Prophylactic Acetaminophen or Ibuprofen Results in Equivalent Acute Mountain Sickness Incidence at High Altitude: A Prospective Randomized Trial.

OBJECTIVE: Recent trials have demonstrated the usefulness of ibuprofen in the prevention of acute mountain sickness (AMS), yet the proposed anti-inflammatory mechanism remains unconfirmed. Acetaminophen and ibuprofen were tested for AMS prevention. We hypothesized that a greater clinical effect would be seen from ibuprofen due to its anti-inflammatory effects compared with acetaminophen's mechanism of possible symptom reduction by predominantly mediating nociception in the brain. METHODS: A double-blind, randomized trial was conducted testing acetaminophen vs ibuprofen for the prevention of AMS. A total of 332 non-Nepali participants were recruited at Pheriche (4371 m) and Dingboche (4410 m) on the Everest Base Camp trek. The participants were randomized to either acetaminophen 1000 mg or ibuprofen 600 mg 3 times a day until they reached Lobuche (4940 m), where they were reassessed. The primary outcome was AMS incidence measured by the Lake Louise Questionnaire score. RESULTS: Data from 225 participants who met inclusion criteria were analyzed. Twenty-five participants (22.1%) in the acetaminophen group and 18 (16.1%) in the ibuprofen group developed AMS (P = .235). The combined AMS incidence was 19.1% (43 participants), 14 percentage points lower than the expected AMS incidence of untreated trekkers in prior studies at this location, suggesting that both interventions reduced the incidence of AMS. CONCLUSIONS: We found little evidence of any difference between acetaminophen and ibuprofen groups in AMS incidence. This suggests that AMS prevention may be multifactorial, affected by anti-inflammatory inhibition of the arachidonic-acid pathway as well as other analgesic mechanisms that mediate nociception. Additional study is needed.

Human Vection Perception Using Inertial Nulling and Certainty Estimation: The Effect of Migraine History.

Vection is an illusory perception of self-motion that can occur when visual motion fills the majority of the visual field. This study examines the effect of the duration of visual field movement (VFM) on the perceived strength of self-motion using an inertial nulling (IN) and a magnitude estimation technique based on the certainty that motion occurred (certainty estimation, CE). These techniques were then used to investigate the association between migraine diagnosis and the strength of perceived vection. Visual star-field stimuli consistent with either looming or receding motion were presented for 1, 4, 8 or 16s. Subjects reported the perceived direction of self-motion during the final 1s of the stimulus. For the IN method, an inertial nulling motion was delivered during this final 1s of the visual stimulus, and subjects reported the direction of perceived self-motion during this final second. The magnitude of inertial motion was varied adaptively to determine the point of subjective equality (PSE) at which forward or backward responses were equally likely. For the CE trials the same range of VFM was used but without inertial motion and subjects rated their certainty of motion on a scale of 0-100. PSE determined with the IN technique depended on direction and duration of visual motion and the CE technique showed greater certainty of perceived vection with longer VFM duration. A strong correlation between CE and IN techniques was present for the 8s stimulus. There was appreciable between-subject variation in both CE and IN techniques and migraine was associated with significantly increased perception of self-motion by CE and IN at 8 and 16s. Together, these results suggest that vection may be measured by both CE and IN techniques with good correlation. The results also suggest that susceptibility to vection may be higher in subjects with a history of migraine.

Perceived stress, stress attributions and psychological distress in psoriasis.

OBJECTIVE: The objective of this study was to measure causal beliefs in individuals with psoriasis and to explore their relationship with perceived stress, quality of life, psychological well-being and psoriasis severity. METHODS: This study was cross-sectional in design, and patients were required to complete validated questionnaires assessing perceptions of illness, quality of life, psoriasis severity, perceived stress and psychological mood. A total of 141 individuals were recruited from two settings: an outpatient skin clinic at King's College Hospital and the Psoriasis Association. RESULTS: A strong belief in stress/psychological attributes as a causal factor was found in 61% of the sample. This belief was significantly associated with higher levels of anxiety, depression and perceived stress (r > or = .38; P < or = .0001). Perceived stress in this sample was significantly associated with a poorer level of quality of life, higher levels of anxiety and depression (r > or = .27; P < or = .002) but not with psoriasis severity. CONCLUSIONS: The belief that stress is causal was associated with lower levels of psychological well-being. However, there was no association between perceived stress and more objective measures of psoriasis severity.