRS who lived in Kohgiluyeh and Boyer-Ahmad province and had undergone sinus surgery from 2014 to 2019. The effects of Mean Annual Humidity (MAH), Mean Annual Rainfall (MAR), Mean Annual Temperature (MAT), maximum MAT (maxMAT), minimum MAT (minMAT), Mean Annual Evaporation (MAE), wind, elevation, slope, and land cover were assessed on the occurrence of CRS using Geographical Information System (GIS). Statistical analysis was performed using univariate and multivariate binary logistic regression. Patients came from 55 points including villages, towns, and cities. In univariate analysis, climatic factors including MAT (OR = 0.537), minMAT (OR = 0.764), maxMAT (OR = 0.63), MAR (OR = 0.994), and MAH (OR = 0.626) were significantly related to CRS occurrence. Elevation (OR = 0.999), slope (OR = 0.9), and urban setting (OR = 24.667) were the significant determinants among geographical factors when analyzed independently. The multivariate analysis found maxMAT (OR = 0.5), MAR (OR = 0.994), elevation (OR = 0.998), and urban (OR = 16.8) as significant factors affecting CRS occurrence. The urban setting is the most critical factor affecting CRS disease. Cold and dry areas and low attitude are the other risk factors for CRS in Kohgiluyeh and Boyer-Ahmad province, southwest Iran.
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Affiliation(s)
- Mohammad Amin Ghatee
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
- Department of Parasitology, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zahra Kanannejad
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Koorosh Nikaein
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Niloufar Fallah
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Gholamabbas Sabz
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Lin A, Mao C, Rao B, Zhao H, Wang Y, Yang G, Lei H, Xie C, Huang D, Deng Y, Zhang X, Wang X, Lu J. Development and validation of nomogram including high altitude as a risk factor for COPD: A cross-sectional study based on Gansu population. Front Public Health 2023; 11:1127566. [PMID: 36935687 PMCID: PMC10019355 DOI: 10.3389/fpubh.2023.1127566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is a common and harmful disease that requires an effective tool to early screen high-risk individuals. Gansu has unique environments and customs, leading to the different prevalence and etiology of COPD from other regions. The association between altitude and COPD once attracted epidemiologists' attention. However, the prevalence in Gansu and the role of altitude are still unclarified. Methods In Gansu, a multistage stratified cluster sampling procedure was utilized to select a representative sample aged 40 years or older. The questionnaire and spirometry examination were implemented to collect participants' information. The diagnosis and assessment of COPD were identified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion, while post-bronchodilator FEV1/FVC < LLN was for sensitivity analysis. Furthermore, the effect of high altitude on COPD was evaluated by the logistic regression model after propensity score matching (PSM). Finally, the participants were randomly divided into training and validation sets. The training set was used to screen the relative factors and construct a nomogram which was further assessed by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) in the two sets. Results There were 2,486 eligible participants in the final analysis, of which 1,584 lived in low altitudes and 902 lived in high altitudes. Based on the GOLD criterion, the crude and standardized prevalences in Gansu were 20.4% (18.7-22.0) and 19.7% (17.9-21.6). After PSM, the logistic regression model indicated that high altitude increased COPD risk [PSM OR: 1.516 (1.162-1.978)]. Altitude, age, sex, history of tuberculosis, coal as fuel, and smoking status were reserved for developing a nomogram that demonstrated excellent discrimination, calibration, and clinical benefit in the two sets. Conclusions COPD has become a serious public health problem in Gansu. High altitude is a risk factor for COPD. The nomogram has satisfactory efficiency in screening high-risk individuals.
