Risk factors for occupational acute mountain sickness.

BACKGROUND: Studies of occupational acute mountain sickness (AMS) have not focused on the more severe end of the spectrum to date. AIMS: To examine risk factors associated with the development of occupational AMS severe enough to receive treatment in a compression chamber. METHODS: A nested case referent study in a cohort of high-altitude (4000 m) mine workers, comparing cases of severe, chamber-treated AMS to matched referents. Using logistic regression, we tested potential risk factors based on premorbid surveillance examinations, including cigarette smoking (current smoking, smoking intensity and exhaled carbon monoxide [CO]). RESULTS: There were 15 cases and 30 controls. In multivariate analysis including age, sex and place of residence, current smoking was associated with increased risk of severe AMS (odds ratio [OR] 10.0; 95% confidence interval [CI] 1.5-67.4), taking into account any prior, less severe AMS event, which was also a potent risk factor (OR 33.3; 95% CI 2.8-390). Smoking intensity (cigarettes per day) and exhaled CO were also statistically significantly associated with severe AMS. CONCLUSIONS: Cigarette smoking is a strong, previously under-appreciated risk factor for severe AMS. Because this is a modifiable factor, these findings suggest that workplace-based smoking cessation should be tested as an intervention to prevent such morbidity.

Feasibility test results of the Practical Approach to Lung Health in Bishkek, Kyrgyzstan.

SETTING: Ambulatory health centres in Bishkek, Kyrgyzstan. OBJECTIVE: To assess the results of training family doctors in Practical Approach to Lung Health (PAL) techniques. DESIGN: Comparison of the results of two surveys, before (baseline) and after (impact) training on PAL guidelines. Both surveys were carried out according to the same protocol. RESULTS: A total of 86 family physicians working in three ambulatory health centres participated in both surveys. Respectively 893 and 992 respiratory patients were registered in the baseline and impact surveys. Baseline survey patients had longer duration of symptoms, were older and had more concomitant health conditions than impact survey patients. Findings suggest that PAL training has resulted in a decrease by one third in referrals to hospital or specialists or for diagnostic tests. Data do not show any improvement in tuberculosis case detection. However, in the impact survey, the number of drugs prescribed per patient decreased by 13.6% and the average cost of prescription of any drug per patient was reduced by 32.2%. CONCLUSION: The study suggests that training in standardised PAL guidelines is likely to reduce referral as well as drug prescription costs for respiratory patients. These findings need to be confirmed by further studies.

Development process of the Practical Approach to Lung Health in Kyrgyzstan.

The Practical Approach to Lung Health (PAL) strategy was adopted by the Ministry of Health of Kyrgyzstan to improve the quality of case management of priority respiratory illnesses, including tuberculosis (TB). The process of development and implementation of the strategy is described in the present study. The World Health Organization stepwise framework was adapted and used to initiate the PAL strategy within the Kyrgyzstan primary health care (PHC) system. The process followed 10 steps which included the government decision to support PAL development, and the establishment of a national working group in charge of adapting guidelines, developing training materials and testing the feasibility and impact of the guidelines. On the basis of the test results, the guidelines and training materials were revised and a national PAL implementation plan was developed. The ongoing health sector reform which focuses, in priority, on strengthening PHC services and the assistance from the government of Finland, generated favourable political, technical and financial circumstances for the development and implementation of the PAL strategy.

[Complex assessment of nicotine dependence using questionnaires and measurement of carbon oxide concentration in exhaled air]. / Kompleksnaia otsenka nikotinovoi zavisimosti s ispol'zovaniem oprosnikov i izmereniem kontsentratsii oksida ugleroda v vydykhaemom vozdukhe.

AIM: To study nicotine dependence (ND) basing on special questionnaires and measurement of CO concentrations in the exhaled air. MATERIAL AND METHODS: 350 smokers (318 males and 32 females) aged 20-57 years (mean age 37.1 +/- 7.3 years) were studied. ND was assessed by Fagerstrom test (FT), motivation to smoke and to quit tests, smoking history and exhaled CO measurement. In addition, respiratory complaints and ventilation parameters such as peak expiratory flow (PEF) and forced expiratory volume per 1 sec (FEV1) were measured. RESULTS: Mean daily cigarette number was 14.2 +/- 7.3; smoking duration 16.3 +/- 7.8 years and smokers index 170.9 +/- 87.8. Smoking women differed from smoking men in ND, PEF% and FEV1% decline as well as CO level. Exhaled CO was 21.1 +/- 9.5 ppm, on the average, corresponding to moderate dependence. ND and daily cigarette number produced a direct impact on the exhaled CO level. FT findings directly correlated with the number of daily cigarettes and CO level (mean 3.2 +/- 2.3). Among motivation to smoke factors was the demand to release tension. CONCLUSION: ND varies considerably among smokers by severity. Smoking men and women differ considerably by ND. Along with dependence tests, exhaled CO measurement provides objective verification of ND.

