Variaciones fisiológicas y antropométricas en trabajadores según su residencia en tres altitudes geográficas del Perú / Physiological and anthropometric variations in workers due to their residence in three geographic altitudes in Peru

Introducción: El organismo se adapta al lugar donde reside, pero este tema no ha sido estudiado en la población laboral peruana. Objetivo: Determinar las variaciones fisiológicas y antropométricas en trabajadores según su residencia en tres altitudes geográficas del Perú. Métodos: Se realizó una investigación transversal analítica, con los datos fisiológicos (6 parámetros de laboratorio) y antropométricos (peso y talla) de 7500 trabajadores en 3 altitudes diferentes: Lima (nivel del mar), Arequipa (2500 m sobre el nivel del mar) y Cerro de Pasco (4300 m sobre el nivel del mar). Estas mediciones fueron estándares, realizadas por clínicas ocupacionales con certificaciones de calidad. Se obtuvo los coeficientes y valores p para las diferencias según cada altitud y ajustados por el sexo y la edad de cada participante. Resultados: Todos los parámetros fisio-antropométricos variaron según la altitud de residencia (todos los valores p fueron menores a 0,005). Los que se incrementaron a mayor altitud fueron la hemoglobina, el colesterol total y el colesterol HDL; en cambio, disminuyeron a mayor altitud el peso y la glucosa en ayunas. En los hombres aumentaron todas las variables menos en el colesterol HDL (que disminuyó significativamente) y el colesterol LDL (que no tuvo variación estadística), en comparación con las mujeres. Conclusiones: Son evidentes las variaciones en las mediciones de los trabajadores según el lugar donde residían, lo que muestra que no se debe tomar parámetros fijos para su valoración laboral. Esto debe servir a los médicos del trabajo y las autoridades, para tener en cuenta al momento de la valoración de la aptitud médica y luego para la vigilancia ocupacional(AU)

Introduction: The human body adapts to its place of residence, but this topic has not been studied in the Peruvian working population. Objective: Determine physiological and anthropometric variations in workers due to their residence in three geographic altitudes in Peru. Methods: An analytical cross-sectional study was conducted of physiological data (6 laboratory parameters) and anthropometric data (weight and height) of 7 500 workers from three different altitudes: Lima (sea level), Arequipa (2 500 m above sea level) and Cerro de Pasco (4 300 m above sea level). The measures were standard and taken by occupational clinics with quality certifications. Coefficients and p values for differences between the altitudes were obtained and adjusted according to the sex and age of participants. Results: All the physio-anthropometric parameters varied with the altitude of the place of residence (all p values were under 0.005). The parameters which increased at a higher altitude were hemoglobin, total cholesterol and HDL cholesterol, whereas the ones which decreased at a higher altitude were weight and fasting glucose. Among men all variables increased except for HDL cholesterol (which decreased significantly) and LDL cholesterol (which did not show any statistical variation), in comparison with women. Conclusions: Variations in measurements taken from workers from different places of residence are obvious, which shows that fixed parameters should not be used for their labor assessment. This should be taken into account by occupational doctors and authorities for medical attitude assessment and occupational surveillance(AU)

Eritrocitosis excesiva y mal de montaña crónico en mujeres residentes a extrema altura (la Rinconada 5200 msnm, Perú) / Excessive erythrocytosis and acute mountain sickness in women living at extreme altitude (La Rinconada, 5200 msnm, Perú)

El objetivo del trabajo fue determinar la prevalencia y el impacto de la eritrocitosis excesiva (EE) y mal de montaña crónico (MMC) en mujeres, y factores asociados en el desarrollo de estas alteraciones, principalmente la edad e índice de masa corporal (IMC). Los resultados mostraron una prevalencia de EE y MMC, de 19,72% y 25,35%, respectivamente. La edad promedio es de 39,79 ± 10,87; el hematocrito promedio fue 51,95 ± 6,85; la saturación de oxígeno fue 79,88 ± 5,24 y el IMC promedio de la participantes es 28,08 ± 3,87. La prevalencia de EE en el sexo femenino es mayor en las mujeres posmenopáusicas, en comparación a las premenopáusicas. Por otro lado, se determinó que un mayor índice de masa corporal se asocia fuertemente a menores valores de saturación de oxígeno. Entonces, así el incremento de la edad y del índice de masa corporal, favorecen el presencia de eritrocitosis excesiva más marcada condicionando un desarrollo de mal de montaña crónico de mayor severidad.

