RESUMEN
The most serious types of heat illnesses, heat exhaustion and heat stroke, are occupational hazards associated with many of the military's training and operational environments. These illnesses can typically be prevented by appropriate situational awareness, risk management strategies, along with effective countermeasures. In 2023, the crude incidence of heat stroke and heat exhaustion were 31.7 and 172.7 cases per 100,000 person-years, respectively. The rates of incident heat stroke declined during the 2019 to 2023 surveillance period, but rates of incident heat exhaustion increased over the same period. In 2023, higher rates of heat stroke were observed among male service members compared to their female counterparts, and female service members experienced higher rates of heat exhaustion compared to male personnel. Heat illness rates were also higher among those younger than age 20, Marine Corps and Army service members, non-Hispanic Black service members, and recruits. Leaders, training cadres, and supporting medical and safety personnel must inform their subordinate and supported service members of heat illness risks, preventive measures, early signs and symptoms of illness, and appropriate interventions.
Asunto(s)
Agotamiento por Calor , Golpe de Calor , Personal Militar , Enfermedades Profesionales , Humanos , Personal Militar/estadística & datos numéricos , Estados Unidos/epidemiología , Femenino , Adulto , Masculino , Golpe de Calor/epidemiología , Adulto Joven , Agotamiento por Calor/epidemiología , Incidencia , Enfermedades Profesionales/epidemiología , Vigilancia de la Población , Trastornos de Estrés por Calor/epidemiologíaRESUMEN
Associations of exertional heat exhaustion (EHE)-related symptoms with lifestyle habits and health factors specific to female athletes, ranked by relative risks from high to low, remain elusive. Addressing this issue would benefit athletes and coaches, ensuring safer practices during summer sports activities. To address this issue, we distributed paper-based questionnaires to seven universities in Japan, and 983 respondents completed our survey. The questionnaires covered various personal characteristics, lifestyle habits, perceived health factors, perceived athletic activity, and EHE-related symptoms. In this retrospective case-control study, we analyzed the relationships of EHE-related symptoms (objective variables) with lifestyle habits, health factors, and athletic activity conditions (explanatory variables) using the partial proportional odds model. The questionnaire responses revealed that perceived dehydration, sickness, loss of appetite, perceived accumulated fatigue, perceived mental stress, lack of ambient wind, and insufficient rest breaks were positively associated with EHE-related symptoms, with relative risks ranging from high to low. Using an air conditioner during sleep and having a sleep duration of ≥ 6 h were associated with a reduced risk of EHE-related symptoms. The study results suggest that female athletes should be allowed to postpone exercise or reduce its intensity and volume based on their perceptions of dehydration, sickness, loss of appetite, accumulated fatigue, and mental stress in summer to prevent heat-related illnesses.
Asunto(s)
Atletas , Agotamiento por Calor , Humanos , Femenino , Japón , Factores de Riesgo , Adulto Joven , Atletas/psicología , Universidades , Estudios Retrospectivos , Estudios de Casos y Controles , Encuestas y Cuestionarios , Adulto , Esfuerzo Físico , Estilo de Vida , PercepciónRESUMEN
Objective: Through the analysis of five cases of occupational heat illness caused by high temperature, we expounded the pathogenesis and summarized the clinical characteristics of heat cramp and heat exhaustion of the newly revised diagnostic criteria for occupational heat illness (GBZ41-2019), in order to prevent the occurrence of occupational heat illness to put forward controllable countermeasures. Methods: According to the occupational history, clinical diagnosis and treatment and the other relevant data submitted by five patients, the diagnosis process was analyzed and summarized. Results: Five patients developed symptoms from July to August in summer, belonging to high-temperature operation. They improved by timely treatment. The symptoms, signs and laboratory tests of the five patients were different, but they were diagnosed as occupational heat illness. Conclusion: Employers should pay attention to the high temperature protection and cooling work, and strengthen the labor protection. If patients with heat cramp and heat exhaustion were timely treated, they could basically recover. Occupational disease diagnosticians should seriously study the new diagnostic criteria of occupational disease and constantly improve their diagnostic ability.
