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Kathmandu, Nepal

Walmsley M.,Himalayan Rescue Association
High Altitude Medicine and Biology | Year: 2013

Walmsley, Megan. Continuous positive airway pressure as adjunct treatment of acute altitude illness. High Alt Med Biol 14:405-407, 2013.-Altitude related illness occurs in unacclimatized individuals ascending to altitudes over 2500 m. Treatment usually involves descending to lower altitudes and pharmacological therapies. There are very few cases, studies, or recommendations regarding the use of positive pressure ventilation in acute mountain sickness (AMS) or high altitude pulmonary edema (HAPE). This case describes the use of CPAP as part of the treatment of a trekker diagnosed with AMS and HAPE in a remote location at 4200 m in Nepal. © 2013 Mary Ann Liebert, Inc. Source

Havryliuk T.,Mount Sinai St Lukes Roosevelt Hospital Center | Acharya B.,Himalayan Rescue Association | Caruso E.,Denver Health Medical Center | Cushing T.,Aurora University
High Altitude Medicine and Biology | Year: 2015

Havryliuk, Tatiana, Bhuwan Acharya, Emily Caruso, and Tracy Cushing. Understanding of altitude illness and use of pharmacotherapy among trekkers and porters in the Annapurna region of Nepal. High Alt Med Biol 16:236-243, 2015.-We surveyed Nepali porters and guides as well as English-and non-English-speaking trekkers on their knowledge of altitude illness and its treatment during trekking expeditions to the Annapurna region of Nepal. From March 15 to April 15, 2014, Nepali porters and visiting trekkers were surveyed regarding their ability to recognize and treat altitude illness in Manang, Nepal (3540m). Their personal use of medications and home remedies and presence of acute mountain sickness (AMS) symptoms were also assessed. 504 subjects were surveyed, including 108 Nepalis. Overall incidence of AMS symptoms was 16%, 5% among Nepalis, and 21% among trekkers. Subjects recognized that headache (88%) was one of the symptoms of AMS, however many reported not knowing the symptoms of high altitude pulmonary edema (40%) or high altitude cerebral edema (42%). 58% of subjects reported carrying and 16% reported taking acetazolamide, while only 2 (0.4%) respondents took dexamethasone. The majority of subjects reported that they would be able to recognize (67%) and treat (62%) altitude illness. Trekkers reported a higher incidence of AMS symptoms than Nepalis. Although most respondents recognized symptoms of AMS, both Nepalis and trekkers lacked knowledge regarding more serious presentations of altitude illness, thus both groups were overconfident in their ability to recognize and treat altitude illness. © Copyright 2015, Mary Ann Liebert, Inc. 2015. Source

Gertsch J.H.,University of California at San Diego | Corbett B.,Himalayan Rescue Association | Holck P.S.,University of Hawaii at Manoa | Mulcahy A.,Himalayan Rescue Association | And 20 more authors.
Wilderness and Environmental Medicine | Year: 2012

Objective: To study the effectiveness of ibuprofen versus placebo in preventing acute mountain sickness (AMS) and high altitude headache (HAH). Methods: Double-blind, randomized, placebo-controlled trial. Results: Two hundred ninety-four healthy Western trekkers were recruited on the Everest approach at 4280 m or 4358 m and randomly assigned to receive either 600 mg of ibuprofen or placebo 3 times daily before and during ascent to 4928 m. One hundred eighty-three of 294 participants completed the trial. Of the participants who did not complete the trial, 62 were lost to follow-up and another 49 broke trial protocol. In an intent-to-treat analysis (232 participants), ibuprofen was found to be more effective than placebo in reducing the incidence of AMS (24.4% vs 40.4%; P =.01) and the incidence of HAH (42.3% vs 60.5%; P <.01). Ibuprofen was also superior to placebo in reducing the severity of HAH (4.9% vs 14.7%; P =.01). The end point of oxygen saturation was also higher in the ibuprofen group (80.8 % vs 82.4%; P =.035). For the 183 participants who completed the trial and conformed to the protocol, the incidence of AMS between placebo and treatment groups was not significant (32.9% vs 22.7%; P =.129 for AMS incidence, 9.6% vs 8.2%; P =.74 for AMS severity, 54.8% vs 42.7%; P =.11 for HAH incidence, and 8.2% vs 3.6%; P =.18 for HAH severity). Conclusions: Ibuprofen was found to be effective in preventing AMS in the intent-to-treat analysis group but not in those who completed the trial. This loss of significance in the subjects who completed the trial may be explained by persons in the placebo group having a higher burden of illness and associated decreased compliance with the protocol. An important limitation of this study may be the possibility that ibuprofen can mask headache, which is a compulsory criterion for the diagnosis of AMS. © 2012 Wilderness Medical Society. Source

