[5, 10, 11] However, whether exposure to high altitude environments per se actually increases incidence Selleckchem ALK inhibitor of diarrhea, upper respiratory symptoms, and anxiety remains unclear. Detailed description of these illnesses is lacking, and how these illnesses interact together is also unknown. Thus, the aim of the present investigation

was to describe physical and mental health during a typical high altitude expedition. This study also aimed to explore relationships between illnesses and commonly implicated physiological factors, such as arterial oxygen saturation,[12] heart rate,[13] and fluid intake.[14] Our hypotheses were that general physical (upper respiratory symptoms, diarrhea) and mental (anxiety) health would deteriorate with increasing altitude, and that presence of any illness symptoms or altered physiological parameters would increase AMS. The study formed one of a series completed on the Medical Expeditions 2008 Hidden Valley Expedition to Nepal.[15] The study exclusion criteria were age less than 18 years, inability to provide informed consent, and any uncontrolled medical condition. The study was approved by both the North West Wales Research Ethics Committee and the Nepal Health Research Council, and all participants provided written informed consent. To MLN0128 nmr enable

the study of AMS and other common illness development over time, an observational prospective cohort study was completed. All participants completed a minimum 19-day (range: 19–24 d) expedition which included a 1-week baseline period at low altitude but under full expedition conditions, followed by ascent to at least 5,372 m (Figure 1). All participants completed the Dhaulagiri trek, which is the remotest and most difficult of the established trekking itineraries of Nepal, while 28 participants also climbed a technically easy peak of 6,035 m. The expedition was split into four trekking groups, each with an individual nominated to supervise data collection. From the first day of the expedition, participants completed a physical and mental health diary. Immediately upon waking, prior to breakfast, and following

a seated rest period of 2 minutes, participants self-reported the following: (1) AMS: symptoms were recorded using the Lake Louise scale, which Nabilone recorded the severity of five items on a 0 to 3 Likert scale. Clinical diagnosis of AMS was defined as the Lake Louise definition of a total score ≥3 including headache, plus one other symptom.[16] Scores for individual symptoms and total symptom scores were also calculated. (2) Stools: recorded using the Bristol Stool Scale, which recorded the consistency of motions on a 1 to 7 Likert scale[17] with an extra question on the number of motions per day. Clinical diagnosis of diarrhea was defined in its strictest sense as loose stool (Bristol Stool Scale ≥ 6) at least three times within 24 hours.