High altitudes and partial pressure of arterial oxygen in patients with chronic obstructive pulmonary disease - A systematic review and meta-analysis.

IMPORTANCE: Prior study in healthy subjects has shown a reduction of partial pressure of arterial oxygen (PaO2) by -1.60 kPa/kilometre of altitude gain. However, the association of altitude-related change in PaO2 and altitude-related adverse health effects (ARAHE) in patients with chronic obstructive pulmonary disease (COPD) remain unknown. OBJECTIVE: To provide an effect size estimate for the decline in PaO2 with each kilometre of altitude gain and to identify ARAHE in relation to altitude in patients with COPD. www.crd.york.ac.uk/prospero: CRD42020217938. DATA SOURCES: A systematic search of PubMed and Embase was performed from inception to May 30, 2023. STUDY SELECTION: Peer-reviewed and prospective studies in patients with COPD staying at altitudes >1500 m providing arterial blood gases within the first 3 days at the target altitude. DATA EXTRACTION AND SYNTHESIS: Aggregate data (AD) on study characteristics were extracted, and individual patient data (IPD) were requested. Estimates were pooled using random-effects meta-analysis. MAIN OUTCOME AND MEASURES: Relative risk estimates and 95 % confidence intervals for the association between PaO2 and altitude in patients with COPD. RESULTS: Thirteen studies were included in the AD analysis, of which 6 studies (222 patients, 45.2 % female) provided IPD, thus were included in the quantitative analysis. The estimated effect size of PaO2 was -0.84 kPa [95 %CI, -0.92 to -0.76] per 1000 m of altitude gain (I2=65.0 %, P < 0.001). In multivariable regression analysis, COPD severity, baseline PaO2, age and time spent at altitude were predictors for PaO2 at altitude. Overall, 37.8 % of COPD patients experienced an ARAHE, whereas older age, female sex, COPD severity, baseline PaO2, and target altitude were predictors for the occurrence of ARAHE (area under ROC curve: 0.9275, P < 0.001). CONCLUSIONS AND RELEVANCE: This meta-analysis, providing altitude-related decrease in PaO2 and risk of ARAHE in patients with COPD ascending to altitudes >1500 m, revealed a lower altitude-related decrease in PaO2 in COPD patients compared with healthy. However, these findings might improve patient care and facilitate decisions about initiating preventive measures against hypoxaemia and ARAHE in patients with COPD planning an altitude sojourn or intercontinental flight, i.e. supplemental oxygen or acetazolamide.

Evaluating low and high vitamin D levels in Ecuadorian cities from 2018 to 2022: interrupted time series and a cross-sectional study.

OBJECTIVES: To identify differences in the mean vitamin D concentrations in samples obtained from a private laboratory in Quito and to explore their relationship with the pre-pandemic and pandemic periods spanning from 2018 to 2022. DESIGN: A combination of an interrupted time series design and a retrospective cross-sectional approach. SETTING AND PARTICIPANTS: The study involved 9285 participants who had their 25-hydroxyvitamin D (25(OH)D) levels tested at a well-known private laboratory in Quito, Ecuador, from 2018 to 2022. PRIMARY AND SECONDARY OUTCOME MEASURES: The 25(OH)D levels were analysed and assessed for correlations with age, and the year the measurements were taken. RESULTS: The mean 25(OH)D level was 27.53 ng/mL (± 14.11). Approximately 68.8% of participants had serum 25(OH)D levels of less than 30 ng/mL, and 0.6% showed potential harm from excess 25(OH)D, with levels over 100 ng/mL. The analysis indicated a significant monthly increase of 0.133 units in 25(OH)D levels (p=0.006). However, the period after March 2020, compared with before, saw a non-significant decrease of 1.605 units in mean 25(OH)D levels (p=0.477). CONCLUSIONS: The study's findings indicate a significant prevalence of 25(OH)D deficiency, underscoring the necessity for preventative measures. However, the increasing trend in high 25(OH)D levels is concerning, emphasising the importance of prudent vitamin D supplement prescriptions and public education against self-medication. For efficient resource allocation and targeting of those with higher risks, it may be advantageous to concentrate vitamin D testing on specific population groups.

