Medicina de las alturas

Impacto de mal de montaña entre los viajeros a Cusco Perú


Acute Mountain Sickness Impact Among Travelers to Cusco, Peru
Hugo Salazar, MS, Jessica Swanson, Karen Mozo, A. Clinton White Jr., Miguel M. Cabada
School of Medicine, University of Texas Medical Branch, Galveston, TX, USA; Department of Medicine, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru; Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
DOI: 10.1111/j.1708-8305.2012.00606.x
Journal of Travel Medicine 2012; Volume 19 (Issue 4): 220-225


Background
Increasing numbers of travelers are visiting high altitude locations in the Andes. The epidemiology of acute mountain sickness (AMS) among tourists to high altitude in South America is not well understood. Methods; A cross-sectional study to evaluate the epidemiology, pre-travel preparation, and impact of AMS among travelers to Cusco, Peru (3,400 m) was performed at Cusco's International Airport during June 2010. Foreign travelers, 18 years or older, staying 15 days or less, departing Cusco were invited to participate. Demographic, itinerary, and behavioral data were collected. The Lake Louise Clinical score (LLCS) was used to assess AMS symptoms. Results. In total, 991 travelers participated, median age 32 years (interquartile range 25-49), 55.5% female, 86.7% tourists, mostly from the United States (48.2%) and England (8.1%). Most (76.7%) flew from sea level to Cusco and 30.5% visited high altitude in the previous 2 months. Only 29.1% received AMS advice from a physician, 19% recalled advice on acetazolamide. Coca leaf products (62.8%) were used more often than acetazolamide (16.6%) for prevention. AMS was reported by 48.5% and 17.1% had severe AMS. One in five travelers with AMS altered their travel plans. Travelers older than 60 years, with recent high altitude exposure, who visited lower cities in their itinerary, or used acetazolamide were less likely to have AMS. Using coca leaf products was associated with increased AMS frequency. Conclusions. AMS was common and adversely impacted plans of one in five travelers. Acetazolamide was associated with decreased AMS but was prescribed infrequently. Other preventive measures were not associated with a decrease in AMS in this population. Pre-travel preparation was suboptimal.


http://onlinelibrary.wiley.com/doi/10.1111/j.1708-8305.2012.00606.x/pdf




Síntomas de fisiológicos y psicológicos de enfermedad en la Alturas y su relación con el mal agudo de montaña: Estudio prospectivo de cohortes
Physiological and Psychological Illness Symptoms at High Altitude and Their Relationship With Acute Mountain Sickness: A Prospective Cohort Study
Samuel J. Oliver, PhD, Stephan J. Sanders, PhD, Catherine J. Williams, MBBCh,, Zoe A.
Smith, Emma Lloyd-Davies, MBBS,Ross Roberts, PhD, Calum Arthur, PhD, Lew Hardy, PhD, and Jamie H. Macdonald, PhD

Journal of Travel Medicine 2012; Volume 19 (Issue 4): 210-219

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*m2; 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.
http://onlinelibrary.wiley.com/doi/10.1111/j.1708-8305.2012.00609.x/pdf

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Anestesiología y Medicina del Dolor
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