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High Altitude Edema

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181. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

are home oxygen and high-frequency nasal cannula. There is emerging evidence for the role of home oxygen in reducing LOS or admission rate for infants with bronchiolitis, including 2 randomized trials. , Most of the studies have been performed in areas of higher altitude, where prolonged hypoxemia is a prime determinant of LOS in the hospital. , Readmission rates may be moderately higher in patients discharged with home oxygen; however, overall hospital use may be reduced, although not in all settings (...) in the discussion of prevention. This guideline will not address long-term sequelae of bronchiolitis, such as recurrent wheezing or risk of asthma, which is a field with a large and distinct literature. Bronchiolitis is a disorder commonly caused by viral lower respiratory tract infection in infants. Bronchiolitis is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, and increased mucus production. Signs and symptoms typically begin with rhinitis and cough, which

2014 American Academy of Pediatrics

182. Heart Disease and Stroke Statistics?2016 Update

and Stroke Statistics Subcommittee Originally published 16 Dec 2015 Circulation. 2016;133:e38–e360 You are viewing the most recent version of this article. Previous versions: Table of Contents Summary e39 1. About These Statistics e46 2. Cardiovascular Health e49 Health Behaviors 3. Smoking/Tobacco Use e68 4. Physical Inactivity e78 5. Nutrition e89 6. Overweight and Obesity e110 Health Factors and Other Risk Factors 7. Family History and Genetics e121 8. High Blood Cholesterol and Other Lipids e127 9 (...) . High Blood Pressure e135 10. Diabetes Mellitus e148 11. Metabolic Syndrome e162 12. Chronic Kidney Disease e178 Cardiovascular Conditions/Diseases 13. Total Cardiovascular Diseases e184 14. Stroke (Cerebrovascular Disease) e204 15. Congenital Cardiovascular Defects and Kawasaki Disease e235 16. Disorders of Heart Rhythm e247 17. Sudden Cardiac Arrest e268 18. Subclinical Atherosclerosis e279 19. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris e292 20. Cardiomyopathy and Heart

2014 American Heart Association

183. Pharmacologic Therapy for Pulmonary Arterial Hypertension in Adults

of childbearing age taking these medications. 76. When pregnancy does occur, we suggest care at a pulmonary hypertension center, using a multidisci- plinary approach including the pulmonary hyperten- sion, the high-risk obstetrical and cardiovascular anesthesiology services (Grade CB) . Altitude and Air Travel 77. In patients with P AH, we suggest that exposure to high altitude be avoided, and that supplemental oxygen be used as needed during altitude exposure or air travel to maintain oxygen saturations (...) , FCCP ; Rex Yung , MD, FCCP ; C. Gregory Elliott , MD, FCCP ; and David B. Badesch , MD, FCCP OBJECTIVE: Choices of pharmacologic therapies for pulmonary arterial hypertension (PAH) are ideally guided by high-level evidence. Th e objective of this guideline is to provide clinicians advice regarding pharmacologic therapy for adult patients with PAH as informed by available evidence. METHODS: Th is guideline was based on systematic reviews of English language evidence pub- lished between 1990

2014 American College of Chest Physicians

184. Management of Hypertension (HTN) in Primary Care

blood pressure (SBP) >140 mmHg or a diastolic blood pressure (DBP) of >90 mmHg. Prehypertension is classified as SBP 120-139 or DBP 80-89. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) went on to further classify hypertension into stages [1] (Stage 1: SBP 140- 159 mmHg or DBP 90-99; Stage 2: SBP >160 mmHg or DBP >100 mmHg), though the use of these stages has begun to be phased out. Hypertension is usually (...) , sedentary lifestyle, and dietary choices, can lead to high blood pressure. [2] Secondary hypertension is high blood pressure that results from an underlying and identifiable cause. [3] Main causes of secondary hypertension include adverse effects of medications, tobacco products or illegal drugs, renal disease, obstructive sleep apnea, pheochromocytoma, aldosteronism, and aortic coarctation. Complications of hypertension include damage to the large arteries (macrovascular complications) that can lead

