Wilderness & Environmental Medicine最新文献

IntroductionSnakebite envenoming is a significant public health issue in India, particularly in Karnataka, where diverse agroclimatic zones contribute to varying incidence rates. However, limited geospatial data are available to inform targeted prevention and intervention strategies. This study uses Health Management Information System data to assess the incidence and spatial distribution of snakebites across Karnataka to identify high-risk areas and inform public health measures.MethodsThis study conducted a secondary analysis of Health Management Information System data from 2018-19 and 2019-20 covering all districts in Karnataka. Participants were reported snakebite victims in the state during the study period. Geospatial analysis was conducted to map snakebite cases across agroclimatic zones. Seasonal trends were examined using the 4 climatologic seasons in India: winter, summer, monsoon, and post-monsoon. The main outcomes measured were snakebite incidence rates and the geographic distribution of cases.ResultsThe overall snakebite incidence in Karnataka decreased slightly from 24.57 per 100,000 in 2018-19 to 24.49 in 2019-20. Significant variations were observed across agroclimatic zones, with the southern dry zone and southern transition zone reporting the highest incidence, peaking during the monsoon season.ConclusionsGeospatial analysis identified high-risk districts, particularly in agricultural and forested areas. Targeted public health interventions, such as awareness campaigns, improved healthcare infrastructure, and timely antivenom administration, could reduce snakebite mortality. Global Information System-based analysis offers valuable insights for effective healthcare planning and preventive strategies.

IntroductionThe aim of this investigation was to gain understanding on the prevalence of impostor syndrome within the backcountry avalanche environment and further explore the associations of impostor syndrome and various demographics.MethodsThis was a cross-sectional secondary data analysis of a larger dataset collected from winter backcountry recreational users. Data were collected through an anonymous online survey disseminated between January 2025 and February 2025 by the Utah Avalanche Center.ResultsA total of 361 participants were included in the final analysis. Overall, 87.9% of the respondents indicated moderate or higher levels of impostor syndrome symptoms. We also identified a negative association between impostor syndrome and age but found no meaningful associations between impostor syndrome and gender, income, experience, education, risk-taking behavior, or expertise within this backcountry user population.ConclusionsThe results of our study suggest that impostor syndrome is present across this study population and that the symptoms of impostor syndrome are pervasive across various demographic factors. They also demonstrate that as age increases within this population, impostor syndrome symptoms decrease. The results are limited by the single-site cross-sectional study design. Thus, future work should aim to expand on generalizability.

Avalanche burial occasionally precipitates pulmonary edema, yet its pathogenesis remains poorly understood. Two male back-country skiers (aged 39 and 53 years) were completely buried for 30 min and 20 min, respectively, by the same avalanche, and immobilized in a right-lateral posture without safety devices. They arrived 2 h post-extrication, conscious but hypothermic (32.4 °C and 34.2 °C, respectively), tachycardic, tachypneic, and hypoxemic (SpO₂ 88% and 83%, respectively). Chest radiography and computed tomography demonstrated extensive infiltrates or ground-glass opacities confined predominantly to the gravity-dependent right lung and no cardiomegaly. C-reactive protein and N-terminal pro-B-type natriuretic peptide values were within normal limits, and transthoracic echocardiography showed preserved biventricular function. Low-flow oxygen and passive rewarming corrected hypoxia and hypothermia; the pulmonary infiltrates resolved within 24 h, permitting discharge without sequelae. Classical mechanisms, such as negative-pressure pulmonary edema from airway obstruction, hypoxia-induced left ventricular failure, and edema secondary to regional hypoxic pulmonary vasoconstriction, do not fully explain the unilateral dependent pattern observed. We propose that excessive sympathetic nervous system activation and fluid distribution changes caused by extreme emotional stress, cold exposure, systemic hypoxia, whole-body compression by snow, and head-down posture led to an excessive cardiac load increase, resulting in gravity-enhanced cardiogenic edema despite normal intrinsic cardiac function. These cases suggest a previously unrecognized hemodynamic pathway for avalanche-related pulmonary edema. Awareness of cardiac overload as a potential contributor may refine field triage and postrescue management. Additional clinical and experimental studies are warranted to validate this hypothesis and inform preventive strategies.

