Mal agudo de montaña: pasado, presente y futuro / Acute mountain sickness: past, present and future

Evidencias en textos históricos Chinos de los años 403 AC y de la Conquista Española en 1590, muestran de las condiciones singulares que afectaban tanto a hombres como a animales al ascender por sectores montañosos por sobre 4000 m., y que ahora reconocemos como mal agudo de montaña. Ya desde el siglo XIX, se ha reconocido que es la falta de oxígeno (hipoxia) el factor determinante de la respuesta aclimatatoria como de la desaclimatización a la hipoxia de altura. El objetivo de la actual revisión fue una puesta al día de definiciones, factores que inciden en una mayor incidencia de mal agudo de montaña, mecanismo fisiológico propuesto, el desarrollo de estrategias farmacológicas para la prevención y/o tratamiento y por último, se ha revisado respecto de las distintas estrategias que se han desarrollado para la evaluación de la susceptibilidad individual, conocido comúnmente como test de hipoxia.

Some Chinese historical text from 403 BC and the Spanish Conquest in 1590 indicates unique conditions that affected both men and animals when climbing mountainous areas over 4000 m. and that is currently known as Acute Mountain Sickness (MAM). Since the XIX century, the lack of oxygen (hypoxia), has been recognized as the main factor of the acclimatization and declimatization to the high altitude hypoxia. The aim of the current revision is an update of definitions, factors that contribute the Acute Mountain Sickness, the proposed physiological mechanism, the development of pharmacological strategies for the prevention and/or treatment, and finally, we reviewed the different strategies developed for the individual susceptibility assessment, generally known as hypoxia test.

Low altitude assessment of arterial blood pressure predicts susceptibility to acute mountain sickness at high altitude / 军事医学

Objective To explore that whether the normoxic low altitude measurement of arterial blood pressure would predict subsequent susceptibility to acute mountain sickness ( AMS) during rapid ascent to high altitude .Methods Arterial blood pressure ( using a wrist sphygmomanometer ) was determined in two hundred and four healthy lowlanders first exposed to 3700 m-altitude (Lhasa) from plain (500 m) by air, and the Lake Louise self-report questionnaire(LLS) was used to assess AMS.We compared the low altitude blood pressure related indicators of two groups ( AMS and non-AMS ) and analyzed the relationship of diagnostic score and blood pressure related indicators .Results ①The incidence of AMS in the selected subjects was 53.92% by LLS.AMS scores increased markedly at high-altitude (P<0.05 versus low altitude).②Diastolic blood pressure (DBP) and mean arterial BP (MABP) in the AMS group were higher than those in the non-AMS group(P<0.05).The low altitude DBP levels for diagnosis of AMS at high-altitude (3700 m) had an area under curve(AUC) =0.598, P<0.05, with sensitivity of 56.3%, specificity of 63.2%, and cut-off point of 72.5 mmHg. Conclusion ①After acute exposure to high altitude , the incidence of AMS increases significantly .②A higher baseline DBP may be considered a potential risk factor for AMS , and is positively associated with LLS .DBP may serve as a predic-tive parameter for diagnosis of AMS .However , the clinical application of DBP as a predictive criterion is limited because of its poor specificity or sensitivity .The use of DBP as a predictive criterion should be combined with other indicators for the better predictive value of AMS .

Medicinal Herbs and Toxic Hepatitis

Medicinal herb-induced liver injury reported on the literature ranges from mild elevation of liver enzymes to fulminant liver failure and liver cirrhosis. Medicinal herbs are common ingredients of traditional Chinese herbs. The mechanisms of medicinal herb-induced liver injury are mainly intrinsic hepatotoxicity. In addition to the potential for hepatotoxicity, medicinal herbs frequently induce herb-drug interaction and herb-herb interaction and may affect its own efficacy and safety. Sometimes hepatotoxicity of medicinal herbs originates from the substances of illegal adulterations and contaminations rather than its own indigenous components. Moreover, individual susceptibility to toxic liver injury should be considered in every instance. Two fundamental problems exist in the management of medicinal herbs-induced liver injury. One is a problem on the verification of herbal medicinal prescriptions, because the details of the herbal prescriptions are not usually disclosed to the public in Korea. Another one is a nation-wide prevailed misconception asserting natural products such as medicinal herbs are not harmful.

Do Natural Health Products Cause Toxic Hepatitis?

Medicinal herb-induced liver injury reported on the literature ranges from mild elevation of liver enzymes to fulminant liver failure and liver cirrhosis. Medicinal herbs are common ingredients of traditional Chinese herbs. The mechanisms of medicinal herb-induced liver injury are mainly intrinsic hepatotoxicity. In addition to the potential for hepatotoxicity, medicinal herbs frequently induce herb-drug interaction and herb-herb interaction and may affect its own efficacy and safety. Sometimes hepatotoxicity of medicinal herbs originates from the substances of illegal adulterations and contaminations rather than its own indigenous components. Moreover, individual susceptibility to toxic liver injury should be considered in every instance. Two big problems exist in the management of medicinal herbs-induced liver injury. Because the release of prescriptions is not obligatory in Korea, it is impossible to identify ingredients in case of medicinal herbsinduced liver injury. Misconception on the safety of medicinal herbs prevails throughout the country.