Predictive model for estimating the risk of high-altitude pulmonary edema: a single-centre retrospective outcome-reporting study.

OBJECTIVE: To develop the first prediction model based on the common clinical symptoms of high-altitude pulmonary edema (HAPE), enabling early identification and an easy-to-execute self-risk prediction tool. METHODS: A total of 614 patients who consulted People's Hospital of Tibet Autonomous Region between January 2014 and April 2022 were enrolled. Out of those, 508 patients (416 males and 92 females) were diagnosed with HAPE and 106 were patients without HAPE (33 females and 72 males). They were randomly distributed into training (n=431) and validation (n=182) groups. Univariate and multivariate analysis were used to screen predictors of HAPE selected from the 36 predictors; nomograms were established based on the results of multivariate analysis. The receiver operating characteristic curve (ROC) was developed to obtain the area under the ROC curve (AUC) of the predictive model, and its predictive power was further evaluated by calibrating the curve, while the Decision Curve Analysis (DCA) was developed to evaluate the clinical applicability of the model, which was visualised by nomogram. RESULTS: All six predictors were significantly associated with the incidence of HAPE, and two models were classified according to whether the value of SpO2 (percentage of oxygen in the blood) was available in the target population. Both could accurately predict the risk of HAPE. In the validation cohort, the AUC of model 1 was 0.934 with 95% CI (0.848 to 1.000), and model 2 had an AUC of 0.889, 95% CI (0.779 to 0.999). Calibration plots showed that the predicted and actual HAPE probabilities fitted well with internal validation, and the clinical decision curve shows intervention in the risk range of 0.01-0.98, resulting in a net benefit of nearly 99%. CONCLUSION: The recommended prediction model (nomogram) could estimate the risk of HAPE with good precision, high discrimination and possible clinical applications for patients with HAPE. More importantly, it is an easy-to-execute scoring tool for individuals without medical professionals' support.

Women's Health at High Altitude: An Introduction to a 7-Part Series by the International Climbing and Mountaineering Federation Medical Commission.

Horakova, Lenka, Peter Paal, Jacqueline Pichler Hefti, Marija Andjelkovic, Beth A. Beidleman, Mia Derstine, David Hillebrandt, Dominique Jean, Kaste Mateikaite-Pipiriene, Alison J. Rosier, Susi Kriemler, and Linda E. Keyes. Women's health at high altitude: An introduction to a 7-part series by the International Climbing and Mountaineering Federation Medical Commission. High Alt Med Biol. 24:243-246, 2023. Background: Women have been traveling to high altitude since the inception of modern mountaineering. Although there are distinct female-specific features such as menstruation and menopause relevant to adaptation to and performance at high altitude, very little data exist on women's high-altitude health. To summarize what is known to date, the Medical Commission of the International Climbing and Mountaineering Federation (UIAA) has created a series of articles on women's health, high altitude illness, and performance at high altitude. Methods: Assembling an international author team, two types of manuscripts were developed: (1) reviews on female-specific topics such as pregnancy; (2) reviews on sex differences in high-altitude related illnesses, nutrition, cold injuries, and mortality. Results: The literature search yielded 7,165 articles, with 482 studies meeting the inclusion criteria for full-text review. The authors of individual chapters reviewed these articles and performed additional hand searches. Conclusions: Some important questions on women sojourning and exercising at high altitude have been studied, but many are still awaiting a qualified and evidence-based response. Our seven reviews, to be published in future issues of this journal, summarize what is known about lowland women sojourning at high altitude, provide recommendations, and highlight knowledge gaps in high altitude women's medicine.

Frostbite: a treatment guideline for prehospital treatment in a military environment.

Frostbite remains a severe medical condition that causes long-lasting sequelae and can threaten military operations. Information on prehospital treatment of frostbite is scarce and existing guidelines are aimed at the general population.This paper provides a guideline on prehospital emergency care of frostbite in the (Netherlands) Armed Forces. The insights gained from studies reporting on frostbite treatment in the prehospital setting were combined with the expert opinions of the authors and applied to the military context. The resulting guideline consists of two stages: (prolonged) field care and care at a Medical Treatment Facility. The cornerstones are rewarming in warm water and evacuation to a medical facility. Additional aspects of prehospital treatment are rehydration, proper analgesia, non-steroidal anti-inflammatory drugs and wound care.We suggest further collaboration among North Atlantic Treaty Organization partners and other affiliated nations, focusing on the full spectrum of military injury management including state-of-the-art aftercare, long-lasting sequelae and return to duty after frostbite.

