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Ugeskrift For Laeger Oct 2016Travelling to high altitudes is an increasingly popular form of recreational holiday. Individual medical advice may be essential for certain groups of individuals such... (Review)
Review
Travelling to high altitudes is an increasingly popular form of recreational holiday. Individual medical advice may be essential for certain groups of individuals such as patients with chronic disorders, pregnant women or children. This is the second part in a series of two articles on mountain medicine. The first part covered high-altitude physiology and medical aspects of objective alpine dangers and the increased exposure to ultraviolet radiation. This part covers altitude sickness, fluid balance, nutrition, and precautions for patients with pre-existing medical conditions, pregnant women and children.
Topics: Adult; Altitude; Altitude Sickness; Cardiovascular Diseases; Child; Energy Metabolism; Female; Humans; Mountaineering; Nutritional Physiological Phenomena; Pregnancy; Pregnancy Complications; Respiratory Tract Diseases; Travel-Related Illness
PubMed: 27808057
DOI: No ID Found -
International Journal of Environmental... Sep 2021Many competitive and elite athletes continue to train throughout their pregnancies and many visit or live at altitude. The purpose of this integrative review is to... (Review)
Review
Many competitive and elite athletes continue to train throughout their pregnancies and many visit or live at altitude. The purpose of this integrative review is to synthesize, analyze and critique published studies regarding the safety of serious recreational or elite athletes exercising at altitude while pregnant. Seven databases were searched, and 157 documents were located, which were screened for appropriateness and reduced to seven articles that met the criteria. The studies were analyzed based on maternal and fetal outcomes. Current recommendations for exercising at altitude were based on sedentary individuals who frequently did not have the expected physiological responses based on research on pregnancy and altitude. It is unknown whether competitive and elite athletes would have similar responses to exercise at altitude. More research on exercise at altitude on individuals with a variety of fitness levels is needed.
Topics: Altitude; Athletes; Exercise; Female; Humans; Hypoxia; Pregnancy; Prenatal Care
PubMed: 34501869
DOI: 10.3390/ijerph18179272 -
Journal of Travel Medicine Jun 2023Altitude sojourns increasingly attract individuals of all ages and different health statuses due to the appeal of high-altitude destinations worldwide and easy access to... (Review)
Review
BACKGROUND
Altitude sojourns increasingly attract individuals of all ages and different health statuses due to the appeal of high-altitude destinations worldwide and easy access to air travel. The risk of acute mountain sickness (AMS) when flying to high-altitude destinations remains underemphasized. Thus, this review aims to evaluate the altitude-dependent AMS incidence depending on the mode of ascending, e.g. by air vs terrestrial travel.
METHODS
A literature search was performed to identify the observational studies assessing AMS incidence after acute ascent of primarily healthy adults to real high altitude. In addition, placebo arms of interventional trials evaluating the prophylactic efficacy of various drugs have been separately analysed to confirm or refute the findings from the observational studies. Linear regression analyses were used to evaluate the altitude-dependent AMS incidence.
RESULTS
Findings of 12 observational studies, in which the AMS incidence in 11 021 individuals ascending to 19 different altitudes (2200-4559 m) was evaluated, revealed an impressive 4.5-fold steeper increase in the AMS incidence for air travel as compared with slower ascent modes, i.e. hiking or combined car and/or air travel and hiking. The higher AMS incidence following transportation by flight vs slower means was also confirmed in placebo-treated participants in 10 studies of drug prophylaxis against AMS.
CONCLUSIONS
Due to the short time span in going from low to high altitude, reduced acclimatization likely is the main reason for a higher AMS risk when travelling to high-altitude destinations by flight. To avoid frustrating travel experiences and health risks, appropriate and timely medical advice on how to prepare for air travel to high altitude is of vital importance. Effective preparation options include the use of modern pre-acclimatization strategies and pharmacological prophylaxis by acetazolamide or dexamethasone, or even considering alternate itineraries with more gradual ascent.
