Article
Psychiatry
Katharina Huefner, Marika Falla, Hermann Brugger, Hannes Gatterer, Giacomo Strapazzon, Iztok Tomazin, Ken Zafren, Barbara Sperner-Unterweger, Paolo Fusar-Poli
Summary: Psychosis can be triggered by high altitude exposure and can occur alone or as a symptom of delirium or high altitude cerebral edema. It is currently unclear how to classify psychotic symptoms at high altitude using existing diagnostic categories.
FRONTIERS IN PSYCHIATRY
(2023)
Review
Physiology
Rachel E. F. Turner, Hannes Gatterer, Marika Falla, Justin S. Lawley
Summary: This review discusses the possible mechanisms underlying the development of HACE and AMS, suggesting that HACE may be caused by either cytotoxic swelling or blood brain barrier permeation, while AMS may involve intracellular swelling and intracranial fluid shifts.
JOURNAL OF APPLIED PHYSIOLOGY
(2021)
Article
Physiology
Marc Moritz Berger, Mahdi Sareban, Lisa Maria Schiefer, Kai E. Swenson, Franziska Treff, Larissa Schafer, Peter Schmidt, Magdalena M. Schimke, Michael Paar, Josef Niebauer, Annalisa Cogo, Susi Kriemler, Stefan Schwery, Philipp A. Pickerodt, Benjamin Mayer, Peter Bartsch, Erik R. Swenson
Summary: Acetazolamide is not recommended for prevention of high-altitude pulmonary edema (HAPE) in mountaineers ascending rapidly to over 4,500 m, despite its ability to alleviate symptoms of acute mountain sickness (AMS) and improve arterial oxygenation.
JOURNAL OF APPLIED PHYSIOLOGY
(2022)
Article
Medicine, General & Internal
Jiahuan Xu, Lianggang Lv, Bo He, Guoqiang Wang, Bianbazhuoma, Delei Kong
Summary: A review of records from 429 patients with high altitude pulmonary edema (HAPE) found that 9.32% also had high altitude cerebral edema (HACE). White blood cell count, neutrophil count, lymphocytes, and hemoglobin concentrations in HAPE patients were significantly higher at admission compared to discharge. Patients with HAPE combined with HACE showed more severe damage in hepatocytes and the myocardium.
AMERICAN JOURNAL OF THE MEDICAL SCIENCES
(2021)
Article
Physiology
Jiuhong You, Xinxin Chen, Mei Zhou, Hui Ma, Qiaoling Liu, Cheng Huang
Summary: Acute high-altitude diseases, including AMS, HACE, and HAPE, are potentially lethal for altitude climbers. HBO preconditioning has been proposed as a safe and effective preventive method for these diseases. The mechanisms of HBO preconditioning may involve protection of the blood-brain barrier, inhibition of inflammatory responses, induction of hypoxia-inducible factor, and increase in antioxidant activity. However, the optimal protocol needs further exploration and more large-scale studies are needed.
FRONTIERS IN PHYSIOLOGY
(2023)
Article
Health Care Sciences & Services
Massimo Martinelli, Davide Moroni, Luca Bastiani, Simona Mrakic-Sposta, Guido Giardini, Lorenza Pratali
Summary: This study developed an innovative teleconsultation platform to address health issues in high-altitude areas. Through remote video conferences, patients could receive diagnoses and treatment recommendations from physicians in an outdoor setting. The platform successfully handled a large number of teleconsultation cases.
JOURNAL OF TELEMEDICINE AND TELECARE
(2022)
Review
Pediatrics
Santiago Ucros, Camila Aparicio, Jose A. Castro-Rodriguez, Dunbar Ivy
Summary: This systematic review focuses on high altitude pulmonary edema (HAPE) occurring in children and adolescents. The study found that HAPE is most commonly seen in children between 6 and 10 years old, with a higher incidence in males and rare occurrence in children under 2 years old. HAPE can be classified into re-entry HAPE (R-HAPE) and classic HAPE (C-HAPE), with a higher prevalence of structural cardiac/pulmonary abnormalities in C-HAPE cases compared to R-HAPE cases.
