Wilderness & Environmental Medicine最新文献

IntroductionPregnant individuals benefit both psychologically and physically by participating in outdoor activities.MethodsThe authors conducted a narrative review of the available literature to address unique pregnancy considerations for the wilderness adventurer. There is limited evidence behind many opinion-based recommendations on participation in wilderness activities in pregnancy.ResultsAs a result, remote or adventurous activities may be considered unsafe or restricted without significant medical literature to support these opinions. The authors reviewed the literature for the best available evidence, including observational studies, case series, limited controlled trials, and extrapolations from physiological data, as well as evaluating expert consensus statements.ConclusionThis narrative review discusses pregnancy-specific medical concerns related to participation in outdoor adventure activities.

IntroductionPulmonary B-lines can be seen on lung ultrasound (LUS) and indicate the presence of pulmonary edema, as is seen in high-altitude pulmonary edema (HAPE). While asymptomatic B-lines have been observed in high-altitude travelers without clinical HAPE, their prevalence and relationship to high-altitude physiology remain poorly understood. This study aims to characterize B-line development in high-altitude travelers and its relationship to physiologic changes.MethodsThis observational study investigated adult trekkers in Nepal's Khumbu Valley. An 8-point LUS was performed to obtain a B-line quantification score. Altitude (2610-5364 m), vital signs, and Lake Louise score (LLS) for acute mountain sickness (AMS) were also recorded. A subset of participants was followed longitudinally as they ascended. Regression analyses were performed to compare the B-line score with altitude, pulse oximetry (SpO2), and LLS.ResultsA total of 88 subjects were enrolled, and 21 of these were followed longitudinally. There was a significant positive correlation between altitude and B-line score (r = 0.18, p = .049) in the general population; however, this finding was not significant in the longitudinal group (r = 0.21, p = 0.13). B-line score was inversely correlated with resting SpO2 (r = -0.3, p = 0.0008). There was no significant relationship between B-line score and LLS (r = 0.14, p = 0.12).ConclusionsLUS B-line scores were higher with increases in altitude, and resting SpO2 decreased with higher B-line scores. B-line scores were not correlated with the development of symptoms of AMS. More research is needed to elucidate the clinical significance of these asymptomatic findings.

The Women in Wilderness Medicine Research Committee of the Wilderness Medical Society conducted a narrative review to address considerations for pregnant individuals in wilderness environments. There is limited evidence behind many opinion-based recommendations on the safety of various environmental exposures in pregnancy. The authors reviewed the literature for the best available evidence, including observational studies, case series, limited controlled trials, and extrapolation from physiological data, as well as evaluating expert consensus statements. The benefits of exposure to natural environments include better pregnancy outcomes and improved maternal mental and physical health. Risks are similar to nonpregnant individuals with the added risks associated with maternal-fetal physiology in wilderness environments and difficulties of evacuation. This narrative review discusses pregnancy-specific concerns in extreme environments, including high altitude, hypothermia, hyperthermia, lightning strikes, envenomations, and common outdoor exposures.

Mosquito-borne infections are a common cause of illness among returning travelers. Frontline healthcare providers should maintain a high degree of suspicion for these infections when evaluating ill returning travelers. This narrative review provides an overview of the most common mosquito-borne infections in travelers. We conducted a search of the medical literature for updates in the past 5 y. We reviewed resources of the US Centers for Disease Control (Yellow Book, Advisory Committee on Immunization Practices), and US Food and Drug Administration. Arboviral infections and malaria are the most frequently diagnosed mosquito-borne infections in returning travelers. Among the mosquito-borne arboviral infections, chikungunya, yellow fever, and Japanese encephalitis are all vaccine preventable. Dengue fever, although the most common arboviral infection worldwide, does not yet have a vaccine approved for use in US travelers. The incidence of Zika virus infection has decreased substantially in recent years, including a reduced frequency of infections reported in travelers. The risk of mosquito-borne illnesses can be reduced by behavioral changes and use of insect repellent, screens, netting, and insecticide-impregnated clothing. Malaria can be further prevented through the appropriate use of chemoprophylaxis.