The aim of the work was to determine the prevalence and impact of excessive erytrochytes (EE) and chronic mountain sickness (MMC) in women, and related factors of the development of these alterations, mainly age and body max index (IMC). Results displayed incidence of EE and MMC, by 19.72% and 25.35%, respectively. The average age was 39.79 ± 10.87; the average hematocrit was 51.95 ± 6.85; the oxygen saturation was 79.88 ± 5.24 and the average IMC of the participants was 28.08 ± 3.87. The prevalence of EE on females is greater in postmenopausal women, in comparison to pre menopausals. On the other hand, it was determined that a greater body mass index is strongly associated to lesser oxygen saturation values. Hence, the increase of age and body max index, favor the most marked excesive erytrochytes presence conditioning the most serious acute mountain sickness.

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.

Effects of altitude on anthropometric and physiological patterns in Aymara and non-Aymara population between 18 and 65 years in the province of Parinacota Chile (3.700 masl) / Efectos de la altura sobre patrones antropométricos y fisiológicos en población Aymará y no Aymará entre 18 y 65 años de la provincia de Parinacota, Chile (3.700 msnm)

The aim of the study was to compare anthropometric and physiological patterns in a sample of 522 Aymara and non-Aymara individuals from Parinacota, Chile (3.700m). After signing voluntary informed consent forms, the residents were separated in two age groups. Groups A: 18 to 35 years, and Group B: 36 to 65 years, by sex and Aymara and non-Aymara ethnicity. The results of this study determined that anthropometric anteroposterior diameter (DAP) are higher in Aymara population. Biacromial diameter (DBA) is significantly lower in the Aymara population. Aymara males between 18 and 35 years are smaller than non-Aymara males. Aymara women had significantly lower heart rates. The respiratory rate is significantly lower in Aymara males and females from 18 to 35 years. Partial oxygen saturation (SaO2) is higher in Aymara women, compared with non-Aymara women. The body mass index (BMI) did not differ within each group according to age, however, in comparison between groups, older individuals independent of sex and ethnicity have index of overweight and obesity. In forced vital capacity (FVC), there is no difference in ages however, while comparing between ages, older populations independent of sex and ethnicity presented significant decreases in this parameter. This may reflect mechanisms of adaptation to the high altitude of Aymara native populations living in the Andes.

El objetivo de este estudio fue comparar patrones antropométricos y fisiológicos en una muestra de 522 individuos aymará y no aymará de la Provincia de Parinacota (3.700 msnm). Luego de la firma del consentimiento informado por los residentes se procedió a separar a los individuos en dos grupos etáreos: población de 18 a 35 años y de 36 a 65 años, según sexo y etnia aymará y no aymará. Los resultados de este estudio determinan que los patrones antropométricos de diámetro antero posterior del tórax son mayores en la población aymará. El diámetro biacromial, es significativamente menor en la población aymará. Los varones aymará de entre 18 a 35 años son de menor tamaño que los varones no aymará. Las mujeres aymará presentan una disminución significativa de la frecuencia cardiaca. La frecuencia respiratoria es significativamente menor en damas y varones aymará de 18 a 35 años. La saturación parcial del oxígeno es mayor en las damas aymará, respecto a mujeres no aymará. El índice de masa corporal no presenta diferencia dentro de cada grupo según edades, pero al comparar entre los grupos, los individuos de mayor edad independiente del sexo y la etnia presentan índice de sobrepeso y obesidad. La capacidad vital forzada, no presenta diferencias dentro de las edades, sin embargo al comparar entre las edades, las poblaciones de mayor edad independiente de la etnia y el sexo presentan disminuciones significativas de este parámetro. Esto posiblemente reflejaría mecanismos de adaptación a la altura de las poblaciones nativas aymará, que viven en los Andes.