Asunto(s)
Agotamiento por Calor , Trastornos de Estrés por Calor , Enfermedades Profesionales , Humanos , Agotamiento por Calor/complicaciones , Agotamiento por Calor/diagnóstico , Agotamiento por Calor/prevención & control , Trastornos de Estrés por Calor/diagnóstico , Trastornos de Estrés por Calor/etiología , Trastornos de Estrés por Calor/prevención & control , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/complicaciones , CalorRESUMEN
The most serious types of heat illness, heat exhaustion and heat stroke, are occupational hazards of the military's training and operational environments. These conditions can be mitigated with appropriate situational aware-ness and effective countermeasures. In 2022, the crude incidence rates of heat stroke and heat exhaustion among active component service members were 32.1 and 147.7 per 100,000 person-years, respectively. The rates of incident heat stroke and heat exhaustion generally declined during the 2018 to 2022 surveillance period. In 2022, those at highest risk were men, those younger than age 20, Marine Corps and Army members, recruit trainees, and those in combat-specific occupations. Leaders, training cadres, and supporting medical personnel must inform their supervised and supported service members of heat illness risks, preventive measures, early signs and symptoms, and first-responder actions.
Asunto(s)
Agotamiento por Calor , Trastornos de Estrés por Calor , Golpe de Calor , Personal Militar , Masculino , Humanos , Estados Unidos/epidemiología , Adulto Joven , Adulto , Femenino , Agotamiento por Calor/epidemiología , Vigilancia de la Población , Golpe de Calor/epidemiología , Trastornos de Estrés por Calor/epidemiología , IncidenciaRESUMEN
OBJECTIVES: To explore the clinical potential of multiparametric cardiac magnetic resonance (CMR) in evaluating myocardial inflammation in patients with exertional heat illness (EHI). METHODS: This prospective study enrolled 28 males with EHI (18 patients with exertional heat exhaustion (EHE) and 10 with exertional heat stroke (EHS)) and 18 age-matched male healthy controls (HC). All subjects underwent multiparametric CMR, and 9 patients had follow-up CMR measurements 3 months after recovery from EHI. CMR-derived left ventricular geometry, function, strain, native T1, extracellular volume (ECV), T2, T2*, and late gadolinium enhancement (LGE) were obtained and compared among different groups. RESULTS: Compared with HC, EHI patients showed increased global ECV, T2, and T2* values (22.6% ± 4.1 vs. 19.7% ± 1.7; 46.8 ms ± 3.4 vs. 45.1 ms ± 1.2; 25.5 ms ± 2.2 vs. 23.8 ms ± 1.7; all p < 0.05). Subgroup analysis showed that ECV was higher in the EHS patients than those in EHE and HC groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). Repeated CMR measurements at 3 months after baseline CMR showed persistently higher ECV than HC (p = 0.042). CONCLUSIONS: With multiparametric CMR, EHI patients demonstrated increased global ECV, T2, and persistent myocardial inflammation at 3-month follow-up after EHI episode. Therefore, multiparametric CMR might be an effective method in evaluating myocardial inflammation in patients with EHI. CLINICAL RELEVANCE STATEMENT: This study showed persistent myocardial inflammation after an exertional heat illness (EHI) episode demonstrated by multiparametric CMR, which is a potential promising method to evaluate the severity of myocardial inflammation and guide return to work, play, or duty in EHI patients. KEY POINTS: ⢠EHI patients showed an increased global extracellular volume (ECV), late gadolinium enhancement, and T2 value, indicating myocardial edema and fibrosis. ⢠ECV was higher in the exertional heat stroke patients than exertional heat exhaustion and healthy control groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). ⢠EHI patients showed persistent myocardial inflammation with higher ECV than healthy controls 3 months after index CMR (22.3% ± 2.4 vs. 19.7% ± 1.7, p = 0.042).