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Affiliation(s)
- Ao Lin
- The State Key Lab of Respiratory Disease, The First Affiliated Hospital, Institute of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Chun Mao
- The State Key Lab of Respiratory Disease, The First Affiliated Hospital, Institute of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Boqi Rao
- The State Key Lab of Respiratory Disease, The First Affiliated Hospital, Institute of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Hongjun Zhao
- Department of Pulmonary and Critical Care Medicine, Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, China
| | - Yunchao Wang
- Institute of Basic Medicine, Institute of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Guokang Yang
- Institute of Basic Medicine, Institute of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Haisheng Lei
- Institute of Basic Medicine, Institute of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Chenli Xie
- Department of Respiratory and Critical Care Medicine, Dongguan Binwan Central Hospital, Dongguan, China
| | - Dongsheng Huang
- Department of Respiratory and Critical Care Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Yibin Deng
- Centre for Medical Laboratory Science, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Xuhui Zhang
- Department of Respiratory Medicine, The Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China
| | - Xinhua Wang
- Institute of Basic Medicine, Institute of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
- Xinhua Wang
| | - Jiachun Lu
- The State Key Lab of Respiratory Disease, The First Affiliated Hospital, Institute of Public Health, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Jiachun Lu
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Vinnikov D, Krasotski V. Healthy worker survival effect at a high-altitude mine: prospective cohort observation. Sci Rep 2022; 12:13903. [PMID: 35974144 PMCID: PMC9381584 DOI: 10.1038/s41598-022-18331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/09/2022] [Indexed: 11/12/2022] Open
Abstract
Very little is known about the factors of healthy worker survival effect at high-altitude mines. We conducted this cohort observation of the new hires for a high-altitude gold mine in Kyrgyzstan with the aim to ascertain predictors of survival at work. All new hires in 2009 through 2012 for a high-altitude gold mine (3600–4500 m above sea level) were followed up to January 2022. We tested the association of demographic, physiological predictors and diagnoses at the pre-employment screening with non-survival at work in Cox proportional hazards yielding hazard ratios (HR) with their 95% confidence intervals (CI). The cumulative observation time was 5190 person-years. Blood pressure at pre-employment, lung function, the diagnoses of essential hypertension, chronic obstructive pulmonary disease (COPD) or any other analyzed physiological variables were not associated with non-survival at work. However, smoking (HR 1.55; 95% CI 1.10; 2.17) increased the likelihood of non-survival at work, independent of any diagnosis or lowland residence (HR 1.95; 95% CI 1.31; 2.90). Adjusted for covariates and all diagnoses, having chronic rheumatic fever (HR 10.95; 95% CI 2.92; 33.92), hemorrhoids (HR 1.32; 95% CI 1.01; 3.75), adhesive otitis (HR 1.74; 95% CI 1.05; 2.89) or obesity (HR 1.71; 95% CI 1.01; 2.88) were associated with non-survival at work with time. This prospective observation of new hires for a high-altitude mining operation demonstrated that selected diagnoses, smoking and lowland residence elevated the risk of early exit in prospective workers.
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Affiliation(s)
- Denis Vinnikov
- al-Farabi Kazakh National University, 71 al-Farabi avenue, Almaty, 050040, Kazakhstan. .,Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation.
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Shang K, Xia Z, Ye X, Li Z, Gong C. Positive end-expiratory pressure and risk of postoperative pulmonary complications in patients living at high altitudes and undergoing surgery at low altitudes: a single-centre, retrospective observational study in China. BMJ Open 2022; 12:e057698. [PMID: 35701068 PMCID: PMC9198711 DOI: 10.1136/bmjopen-2021-057698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To examine whether a high positive end-expiratory pressure (PEEP ≥5 cmH2O) has a protective effect on the risk of postoperative pulmonary complications (PPCs) in a cohort of patients living at high altitudes and undergoing general anaesthesia. DESIGN Retrospective, observational study. SETTING A tertiary hospital in China. PARTICIPANTS Adult Tibetan patients living at high altitudes (≥3000 m) and who went to the low-altitude plain to undergo non-cardiothoracic surgery under general anaesthesia, from January 2018 to April 2020. MEASUREMENTS This study included 1905 patients who were divided according to the application of an intraoperative PEEP: low PEEP (<5 cmH2O, including 0 cmH2O) or high PEEP (≥5 cmH2O). The primary outcome was a composite of PPCs within the first 7 postoperative days. The secondary outcomes included reintubation and unplanned intensive care unit (ICU) admission within the first 7 postoperative days and total hospital stays (day). RESULTS The study included 1032 patients in the low PEEP group and 873 in the high PEEP group. There were no differences in the incidence of PPCs between the high and low PEEP groups (relative risk (RR) 0.913; 95% CI 0.716 to 1.165; p=0.465). After propensity score matching, 643 patients remained in each group, and the incidence of PPCs in the low PEEP group (18.0%) was higher than in the high PEEP group (13.7%; RR 0.720; 95% CI 0.533 to 0.974; p=0.033). There were no differences in the incidence of reintubation, unplanned ICU admission or hospital stays. The risk factors of PPCs derived from multiple regression showed that the application of >5 cmH2O PEEP during intraoperative mechanical ventilation was associated with a significantly lower risk of PPCs in patients from a high altitude (OR=0.725, 95% CI 0.530 to 0.992; p=0.044). CONCLUSIONS The application of PEEP ≥5 cmH2O during intraoperative mechanical ventilation in patients living at high altitudes and undergoing surgery at low altitudes may be associated with a lower risk of PPCs. Prospective longitudinal studies are needed to further investigate perioperative lung protection ventilation strategies for patients from high altitudes. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2100044260).