PEDIATRIC PULMONOLOGY
(2023)
Review
Medicine, General & Internal
Andrew M. Luks, Peter H. Hackett
Summary: This article discusses the physiological changes and risks that individuals with medical problems may face when traveling to high altitude, including high-altitude headache, acute mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. It also mentions the pretravel evaluation for common medical conditions that these individuals should undergo.
NEW ENGLAND JOURNAL OF MEDICINE
(2022)
Review
Medicine, General & Internal
Gabriele Savioli, Iride Francesca Ceresa, Giulia Gori, Federica Fumoso, Nicole Gri, Valentina Floris, Angelica Varesi, Ermelinda Martuscelli, Sara Marchisio, Yaroslava Longhitano, Giovanni Ricevuti, Ciro Esposito, Guido Caironi, Guido Giardini, Christian Zanza
Summary: This paper provides a comprehensive review of high-altitude sickness, discussing its epidemiology, pathophysiology, and treatments. It highlights the mechanisms of adaptation to high altitude and the associated risk factors for low adaptability. It also focuses on the main high-altitude diseases and the importance of early recognition and correct therapy.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Sport Sciences
Jean-Paul Richalet, Fabien Pillard, David Le Moal, Daniel Riviere, Philippe Oriol, Mathias Poussel, Bruno Chenuel, Stephane Doutreleau, Samuel Verges, Sophie Demanez, Michel Vergnion, Jean-Michel Boulet, Herve Douard, Maryse Dupre, Olivier Mesland, Romain Remetter, Evelyne Lonsdorfer-Wolf, Alain Frey, Louis Vilcoq, Anne Nedelec Jaffuel, David Debeaumont, Guy Duperrex, Francois Lecoq, Christophe Hedon, Maurice Hayot, Guido Giardini, Francois J. Lhuissier
Summary: The decision tree based on the SHAI score showed efficient in detecting subjects at high risk of SHAI, reducing the reliance on ACZ prescription. The study identified a 400 m daily altitude gain limit to minimize the occurrence of SHAI, with adherence to this rule leading to a significant decrease in SHAI occurrence by respecting recommendations for ACZ use as well.
MEDICINE & SCIENCE IN SPORTS & EXERCISE
(2021)
Article
Biochemistry & Molecular Biology
Rahul Kumar, Neha Chanana, Kavita Sharma, Tsering Palmo, Michael H. Lee, Aastha Mishra, Kevin Nolan, Dara C. Fonseca Balladares, Claudia Mickael, Mohit D. Gupta, Tashi Thinlas, Qadar Pasha, Brian B. Graham
Summary: Acute high-altitude (HA) travel and dexamethasone (DEX) prophylaxis induce significant changes in the peripheral blood mononuclear cell (PBMC) transcriptome, particularly in inflammation pathways and immune pathways. DEX prophylaxis may prevent HA disease by suppressing inflammatory pathways and altering leukocyte population distribution.
BIOSCIENCE REPORTS
(2023)
Article
Genetics & Heredity
Tianbo Jin, Hongyan Lu, Zhanhao Zhang, Yuliang Wang, Wei Yang, Yuhe Wang, Xue He, Dongya Yuan, Yongjun He
Summary: Research has found that HAPE patients have abnormal DNA methylation at multiple CpG sites in the promoter regions of the CYP2S1 gene. Among these sites, the higher risk of hypermethylation was observed at CYP2S1_1_CPG_1.2.3, and the methylation level of CYP2S1 could effectively predict the risk of HAPE patients.
Article
Public, Environmental & Occupational Health
Johannes Burtscher, Erik R. Swenson, Peter Hackett, Gregoire P. Millet, Martin Burtscher
Summary: Background altitude sojourns attract individuals of all ages and different health statuses, but the risk of acute mountain sickness (AMS) when flying to high altitude destinations is often overlooked. This mini-review evaluates the altitude-dependent AMS incidence depending on the mode of ascending, such as air travel or terrestrial travel.