Basnyat B.,Nepal International Clinic | Holck P.S.,Himalayan Rescue Association | Pun M.,Mountain Medicine Society of Nepal | Pun M.,University of Calgary | And 13 more authors.
Wilderness and Environmental Medicine | Year: 2011

Objectives Over the last 20 years a number of small trials have reported that spironolactone effectively prevents acute mountain sickness (AMS), but to date there have been no large randomized trials investigating the efcacy of spironolactone in prevention of AMS. Hence, a prospective, double-blind, randomized, placebo-controlled trial was conducted to evaluate the efcacy of spironolactone in the prevention of AMS. Methods Participants were sampled from a diverse population of western trekkers recruited at 4300 m on the Mount Everest base camp approach (Nepal side) en route to the study endpoint at 5000 m. Three hundred and eleven healthy trekkers were enrolled, and 251 completed the trial from October to November 2007. Participants were randomly assigned to receive at least 3 doses of spironolactone 50 mg BID, acetazolamide 250 mg BID, or visually matched placebo. A Lake Louise AMS Score of 3 or more, together with the presence of headache and 1 other symptom, was used to evaluate the incidence and severity of AMS. Secondary outcome measures were blood oxygen content and the incidence and severity of high altitude headache (HAH). Results Acetazolamide was more effective than spironolactone in preventing AMS (OR = 0.28, 95% CI 0.120.60, p < 0.01). Spironolactone was not signicantly different from placebo in the prevention of AMS. AMS incidence for placebo was 20.3%, acetazolamide 10.5%, and spironolactone 29.4%. Oxygen saturation was also signicantly increased in the acetazolamide group (83% ± 0.04) vs spironolactone group (80% ± 0.05, p < 0.01). Conclusions Spironolactone (50 mg BID) was ineffective in comparison to acetazolamide (250 mg BID) in the prevention of AMS in partially acclimatized western trekkers ascending to 5000 m in the Nepali Himalaya. © 2011 Wilderness Medical Society. Source

Tanner J.B.,Massachusetts General Hospital | Tanner S.M.E.,Himalayan Rescue Association | Thapa G.B.,Mountain Medicine Society of Nepal | Chang Y.,Massachusetts General Hospital | And 5 more authors.
High Altitude Medicine and Biology | Year: 2013

This study is the first comparative trial of sleep medications at high altitude. We performed a randomized, double-blind trial of temazepam and acetazolamide at an altitude of 3540 meters. 34 healthy trekkers with self-reports of high-altitude sleep disturbance were randomized to temazepam 7.5 mg or acetazolamide 125 mg taken at bedtime for one night. The primary outcome was sleep quality on a 100 mm visual analog scale. Additional measurements were obtained with actigraphy; pulse oximetry; and questionnaire evaluation of sleep, daytime drowsiness, daytime sleepiness, and acute mountain sickness. Sixteen subjects were randomized to temazepam and 18 to acetazolamide. Sleep quality on the 100 mm visual analog scale was higher for temazepam (59.6, SD 20.1) than acetazolamide (46.2, SD 20.2; p=0.048). Temazepam also demonstrated higher subjective sleep quality on the Groningen Sleep Quality Scale (3.5 vs. 6.8, p=0.009) and sleep depth visual analog scale (60.3 vs. 41.4, p=0.028). The acetazolamide group reported significantly more awakenings to urinate (1.8 vs. 0.5, p=0.007). No difference was found with regards to mean nocturnal oxygen saturation (84.1 vs. 84.4, p=0.57), proportion of the night spent in periodic breathing, relative desaturations, sleep onset latency, awakenings, wake after sleep onset, sleep efficiency, Stanford Sleepiness Scale scores, daytime drowsiness, or change in self-reported Lake Louise Acute Mountain Sickness scores. We conclude that, at current recommended dosing, treatment of high-altitude sleep disturbance with temazepam is associated with increased subjective sleep quality compared to acetazolamide. © Copyright 2013, Mary Ann Liebert, Inc. 2013. Source

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