Asunto(s)
Agotamiento por Calor , Golpe de Calor , Miocarditis , Humanos , Masculino , Medios de Contraste/farmacología , Estudios Prospectivos , Agotamiento por Calor/patología , Gadolinio , Función Ventricular Izquierda , Imagen por Resonancia Cinemagnética , Estudios de Casos y Controles , Miocardio/patología , Espectroscopía de Resonancia Magnética , Golpe de Calor/complicaciones , Golpe de Calor/diagnóstico por imagen , Golpe de Calor/patología , Inflamación/diagnóstico por imagen , Inflamación/patología , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: The incidence of heat emergencies, including heat stroke and heat exhaustion, have increased recently due to climate change. This has affected global health and has become an issue of consideration for human health and well-being. Due to overlapping clinical manifestations with other diseases, and most of these emergencies occurring in an elderly patient, patients with a comorbid condition, or patients on poly medicine, diagnosing and managing them in the emergency department can be challenging. This study assessed whether an educational training on heat emergencies, defined as heat intervention in our study, could improve the diagnosis and management practices of ED healthcare providers in the ED setting. METHODS: A quasi-experimental study was conducted in the EDs of four hospitals in Karachi, Pakistan. Eight thousand two hundred three (8203) patients were enrolled at the ED triage based on symptoms of heat emergencies. The pre-intervention data were collected from May to July 2017, while the post-intervention data were collected from May to July 2018. The HEAT intervention, consisting of educational activities targeted toward ED healthcare providers, was implemented in April 2018. The outcomes assessed were improved recognition-measured by increased frequency of diagnosing heat emergencies and improved management-measured by increased temperature monitoring, external cooling measures, and intravenous fluids in the post-intervention period compared to pre-intervention. RESULTS: Four thousand one hundred eighty-two patients were enrolled in the pre-intervention period and 4022 in the post-intervention period, with at least one symptom falling under the criteria for diagnosis of a heat emergency. The diagnosis rate improved from 3% (n = 125/4181) to 7.5% (n = 7.5/4022) (p-value < 0.001), temperature monitoring improved from 0.9% (n = 41/4181) to 13% (n = 496/4022) (p-value < 0.001) and external cooling measure (water sponging) improved from 1.3% (n = 89/4181) to 3.4% (n = 210/4022) (p-value < 0.001) after the administration of the HEAT intervention. CONCLUSION: The HEAT intervention in our study improved ED healthcare providers' approach towards diagnosis and management practices of patients presenting with health emergencies (heat stroke or heat exhaustion) in the ED setting. The findings support the case of training ED healthcare providers to address emerging health issues due to rising temperatures/ climate change using standardized treatment algorithms.
Asunto(s)
Agotamiento por Calor , Golpe de Calor , Anciano , Humanos , Calor , Urgencias Médicas , Tratamiento de Urgencia , Golpe de Calor/diagnóstico , Golpe de Calor/terapiaRESUMEN
The purpose of this study was to investigate associations between lifestyle habits, health factors, athletic activity conditions, and exertional heat exhaustion (EHE)-related symptoms among male college athletes in Japan based on a self-completed questionnaire. The paper-based questionnaires were distributed to 11 universities in Japan, and 2006 respondents completed the survey. Data of personal characteristics (age, body mass), lifestyle habits (sleep duration, use of air-conditioner while sleeping, and practice duration), perceived health factors (loss of appetite, sleep deprivation, sickness, dehydration, accumulated fatigue, and mental stress), perceived athletic activity (insufficient rest breaks, high ambient temperature, excessive humidity, strong solar radiation, lack of ambient wind, and clothing discomfort), and EHE-related symptoms (dizziness, headaches, nausea, and malaise) were collected. The association between lifestyle habits, health factors, athletic activity conditions (explanatory variables), and EHE-related symptoms (objective variables) was analyzed using the partial-proportional odds model. "Perceived dehydration" (odds ratios [ORs] 1.70-2.31, p < 0.002)," "sickness" (ORs 1.35-1.76), p < 0.001), "perceived accumulated fatigue" (ORs 1.13-1.31, p ≤ 0.001), "perceived mental stress" (ORs 1.17-1.31, p < 0.019), "lack of ambient wind" (ORs 1.12-1.19, p < 0.022), "loss of appetite" (ORs 1.16-1.23, p < 0.037), and "sleep deprivation" (ORs 1.15-1.17, p < 0.025) were positively associated with EHE-related symptoms, whereas "using an air conditioner during sleeping" (ORs 0.91, p = 0.047) during summer seasons was negatively associated. These findings suggest that athletes should be allowed to postpone or downregulate exercise intensity and/or volume based on their perceptions of dehydration, sickness, accumulated fatigue, mental stress, loss of appetite, and/or sleep deprivation in the summer to prevent heat illness.