JOURNAL OF TRAVEL MEDICINE
(2023)
Article
Physiology
Craig Winter, Tracy Bjorkman, Stephanie Miller, Paul Nichols, John Cardinal, Peter O'Rourke, Emma Ballard, Fatima Nasrallah, Viktor Vegh
Summary: The study aimed to investigate the relationship between acute mountain sickness (AMS) and changes in plasma vascular endothelial growth factor (VEGF) levels during a high-altitude ascent. The findings suggested that elevated VEGF levels could be a hallmark of AMS, and that exercise did not significantly alter VEGF levels, supporting the idea that elevated plasma VEGF was brain-derived and related to AMS.
FRONTIERS IN PHYSIOLOGY
(2021)
Article
Medicine, Research & Experimental
Karen Sanchez, Santiago J. Ballaz
Summary: Exposure to high altitudes may lead to life-threatening pulmonary edema (HAPE) due to rapid fluid accumulation, with high hemoglobin mass potentially increasing the risk. In Andeans, high-altitude adaptation may contribute to chronic mountain sickness, highlighting the importance of studying vaso-endothelial homeostasis and erythropoiesis in maladaptation to high altitude and HAPE.
MEDICAL HYPOTHESES
(2021)
Editorial Material
Anesthesiology
Peter Paal, Ken Zafren, Mathieu Pasquier
Summary: Senior physicians with higher pre-hospital anaesthesia case volume have better outcomes in tracheal intubation, shorter on-site times, and lower patient mortality rates. They possess the necessary skills for airway and breathing management, circulation, disability and environment, and are capable of technical rescue in hazardous situations. In mass casualty situations, they are also skilled in patient triage, prioritization, resource allocation, and transport decision-making.
BRITISH JOURNAL OF ANAESTHESIA
(2022)
Article
Environmental Sciences
Peter Paal, Mathieu Pasquier, Tomasz Darocha, Raimund Lechner, Sylweriusz Kosinski, Bernd Wallner, Ken Zafren, Hermann Brugger
Summary: Accidental hypothermia is when the core temperature drops below 35 degrees C unintentionally. It is important to diagnose and assess the risk of cardiac arrest in hypothermic patients. Those with high risk should be transferred to an extracorporeal life support center. The chances of survival and good neurological outcome are higher for hypothermic patients in cardiac arrest compared to normothermic patients.
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
(2022)
Article
Environmental Sciences
Kazue Oshiro, Yuichiro Tanioka, Juerg Schweizer, Ken Zafren, Hermann Brugger, Peter Paal
Summary: This article reviews the causes and preventive measures of accidental hypothermia caused by natural disasters. Pre-disaster preventive measures include risk analysis, hazard mapping and warning, as well as protection of existing structures. Post-disaster measures involve analyzing failures and implementing corrective actions.
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
(2022)
Editorial Material
Critical Care Medicine
Ken Zafren, Peter Paal
Article
Public, Environmental & Occupational Health
Robert Blasco Marino, Inigo Soteras Martinez, Ana Isabel Hernandez Roca, Ken Zafren
Summary: Snakebites in Spain are rare medical emergencies, with only around 100 hospitalizations reported annually. Viperidae family snakes are responsible for most venomous bites, which can have cytotoxic and hematotoxic effects, as well as neurological effects. Ptosis, or eyelid drooping, is the most common symptom, but other cranial nerves can also be affected. This case report describes a patient with isolated ptosis following a Vipera aspis bite in the Catalan Pyrenees, which resolved spontaneously within 10 hours without antivenom administration. Neurological findings, although usually mild, indicate a moderate to severe envenomation. Treating snakebites can be challenging, especially when uncommon clinical manifestations occur. Consultation with a toxicologist at a poison center and the development of local protocols can provide clinical support.
WILDERNESS & ENVIRONMENTAL MEDICINE
(2022)
Editorial Material
Public, Environmental & Occupational Health
Thomas Kupper, Ken Zafren, Jenny Visser
JOURNAL OF TRAVEL MEDICINE
(2022)
Article
Public, Environmental & Occupational Health
Ken Zafren, Sarah Hollis, Eric A. Weiss, Daniel Danzl, Jessie Wilburn, Nadia Kimmel, Chris Imray, Gordon Giesbrecht, Mike Tipton
Summary: We gathered a group of experts to develop evidence-based guidelines for the evaluation, treatment, and prevention of NFCIs and warm water immersion injuries. The recommendations were graded based on evidence quality and the balance between benefits and risks/burdens. Treating NFCIs is more challenging and may result in prolonged debilitating symptoms, while warm water immersion injuries usually resolve without complications.