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Affiliation(s)
- Kaixi Shang
- Department of Anesthesiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (West China Hospital Sichuan University Tibet Chengdu Branch Hospital), Chengdu, China
| | - Zongjing Xia
- Department of Anesthesiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (West China Hospital Sichuan University Tibet Chengdu Branch Hospital), Chengdu, China
| | - Xiaoli Ye
- Department of Anesthesiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (West China Hospital Sichuan University Tibet Chengdu Branch Hospital), Chengdu, China
| | - Zhuoning Li
- Department of Anesthesiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (West China Hospital Sichuan University Tibet Chengdu Branch Hospital), Chengdu, China
| | - Chongcong Gong
- Department of Anesthesiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (West China Hospital Sichuan University Tibet Chengdu Branch Hospital), Chengdu, China
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Fieten KB, Drijver‐Messelink MT, Cogo A, Charpin D, Sokolowska M, Agache I, Taborda‐Barata LM, Eguiluz‐Gracia I, Braunstahl GJ, Seys SF, den Berge M, Bloch KE, Ulrich S, Cardoso‐Vigueros C, Kappen JH, Brinke AT, Koch M, Traidl‐Hoffmann C, da Mata P, Prins DJ, Pasmans SGMA, Bendien S, Rukhadze M, Shamji MH, Couto M, Oude Elberink H, Peroni DG, Piacentini G, Weersink EJM, Bonini M, Rijssenbeek‐Nouwens LHM, Akdis CA. Alpine altitude climate treatment for severe and uncontrolled asthma: An EAACI position paper. Allergy 2022; 77:1991-2024. [PMID: 35113452 PMCID: PMC9305916 DOI: 10.1111/all.15242] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/14/2022] [Accepted: 01/30/2022] [Indexed: 12/30/2022]
Abstract
Currently available European Alpine Altitude Climate Treatment (AACT) programs combine the physical characteristics of altitude with the avoidance of environmental triggers in the alpine climate and a personalized multidisciplinary pulmonary rehabilitation approach. The reduced barometric pressure, oxygen pressure, and air density, the relatively low temperature and humidity, and the increased UV radiation at moderate altitude induce several physiological and immunological adaptation responses. The environmental characteristics of the alpine climate include reduced aeroallergens such as house dust mites (HDM), pollen, fungi, and less air pollution. These combined factors seem to have immunomodulatory effects controlling pathogenic inflammatory responses and favoring less neuro‐immune stress in patients with different asthma phenotypes. The extensive multidisciplinary treatment program may further contribute to the observed clinical improvement by AACT in asthma control and quality of life, fewer exacerbations and hospitalizations, reduced need for oral corticosteroids (OCS), improved lung function, decreased airway hyperresponsiveness (AHR), improved exercise tolerance, and improved sinonasal outcomes. Based on observational studies and expert opinion, AACT represents a valuable therapy for those patients irrespective of their asthma phenotype, who cannot achieve optimal control of their complex condition despite all the advances in medical science and treatment according to guidelines, and therefore run the risk of falling into a downward spiral of loss of physical and mental health. In the light of the observed rapid decrease in inflammation and immunomodulatory effects, AACT can be considered as a natural treatment that targets biological pathways.