Association between obesity and 1-year mortality in septic patients: a retrospective cohort study.

OBJECTIVE: Sepsis is a major contributor of intensive care units (ICUs) patient mortality. Prior investigations claimed that obesity enhances overall survival (OS) of septic patients. However, the reported results were inconsistent. This study examined the association between obesity and the 1-year mortality of septic patients. DESIGN: A retrospective cohort study. SETTING: The Medical Information Mart for Intensive Care III database. PARTICIPANTS: 3145 septic patients were separated into three distinct cohorts, based on their WHO body mass index (BMI) status. OUTCOMES: Our primary endpoint was the 1-year mortality from the date of ICU hospitalization. RESULT: 1334 (42.4%) died within 1 year. The 1-year mortality rate was low in obese patients (38.8%), compared with normal (46.9%) and overweight (42.1%) patients. Crude assessment revealed that obese patients experienced reduced 1-year mortality, relative to normal weight patients (HR 0.79, 95% CI 0.69 to 0.9, p<0.001). However, once adjusted for baseline variables and comorbidities, no correlation was found between obesity and the 1-year mortality (HR 0.93, 95% CI 0.81 to 1.06, p=0.28) of septic patients. There was an association among diabetic (HR 0.72, 95% CI 0.56 to 0.93, p=0.012) and hypertensive (HR 0.73, 95% CI 0.58 to 0.92, p=0.008) patients, and among males (HR 0.71, 95% CI 0.59 to 0.86, p<0.001), with obese individuals experiencing the lowest mortality rate. Given these evidences, the interactions between BMI and mortality in diabetic (p=0.031) and hypertensive (p=0.035) patients were significant. CONCLUSION: In our study, obese diabetic and hypertensive patients associated to less sepsis-related mortality risk, compared with normal weight patients. Further researches were need to validated.

Frostbite: a systematic review on freezing cold injuries in a military environment.

BACKGROUND: Military practice or deployment in extreme conditions includes risks, dangers and rare disorders. One of the challenges is frostbite; however, current literature does not provide an overview of this condition in a military context. This review aims to map the incidence, risk factors and outcome of frostbite in military casualties in the armed forces. METHODS: A systematic literature search on frostbite (freezing cold injuries) in military settings from 1995 to the present was performed. A critical appraisal of the included articles was conducted. Data on incidence, risk factors, treatment and outcome were extracted. RESULTS: Fourteen studies were included in our systematic review. Most studies of frostbite in a military setting were published nearly half a century ago. Frostbite incidence has declined from 7% to around 1% in armed forces in arctic regions but could be as high as 20% in small-scale arctic manoeuvres. Overall and military-specific risk factors for contracting frostbite were identified. CONCLUSION: During inevitable arctic manoeuvres, frostbite is a frequently diagnosed injury in service members. Postfreezing symptoms often persist after severe frostbite injury, which decreases employability within the service. Over time, military practice has changed considerably, and modern protective materials have been introduced; therefore, re-evaluation and future study in the military field are appropriate, preferably with other North Atlantic Treaty Organization partners.

Musculoskeletal system injuries in the Polish Territorial Defence Forces.