Asunto(s)
Agotamiento por Calor , Humanos , Masculino , Japón/epidemiología , Estudios de Casos y Controles , Deshidratación , Atletas , Fatiga/epidemiología , Factores de RiesgoRESUMEN
A pesquisa teve como objetivo geral analisar a atividade e o ofício dos mototaxistas de Sobral, Ceará. O objetivo específico foi compreender: a) a atividade exercida e o conceito de real da atividade; b) as prescrições; c) as regras informais; e d) as relações profissionais. A investigação adotou o referencial teórico da Clínica da Atividade, e participaram oito mototaxistas. Inspiradas no método da Instrução ao Sósia, foram realizadas e gravadas entrevistas semiestruturadas. Seu áudio foi transcrito e o conteúdo passou por análise construtivo-interpretativa. Os resultados mostraram que a atividade era regulamentada pela prefeitura e dependia da manutenção dos instrumentos utilizados. O expediente era organizado por uma regra do coletivo de trabalho relacionada ao horário de funcionamento de escolas e universidades. A busca por passageiros variava, sendo possível ficar em pontos fixos ou circular pela cidade. As condições ambientais demandavam cuidados como o uso de protetor solar e hidratação. A autonomia da profissão permitia organizar o próprio expediente e o ganho mensal. Entretanto, houve queixas relativas à falta de direitos previdenciários e ao fato de que a flexibilidade geraria uma sobrecarga de trabalho que poderia trazer prejuízos à saúde. Riscos foram identificados em acidentes de trânsito e violência urbana. Os relatos acerca das relações com os colegas mostraram um ambiente amistoso, e as relações com os passageiros eram definidas por cada situação, abrangendo desde interações objetivas até conversas pessoais.(AU)
The research had as general objective to analyze the activity and the work of motorcycle taxi drivers in Sobral, Ceará. Specific objectives were to understand: (a) the activity performed and the real of activity; (b) the prescriptions; (c) informal rules and (d) professional relationships. The investigation adopted the theoretical framework of the Clinic of Activity. Eight motorcycle taxi drivers participated in the investigation. Inspired by the instruction to the double method, semi-structured interviews were conducted. The audio of the interviews was transcribed and underwent constructive-interpretive analysis. The results showed that the activity was regulated by the city and depended on the maintenance of the instruments used. The working hours were organized by a collective labor rule related to the opening hours of schools and universities. The looking-for for passengers also varied: it was possible to stay at fixed points or move around the city. Environmental conditions required care such as the use of sunscreen and hydration. The profession's autonomy made it possible to organize its own hours and monthly earnings. However, there were complaints regarding the lack of social security rights and that flexibility would create an overload of work that could harm health. Risks have been identified in traffic accidents and urban violence. Reports about relationships with colleagues showed a friendly atmosphere. Relations with passengers were defined by each situation, ranging from objective interactions to personal conversations.(AU)
La investigación tuvo como objetivo general analizar la actividad y el trabajo de los mototaxis en Sobral, Ceará. Los objetivos específicos eran comprender: (a) la actividad realizada y la real de la actividad; (b) las prescripciones; (c) reglas informales y (d) relaciones profesionales. La investigación adoptó el marco teórico de la Clínica de Actividad. En la investigación participaron ocho mototaxis. Inspirándose en el método de instrucción al doble, se realizaron entrevistas semiestructuradas. El audio de las entrevistas fue transcrito y sometido a un análisis constructivo-interpretativo. Los resultados mostraron que la actividad estaba regulada por la prefectura municipal y dependía del mantenimiento de los instrumentos utilizados. Los horarios de trabajo fueron organizados por una norma laboral colectiva relacionada con los horarios de apertura de escuelas y universidades. La búsqueda de pasajeros también variaba: era posible permanecer en puntos fijos o moverse por la ciudad. Las condiciones ambientales requerían cuidados como el uso de protector solar e hidratación. La autonomía de la profesión permitió organizar sus propias horas y ganancias mensuales. Sin embargo, hubo quejas sobre la falta de derechos de seguridad social y que la flexibilidad crearía una sobrecarga de trabajo que podría dañar la salud. Se han identificado riesgos en accidentes de tráfico y violencia urbana. Los informes sobre las relaciones con los colegas mostraron un ambiente agradable. Las relaciones con los pasajeros se definieron por cada situación, desde interacciones objetivas hasta conversaciones personales.