[Periodic breathing during sleep at high altitudes in patients with bronchial asthma]. / Oddychanie okresowe w czasie snu w wysokich górach u chorych na astme oskrzelowa.

Earlier we found that asthmatic patients treated at a high altitude sanatorium (3.200 m) had numerous episodes of arterial blood desaturation during the night. To investigate if periodic breathing (PB) was responsible for those episode we studied 5 asthmatics (A) (mean age 34 yrs) and 3 healthy controls (C) (mean age 28 yrs) using MESAM 4, a simple, portable system recording breathing sounds, heart frequency, arterial blood saturation and body position. A and C subjects were first investigated at low altitude (760 m). There was no PB at 760 m in either group. At high altitude MESAM 4 recordings were performed on the 2nd and the 7th night after the ascent. On the 2nd night in the A group subjects the number of PB cycles averaged 37.2 (22-54) occupying 3.2% (2-5%) of estimated sleep time. The number of no-PB episodes was 52.4 (23-109). In the C group subjects the number of PB cycles was 83.6 (10-147) occupying 9% (1-14%) of estimated sleep time. The number of no-PB episodes averaged 45.6 (6-84). On the 7th night in A the number of PB cycles was 46.6 (15-69) occupying 4% (1-7%) of estimated sleep time. The number of no-PB was 54.8 (13-147). In C the number of PB cycles averaged 29.3 (12-59) occupying 3.3% (2-6%) of estimated sleep time. The number of no-PB was 20.3 (9-37). We conclude that majority of desaturations during sleep in asthmatics at altitude of 3.200 m was not related to PB; the mechanisms of these desaturations require more investigations.

[Effect of altitude on blood oxygenation during sleep in patients with bronchial asthma]. / Wplyw wysokosci na utlenowanie krwi w czasie snu u chorych na astme oskrzelowa.

The aim of our study was to investigate the severity of overnight arterial blood desaturations in patients with asthma at the altitude of 3200 meters above sea level. 12 asthmatics and 12 healthy controls were investigated. Three overnight pulsoximetries were performed in all subjects, one at the lowland and on the 1st and 5th night at the altitude. Mean SaO2 at the lowland was significantly lower in asthmatics than in the controls (p < 0.01). After the ascent to high altitude severe fall in mean SaO2 was noted in both groups (from 94.3% to 85.8% in asthmatics and from 97.1% to 88.7% in controls) (p < 0.001 for both groups). After few days of acclimatization mean SaO2 rose to 88.8% in asthmatics and to 91.3% in controls, but was still significantly lower than at the lowland (p < 0.001 for both groups). At the altitude differences in mean SaO2 between two groups were not statistically significant. We conclude that severity of overnight desaturations at high altitude do not vary between asthmatics with impaired respiratory function and healthy subjects.

[The rehabilitation under alpine conditions of the participants in the cleanup of the accident at the Chernobyl Atomic Electric Power Station who are ill with chronic bronchitis]. / Reabilitatsiia v usloviiakh vysokogor'ia uchastnikov likvidatsii avarii na Chernobyl'skoi AES, bol'nykh khronicheskim bronkhitom.

24 patients exposed to low-dose radiation after the Chernobyl accident were examined before and after 24-day treatment of chronic bronchitis in the high-altitude rehabilitation center (3200 m above the sea level) in Tien Shan. Sanogenic alpine climate improved the patients' general condition, physical performance and lung ventilation, corrected compromised immunity. After high-altitude adaptation tracheobronchial inflammation alleviated, cytologic composition and surface activity of bronchoalveolar fluid returned to normal. Therefore, high-altitude treatment of Chernobyl accident victims with chronic bronchitis is effective and can be recommended for such patients.

Assesment of q-heterochromatin in patients with acute mountain sikness / En pacientes con el mal de montaña agudo

El presente estudio se ha diseñado para determinar marcadores genéticos del posible desarrollo del mal de montaña agudo (MMA), para lo cual se ha evaluado el número y distribución de las regiones cromosomiales específicas, nominalmente, las regiones de heterocromatina-Q (Q-HR) en 34 sujetos que desarrollaron MMA después de ascender a 3600 metros sobre el nivel del mar (Eastern Pamir). Los controles fueron 36 sujetos sin signos de MMA. El análisis de Q-HR se realizó utilizando la tinción de mostaza de propil quinacrina de las preparaciones cromosomales obtenidas de los cultivos de linfocitos. A diferencia de los controles, los sujetos con MMA mostraron ciertas diferencias en la distribución de características cuantitativas de la Variabilidad cromosomal Q-HR; el número total de Q-HR en sujetos con MMA fue de 2.15 +/- 0.19 en tanto que en los cointroles fue de 1.06 +/- 0.14 (P menor que 0,001). Estos datos sugieren el rol de la predisposición hereditaria en el desarrollo del mal de montaña agudo.