BACKGROUND: Musculoskeletal system injuries (MSIs) are the major health problem of soldiers. The aim of this study was to assess the types of MSIs that occurred most frequently among soldiers and which parts of the body they generally affected. METHODS: The study included 140 Territorial Army soldiers, both men and women, serving in the Polish Territorial Defence Forces (TDF). Times and frequency of MSIs were assessed using an original questionnaire available via a web-based platform, the TDF Information Portal and the Yammer network. RESULTS: Among the participants, 42% reported MSIs, most often a single one (19%), incurred while doing military service. Damaged muscles and ligaments were the most common injuries in both groups (p>0.05). The knee joint was the main location of injuries for both sexes (24% in men vs 50% in women, p>0.05). Other parts of the body often affected by injuries were the shoulder joint (24%, p>0.05), head, spine, wrist, fingers, ankle and feet (19% each) in the male soldiers and the ankle (24%), spine (14%), head, chest, shoulder joint and foot (10% each) in the female soldiers. Injuries reoccurred with similar frequency in the female and male soldiers (43% vs 40%, p>0.05) and had the same location in both groups (43% vs 40%, respectively, p>0.05). Difficult terrain, too intensive military training and heavy loads were the main risk factors for MSIs in both groups (p>0.05). CONCLUSIONS: More than half of all the participants (19% of the men and 33% of the women) reported at least one injury incurred during military service. Over 40% of all the study subjects had reinjuries. The males and females were similar in terms of the most common type and location of MSI. Occurrence of MSIs rarely required interruption in the military training/service.

Complications with hot, cold and altitude environments in disaster management.

INTRODUCTION: Disaster management is the process of preparing, responding and recovering to an emergency whether that be natural or man-made. It is a time-consuming, resource-heavy process with the aim of reducing the risk of certain events and, where not possible, reducing the impact of said disaster, ensuring that the risks have been identified and appropriate rescue and recovery plan is in place. METHODS: We carried out a thorough literature search on the complications of hot, cold and altitude environments in disaster management and distilled the learnings into this article. RESULTS: The incidence of disasters of natural, man-made and complex origin is likely to continue increasing as global temperatures continue to rise. CONCLUSION: Disaster management in the extreme environments of hot, cold and high altitude is fraught with unique challenges, especially around the physiological response of rescuers, resource constraints and logistics. Recognising these challenges is an important aspect of planning and preparation for disaster management in these environments.

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.

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).

Establishing the reference interval for pulse oxygen saturation in neonates at high altitudes: protocol for a multicentre, open, cross-sectional study.

INTRODUCTION: Establishing the reference interval for pulse oxygen saturation (SpO2) is essential for sensitively identifying neonatal hypoxaemia due to various causes. However, the reference interval for high altitudes has not yet been established, and existing studies have many limitations. This study will aim to establish the reference interval for various high altitudes and determine whether preductal and postductal measurements at the same altitude vary. METHODS AND ANALYSIS: This is a multicentre, open, cross-sectional study, which will begin in February 2022. Approximately 2000 healthy full-term singleton neonates will be recruited from six hospitals (altitude ≥2000 m) in Qinghai Province, China. The participating hospitals will use a uniform pulse oximeter type. The measurements will be performed between 24 hours after birth and discharge. During the measurement, the neonate will be awake and quiet. Preductal and postductal measurements will be performed. The measurement time, site and results will be recorded and input, along with the collected basic information, into the perinatal cloud database. We will carry out strict quality control for basic information collection, measurement and data filing. We will perform descriptive statistics on the distribution range of the collected data, determine the lower limit value of the reference interval for each hospital and the corresponding altitude, perform curve fitting for the lower limit value, use the altitude as a covariate for the function corresponding to the fitted curve, establish the prediction equation and ultimately determine the reference intervals of each high altitude location. ETHICS AND DISSEMINATION: Our protocol has been approved by the Medical Ethics Committee of all participating hospitals. We will publish our study results in academic conferences and peer-reviewed public journals. TRIAL REGISTRATION NUMBER: NCT05115721.

Prevalence, awareness, treatment and control of hypertension among Ngawa Tibetans in China: a cross-sectional study.

OBJECTIVES: To explore the prevalence, awareness, treatment and control rate of hypertension and analyse the potential social environment factors among Ngawa Tibetans in China. DESIGN: This was a cross-sectional observational study. SETTING: The investigation based on a multistage stratified cluster sampling was conducted in the Ngawa area, Sichuan Province, Southwest China. Tibetan residents were selected by random sampling method from one city and six counties in Ngawa. METHODS: Basic demographical information, physical activity and blood pressure were collected. In addition, the participants completed the questionnaire. A multivariate logistic regression analysis was used to examine the association between the prevalence, awareness, treatment and control rate of hypertension and the potential risk factors. PARTICIPANTS: The sample comprised 2228 Ngawa Tibetan residents (age 18-80 years) from September 2018 to June 2019. RESULTS: The prevalence rate of hypertension was 24.6%. The control rate was 6.2%, while the awareness rate (32.3%) and treatment rate (21.7%) of hypertension had been significantly improved. CONCLUSION: The prevalence of hypertension among Ngawa Tibetans was high. The awareness and treatment were improved in recent years. But the control rate was low. The government needs to strengthen the basic medical care and health education for Ngawa Tibetans.