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Trabajo , Motocicletas , Salud Laboral , Condiciones de Trabajo , Psicología , Política Pública , Calidad de Vida , Seguridad , Salarios y Beneficios , Autocuidado , Problemas Sociales , Protectores Solares , Horas de Trabajo , Agotamiento Profesional , Accidentes , Enfermedad , Vulnerabilidad ante Desastres , Empleo , Sector Informal , Estrés Laboral , Frustación , Agotamiento por Calor , Relaciones Interpersonales , Satisfacción en el Trabajo , SindicatosRESUMEN
Background: Many individuals who use the sauna at a temperature of 120°C of higher are not aware of the negative consequences of extreme thermal stress. Despite extensive research into sauna use, the impact of extreme thermal stress on the physiological and psychological characteristics of sauna users have not been examined to date. Aim: The aim was to determine the effect of 20 min sauna sessions with a temperature of 80°C and 120°C on the physiological and psychological characteristics of women who sporadically visit the sauna. Methods: The study was conducted on 22 full-time female university students. Physical activity (PA) levels were evaluated with the Polish short version of the International Physical Activity Questionnaire (IPAQ). Anthropometric characteristics were measured before the first sauna session by the InBody270 body composition analyzer. Physiological parameters, including heart, energy expenditure, physical effort, and blood pressure (systolic blood pressure - SBP, and diastolic blood pressure - DBP), were assessed indirectly using Polar V800 heart rate monitors and the Omron M6 Comfort blood pressure monitor. The participants' wellbeing was assessed with the Profile of Mood States (POMS) questionnaire. The presence of significant correlations between heat exhaustion and heat stress variables and syncope during the second sauna session was examined with the use of classification and regression trees (CRT) and the cross-validation technique. Results: Twenty-minute sauna sessions with a temperature of 80°C and 120°C induced a significant (p < 0.001) decrease in the values of SBP (excluding the temperature of 120°C), DBP, and body mass, as well as a significant increase in HR and forehead temperature. Exposure to a temperature of 80°C led to a significant (p < 0.001) increase in vigor with a simultaneous decrease in tension, depression, anger, fatigue, and confusion. In turn, sauna bathing at a temperature of 120°C had an opposite effect on the above mood parameters. Vomiting and confusion were the main predictors of syncope that occurred in some of the surveyed women. Conclusion: Excessive air temperature can induce symptoms characteristic of heat exhaustion and heat stress nausea, heavy sweating, fast weak or strong HR, high body temperature, and confusion. Therefore, sauna bathing at a temperature of 80°C can be recommended to women who sporadically use the sauna, whereas exposure to a temperature of 120°C is not advised in this group of sauna users. The present findings provide highly valuable inputs for managing wellness and SPA centers.
Asunto(s)
Agotamiento por Calor , Baño de Vapor , Humanos , Femenino , Temperatura , Presión Sanguínea/fisiología , SíncopeRESUMEN
The Army Heat Center at Fort Benning, GA was established to identify and disseminate best practices for the prevention, field care, evacuation, hospital care, and return to duty of exertional heat casualties. During the 2017-2021 surveillance period, there were 1,911 heat casualties treated at Ft. Benning's Martin Army Community Hospital. Most patients were junior enlisted and officer personnel who were engaged in initial entry training. Heat exhaustion, heat injury, heat stroke, and hyponatremia accounted for 52.6%, 18.4%, 18.2%, and 2.0% of total heat illnesses, respectively. The annual proportion of heat casualties that were due to heat exhaustion rose steadily during the surveillance period, reaching 77.7% in 2021, while the incidence of heat injury and heat stroke did not increase during this period. Data are presented on the occurrence of clusters of heat illness, the association of cases of heat stroke with arduous physical activities, and the seasonal variation in incidence of heat illnesses. It is important that unit leaders and trainers understand the risk factors for heat illness among those being trained and that early first aid measures be employed in the field (especially rapid cooling).