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Akin S, Bastug M, Colak R, Ficicilar H, Saglam BS, Kosar NS, Demirel H. Possible Adaptation of the Adrenal Gland Hsp72 Expression to Hypoxic Stress. High Alt Med Biol 2021; 22:293-299. [PMID: 34191602 DOI: 10.1089/ham.2021.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Akin, Senay, Metin Bastug, Ridvan Colak, Hakan Ficicilar, Betul Simten Saglam, Nazan S. Kosar, and Haydar Demirel. Possible adaptation of the adrenal gland Hsp72 expression to hypoxic stress. High Alt Med Biol. 00:000-000, 2021. Background: Adrenal glands play a central role in the general response to stress and controlling wholebody homeostasis. One of the most severe environmental stresses encountered by high-altitude climbers is hypoxia. Since the 72 kDa heat shock protein (Hsp72) has a critical role in cellular homeostasis, regulation of Hsp72 in adrenal glands seems to be crucial for maintaining cellular integrity of the gland and sustaining an adequate whole-body stress response in a hypoxic environment. Therefore, this study investigated if 15 days of hypoxia results in the induction of Hsp72 in adrenal glands. In addition, we examined whether heat treatment had any effect on adrenal Hsp72 expression to hypoxia, as cellular and systemic physiological cross-adaptation was suggested between heat stress and hypoxic stress. Materials and Methods: Male 4-month-old Wistar rats were randomly assigned to one of the four experimental groups (n = 8 each group): (1) control (C), (2) heat treatment (15H), (3) heat treatment and 15 days of normobaric hypoxia (15HHp), and (4) 15 days of normobaric hypoxia (15Hp). Three one-hour heat treatment sessions at 41°C were applied on the first two days before hypoxic exposure and on the day 7. Hypoxic exposure was consisting of normobaric hypoxia containing 9.7% O2. Results: Fifteen days of hypoxia did not increase the adrenal Hsp72 levels (p = 0.99). Furthermore, when hypoxia was added to the heat treatment, heat-related increases in adrenal Hsp72 levels disappeared. Adrenal weight to body weight ratio was not different among groups (p = 0.11). Plasma corticosterone levels were significantly lower in all experimental groups compared with control (p < 0.05), and addition of hypoxia resulted in further significant reduction of the plasma corticosterone levels (C > 15H>15HHp >15Hp; p < 0.05). Conclusions: These data demonstrate the adaptation of the adrenal gland to 15-day chronic normobaric hypoxic stress as well as possible cross-adaptation between heat and hypoxic stress in the adrenal gland.
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Affiliation(s)
- Senay Akin
- Department of Exercise and Sport Physiology, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
| | - Metin Bastug
- Department of Physiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ridvan Colak
- School of Physical Education and Sport, Ardahan University, Ardahan, Turkey
| | - Hakan Ficicilar
- Department of Physiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Nazan S Kosar
- Department of Nutrition and Metabolism in Exercise, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
| | - Haydar Demirel
- Department of Exercise and Sport Physiology, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
- Department of Sports Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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10
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Cossio-Bolaños M, Vidal-Espinoza R, Castelli Correia de Campos LF, Urzua-Alul L, Fuentes-López JD, Sulla-Torres J, Andruske CL, Gomez-Campos R. Maximum Expiratory Flow of Children and Adolescents Living at Moderate Altitudes: Proposed Reference Values. Healthcare (Basel) 2021; 9:264. [PMID: 33801430 PMCID: PMC7998629 DOI: 10.3390/healthcare9030264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 12/02/2022] Open
Abstract
(1) Background: Spirometry is useful for diagnosing and monitoring many respiratory diseases. The objectives were: (a) compare maximum expiratory flow (MEF) values with those from international studies, (b) determine if MEF should be evaluated by chronological age and/or maturity, (c) develop reference norms for children, and adolescents. (2) Methods: A cross-sectional study was designed with 3900 subjects ages 6.0 and 17.9 years old. Weight, standing height, sitting height, and MEF were measured. Length of the lower limbs, body mass index (BMI), and age of peak height velocity growth (APHV) were calculated. (3) Results: Values for the curves (p50) for females of all ages from Spain and Italy were higher (92 to 382 (L/min)) than those for females from Arequipa (Peru). Curve values for males from Spain and Italy were greater [70 to 125 (L/min)] than the males studied. MEF values were similar to those of Chilean students ages 6 to 11. However, from 12 to 17 years old, values were lower in males (25 to 55 (L/min)) and in females (23.5 to 90 (L/min)). Correlations between chronological age and MEF in males were from (r = 0.68, R2 = 0.39) and in females from (r = 0.46, R2 = 0.21). Correlations between maturity (APHV) and MEF for males were from (r = 0.66, R2 = 0.44) and for females (r = 0.51, R2 = 0.26). Percentiles were calculated for chronological age and APHV. Conclusion: Differences occurred in MEF when compared with other geographical regions of the world. We determined that maturity may be a more effective indicator for analyzing MEF. Reference values were generated using chronological age and maturity.
