Determinants of acute mountain sickness and success on Mount Aconcagua (6962 m)

To investigate the determinants of acute mountain sickness (AMS) and of summiting in expedition-style mountaineering, 919 mountaineers (15.4% female) leaving Aconcagua Provincial Park at the end of an expedition to Mt. Aconcagua (6962 m) via the normal route were retrospectively evaluated by questionnaires. Symptoms of AMS were reported from the day when mountaineers felt worst. The prevalence of AMS, defined as a Lake Louise Score (self-assessment) > 4, was 39%. Low AMS scores were associated with faster ascent rates. The following parameters were independent predictors for AMS: no susceptibility for AMS (odds ratio, OR, 0.24; 95% confidence interval 0.17 to 0.35) more than 10 exposures per year above 3000 m (OR 0.60; 0.41 to 0.86), and previous exposures above 6000 m (OR, 0.48; 0.33 to 0.68). This last variable increased the OR for summiting 3.7-fold while female gender reduced this OR to 0.41 (0.25 to 0.67). Susceptibility and few exposures to high altitude are major predictors for AMS on Aconcagua, but AMS does not substantially reduce the chances for summiting. Those who are often in the mountains and who have already climbed to altitudes above 6000 m and are not susceptible for AMS have the best options for summiting Aconcagua.     

Pre/post assessment of an HIV infection prevention intervention targeted at teenagers in Southern Tarragona,Spain

BACKGROUND: Human immuno-deficiency virus (HIV) infection is one of the leading public health problems in our country. Preventive education has shown itself to be a useful tool for curtailing this disease. The objective of this study is that of assessing the effectiveness of a preventive intervention at the Secondary Schools in the Baix Ebre and Montsià areas of the Tortosa Healthcare District aimed at reducing the risk of HIV transmission and furthering the knowledge of this disease. METHOD: A pre/post intervention study was conducted with no control group. A total of 19 schools, corresponding to the fourth year of Compulsory Secondary Education and first year of "Bachillerato" studies were invited to participate. The activity consisted of a workshop 60-90 minutes in length, in conjunction with educational material. A questionnaire was used as the gauging tool. RESULTS: Twelve schools agreed to participate, a total of 896 answers having been gotten for the pre-test and 805 answers for the post-test. A statistically significant increase was found for 52% (10/19) of the items regarding the correct answers on the post-test. A statistically significant improvements was found in four of the five items (80%) related to attitudes, and in five of the eight (62.5%) items related to overall knowledge of this infection following the intervention. A statistically significant improvement regarding prevention-related knowledge was found solely in one of the six items (16.6%). CONCLUSIONS: Preventive activities in the form of participational workshops are a good way of furthering the knowledge and improving the attitudes regarding HIV/AIDS of the participating teenagers. As no curative treatment exists for this disease, prevention from the educational realm is of importance for curtailing increased HIV transmission.     

Cancer knowledge among Spanish women participating in literacy schemes

Access to information on cancer prevention and treatment is often difficult for ethnic or low socio-economic groups. This study aimed to ascertain level of knowledge about cancer, and breast cancer in particular, in Spanish women from low socio-economic groups participating in literacy schemes. A study specific questionnaire was administered to 541 women All participants were married with a median of 2 children, and a total family income of less than 10,000 euros per year. The main themes covered: understanding of and access to screening, knowledge about cancer risk, diagnosis and prognosis.The majority of these women (66%) feel they have no control over getting cancer and 26% report that it can be caught from others. Most believe that a mammogram is the best method of diagnosis (87%) but a minority (14%) agree with the statement that breast cancer can be caused by breast feeding. In general, younger women are better informed and more optimistic about prognosis.In Spain there are problems in disseminating information about cancer to lower social-economic groups. These results confirm that more cancer education needs to be directed to low income and socially deprived groups.     

Clinical events after transjugular intrahepatic portosystemic shunt: Correlation with hemodynamic findings

Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) procedures are increasingly being used, but the relationship between the hemodynamic effects of TIPS and the clinical events on follow-up remains undefined. Hence, we have investigated the hemodynamic correlations of portal hypertension–related events after a TIPS procedure. Methods: Prospective follow-up of 122 cirrhotic patients who had a TIPS procedure performed because of variceal hemorrhage was conducted. Results: The portacaval pressure gradient (PPG) significantly decreased after the TIPS procedure (from 19.7 ± 4.6 to 8.6 ± 2.7 mm Hg; P > 0.001), but increased thereafter and at rebleeding (n = 25) was >12 mm Hg in all patients (18.4 ± 4.6 mm Hg). Twenty-six patients developed ascites; the PPG (measured in 19) was always >12 mm Hg. Increasing the PPG to >12 mm Hg occurred very frequently (83% at 1 year). Within 1 year, 77% of patients underwent balloon angioplasty or restenting. However, 80% had again a PPG of >12 mm Hg 1 year after reintervention. Hepatic encephalopathy developed in 31% of patients at 1 year; 21 of 23 patients had a PPG of <12 mm Hg. Conclusions: Total protection from the risk of recurrent complications of portal hypertension after a TIPS procedure requires that the PPG be decreased and maintained <12 mm Hg. However, reintervention will be required in most patients within 1 year and again the second year. On the other hand, such portal decompression is associated with an increased risk of hepatic encephalopathy.GASTROENTEROLOGY 1998;114:1296-1303     