Asunto(s)
Agotamiento por Calor , Trastornos de Estrés por Calor , Golpe de Calor , Personal Militar , Agotamiento por Calor/epidemiología , Trastornos de Estrés por Calor/epidemiología , Trastornos de Estrés por Calor/etiología , Golpe de Calor/epidemiología , Calor , HumanosRESUMEN
In 2021, there were 488 incident cases of heat stroke and 1,864 incident cases of heat exhaustion among active component service members of the U.S. Armed Forces. The unadjusted annual rates of incident heat stroke and heat exhaustion peaked in 2018 and then declined in 2019 and 2020. Between 2020 and 2021, the rate of incident heat stroke was relatively stable (0.37 cases per 1,000 person-years [p-yrs]) while the rate of heat exhaustion increased slightly (1.40 cases per 1,000 p-yrs). In 2021, subgroup-specific rates of incident heat stroke and heat exhaustion were highest among male service members, those less than 20 years old, Marine Corps and Army members, recruit trainees, and those in combat-specific occupations. During 20172021, a total of 312 heat illnesses were documented among service members in the U.S. Central Command (CENTCOM) area of responsibility (AOR); 6.4% (n=20) were diagnosed as heat stroke. Commanders, small unit leaders, training cadre, and supporting medical personnel must ensure that the military members whom they supervise and support are informed about the risks, preventive countermeasures, early signs and symptoms, and first-responder actions related to heat illnesses.
Asunto(s)
Agotamiento por Calor , Trastornos de Estrés por Calor , Golpe de Calor , Personal Militar , Adulto , Campaña Afgana 2001- , Trastornos de Estrés por Calor/epidemiología , Golpe de Calor/epidemiología , Humanos , Incidencia , Guerra de Irak 2003-2011 , Masculino , Vigilancia de la Población , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the "severe" group or the "mild-to-moderate" group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received "active cooling + rehydration" and patients who received "rehydration only," with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21-8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92-5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.
Asunto(s)
Golpe de Calor , Agotamiento por CalorRESUMEN
The active participation of skeletal muscles is a unique characteristic of exertional heat stroke. Nevertheless, the only well-documented link between skeletal muscle activities and exertional heat stroke pathophysiology is the extensive muscle damage (e. g., rhabdomyolysis) and subsequent leakage of intramuscular content into the circulation of exertional heat stroke victims. Here, we will present and discuss rarely explored roles of skeletal muscles in the context of exertional heat stroke pathophysiology and recovery. This includes an overview of heat production that contributes to severe hyperthermia and the synthesis and secretion of bioactive molecules, such as cytokines, chemokines and acute phase proteins. These molecules can alter the overall inflammatory status from pro- to anti-inflammatory, affecting other organ systems and influencing recovery. The activation of innate immunity can determine whether a victim is ready to return to physical activity or experiences a prolonged convalescence. We also provide a brief discussion on whether heat acclimation can shift skeletal muscle secretory phenotype to prevent or aid recovery from exertional heat stroke. We conclude that skeletal muscles should be considered as a key organ system in exertional heat stroke pathophysiology.