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Affiliation(s)
| | | | | | - Luis Urzua-Alul
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, 8320000 Santiago, Chile;
| | - José Damián Fuentes-López
- Instituto de Investigación en Ciencias de la Educación (IICE), Universidad Nacional del Altiplano de Puno, 21001 Puno, Peru;
| | - Jose Sulla-Torres
- Universidad Nacional de San Agustín de Arequipa, 04000 Arequipa, Peru;
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11
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Gupta A, Gupta R, Kumar V, Samarany S. Blue Toes at High Altitude: Peripheral Cyanosis. Am J Med 2020; 133:573-575. [PMID: 31668899 DOI: 10.1016/j.amjmed.2019.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Amol Gupta
- Heart, Vascular, and Leg Center, Bakersfield, Calif
| | - Ravi Gupta
- Heart, Vascular, and Leg Center, Bakersfield, Calif
| | - Vinod Kumar
- Heart, Vascular, and Leg Center, Bakersfield, Calif.
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12
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Hwang J, Jang M, Kim N, Choi S, Oh YM, Seo JB. Positive association between moderate altitude and chronic lower respiratory disease mortality in United States counties. PLoS One 2018; 13:e0200557. [PMID: 29995931 PMCID: PMC6040762 DOI: 10.1371/journal.pone.0200557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
For patients with chronic lower respiratory disease, hypobaric hypoxia at a high altitude is considered a risk factor for mortality. However, the effects of residing at moderately high altitudes remain unclear. We investigated the association between moderate altitude and chronic lower respiratory disease mortality. In particular, we examined the lower 48 United States counties for age-adjusted chronic lower respiratory disease mortality rates, altitude, and socioeconomic factors, including tobacco use, per capita income, population density, sex ratio, unemployment, poverty, and education between 1979 and 1998. The socioeconomic factors were incorporated into the correlation analysis as potential covariates. Considerable positive (R = 0.235; P <0.001) and partial (R = 0.260; P <0.001) correlations were observed between altitude and chronic lower respiratory disease mortality rate. In the subgroup with high COPD prevalence subgroup, even stronger positive (R = 0.346; P <0.001) and partial (R = 0.423, P <0.001) correlations were observed. Multivariate regression analysis of all available socioeconomic factors revealed that additional knowledge on altitude improved the adjusted R2 values from 0.128 to 0.186 for all counties and from 0.301 to 0.421 for counties with high COPD prevalence. We concluded that in the lower 48 United States counties, even a moderate altitude may pose considerable risks in patients with chronic lower respiratory disease.
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Affiliation(s)
- Jeongeun Hwang
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Miso Jang
- Department of Family Medicine and Center for Cancer Prevention and Detection, Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seunghyun Choi
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yeon-Mok Oh
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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13
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Autism-Like Behaviours and Memory Deficits Result from a Western Diet in Mice. Neural Plast 2017; 2017:9498247. [PMID: 28685102 PMCID: PMC5480052 DOI: 10.1155/2017/9498247] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/09/2017] [Accepted: 03/20/2017] [Indexed: 01/02/2023] Open
Abstract
Nonalcoholic fatty liver disease, induced by a Western diet (WD), evokes central and peripheral inflammation that is accompanied by altered emotionality. These changes can be associated with abnormalities in social behaviour, hippocampus-dependent cognitive functions, and metabolism. Female C57BL/6J mice were fed with a regular chow or with a WD containing 0.2% of cholesterol and 21% of saturated fat for three weeks. WD-treated mice exhibited increased social avoidance, crawl-over and digging behaviours, decreased body-body contacts, and hyperlocomotion. The WD-fed group also displayed deficits in hippocampal-dependent performance such as contextual memory in a fear conditioning and pellet displacement paradigms. A reduction in glucose tolerance and elevated levels of serum cholesterol and leptin were also associated with the WD. The peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PPARGC1a) mRNA, a marker of mitochondrial activity, was decreased in the prefrontal cortex, hippocampus, hypothalamus, and dorsal raphe, suggesting suppressed brain mitochondrial functions, but not in the liver. This is the first report to show that a WD can profoundly suppress social interactions and induce dominant-like behaviours in naïve adult mice. The spectrum of behaviours that were found to be induced are reminiscent of symptoms associated with autism, and, if paralleled in humans, suggest that a WD might exacerbate autism spectrum disorder.
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