WILDERNESS & ENVIRONMENTAL MEDICINE
(2023)
Editorial Material
Emergency Medicine
Mary Starrs, Ken Zafren
JOURNAL OF THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS OPEN
(2023)
Article
Public, Environmental & Occupational Health
Robert Blasco Marino, Inigo Soteras Martinez, Montserrat Bacardit, Ken Zafren, Peter Paal
Summary: This study examines the historical effects of avalanches on communities in the eastern Spanish Pyrenees. Efforts to mitigate avalanches have significantly reduced their impact on inhabited areas, but backcountry skiers and those travelling near avalanche-controlled ski resorts remain at risk.
WILDERNESS & ENVIRONMENTAL MEDICINE
(2023)
Article
Psychiatry
Katharina Huefner, Marika Falla, Hermann Brugger, Hannes Gatterer, Giacomo Strapazzon, Iztok Tomazin, Ken Zafren, Barbara Sperner-Unterweger, Paolo Fusar-Poli
Summary: Psychosis can be triggered by high altitude exposure and can occur alone or as a symptom of delirium or high altitude cerebral edema. It is currently unclear how to classify psychotic symptoms at high altitude using existing diagnostic categories.
FRONTIERS IN PSYCHIATRY
(2023)
Article
Biophysics
Marie Libersa, Louis Marxer, Ken Zafren, Stephane Oggier, Lorenzo Pucci, Mathieu Pasquier
Summary: This article reports a case of mid-ventricular takotsubo stress cardiomyopathy in an avalanche survivor. The patient experienced symptoms of arrhythmia and myocardial dysfunction after being completely buried under snow for 30 minutes, but gradually recovered after treatment.
HIGH ALTITUDE MEDICINE & BIOLOGY
(2023)
Letter
Biophysics
Ken Zafren, Matiram Pun, Buddha Basnyat
HIGH ALTITUDE MEDICINE & BIOLOGY
(2023)
Article
Biophysics
Katharina Huefner, Fabio Caramazza, Evelyn R. Pircher Noeckler, Agnieszka E. Stawinoga, Paolo Fusar-Poli, Sanjeeb S. Bhandari, Buddha Basnyat, Monika Brodmann Maeder, Giacomo Strapazzon, Iztok Tomazin, Ken Zafren, Hermann Brugger, Barbara Sperner-Unterweger
Summary: This study investigated the association between pre-existing mental health conditions and acute mountain sickness (AMS) at Everest Base Camp. The analysis of data from previous research showed that individuals with a history of anxiety disorder, depression, and recreational drug use had an increased risk of AMS.
HIGH ALTITUDE MEDICINE & BIOLOGY
(2022)
Review
Public, Environmental & Occupational Health
Sylweriusz Kosinski, Pawel Podsiadlo, Tomasz Darocha, Mathieu Pasquier, Konrad Mendrala, Tomasz Sanak, Ken Zafren
Summary: Ultrathin reflective foils are commonly used for thermal insulation, but their effectiveness lacks clear evidence. The high reflectivity of the metallic side of the foil is considered relatively insignificant, while the insulation largely depends on trapping air and the number of layers.
WILDERNESS & ENVIRONMENTAL MEDICINE
(2022)
Article
Biophysics
Ken Zafren, Raimund Lechner, Peter Paal, Hermann Brugger, Giles Peek, Tomasz Darocha
Summary: The study discusses the rediscovery of case series where induced hypothermia was used in patients for surgery. It reports the lowest core temperature achieved during induced hypothermia and suggests that survival from very low temperatures provides evidence that accidental hypothermia can also be successfully treated. The study highlights the importance of not relying solely on core temperature when determining the chances of survival in hypothermic patients.
HIGH ALTITUDE MEDICINE & BIOLOGY
(2022)