Topics: Adult; Humans; Altitude Sickness; Altitude; Acute Disease; Acetazolamide; Air Travel
PubMed: 36694981
DOI: 10.1093/jtm/taad011 -
Revista de Investigacion Clinica;... Jan 2022A large world population resides at moderate altitude. In the Valley of Mexico (2,240 m above sea level), its inhabitants, breathe approximately 29% more on average and... (Review)
Review
A large world population resides at moderate altitude. In the Valley of Mexico (2,240 m above sea level), its inhabitants, breathe approximately 29% more on average and have 10% increased hemoglobin concentrations compared to sea level residents, among other differences. These compensations reduce but not eliminate the impact of altitude hypoxemia. The objective of the manuscript is to review and describe the information available on health and disease at moderate altitudes, mainly with data in Spanish language from Latin-American countries. Young adults in Mexico City have an SaO2 between 92% and 94% versus 97% at sea level, frequently decreasing below 90% during sleep and intense exercise. It is likely that among the population living at this altitude, lung growth, and development during pregnancy and infancy are enhanced, and that after residing for several tens of thousands of years, more important adaptations in oxygen transport and utilization have developed, but we are not certain about it. For patients with respiratory diseases, residing at moderate altitudes implies increased hypoxemia and clinical deterioration, unless supplementary oxygen is prescribed or patients move to sea level. Hyperventilation increases exposure of residents to air pollutants compared to those living in cities with similar concentrations of pollutants, although at sea level. Humans evolved at sea level and lack the best-known adaptations to reside at moderate or high altitudes. Residents of moderate altitudes breathe deeply the city´s air with all its pollutants, and more often require supplementary oxygen.
Topics: Adaptation, Physiological; Altitude; Humans; Hypoxia; Mexico; Oxygen; Young Adult
PubMed: 34495023
DOI: 10.24875/RIC.21000159 -
Veterinary Medicine and Science Jul 2022This review covers the challenges of broiler chickens at high altitude, with the focus on growth performance and physiological response. The review also sheds light on... (Review)
Review
This review covers the challenges of broiler chickens at high altitude, with the focus on growth performance and physiological response. The review also sheds light on nutritional and management interventions that help overcome the challenges raised at high altitude. Reduced concentration of atmospheric oxygen is by far the biggest challenge that remarkably affect growth performance and livability of broiler chickens reared in high altitude area. Broiler chickens have endured intensive genetic selection, which potentially predispose them to several metabolic disorders. Hypoxia is an overriding factor that may increase the incidence of metabolic disorders, mainly ascites syndrome at high altitude. Commercial broiler strains cannot fully achieve their genetic potential when raising at highland regions. Careful nutrition and management considerations are required to prevent metabolic disorders when raising broilers at high altitude. In ovo or in-feed nutraceuticals such as l-carnitine and guanidinoacetic acid as well as pharmaceuticals, texture of feed and the use of proper sources and levels of dietary energy and protein are important factors that need to be carefully considered for rearing broiler chickens at high altitude. Management strategies such as lighting programs have been shown to be effective to circumvent ascites prevalence. Special breeding programs may also be considered to develop strains with resistance to ascites.
Topics: Altitude; Animals; Ascites; Chickens; Diet
PubMed: 35290706
DOI: 10.1002/vms3.784 -
Prevalence and risk factors of stroke in high-altitude areas: a systematic review and meta-analysis.BMJ Open Sep 2023The primary objective of this study is to investigate the prevalence and risk factors of stroke in high-altitude areas through a comprehensive systematic review and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The primary objective of this study is to investigate the prevalence and risk factors of stroke in high-altitude areas through a comprehensive systematic review and meta-analysis.
DESIGN
This study adopts a systematic review and meta-analysis design.
DATA SOURCES
A thorough search was conducted on databases including PubMed, Web of Science, Embase, Cochrane Library, MEDLINE and SCOPUS, covering the period up to June 2023.
ELIGIBILITY CRITERIA
Studies reporting the prevalence of stroke in high-altitude areas and exploring related risk factors were included, regardless of whether they involved clinical samples or the general population. Studies with incomplete, outdated or duplicate data were excluded.
DATA EXTRACTION AND SYNTHESIS
We performed eligibility screening, data extraction and quality evaluation of the retrieved articles. Meta-analysis was employed to estimate the prevalence and risk factors of stroke in high-altitude areas. The Newcastle-Ottawa Scale was used to assess the risk of bias.
RESULTS
A total of 17 studies encompassing 8 566 042 participants from four continents were included, with altitudes ranging from 1500 m to nearly 5000 m. The pooled prevalence of stroke in high-altitude areas was found to be 0.5% (95% CI 0.3%-7%). Notably, the prevalence was higher in clinical samples (1.2%; 0.4%-2.5%) compared with the general population (0.3%; 95% CI 0.1%-0.6%). When considering geographic regions, the aggregated data indicated that stroke prevalence in the Eurasia plate was 0.3% (0.2%-0.4%), while in the American region, it was 0.8% (0.4%-1.3%). Age (OR, 14.891), gender (OR, 1.289), hypertension (OR, 3.158) and obesity (OR, 1.502) were identified as significant risk factors for stroke in high-altitude areas.