2014 VA/DoD Clinical Practice Guidelines

185. Myths and Realities: Airline Travel and Deep Venous Thrombosis-Does Economy Class Syndrome Really Exist?

and venous thrombosis in long flights with elastic stockings. A randomized trial: The LONFLIT 4 Concorde Edema-SSL Study. Angiology. 2002;53:635-645. . 9. Cesarone M.R. Venous thrombosis from air travel: the LONFLIT 3 study – prevention with aspirin vs low-molecular-weight heparin (LMWH) in high-risk subjects: a randomized trial. Angiology. 2002;53:1-6. . 10. Lapostolle, F. Severe pulmonary embolism associated with air travel. New Eng J Med. 2001;345:779-783. . 11. Landgraf, H. Economy class syndrome (...) of the general population, all travelers departing on prolonged flights are – at a minimum – predisposed to increased periods of blood flow stasis secondary to prolonged cramped seating, possible dehydration, and hypobaric hypoxia. These conditions, in addition to passenger-specific conditions (obesity, age, inherited thrombophilias etc.), account for the roughly three-fold higher incidence of VTE in non-high risk patients [5]. Blood flow stasis and subsequent coagulation activation have been known to stem

2014 Clinical Correlations

186. 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD

(in mg/l), min indicates the minimum of SCysC/0.8 or 1, and max indicates the maximum of SCysC/0.8 or 1. Grade Quality of evidence Meaning A High We are confident that the true effect lies close to that of the estimate of the effect. B Moderate The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. C Low The true effect may be substantially different from the estimate of the effect. D Very low The estimate of effect is very (...) / 1.73 m 2 ) Description and range G1 Normal or high =90 G2 Mildly decreased 60-89 G3a Mildly to moderately decreased 45-59 G3b Moderately to severely decreased 30-44 G4 Severely decreased 15-29 G5 Kidney failure 300 mg/g >30 mg/mmol GFR categories (ml/min/ 1.73 m 2 ) Description and range G1 Normal or high =90 G2 Mildly decreased 60-89 G3a Mildly to moderately decreased 45-59 G3b Moderately to severely decreased 30-44 G4 Severely decreased 15-29 G5 Kidney failure 300 mg/g >30mg/mmol GFR

2012 National Kidney Foundation

187. Association between genetic polymorphism of telomere-associated gene ACYP2 and the risk of HAPE among the Chinese Han population: A Case-control study. Full Text available with Trip Pro

Association between genetic polymorphism of telomere-associated gene ACYP2 and the risk of HAPE among the Chinese Han population: A Case-control study. High-altitude pulmonary edema (HAPE) is a hypoxia-induced, life-threatening, pulmonary edema, which is characterized by exaggerated pulmonary hypertension caused by stress failure. ACYP2 was found to associated with telomere length, the aim of this study was to identify whether ACYP2 polymorphisms increase or decrease HAPE risk in the Chinese

2017 Medicine

188. Magnetic Resonance Spectroscopy Studies of Acute Hypoxic and Hyperoxic Breathing in Healthy Volunteers

endanger the subject during or after a blood draw (e.g. hemophilia) Significant medical or neurological illness Prior high altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE) diagnosis Born at altitudes greater than 2,100 m (~7,000 ft) Systemic disease with or without any functional limitation; including controlled hypertension controlled diabetes without systemic effects any cardiac conditions with or without functional limitation, such as, coronary artery disease or valve disease

2017 Clinical Trials

189. Stress Echo 2020

at high altitude) will undergo lung ultrasound scan for B-lines before, soon after (within 10 minutes) and (when positive) soon after, later after (6 to 24 h) the acute extreme exercise. A sample size of 80 patients is required to detect a significant stress-induced increase in B-lines in each of the three major study subgroups: high altitude trekkers (n=100); marathon runners (n=80) and apnea divers (n=70). Procedure: B-lines SE SE will be performed with special focus on lung sonography and B-lines (...) , multicenter, international, observational study design, > 100 certified high-volume SE labs will be networked with an organized system of clinical, laboratory and imaging data collection at the time of physical or pharmacological SE, with structured follow-up information. The study is endorsed by the Italian Society of Echocardiography and organized in 10 subprojects focusing on: contractile reserve for prediction of cardiac resynchronization or medical therapy response; stress B-lines in heart failure

2017 Clinical Trials

190. IL-10 Dysregulation in Acute Mountain Sickness Revealed by Transcriptome Analysis Full Text available with Trip Pro

IL-10 Dysregulation in Acute Mountain Sickness Revealed by Transcriptome Analysis Acute mountain sickness (AMS), which may progress to life-threatening high-altitude cerebral edema, is a major threat to millions of people who live in or travel to high altitude. Although studies have revealed the risk factors and pathophysiology theories of AMS, the molecular mechanisms of it do not comprehensively illustrate. Here, we used a system-level methodology, RNA sequencing, to explore the molecular (...) mechanisms of AMS at genome-wide level in 10 individuals. After exposure to high altitude, a total of 1,164 and 1,322 differentially expressed transcripts were identified in AMS and non-AMS groups, respectively. Among them, only 328 common transcripts presented between the two groups. Immune and inflammatory responses were overrepresented in participants with AMS, but not in non-AMS individuals. Anti-inflammatory cytokine IL10 and inflammation cytokines IF17F and CCL8 exhibited significantly different