Psychiatric morbidity amongst the troops deployed at siachen

To compare the psychiatric morbidity in acclimatized "deployed" troops with acclimatized but "not yet deployed" troops and to find out the usefulness of General Health Questionnaire - 12, as a screening tool to identify psychiatric morbidity in troops at high altitudes. Comparative study. The study was conducted at Siachen from June to July 1996. The study population [n= 245] was divided into two groups. Group I [n=126] comprised of troops acclimatized and trained for 07 weeks below 14000 feet by staged and graded ascent but were "not yet deployed", and Group II [n=119] comprised of acclimatized troops who remained "deployed" above 15000 feet for an average duration of 07 weeks, and had descended to a mean height of 14200 feet, in previous two - three weeks. General Health Questionnaire - 12 and Present State Examination were used for psychiatric evaluation. Out of 245 troops exposed to high altitude, 105 [42.8%], had psychiatric morbidity, as measured by a score of more than 2 on General Health Questionnaire -12 and a positive International Classification of Diseases - 10 diagnosed on clinical psychiatric interview based on Present State Examination. More troops 67 [56.3%], in Group II had psychiatric morbidity as compared to Group I, 38 [30.2%]. Psychotic symptoms; delusions 2 [1.68%] and hallucinations 3 [2.52%] were seen in Group II patients whereas no psychotic symptoms were seen in Group I. The psychotic symptoms resolved completely after descending to 14200 feet but the neurotic symptoms, did not resolve completely. Cases, scoring 2/12 or above [42.8%] on General Health Questionnaire -12 were highly associated with a positive psychiatric diagnosis. The sensitivity, specificity and Positive Predictive Value and Negative Predictive Value of GHQ-12 in group I was 100%, 91%, 82.6% and 100%; whereas in group flit was 100%, 98.1%, 98.5% and 100% respectively. High altitude "deployment" is stressful for troops and is associated with development of "psychotic and "neurotic" symptoms above 15000 feet. The "psychotic" symptoms abate completely but some "neurotic" symptoms persist even after descent to 14200 feet. General Health Questionnaire - 12 followed by psychiatric interview can effectively determine psychiatric morbidity in troops deployed at high altitudes

Predicción de mal agudo de montaña en Chile mediante una prueba en cámara hipobárica / Acute mountain sickness prediction in Chile via a hypobaric chamber test

La baja presión barométrica y de oxígeno son características principales del ambiente de gran altura. La falla de los mecanismos de acomodación pueden causar Mal Agudo de Montaña (MAM). En Chile miles de trabajadores se trasladan desde el nivel del mar al trabajo a gran altura y muchos de ellos sufren MAM (10 a 75 por ciento). Para determinar si acaso la hemodinámica, parámetros respiratorios y el cuestionario de autoevaluación Lake Louise (LLQ) medidos a una altitud simulada en una cámara hipobárica puede predecir el desarrollo de MAM, 126 voluntarios sanos fueron estudiados. Se les realizó un examen médico, medición de parámetros antropométricos, presión arterial, frecuencia cardíaca, saturación de oxígeno transcutánea, frecuencia respiratoria, volumen corriente, Ti/Ttot (tiempo inspiratorio/tiempo total del ciclo ventilatorio) y Vt/ti (volumen corriente/tiempo inspiratorio) y respondieron un cuestionario acerca de síntomas MAM. Empleando un modelo de regresión logística múltiple, se encontró que utilizando el género, edad, saturación de oxígeno transcutánea y LLQ obtenidos a gran altitud simulada en la cámara, se puede predecir el inicio de MAM con una sensibilidad del 87 por ciento y una especificidad de 64 por ciento.