IntroductionThe primary objective of this study was to assess cardiovascular risk among members of the Bulgarian Antarctic expedition and identify strategies for risk reduction. The combination of intense physical and psychological stress, prolonged cold exposure, isolation, and challenging travel conditions contributes to an increased risk of cardiovascular disease, especially given the participants' mature age, which is a key factor in greater cardiovascular disease susceptibility.MethodsThis research included 29 participants (23 males and 6 females) with average ages of 43.0±8.00 y for the males and 45.5±11.31 y for the females. All participants spent 30 d in Antarctica. They were subjected to comprehensive assessments, including anthropometric measurements, physiologic evaluations, and biochemical analyses both before departure and shortly after return. The updated SCORE2 algorithm following the European guidelines was used to estimate the 10-y cardiovascular event risk, which factored in age, blood pressure, lipid profile, and smoking status. All participants underwent the veloergometer stress test under electrocardiographic control twice, before and after the expedition.ResultsThe results indicated that while most participants fell into the moderate-risk category, some of them exhibited elevated-risk profiles, primarily influenced by obesity, cholesterol levels, systolic blood pressure, and serum ferritin levels. No critical cardiovascular events were reported during the expedition.ConclusionThis study highlights the importance of pre-expedition screening, including the conduct of an exercise stress test, targeted risk-factor management, and continuous monitoring for safeguarding the health and physiologic resilience of Antarctic expedition participants, ultimately underscoring the feasibility and necessity of cardiovascular prevention strategies in extreme environments.

We describe full neurologic recovery from an out-of-hospital cardiac arrest with a prolonged arrest time (35 min) and prehospital interval (12 h) from the Antarctic continent after the use of standard advanced cardiac life support (ACLS) protocols and thrombolytic therapy. A 61-year-old male had a witnessed collapse in the dining facility at McMurdo Station, Antarctica, resulting in prompt activation of emergency services. The responding firefighter team found the patient in ventricular fibrillation and administered defibrillations. After the defibrillations, the responding team transported the patient to the base clinic. Clinic staff in the resuscitation bay achieved return of spontaneous circulation (ROSC) after successful defibrillation and medication administration. The postarrest electrocardiogram (EKG) showed that an anterior ST-elevation myocardial infarction was the cause of the ventricular fibrillation. Clinic staff administered tenecteplase, and the patient was prepared for transport to New Zealand. The patient was transported aboard an LC-130 aircraft with a transport time of 7 h. The total time from cardiac arrest to arrival at the receiving hospital was 12 h. On arrival to definitive care, the patient underwent percutaneous coronary intervention revealing 100% occlusion of the left anterior descending artery. The vessel was opened and 2 drug-eluting stents were placed. Remarkably, the patient survived the arrest completely neurologically intact. This case highlights the effectiveness of the current ACLS algorithms and chain of survival despite austere locales and long transport times.

This case series aimed to observe the impact of a single-stage ultramarathon (50-100 km) on gastrointestinal integrity, systemic immune responses, and exercise-associated gastrointestinal symptoms in 3 adolescent (aged 12-15 y) competitors. Body mass, venous and finger-prick blood samples and fecal samples were taken before and after the race for analysis of exercise-induced body mass loss, plasma osmolality, plasma intestinal fatty acid binding protein, soluble CD14, and C-reactive protein, total and differential leukocyte counts, and fecal bacterial alpha-diversity. Gastrointestinal symptom incidence were recorded before, during, immediately after, and 24 h after the race. Food and fluid intake were recorded for the 48 h before the race and each hour during the race. Body mass decreased in Youth 1 (-0.4%) and Youth 3 (-0.9%) and increased in Youth 2 (+0.5%) from before to after the race. No youth competitor met carbohydrate intake recommendations in the lead-up to (2.8-5.1 g·kg^-1·d^-1) or during the race (24-26 g·h^-1). Pre- to post-race plasma intestinal fatty acid binding protein and C-reactive protein concentrations increased in the youth competitors, but was of no clinical significance (≤657 pg·mL^-1 and ≤3.36 micrograms·mL^-1, respectively). A pre- to postrace change in plasma soluble CD14 of clinical relevance was observed in Youth 3 (1.5 micrograms·mL^-1), but not Youth 1 (-0.1 micrograms·mL^-1). Total and differential leukocyte counts increased beyond the normal reference range in Youth 1 and Youth 2, but not Youth 3. The incidence and severity of gastrointestinal symptoms were low at all timepoints in the competitors. Large intra- and interindividual responses to ultramarathon events observed in this case series suggest that adolescent ultramarathon runners require individually tailored nutrition support.

First aid recommendations for burn injuries are not standardized around the world, and there exist a variety of conflicting guidelines. We discuss the rationale of implementing 20 min of cool running water (20CRW) within 3 h of burn injury as standard burn first aid. Animal models and human data in both adults and children have shown that 20CRW is optimal in reducing scar tissue formation and improving tissue reepithelialization. 20CRW within 3 h of injury can be implemented in urban, rural, and wilderness settings with minimal equipment or training, although some austere environments may pose challenges. We advocate incorporating 20CRW as a standard component of burn first aid, first-responder protocols, and wilderness medical training curricula wherever feasible.