Two-photon confocal imaging study: cell uptake of two photon dyes-labeled PAMAM dendrons in HeLa cells

A two-photon excitation difluoroboron dye activated in the near infrared region for biological image analysis was synthesized in this study. Cell affinity, membrane interaction, and the endocytosis pathway of PAMAM dendrons were investigated using only covalent two-photon dyes (TPD) at the periphery of the PAMAM dendrons. Generation 3 TPD-labeled PAMAM dendrons (BG3) exhibited multivalency binding on the HeLa cell membranes from the cell affinity study in the fixation of HeLa cells. Photo-stimulation on the membrane of the living HeLa cell was observed by confocal optical imaging in situ, using the two-photon model, when incubated with BG3. Analyses of cell membrane integrity via lactate dehydrogenase (LDH) assay confirmed membrane damage at two photon excitation model. However, no variation in the cell was observed using the one-photon excitation model. These results indicated a high degree of dendrons uptake by cells through binding to the cell membrane following the endocytotic pathway. Furthermore, the wide excitation fluorescence spectrum of difluoroboron dye provides dual imaging with which to study the endocytosis of TPD-labeled PAMAM dendrons using a single near infrared laser.     

VIG-Express: Consenso de un sistema de valoración multidimensional/geriátrica rápida en Cataluña

ObjetivoConsensuar una herramienta de valoración multidimensional/geriátrica rápida (VMGR), como sistema compartido y universal de valoración multidimensional de personas con multimorbilidad, fragilidad, complejidad o situación avanzada, para todos los profesionales del sistema de salud y social de Cataluña.DiseñoConsenso de profesionales en tres fases, combinando sesiones presenciales con trabajo telemático.EmplazamientoCataluña.ParticipantesSe constituyó un grupo de 27 profesionales de carácter interdisciplinario representativo de los distintos ámbitos de atención.MétodoSe han combinado las metodologías de Design thinking para el consenso inicial de características de la herramienta de VMGR (fase 1), con la metodología Lean Start-Up para el diseño de la nueva herramienta de VMGR (fase 2), que finalmente se testeó en un grupo de pacientes (fase 3).ResultadosEn la fase 1 se consensuó que la herramienta de VMGR ideal debía permitir una valoración ad hoc de las personas, ser rápida y ágil (tiempo < 10 minutos), identificar las dimensiones alteradas mediante preguntas trigger y facilitar el diagnóstico de situación (idealmente cuantificado). En la fase 2 se elaboró el prototipo de una nueva herramienta de VMGR de 15 + dos preguntas (VIG-Express), finalmente testeada en 35 personas en la fase 3.ConclusionesEn los resultados preliminares, la herramienta VIG-Express parece facilitar una valoración multidimensional sencilla y rápida y la personalización de las intervenciones, así como una mirada única y un relato compartido entre los profesionales de los distintos ámbitos de atención. Serán necesarios más estudios para corroborar estos hallazgos.Palabras clave: Evaluación geriátrica, Consenso, Diagnóstico de la situación, Atención dirigida al paciente, Sistemas de atención de salud integrada     

Diabetic retinopathy at high altitude

The objective of this study was to determine whether altitude hypoxia favors the development of diabetic retinopathy (DR) in healthy type 1 diabetic climbers with tight glycemia control. The retinas of 7 type 1 diabetic climbers with a history of stays at high altitude were studied through nonmydriatic chamber retinography (Ffo-CNM). The retinographies were performed before and after a 7,143 m peak expedition. One of the subjects presented evidence of DR prior to the ascent, in addition to a microhemorrhage afterward; the rest of the retinographies were normal. Fine glycemia management and adequate acclimatization are not the only cautions for diabetics going to altitude; an ophthalmologic exam beforehand is also recommended.     

Triterpene glycosides from Antarctic sea cucumbers. 1. Structure of liouvillosides A1, A2, A3, B1, and B2 from the sea cucumber Staurocucumis liouvillei: new procedure for separation of highly polar glycoside fractions and taxonomic revision

Five new triterpene glycosides, liouvillosides A1 (1), A2 (2), A3 (3), B1 (4), and B2 (5), have been isolated from the Antarctic sea cucumber Staurocucumis liouviellei along with the known liouvilloside A(6), isolated earlier from the same species, and hemoiedemosides A (7) and B (8), isolated earlier from the Patagonian sea cucumber Hemioedema spectabilis. The isolation was carried out using a new chromatographic procedure including application of ion-pair reversed-phase chromatography followed by chiral chromatography on a cyclodextrin ChiraDex column. The structures of the new glycosides were elucidated using extensive NMR spectroscopy (1H and 13C NMR spectrometry, DEPT, 1H-(1)H COSY, HMBC, HMQC, and NOESY), ESI-FTMS, and CID MS/MS, and chemical transformations. Glycosides 1-3 are disulfated tetraosides and glycosides 4 and 5 are trisulfated tetraosides. Glycosides 2 and 3 contain 3-O-methylquinovose, found for the first time as a natural monosaccharide in sea cucumber glycosides. On the basis of analyses of glycoside structures a taxonomic revision is proposed.