In addition, proper treatment may ameliorate symptoms and speed u

In addition, proper treatment may ameliorate symptoms and speed up recovery which will decrease the impact of AMS on trip plans. Travelers to Cusco and other major high altitude cities should be encouraged to identify reliable sources of medical assistance before departure. Moreover,

in Cusco, well-timed evacuations are important because commercial flights are only available during limited hours. As in the case illustrated by Hart of a patient with high altitude cerebral edema on the Inca Trail, air evacuation buy AZD1208 by helicopter in Cusco might be difficult or impossible to coordinate.[29] Conditions like obesity, obstructive sleep apnea, chronic obstructive pulmonary disease, and congestive AZD1152-HQPA cost heart failure have been associated with a higher risk for AMS and high altitude pulmonary edema.[30] Ten percent of the study participants had an AMS predisposing medical condition. Subjects with these underlying medical conditions were more likely to develop severe AMS. Similar results were reported by Ri-Li and colleagues among obese subjects at a simulated altitude of 3,600 m.[31] Thus,

travelers with medical conditions associated with increased risk for AMS should be encouraged to seek counseling from travel medicine specialists. Pre-travel counseling in this group should stress the need for early symptom recognition, prompt medical attention, and proper AMS prophylaxis use. It is important to acknowledge some of the limitations of the study. The data were collected as part of a cross-sectional study and recall bias is a potential weakness of this study design. For example, some travelers may have limited their physical activity due to symptoms of AMS rather than due

to a desire to prevent it falsely creating a positive association. GNA12 The study sample was biased toward a large number of North American participants. Differences in pre-travel preparation and health-related behaviors abroad have been described between travelers of different nationalities.[16],[32] These may account for the differences found between the present study and previous studies in Cusco. Lastly, visiting high altitude in the previous 2 months remained in the regression model analysis as weakly associated with severe AMS. The reasons for this association are unclear; on the one hand, travelers may have reported symptoms occurring at higher destinations (ie, La Paz) visited immediately before Cusco or may have continued ascending from lower cities (ie, Arequipa) despite symptoms. On the other, it is likely that the study missed most cases with severe altitude-related illnesses which could have influenced the results of the regression model analysis. This group of subjects with severe symptoms needing urgent evacuation is less likely to use the regular commercial departure area of the airport.

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