Asunto(s)
Golpe de Calor/fisiopatología , Músculo Esquelético/fisiopatología , Esfuerzo Físico/fisiología , Aclimatación/fisiología , Proteínas de Fase Aguda/metabolismo , Calcio/metabolismo , Quimiocinas/metabolismo , Convalecencia , Citocinas/metabolismo , Agotamiento por Calor , Golpe de Calor/sangre , Golpe de Calor/etiología , Golpe de Calor/inmunología , Humanos , Hipertermia/etiología , Hipertermia/metabolismo , Hipertermia/fisiopatología , Inmunidad Innata/fisiología , Contracción Muscular/fisiología , Desarrollo de Músculos/fisiología , Fibras Musculares Esqueléticas/fisiología , Músculo Esquelético/inmunología , Músculo Esquelético/metabolismo , Esfuerzo Físico/inmunología , Recuperación de la Función , Rabdomiólisis/etiología , Termogénesis/fisiología , Termotolerancia/fisiologíaRESUMEN
PURPOSE: Endurance exercise and hyperthermia are associated with compromised intestinal permeability and endotoxaemia. The presence of intestinal fatty acid-binding protein (I-FABP) in the systemic circulation suggests intestinal wall damage, but this marker has not previously been used to investigate intestinal integrity after marathon running. METHODS: Twenty-four runners were recruited as controls prior to completing a standard marathon and had sequential I-FABP measurements before and on completion of the marathon, then at four and 24 h later. Eight runners incapacitated with exercise-associated collapse (EAC) with hyperthermia had I-FABP measured at the time of collapse and 1 hour later. RESULTS: I-FABP was increased immediately on completing the marathon (T0; 2593 ± 1373 ng·l-1) compared with baseline (1129 ± 493 ng·l-1; p < 0.01) in the controls, but there was no significant difference between baseline and the levels at four hours (1419 ± 1124 ng·l-1; p = 0.7), or at 24 h (1086 ± 302 ng·l-1; p = 0.5). At T0, EAC cases had a significantly higher I-FABP concentration (15,389 ± 8547 ng.l-1) compared with controls at T0 (p < 0.01), and remained higher at 1 hour after collapse (13,951 ± 10,476 ng.l-1) than the pre-race control baseline (p < 0.05). CONCLUSION: I-FABP is a recently described biomarker whose presence in the circulation is associated with intestinal wall damage. I-FABP levels increase after marathon running and increase further if the endurance exercise is associated with EAC and hyperthermia. After EAC, I-FABP remains high in the circulation for an extended period, suggesting ongoing intestinal wall stress.
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Agotamiento por Calor/fisiopatología , Hipertermia/fisiopatología , Mucosa Intestinal/fisiopatología , Carrera de Maratón/fisiología , Adulto , Biomarcadores/sangre , Proteínas de Unión a Ácidos Grasos/sangre , Femenino , Agotamiento por Calor/sangre , Agotamiento por Calor/etiología , Humanos , Hipertermia/sangre , Hipertermia/etiología , Mucosa Intestinal/metabolismo , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The Wet-Bulb Globe Temperature (WBGT) index is a common tool to screen for heat stress for sporting events. However, the index has a number of limitations. Rational indices, such as the physiological equivalent temperature (PET) and Universal Thermal Climate Index (UTCI), are potential alternatives. AIM: To identify the thermal index that best predicts ambulance-required assistances and collapses during a city half marathon. METHODS: Eight years (2010-2017) of meteorological and ambulance transport data, including medical records, from Gothenburg's half-marathon were used to analyse associations between WBGT, PET and UTCI and the rates of ambulance-required assistances and collapses. All associations were evaluated by Monte-Carlo simulations and leave-one-out-cross-validation. RESULTS: The PET index showed the strongest correlation with both the rate of ambulance-required assistances (R2=0.72, p=0.008) and collapses (R2=0.71, p=0.008), followed by the UTCI (R2=0.64, p=0.017; R2=0.64, p=0.017) whereas the WBGT index showed substantially poorer correlations (R2=0.56, p=0.031; R2=0.56, p=0.033). PET stages of stress, match the rates of collapses better that the WBGT flag colour warning. Compared with the PET, the WBGT underestimates heat stress, especially at high radiant heat load. The rate of collapses increases with increasing heat stress; large increase from the day before the race seems to have an impact of the rate of collapses. CONCLUSION: We contend that the PET is a better predictor of collapses during a half marathon than the WBGT. We call for further investigation of PET as a screening tool alongside WBGT.