Low barometric and oxygen pressure are major characteristics of the altitude environment. Failure of the accommodation mechanisms may cause Acute Mountain Sickness (AMS). In Chile thousands of workers commute from sea level to work at high altitude, and many of them suffer from AMS (10 to 75%). To determine whether haemodinamics, respiratory parameters and Lake Louise self reported Questionnaire (LLQ) measured at simulated altitude in a hypobaric chamber can predict the development of AMS, 126 healthy volunteers were studied. They had medical examination, measurement of anthropometric parameters, arterial blood pressure, cardiac rate, transcutaneous oxygen blood saturation, respiratory rate, tidal volume, Ti/Ttot (inspiratory time/total respiratory time) and Vt/ti (tidal volume/inspiratory time) and answered a questionnaire about AMS symptoms. Using a multiple logistic regression model, we found that using gender, age, oxygen blood saturation and LLQ obtained at simulated high altitude in thechamber, we may predict the onset of AMS at altitude with an 87% sensitivity and a 64% specificity.

Risk factors in high altitude pulmonary oedema

To identify the risk factors for high altitude pulmonary oedema. A case control study. The study was conducted in the Department of Medicine, Military Hospital, Rawalpindi during October 1998 to October 2000. One hundred serving army personnel between 20 to 50 years of age were divided in two groups. First group comprised of 50 patients who developed high altitude pulmonary oedema at 4000 meters height and above. Second group consisted of 50 control subjects who accompanied the patients. Detailed history was obtained regarding height of native dwelling, rate of ascent, amount of exertion and preceding respiratory tract infection. The findings of both the groups were compared and statistically analyzed by application of Pearson's chi-square test. Difference was considered significant when p-value was < 0.05. All the subjects were male. Average age of the indexed group was 29.4[ +/- 4] years as compared to 27[ +/- 5] years in the control group. Six patients [12%] were highland dwellers whereas 44 patients [88%] were inhabitants of lower heights. Average rate of ascent from 4000 meters to 4500 meters of the indexed group was 5[ +/- 2] days while in control group it was 10[ +/- 3] days. Twenty cases [40%] had history of severe exertion whereas such history was not present in any of the control group subjects. Only 2 patients had signs and symptoms of preceding respiratory tract infection. Rapid rate of ascent, extreme physical exertion, low height of native dwelling and preceding respiratory tract infection are important risk factors for the development of high altitude pulmonary oedema. Proper acclimatization with gradual ascent plays important role in preventing this potentially fatal condition

Mal agudo de montaña a 3.500 y 4.250 m: un estudio de la incidencia y severidad de la sintomatología / Acute mountain sickness at 3.500 and 4.250 m: a study of symptom incidence an severity

Background: Acute Mountain Sickness (AMS) refers to signs and symptoms associated with hypobaric hypoxia. Its reported incidence is highly variable. Aim: To determine the incidence of AMS symptoms and severity at 3,500 and 4,250 m above sea level. Subjects and methods : A population of 362 soldiers without former exposure to altitude was studied. AMS symptoms, were assessed by an extensively used standard questionnaire (Lake Louise), applied 36-72 hours after exposure to high altitude. Results : A group of 200 recruits ascended to Putre (3,500 m) and a second group (162) ascended to Alto Pacollo (4,250 m). The incidence of AMS was 28 percent and 60 percent respectively (p<0.05). Headaches and sleeping difficulties were the most frequent symptoms at both altitudes. Furthermore, severe digestive problems and dizziness were described in a high proportion of individuals at both 3,500 and 4,250 m. Conclusions: The prevalence of AMS in this study is similar to that reported elsewhere at equivalent altitudes

Enfermedad de altura aguda y función ventilatoria en sujetos expuestos intermitentemente a hipoxia hipobárica / Acute altitude disease and ventilatory function in subjects intermittently exposed to hypobaric hypoxia