BASAN index (Body mass index, Age, Sex, Arterial hypertension and Neck circumference) predicts severe apnoea in adults living at high altitude.

OBJECTIVES: Obstructive sleep apnoea (OSA)/hypopnoea syndrome is associated with serious and major multiorgan morbidities, particularly in its most severe forms. However, no severe OSA screening instruments are available for high altitude residents that enable adequate identification and clinical prioritisation of such patients. We aimed at developing a severe OSA prediction tool based on the clinical characteristics and anthropometric measurements of a clinical referral cohort living at 2640 m.a.s.l. DESIGN: Cohort-nested cross-sectional study. SETTING: Sleep laboratory for standard polysomnography (PSG) in Colombia. PARTICIPANTS: A predictive model was generated from 8718 participants referred to the PSG laboratory. Results were subsequently validated in a second cohort of 1898 participants. PRIMARY OUTCOME: To identify clinical and anthropometric variables associated with severe OSA (>30 events/hour) and to include them in a binary logistic regression model. RESULTS: The significant variables that were retained with the presence of severe OSA included Body mass index (BMI), Age, Sex, Arterial hypertension and Neck circumference (BASAN). The area under the receiver operating characteristic curvefor the BASAN index was 0.69 (95% CI: 0.68 to 0.70) in the derivation cohort and 0.67 (95% CI: 0.65 to 0.69) in the validation cohort, whereby a BASAN index ≥2 had a sensitivity of 95% and a specificity of 17% to detect severe OSA. CONCLUSION: An objectively based approach to screen for the presence of severe OSA, the BASAN index, exhibits favourable sensitivity characteristics that should enable its operational use as a screening tool in a Hispanic population with a clinical suspicion of OSA and living at high altitude.

Does living at moderate altitudes in Austria affect mortality rates of various causes? An ecological study.

OBJECTIVES: The effects of altitude residence on ageing, longevity and mortality are poorly understood. While adaptations to chronic exposure to altitude may exert beneficial effects on cardiovascular risk factors and some types of cancer, an elevated risk to die from chronic respiratory diseases has been reported. Moreover, high-altitude residence may be correlated with increased depression and suicide rates. The present study tested the hypothesis that living at moderate altitudes (up to 2000 m) is associated with reduced mortality from all causes. SETTING AND PARTICIPANTS: We used a dataset comprising all deaths (n=467 834) across 10 years of a country (Austria) characterised by varying levels of altitudes up to 2000 m. MAIN OUTCOME MEASURES: Total number of deaths, age-standardised mortality rates (ASMRs) per 100 000 population, cause-specific ASMRs. RESULTS: ASMRs for residents living in higher (>1000 m) versus lower (<251 m) altitude regions (with agriculture employment below 3%) were 485.8 versus 597.0 (rate ratio and 95% CI 0.81 (0.72 to 0.92); p<0.001) for men and 284.6 versus 365.5 (0.78; 0.66 to 0.91); p=0.002) for women. Higher levels of agriculture employment did not influence mortality rates. Diseases of the circulatory system and cancers were main contributors to lower mortality rates at higher altitude. Residence at higher altitude did not negatively affect mortality rates from any other diseases. We highlight gender effects and-beside environmental factors-also discuss socioeconomic factors that may be responsible for conflicting results with data from other populations. CONCLUSIONS: Living at moderate altitude (1000-2000 m) elicits beneficial effects on all-cause mortality for both sexes, primarily due to lower ASMRs from circulatory diseases and cancer. The presented analysis on cause-specific ASMRs over a 10-year period among the entire population of an alpine country will contribute to a better understanding on the effects of altitude-related mortality.