CONCLUSIONS
The findings of this study provide insights into the pooled prevalence of stroke in high-altitude areas, highlighting variations based on geographic regions and sampling type. Moreover, age, gender, hypertension and obesity were found to be associated with the occurrence of stroke.
PROSPERO REGISTRATION NUMBER
CRD42022381541.
Topics: Humans; Altitude; Prevalence; Risk Factors; Obesity; Hypertension; Stroke
PubMed: 37734891
DOI: 10.1136/bmjopen-2022-071433 -
Journal of Applied Physiology... Dec 2015Lowlanders commonly report a poor sleep quality during the first few nights after arriving at high altitude. Polysomnographic studies reveal that reductions in slow wave... (Review)
Review
Lowlanders commonly report a poor sleep quality during the first few nights after arriving at high altitude. Polysomnographic studies reveal that reductions in slow wave sleep are the most consistent altitude-induced changes in sleep structure identified by visual scoring. Quantitative spectral analyses of the sleep electroencephalogram have confirmed an altitude-related reduction in the low-frequency power (0.8-4.6 Hz). Although some studies suggest an increase in arousals from sleep at high altitude, this is not a consistent finding. Whether sleep instability at high altitude is triggered by periodic breathing or vice versa is still uncertain. Overnight changes in slow wave-derived encephalographic measures of neuronal synchronization in healthy subjects were less pronounced at moderately high (2,590 m) compared with low altitude (490 m), and this was associated with a decline in sleep-related memory consolidation. Correspondingly, exacerbation of breathing and sleep disturbances experienced by lowlanders with obstructive sleep apnea during a stay at 2,590 m was associated with poor performance in driving simulator tests. These findings suggest that altitude-related alterations in sleep may adversely affect daytime performance. Despite recent advances in our understanding of sleep at altitude, further research is required to better establish the role of gender and age in alterations of sleep at different altitudes, to determine the influence of acclimatization and of altitude-related illness, and to uncover the characteristics of sleep in highlanders that may serve as a study paradigm of sleep in patients exposed to chronic hypoxia due to cardiorespiratory disease.
Topics: Altitude; Animals; Humans; Hypoxia; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 26229000
DOI: 10.1152/japplphysiol.00448.2015 -
International Journal of Environmental... Mar 2023Nowadays, with the convenience of international traveling and driven by many individuals' fond dreams of challenging high-altitude exercises, high-altitude... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Nowadays, with the convenience of international traveling and driven by many individuals' fond dreams of challenging high-altitude exercises, high-altitude mountaineering is becoming increasingly popular worldwide. Therefore, we performed a meta-analysis to determine the effects of high-altitude mountaineering on cognitive functions in mountaineers before and after climbing.
METHODS
After a thorough electronic literature search and selection, eight studies were included in this meta-analysis, and the conducted test cycles ranged from 8 to 140 days. Eight variables were included in this meta-analysis: the Trail-Making Test (TMB), Digit Span-Forward (DSF), Digit Span-Backward (DSB), Finger Tapping Test-Right (FTR) Finger Tapping Test-Left (FTL), Wechsler Memory Scale Visual (WMSV), the Aphasia Screening Test (Verbal Items) (AST-Ver), and the Aphasia Screening Test (Visual Motor Errors) (AST-Vis). The effect sizes (ES) and forest plots of these eight variables were generated.
RESULTS
Five variables (TMB, ES = 0.39; DSF, ES = 0.57; FTR, ES = 0.50; FTL, ES = 0.16; WMSV, ES = 0.63) out of eight were significantly improved after high-altitude mountaineering, whereas the ES values of DSB, AST-Ver, and AST-Vis did not show significant improvement after climbing.
CONCLUSION
Despite two limitations, namely, methodological issues inherent in the meta-analysis and the inability to explain high heterogeneity between studies, this study is the first meta-analysis that has attempted to specify and compare the cognitive functions of mountaineers before and after high-altitude mountaineering. Furthermore, as a short-term plateau exercise, high-altitude mountaineering has no significant negative impacts on the cognitive functions of climbers. Future research is needed for a long period of high-altitude mountaineering.