2017 Frontiers in immunology

191. Chronic Hypobaric Hypoxia Modulates Primary Cilia Differently in Adult and Fetal Ovine Kidneys Full Text available with Trip Pro

Chronic Hypobaric Hypoxia Modulates Primary Cilia Differently in Adult and Fetal Ovine Kidneys Hypoxic environments at high altitude have significant effects on kidney injury. Following injury, renal primary cilia display length alterations. Primary cilia are mechanosensory organelles that regulate tubular architecture. The effect of hypoxia on cilia length is still controversial in cultured cells, and no corresponding in vivo study exists. Using fetal and adult sheep, we here study the effect (...) of chronic hypobaric hypoxia on the renal injury, intracellular calcium signaling and the relationship between cilia length and cilia function. Our results show that although long-term hypoxia induces renal fibrosis in both fetal and adult kidneys, fetal kidneys are more susceptible to hypoxia-induced renal injury. Unlike hypoxic adult kidneys, hypoxic fetal kidneys are characterized by interstitial edema, tubular disparition and atrophy. We also noted that there is an increase in the cilia length

2017 Frontiers in physiology

192. Family Practice Notebook Updates 2018

loose wound closure If closing a potentially contaminated wound, choose either primary closure or by second intention (ob, bleed) Painless after 18-20 weeks is until proven otherwise (surgery, procedure) High volume >5 liters may result in significant , , pulmonary edema (surgery, procedure) Bleeding after implant placement may occur in the first 24 hours requiring return to surgery V. Updates: September 2018 (hemeonc, cancer, bone, ) s include , , and much less common, is most common, affects age 5 (...) altitude with cabins pressurized to 7000 feet (urology, sx) May be due to instrumentation (cystoscopy), fistula from bowel or vagina, renal tumor infarction, urinary diversion or with p-valve However, it is critical to exclude UTI with gas forming organisms (e.g. , , , Candida, ) UTI with gas forming organisms may result in or which are associated with high mortality Staghorn calculi and low may indicate the presence of gas forming organisms (surgery, gi) The classic triad of or back pain

2019 FP Notebook

193. A Signature of Circulating microRNAs Predicts the Susceptibility of Acute Mountain Sickness Full Text available with Trip Pro

A Signature of Circulating microRNAs Predicts the Susceptibility of Acute Mountain Sickness Background: Acute mountain sickness (AMS) is a common disabling condition in individuals experiencing high altitudes, which may progress to life-threatening high altitude cerebral edema. Today, no established biomarkers are available for prediction the susceptibility of AMS. MicroRNAs emerge as promising sensitive and specific biomarkers for a variety of diseases. Thus, we sought to identify circulating (...) microRNAs suitable for prediction the susceptible of AMS before exposure to high altitude. Methods: We enrolled 109 healthy man adults and collected blood samples before their exposure to high altitude. Then we took them to an elevation of 3648 m for 5 days. Circulating microRNAs expression was measured by microarray and quantitative reverse-transcription polymerase chain reaction (qRT-PCR). AMS was defined as Lake Louise score ≥3 and headache using Lake Louise Acute Mountain Sickness Scoring System

2017 Frontiers in physiology

194. Association between regulator of telomere elongation helicase1 (RTEL1) gene and HAPE risk: A case-control study. Full Text available with Trip Pro

Association between regulator of telomere elongation helicase1 (RTEL1) gene and HAPE risk: A case-control study. High altitude pulmonary edema (HAPE) is a paradigm of pulmonary edema. Mutations in regulator of telomere elongation helicase1 (RTEL1) represent an important contributor to risk for pulmonary fibrosis. However, little information is found about the association between RTEL1 and HAPE risk. The present study was undertaken to tentatively explore the potential relation between single

2017 Medicine

195. Exercise Testing, Supplemental Oxygen and Hypoxia. (Abstract)

in such patients is lacking. CPET performance with supplemental O2 in respiratory patients residing at high altitudes is also poorly studied. Finally, CPET has the potential to give physiological and clinical information about acute and chronic mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. It may also translate high-altitude acclimatization and adaptive processes in healthy individuals into intensive care medical practice. (...) peak [Formula: see text]o2, care should be taken in the selection of work-rate incrementation rates when CPET performance is to be compared with normobaria at sea level. CPET has been used to evaluate the effects of supplemental O2 on exercise intolerance in chronic obstructive pulmonary disease, interstitial pulmonary fibrosis, and cystic fibrosis at sea level. However, identification of those CPET indices likely to be predictive of supplemental O2 outcomes for exercise tolerance at altitude