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Aire , Ambulancias/estadística & datos numéricos , Temperatura Corporal/fisiología , Agotamiento por Calor/epidemiología , Carrera/estadística & datos numéricos , Termografía/métodos , Adolescente , Adulto , Distribución por Edad , Anciano , Regulación de la Temperatura Corporal , Intervalos de Confianza , Femenino , Agotamiento por Calor/diagnóstico , Trastornos de Estrés por Calor , Respuesta al Choque Térmico , Humanos , Humedad , Modelos Lineales , Masculino , Carrera de Maratón , Persona de Mediana Edad , Método de Montecarlo , Riesgo , Carrera/fisiología , Distribución por Sexo , Temperatura Cutánea/fisiología , Luz Solar , Suecia/epidemiología , Termografía/instrumentación , Sensación Térmica , Factores de Tiempo , Viento , Adulto JovenRESUMEN
To our knowledge, there are no published reports of heat exhaustion and pesticide exposure in a labor trafficked patient in the literature. Here we represent the case of J.C.J.L., who was labor trafficked. He presented to a local emergency department with heat exhaustion and pesticide exposure related to working conditions in a Mississippi corn field. Unfortunately, while he received medical treatment, his labor trafficking condition was missed. Emergency departments should be equipped to assess for human trafficking and connect trafficked persons with the resources they need. Emergency physicians should maintain a high index of suspicion for human trafficking among migrant workers presenting with occupation-related complaints.
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Deshidratación/diagnóstico , Agricultores , Agotamiento por Calor/diagnóstico , Trata de Personas , Exposición Profesional , Insuficiencia Renal/diagnóstico , Migrantes , Adulto , Servicio de Urgencia en Hospital , Humanos , Masculino , Mississippi , PlaguicidasRESUMEN
INTRODUCTION: Psoriasis vulgaris (PV) is a chronic, painful, disfiguring, and disabling dermatological disease, which affects the physical and mental health of patients and impacts their quality of life. Current conventional systemic therapies can be costly, present risks of side effects, have limited efficacy and commonly recur following treatment cessation. Some Chinese herbal medicine therapies have shown therapeutic benefits for psoriasis vulgaris, including relieving symptoms and improving quality of life, and a potential of reducing relapse rate. However, explicit evidence has not yet been obtained. METHODS AND ANALYSIS: This is a pilot randomized controlled trial with the objective of investigating the effect of Jia Wei Liang Xue Xiao Feng San granules on relapse rate of recurrent PV and the correlation between Psoriasis area severity index (PASI) and key psoriasis-related cytokine changes and the number of cells. A total of 102 participants were recruited for this study, including 72 patients with recurrent PV, 15 healthy volunteers and 15 patients with psoriasis vulgaris who have recovered for more than 1 year. A total of 72 patients, with recurrent PV, will be randomized (1:1) to receive the oral Chinese herbal medicine Jia Wei Liang Xue Xiao Feng San or the oral Acitretin Capsule treatments for a period of 8 weeks. After this period, participants whose PASI scores improvement reached more than 75%, will undergo a 52-week follow-up phase.The primary outcome measures are as follows:The secondary study outcomes will include:This trial may provide a novel regimen for recurrent PV patients if the granules decrease recurrence rate without further adverse effects. ETHICS AND DISSEMINATION: The ethics approval was provided by the Sichuan Traditional Chinese medicine regional ethics review committee. The ethics approval number is 2018KL-055. The design and the results of the study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (ChiCTR1900022766).
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Agotamiento por Calor/inmunología , Calor/efectos adversos , Inmunidad Celular/efectos de los fármacos , Psoriasis/tratamiento farmacológico , Linfocitos T Colaboradores-Inductores/inmunología , Acitretina/administración & dosificación , Acitretina/uso terapéutico , Administración Oral , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Citocinas/efectos de los fármacos , Citocinas/metabolismo , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/uso terapéutico , Femenino , Humanos , Inmunidad Celular/fisiología , Queratolíticos/administración & dosificación , Queratolíticos/uso terapéutico , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Psoriasis/psicología , Calidad de Vida , Recurrencia , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Heatstroke is a life-threatening and the most severe form of heat-related illnesses, characterized by body temperature >40ºC and central nervous system dysfunction. Heatstroke is classified into Non-Exertional Heatstroke (NEHS) and Exertional Heatstroke (EHS). The pathophysiology of heatstroke involves a combination of direct heat effects on the host, the systemic inflammatory and coagulopathic response. The diagnosis of heatstroke based on Bouchama's definition or Japan Association of Acute Medicine (JAAM) criteria. The basic principle of heatstroke management is early resuscitation and immediate cooling. Cold water immersion or convection evaporation method can be implemented based on the specific patient characteristic. Preventive strategies are early recognition by health workers, socialization to vulnerable groups and adequate acclimatization.