Inmunologic prognosis of acute mountain sikness / Pronóstico inmunológico del mal de montaña agudo

En las personas predipuestas al mal de montaña agudo se observan, un reducción de EHC-células formadoras de rosetas (E-RFC), células T salvadoras, la reducción de monocitos y capacidad de los neutrófilos para la adhesión, la inhibición de C3 - y receptores FC en la membrana, aumento de células O.

Effects of acetazolamide on overnight oxygenation and acute mountain sickness in patients with asthma.

The aim of the study was to assess effects of acetazolamide in prevention of acute mountain sickness (AMS) and on overnight oxygenation, in patients with asthma treated at the altitude of 3,200 m. Sixteen patients with asthma, 6 males and 10 females, mean age 32 yrs, were first investigated at low altitude (760 m). They presented with mild airways obstruction, normal arterial blood gases, and normal oxygenation at night studied by pulse oximetry. After initial investigations, patients were divided by random number into the treated (T) and control (C) groups of eight patients each. T group patients received acetazolamide, 750 mg daily for 2 days, before the ascent and on the first day at altitude (3,200 m). Symptoms of AMS developed in seven patients from group C and in three from group T. The overnight pulse oximetry, performed on the first night at altitude, revealed that group T patients had statistically higher (p < 0.05) initial, 91 vs 87%, mean, 90 vs 86%, and minimum, 84 vs 75%, arterial oxygen saturation than group C patients. Overnight pulse oximetry was repeated on the 5th, 10th and 17th day at altitude, and showed that in group C patients, from the 5th day onwards, oxygenation improved to the level observed in group T patients on the first night. We conclude that pretreatment with acetazolamide before the ascent prevented patients with asthma from developing symptoms of AMS, and alleviated acute changes in arterial oxygen saturation brought about by the high altitude hypoxia.

[The alpine climatotherapy of bronchial asthma patients]. / Vysokogornaia klimatoterapiia bol'nykh bronkhial'noi astmoi.

As many as 132 patients with bronchial asthma were examined for the clinical, functional and laboratory parameters before and during alpine climatotherapy at a height of 3200 m above the sea level (the Tyuya-Ashu pass, the northern Tien Shan). In addition to the improvement of the general status, the patients manifested amelioration of ventilation and decreased responsiveness of the bronchial tree by the end of alpine climatotherapy. Favourable alterations in the immune parameters together with appreciable stimulation of steroidogenesis in the adrenals were discovered. Investigation into surface activity of the exhaled air condensate revealed activation of the surfactant system. These data and endoscopy with bronchoalveolar lavage confirmed the reduction of the inflammatory lesions in the tracheobronchial tree. Therefore, alpine climatotherapy produces a favourable effect on the main mechanisms of the disease development and can be used on a wider basis for the treatment of patients suffering from bronchial asthma.

[Effect of high-altitude climate therapy on the adrenal cortex function in patients with bronchial asthma]. / Vliianie vysokogornoi klimatoterapii na funktsiiu kory nad- pochechnikov u bolnykh bronkhial'noi astmoi.

132 bronchial asthma patients living in Frunze (760 m above the sea level) and those on adaptation days 3-5 and 25-30 to the climate of North Tien Shan (3200 m above the sea level) underwent clinical and functional examination involving assessment of ACTH, cortisol and aldosterone levels. The patients showed clinical response and improvement of bronchial permeability associated with a pronounced growth of plasma cortisol levels starting on adaptation days 3-5. By adaptation days 25-30 cortisol levels were still on the increase while ACTH concentration tended to reduction.

[Changes in the surface activity of bronchoalveolar washings and their cellular composition in bronchial asthma]. / Izmeneniia poverkhnostnoi aktivnosti bronkhoal'veoliarnykh smyvov i ikh kletochnogo sostava u bol'nykh bronkhial'noi astmoi.

The superficial activity and cytological composition of bronchoalveolar washes off (BAW) were investigated in 55 patients with bronchial asthma. As compared to the control group the patients with bronchial asthma in remission demonstrated a moderate decrease in the superficial BAW activity which grew in the phase of exacerbation, a degree of variations of the superficial BAW activity depending on the expression of exacerbation. Correlation between a decrease in the superficial BAW activity and changes in an endopulmonary cytogram was found. On the 25th day of the treatment of the patients with bronchial asthma at the Tuya-Ashu mountain pass (Tien Shan, 3200 m above the sea level) under the conditions of mountain climate superficially active BAW properties and edopulmonary cytogram got back to normal.

[Acute hemodynamic effects of finoptin in patients with bronchial asthma complicated by pulmonary hypertension]. / Ostrye gemodinamicheskie éffekty finoptina u bol'nykh bronkhial'noi astmoi, oslozhnennoi legochnoi gipertenziei.

The effect of i. v. verapamil administration on some indices of the hemodynamics of the greater and lesser circulation was studied in 19 patients with bronchial asthma by a multiple approach using noninvasive methods (rheopulmonography, polycardiography, tetrapolar chest rheography). A decrease in the systemic as well as pulmonary arterial pressure and vascular resistance was revealed. The anti-hypertensive effect of verapamil on the lesser circulation was more pronounced and stable.