2017 Annals of the American Thoracic Society

196. Corydalis hendersonii Hemsl. protects against myocardial injury by attenuating inflammation and fibrosis via NF-κB and JAK2-STAT3 signaling pathways. (Abstract)

Corydalis hendersonii Hemsl. protects against myocardial injury by attenuating inflammation and fibrosis via NF-κB and JAK2-STAT3 signaling pathways. Corydalis hendersonii Hemsl. (CH) with heat clearing and detoxifying effects are well described in Tibetan folk medicine. It has been used for centuries in China largely for the treatment of high altitude polycythemia, a pathophysiological condition referred to "plethora" in Tibetan medicine, hypertension, hepatitis, edema, gastritis, and other

2017 Journal of Ethnopharmacology

197. Dyspnea Causes

, Causes of Dyspnea with Clear Lung Sounds From Related Chapters II. Causes: Categories of Dyspnea Oxygen Ingress problem High altitude Airway Obstruction or trachea (e.g. , ) (e.g. , ) Alveoli (e.g. , ) External compression (e.g. ) Thoracic wall (e.g. ) Oxygen Uptake problem circulation (left side) disorder (oxygen carrying capacity) Neuromuscular problem Miscellaneous causes Perceived (e.g. anxiety) (with compensatory ) III. Causes: Common in Adults in Adults (Mnemonic: PPOPPA) Pulmonary edema (...) Pulmonary: Noxious gas inhalation, Cardiogenic: Obstructed Airway (Foreign body, ) (Spontaneous) or in Adults (Duration >1 month) ( , ) Kyphoscoliosis Neuromuscular disease (e.g. ) Upper airway conditions Psychiatric cause (e.g. ) IV. Causes: Dyspnea with Clear Lung Sounds Observe for signs of right (edema, JVD) V. Causes: Acute Dyspnea in Children VI. Causes: Airway Causes VII. Causes: Cardiac Causes ( ) Asymmetric septal hypertrophy Valvular dysfunction (e.g. ) Arrhythmias (e.g. ) VIII. Causes

2018 FP Notebook

198. Frostbite

Chapters II. Definitions Frostbite Skin (and deeper structures) freeze resulting in tissue injury Frostnip Superficial ice crystals deposit on the skin surface without tissue injury III. Risk Factors (e.g. ) Prolonged cold or moisture exposure High wind (high wind chill) High altitude Inadequate clothing Extremes of age strictive agents (e.g. nicotine) IV. Pathophysiology: Changes by skin Temperature Room Normal skin perfusion >200 ml/min Skin 59 F (15 C) Skin perfusion 20-50 ml/min striction (...) bullae Fourth-degree Frostbite (full skin thickness AND muscle/bone involvement) Mottled, deep red or cyanotic skin Bone and muscle freezing Dry , black mummified skin VII. Signs: Classification - 2 category (preferred in the acute setting) Distribution - high risk areas Extremities (hands, feet) Face (ears, nose) Genitalia (penis) Superficial Frostbite (includes first and second degree Frostbite as above) Erythema and edema Minimal to no tissue loss No hemorrhagic bullae (but clear or milky bullae

2018 FP Notebook

199. Hypoxia

or Hypoxemia <70 to 80 mmHg III. Causes Pulmonary edema ( ) Acute ic Hypersensitivity pneumonitis ( ) Miscellaneous Causes Decreased FIO2 of inspired air (high altitude) Cyanide IV. Causes: Hypoxia or Hypoxemia (PaO2 <70 to 80 mmHg) See Hypoxemia V. Symptoms VI. Signs Mental status changes Acute: Chronic: , drowsy, inattentive ( ) decreased Usually correlates with However, relationship is not linear (See ) Not sensitive for increased Conditions where low despite normal or other abnormal VII. Evaluation

2018 FP Notebook

200. Respiratory Alkalosis

Alkalosis Aka: Respiratory Alkalosis II. Causes Increased Central Respiratory Drive Anxiety Medications s Nicotine s (especially with ) Pregnancy failure, or Increased Chemoreceptor Stimulation Pulmonary edema High altitude (decreased FIO2) (early) Iatrogenic with III. Labs Arterial pH increased Serum bicarbonate decreased decreased Acute Respiratory Alkalosis decreases by 10 mmHg increases pH by 0.08 Bicarbonate decreases 2 meq/L per 10 mmHg fall Chronic Respiratory Alkalosis decrease by 10 mmHg

2018 FP Notebook

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