Topics: Humans; Mountaineering; Altitude; Altitude Sickness; Cognition; Aphasia
PubMed: 36982007
DOI: 10.3390/ijerph20065101 -
Scientific Reports Nov 2023Recently, there has been considerable interest in the functions of gut microbiota in broiler chickens in relation to their use as feed additives. However, the...
Recently, there has been considerable interest in the functions of gut microbiota in broiler chickens in relation to their use as feed additives. However, the gut-microbiota of chickens reared at different altitudes are not well documented for their potential role in adapting to prevailing conditions and functional changes. In this context, the present study investigates the functional diversity of gut-microbes in high-altitude (HACh) and low-altitude adapted chickens (LACh), assessing their substrate utilization profile through Biolog Ecoplates technology. This will help in the identification of potential microbes or their synthesized metabolites, which could be beneficial for the host or industrial applications. Results revealed that among the 31 different types of studied substrates, only polymers, carbohydrates, carboxylic acids, and amine-based substrates utilization varied significantly (p < 0.05) among the chickens reared at two different altitudes where gut-microbes of LACh utilized a broad range of substrates than the HACh. Further, diversity indices (Shannon and MacIntosh) analysis in LACh samples showed significant (p < 0.05) higher richness and evenness of microbes as compared to the HACh samples. However, no significant difference was observed in the Simpson diversity index in gut microbes of lowversus high-altitude chickens. In addition, the Principal Component Analysis elucidated variation in substrate preferences of gut-microbes, where 13 and 8 carbon substrates were found to constitute PC1 and PC2, respectively, where γ-aminobutyric acid, D-glucosaminic acid, i-erythritol and tween 40 were the most relevant substrates that had a major effect on PC1, however, alpha-ketobutyric acid and glycyl-L-glutamic acid affected PC2. Hence, this study concludes that the gut-microbes of high and low-altitudes adapted chickens use different carbon substrates so that they could play a vital role in the health and immunity of an animal host based on their geographical location. Consequently, this study substantiates the difference in the substrate utilization and functional diversity of the microbial flora in chickens reared at high and low altitudes due to altitudinal changes.
Topics: Animals; Altitude; Chickens; Glutamic Acid; Gastrointestinal Microbiome; Carbon
PubMed: 38012260
DOI: 10.1038/s41598-023-48147-9 -
High Altitude Medicine & Biology Jun 2022Nicolaou, Laura, Anne Steinberg, Rodrigo M. Carrillo-Larco, Stella Hartinger, Andres G. Lescano, and William Checkley. Living at high altitude and COVID-19 mortality in...
Nicolaou, Laura, Anne Steinberg, Rodrigo M. Carrillo-Larco, Stella Hartinger, Andres G. Lescano, and William Checkley. Living at high altitude and COVID-19 mortality in Peru. . 23:146-158, 2022. Previous studies have reported a lower severity of COVID-19 infections at higher altitudes; however, this association may be confounded by various factors. We examined the association between living at altitude and COVID-19 mortality in Peru adjusting for population density, prevalence of comorbidities, indicators of socioeconomic status, and health care access. Utilizing administrative data across 196 provinces located at varying altitudes (sea level to 4,373 m), we conducted a two-stage analysis of COVID-19 deaths between March 19 and December 31, 2020, Peru's first wave. We first calculated cumulative daily mortality rate for each province and fit lognormal cumulative distribution functions to estimate total mortality rate, and start, peak, and duration of the first wave. We then regressed province-level total mortality rate, start, peak, and duration of the first wave as a function of altitude adjusted for confounders. There were 93,528 recorded deaths from COVID-19 (mean age 66.5 years, 64.5% male) for a cumulative mortality of 272.5 per 100,000 population between March 19 and December 31, 2020. We did not find a consistent monotonic trend between living at higher altitudes and estimated total mortality rate for provinces at 500 - 1,000 m (-12.1 deaths per 100,000 population per 100 m, 95% familywise confidence interval -27.7 to 3.5) or > 1,000 m (-0.3, -2.7 to 2.0). We also did not find consistent monotonic trends for the start, peak, and duration of the first wave beyond the first 500 m. Our findings suggest that living at high altitude may not confer a lower risk of death from COVID-19.
Topics: Aged; Altitude; COVID-19; Female; Humans; Male; Peru; Prevalence
PubMed: 35483043
DOI: 10.1089/ham.2021.0149