Aiming to assess the magnitude of acute mountain sickness symptoms and ventilatory function in subjects intermittently exposed to hypobaric hypoxia, we studies 48 healthy men aged 32.6 ñ 8.2 years old who worked in a gold mine at a altitude of 4600 m. using a schedule of 8-12 days of work at the mine followed by 4 days of rest at the sea level. Studies were performed at the sea level (A), during the first 2 days of ascention (B) and after 3 or 4 days of stay at 4600 m (C). Mountain sickness symptoms were evaluated with a questionnaire devised in the 1991 International Hypoxia Sumposium and respiratory function was assessed with Collins Eagle II respirometer, following American Thoracic Society recommendations. Subjects reported mild to moderate symptoms during the first 24 hours of ascending (mean score of 6.4 ñ 3.1 for a maximun of 15). Forced vital capacity fell significantly in period B and returned to normal in period C and forced expiratory volume in 1s did not change in any period. However, maximal expiratory flow and maximal midexpiratory flow rate significantly increased and remained elevated during the 4 days stay at the mine. No correlation was found between acute mountain sickness symptoms and changes in ventilatory function

High altitude disease on the Tibetan Plateau / Enfermedad de altura en la planicie del Tibet

En China, las altiplanicies de Qinghai en el Tibet son las más altas del mundo, y en ellas residen los tibetianos nativos y los inmigrantes chinos (Han). Este artículo se ocupa de las enfermedades producidas por la altura. Existen tres problemas serios producidos por la altura. Primero, el edema pulmonar de altura (HAPE); se observa una alta incidencia de HAPE en los recién llegados a la altura, y por el contrario una menor incidencia en los nativos de altura que reascienden a ella, lo que difiere con los reportes en Norte América y en los Andes. Segundo, la enfermedad cardiaca de altura (HAHD). Los niños y los infantes son los que se encuentran especialmente en riesgo. La mayoría de infantes afectados por esta enfermedad son de origen Han, y presentan insuficiencia cardiaca congestiva severa debido a hipertension pulmonar dentro de los pocos meses de nacido o de arribo a la altura. Las autopsias muestran una hipertrofia ventricular derecha y un engrosamiento de la muscular de las arterias pulmonares periféricas. La mortalidad en promedio fue de 15 por ciento, tal que la HAHD infantil es una emfermedad fatal. Tercero, la enfermedad de Monge o mal de Montaña Crónico (CMS). En los indígenas tibetianos se han observado 15 casos de CMS entre 1991-1993. Los datos epidemiológicos y clínicos muestran que la CMS existe en la altiplanicie de Qinghai-Tibet.

Relationship of body weight to altitude in Saudi Arabia

Measurement of weight and height in 451 Saudi nationals ages 17 to 72 years, born and living permanently at high altitude [3150 meters] and Saudi nationals ages 17 to 76 years, born and living permanently at low altitude [500 meters] are reported. The native highlanders were significantly heavier [P<0.005 for men and <0.001 for women] and taller [P<0.001 for both men and women] than lowlanders. Body mass index [BMI=kg/m[2]] was used for assessment of normal weight, overweight or obesity, and underweight or thinness in the two communities. Only 30.8% of all highlanders and 34% of all lowlanders were found to have normal weight. The prevalence of overweight or obesity was significantly greater among highlanders [55.7%] than among lowlanders [42.9%] [P<0.01], while underweight or thinness was significantly more common among lowlanders [23.1%] as compared to highlanders [13.5%] [P<0.01]. Among highlanders, overweight or obesity was significantly more common in women than men [P<0.01] while underweight or thinness was more common among men than women, although the difference was not statistically significant. This sex difference in the prevalence of overweight or obesity and underweight or thinness was not apparent among lowlanders. The percentage of overweight or obese highland and lowland men and women increased after the age of 39 years; conversely, the incidence of underweight or thinness in highland and lowland men and women decreased after the age of 39 years. The findings of this study indicate that overweight or obesity and, to a lesser extent, underweight or thinness are major nutritional problems in the two groups studied

Hipoventilación alveolar primaria: ¿Enfermedad de monge en Bogotá?

Se presentan dos casos de hipoventilación alveolar sin enfermedad pulmonar ni apneas de sueño, secundarias a trastornos no anatómicos del sistema de control de la respiración. Se discuten los diagnósticos diferenciales y se plantea la hipótesis que su etiología es la hipoventilación crónica de la altura o enfermedad de Monge