Psychophysiological anxiety response of a rescue helicopter crew in a crane rescue manoeuvre.

BACKGROUND: This research aimed to analyse the psychophysiological modifications of a rescuer helicopter crew in a crane rescue manoeuvre. METHODS: We analysed in eight participants (32.5±6.6 years) divided in four categories (pilot, mechanic, rescuer and control) with variables of anxiety, rating of perceived exertion (RPE), stress subjective perception (SSP), heart rate, blood oxygen saturation (BOS), skin temperature, blood lactate, cortical arousal, autonomic modulation, legs and hands strength, legs flexibility, spirometry, urine, and short-term memory before and after a helicopter crane rescue manoeuvre. RESULTS: The manoeuvre produced a significant (p≤0.05) increment in the RPE, SSP, anxiety, blood lactate and sympathetic modulation, and a decrease in BOS and pulmonary capacity. CONCLUSION: A helicopter rescue crane manoeuvre produced an increase in the sympathetic nervous system modulation, increasing the psychophysiological response of the crew independently of their experience or role. This information allowed us to improve actual specific operative training in this population.

Medicine in Extreme Environments: A New Medical Student Elective Class for Wilderness, Aerospace, Hyperbaric, Exercise, and Combat Medicine.

We developed an elective course titled Medicine in Extreme Environments (MEE) at the University of Texas Southwestern Medical Center for first- and second-year medical students. This course covered physiology, research, clinical practice, and career guidance regarding the fields of wilderness, space, hyperbaric, combat, and exercise medicine. The primary aim was to generate interest in and awareness of these seldom covered fields of medicine by exposing medical students to these disciplines during their preclinical years. A postcourse questionnaire was implemented to investigate whether the MEE course increased awareness of, interest in, and knowledge in the fields of medicine included in the curriculum. Through 2 iterations of the class, a total of 67 students enrolled in the course, and 38 students completed the questionnaire. After course completion, 95% felt they better understood the work and lifestyle of the fields covered, 100% learned more about concepts of each field, and 74% agreed that the elective influenced the direction of their future careers to include some part of the fields emphasized. Although only a limited number of students enrolled in this course, these initial findings suggest that the MEE curriculum may have some utility in promoting awareness of and interest in these medical disciplines among students who attend the course. With continued student and faculty support, this course will likely be continued annually at our institution. We believe that certain aspects of this course may be useful in helping develop similar courses at other medical schools.

A Review of Medical Problems in Himalayan Porters.

Porters have accompanied trekkers and climbers to high altitude since the earliest expeditions in the Himalayas. As the existing body of knowledge on high-altitude medicine expands, the focus remains on trekkers or climbers. And published literature on medical problems in the large porter population remains sparse. It is well known that porters working at high altitude in the Nepal Himalayas are often lowland dwellers and are as prone to high-altitude illnesses such as acute mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema as the trekkers are. Other illnesses such as diarrhea, respiratory illnesses, and infections also occur in this population. In this review, studies reporting these findings will be discussed along with the local context of socioeconomic barriers to adequate health care for these porters.

Primer for Mainstreaming Mind-Body Techniques for Extreme Climates-Insights and Future Directions.

Background: The deprivation of oxygen reaching the tissues (also termed as hypoxia) affects the normal functioning of the body. This results in development of many diseases like ischemia, glaucoma, MCI (Mild Cognitive Impairment), pulmonary and cerebral edema, stress and depression. There are no effective drugs that can treat such diseases. Despite such failure, alternative interventions such as mind-body techniques (MBTs) have not been adequately investigated. Methods: The first part of this review has been focused on philosophical aspects of various MBTs besides evolving an ayurgenomic perspective. The potential of MBTs as a preventive non-pharmacological intervention in the treatment of various general and hypoxic pathologies has been further described in this section. In the second part, molecular, physiological, and neuroprotective roles of MBTs in normal and hypoxic/ischemic conditions has been discussed. Results: In this respect, the importance of and in vivo studies has also been discussed. Conclusions: Although several studies have investigated the role of protective strategies in coping with the hypoxic environment, the efficacy of MBTs at the molecular level has been ignored.