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High altitude pulmonary edema among "Amarnath Yatris".

Koul PA, Khan UH, Hussain T, Koul AN, Malik S, Shah S, Bazaz SR, Rashid W, Jan RA - Lung India (2013)

Bottom Line: Sixteen patients had associated encephalopathy.Ten patients had evidence of high-altitude cerebral edema.Three patients died due to multiorgan dysfunction.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.

ABSTRACT

Background: Annual pilgrimage (Yatra) to the cave shrine of Shri Amarnath Ji' is a holy ritual among the Hindu devotees of Lord Shiva. Located in the Himalayan Mountain Range (altitude 13,000 ft) in south Kashmir, the shrine is visited by thousands of devotees and altitude sickness is reportedly common.

Materials and methods: More than 600,000 pilgrims visited the cave shrine in 2011 and 2012 with 239 recorded deaths. Thirty one patients with suspected altitude sickness were referred from medical centers en-route the cave to Sher-i-Kashmir Institute of Medical Sciences, a tertiary-care center in capital Srinagar (5,000 ft). The clinical features and the response to treatment were recorded.

Results: Thirty-one patients (all lowlanders, 19 male; age 18-60 years, median 41) had presented with acute onset breathlessness of 1-4 days (median 1.9 d) starting within 12-24 h of a rapid ascent; accompanied by cough (68%), headache (8%), dizziness and nausea (65%). Sixteen patients had associated encephalopathy. Clinical features on admission included tachypnea (n = 31), tachycardia (n = 23), bilateral chest rales (n = 29), cyanosis (n = 22) and grade 2-4 encephalopathy. Hypoxemia was demonstrable in 24 cases and bilateral infiltrates on radiologic imaging in 29. Ten patients had evidence of high-altitude cerebral edema. All patients were managed with oxygen, steroids, nifedipine, sildenafil and other supportive measures including invasive ventilation (n = 3). Three patients died due to multiorgan dysfunction.

Conclusions: Altitude sickness is common among Amaranath Yatris from the plains and appropriate educational strategies should be invoked for prevention and prompt treatment.

No MeSH data available.


Related in: MedlinePlus

Computed tomography of the head revealing diffuse effacement of cerebral sulci and compression of ventricles. In a case with high altitude cerebral edema
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Figure 5: Computed tomography of the head revealing diffuse effacement of cerebral sulci and compression of ventricles. In a case with high altitude cerebral edema

Mentions: The various investigations at admission are depicted in Table 2. Hypoxemia on admission was seen in 24 patients. Hypokaemia was demonstrable in 18 (58%) cases and 20 had a polymorphonuclear leucocytosis at presentation. Serum urea was elevated in 12 patients. Bilateral infiltrates were observed on radiographic imaging of the chest in 29 patients and unilateral pulmonary edema in 2 cases. High resolution computed tomography done in 10 patients showed bilateral patchy infiltrates in 5 patients with 2 patients having features of unilateral pulmonary edema being predominantly right sided in one and left sided in the other [Figures 2-4]. None of the patients had electrocardiographic evidence of myocardial infarction, and troponin-T and cardiac enzymes (CK and LDH) were normal in all. Ten patients had evidence of HACE with computed tomography of the head revealing diffuse effacement of cerebral sulci and compression of ventricles [Figure 5]. One patient had evidence of renal failure at admission. Bacterial cultures of blood and sputum were sterile. Nasopharyngeal swabs for Influenza A and B viruses tested negative on real-time reverse transcriptase polymerase chain reaction. Patients were managed with oxygen, steroids, nifedipine, and sildenafil and other supportive measures. Invasive ventilation was required in 3 cases. While 28 of the patients recovered with a median hospital stay of 4 days, 3 patients developed multi-organ dysfunction and succumbed to their illness. Autopsies were denied by attendants of all the deceased citing religious reasons.


High altitude pulmonary edema among "Amarnath Yatris".

Koul PA, Khan UH, Hussain T, Koul AN, Malik S, Shah S, Bazaz SR, Rashid W, Jan RA - Lung India (2013)

Computed tomography of the head revealing diffuse effacement of cerebral sulci and compression of ventricles. In a case with high altitude cerebral edema
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3775198&req=5

Figure 5: Computed tomography of the head revealing diffuse effacement of cerebral sulci and compression of ventricles. In a case with high altitude cerebral edema
Mentions: The various investigations at admission are depicted in Table 2. Hypoxemia on admission was seen in 24 patients. Hypokaemia was demonstrable in 18 (58%) cases and 20 had a polymorphonuclear leucocytosis at presentation. Serum urea was elevated in 12 patients. Bilateral infiltrates were observed on radiographic imaging of the chest in 29 patients and unilateral pulmonary edema in 2 cases. High resolution computed tomography done in 10 patients showed bilateral patchy infiltrates in 5 patients with 2 patients having features of unilateral pulmonary edema being predominantly right sided in one and left sided in the other [Figures 2-4]. None of the patients had electrocardiographic evidence of myocardial infarction, and troponin-T and cardiac enzymes (CK and LDH) were normal in all. Ten patients had evidence of HACE with computed tomography of the head revealing diffuse effacement of cerebral sulci and compression of ventricles [Figure 5]. One patient had evidence of renal failure at admission. Bacterial cultures of blood and sputum were sterile. Nasopharyngeal swabs for Influenza A and B viruses tested negative on real-time reverse transcriptase polymerase chain reaction. Patients were managed with oxygen, steroids, nifedipine, and sildenafil and other supportive measures. Invasive ventilation was required in 3 cases. While 28 of the patients recovered with a median hospital stay of 4 days, 3 patients developed multi-organ dysfunction and succumbed to their illness. Autopsies were denied by attendants of all the deceased citing religious reasons.

Bottom Line: Sixteen patients had associated encephalopathy.Ten patients had evidence of high-altitude cerebral edema.Three patients died due to multiorgan dysfunction.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.

ABSTRACT

Background: Annual pilgrimage (Yatra) to the cave shrine of Shri Amarnath Ji' is a holy ritual among the Hindu devotees of Lord Shiva. Located in the Himalayan Mountain Range (altitude 13,000 ft) in south Kashmir, the shrine is visited by thousands of devotees and altitude sickness is reportedly common.

Materials and methods: More than 600,000 pilgrims visited the cave shrine in 2011 and 2012 with 239 recorded deaths. Thirty one patients with suspected altitude sickness were referred from medical centers en-route the cave to Sher-i-Kashmir Institute of Medical Sciences, a tertiary-care center in capital Srinagar (5,000 ft). The clinical features and the response to treatment were recorded.

Results: Thirty-one patients (all lowlanders, 19 male; age 18-60 years, median 41) had presented with acute onset breathlessness of 1-4 days (median 1.9 d) starting within 12-24 h of a rapid ascent; accompanied by cough (68%), headache (8%), dizziness and nausea (65%). Sixteen patients had associated encephalopathy. Clinical features on admission included tachypnea (n = 31), tachycardia (n = 23), bilateral chest rales (n = 29), cyanosis (n = 22) and grade 2-4 encephalopathy. Hypoxemia was demonstrable in 24 cases and bilateral infiltrates on radiologic imaging in 29. Ten patients had evidence of high-altitude cerebral edema. All patients were managed with oxygen, steroids, nifedipine, sildenafil and other supportive measures including invasive ventilation (n = 3). Three patients died due to multiorgan dysfunction.

Conclusions: Altitude sickness is common among Amaranath Yatris from the plains and appropriate educational strategies should be invoked for prevention and prompt treatment.

No MeSH data available.


Related in: MedlinePlus