Clinical studies were performed in eight consecutive patients who developed high-altitude pulmonary edema (HAPE) after 6 days of stay (range: 8–121 days) at the same altitude who were admitted to our hospital. The findings of this series revealed respiratory infection with exertion and cold exposure as the predominant causes of delayed-onset HAPE. HAPE in its delayed-onset form is likely to be more severe based on mortality findings in our series and requires intense monitoring and preparation of contingencies for prompt evacuation in severe or nonresponsive cases.

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Purpose: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease that has a serious effect on worldwide public health. We sought relationships among ANGPTL2, ANGPTL3, and ANGPTL6 with NAFLD metabolic and biochemical parameters, to assess their potential as diagnostic tools for NAFLD. Materials and Methods: Serum levels of ANGPTL2, ANGPTL3, and ANGPTL6 in NAFLD patients (n = 52) and non-NAFLD participants (n = 51) were quantified by ELISA. The utility of ANGPTLs as biomarkers for NAFLD prediction was assessed using receiver operating characteristic (ROC) analysis. Results: Serum ANGPTL2 levels were increased (P = 0.0102), serum ANGPTL3 levels were decreased (P < 0.0001), and ANGPTL6 levels did not change (P = 0.3174) in 52 patients with NAFLD when compared to 51 participants without NAFLD. The areas under the ROC curves for ANGPTL2 and ANGPTL3 were 0.647 and 0.746, respectively. When two factors were jointly analyzed, the area under the ROC curve for ANGPTL2 and ANGPTL3 was 0.773. Conclusion: ANGPTL2 and ANGPTL3 levels may be novel and important predictors of NAFLD severity.

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The provision of drinking water, sanitation, and hygiene (WASH) facilities has been identified as one of the important goals required for the attainment of universal health coverage. However, billions of people across the globe are having poor access to water, sanitation, and hygiene (WASH). It is important to note that significant progress has been observed in ensuring access to WASH facilities since the start of the current century; nevertheless, massive gaps and inequalities persist in the field with regard to access, availability, and the quality of the offered services. Another important aspect is that ensuring mere access to these facilities is not enough. The time has come wherein all the concerned stakeholders should commit themselves toward the realization of this essential and fundamental human right. In conclusion, the need of the hour is to minimize the inequality gaps in WASH facilities and that will essentially require a concerted and well-coordinated response from all the stakeholders, including the general population.

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Objective: The objective of the study was to determine the association between positive cumulative fluid balance following heat stroke (HS) and its impact on patient outcomes. Methods: A retrospective chart review of HS patients admitted to the emergent intensive care unit (ICU), Beijing Lu He Hospital, Capital Medical University, from 2015 to 2018 was conducted. Results: Forty-nine surviving HS patients met the inclusion criteria. Patients were divided into two groups based on the median duration of mechanical ventilation (MV). Patients with MV for more than 6 days were placed in the longer length of the MV group. Patients with MV for <6 days were placed in the shorter MV group. There were significant differences between the two groups regarding the fluid balance on day 2 (3040 ml vs. −533 ml, P = 0.017) and persistent cumulative fluid overload in the first 72 h (6112 ml vs. −46 ml, P = 0.04). Patients with a higher cumulative fluid overload in the first 72 h were more likely to receive a longer duration of MV (10.7 days vs. 3.2 days, P < 0.001) and ICU length of stay (22.5 days vs. 6.2 days, P < 0.001). Spearman analysis of fluid overload in the first 72 h and MV time showed that the correlation coefficient was 0.662. Binary logistic regression analysis showed that the positive cumulative fluid balance in the first 72 h (odds ratio [OR] = 1, 95% confidence interval [95% CI] = 0.99–1.01] and alanine aminotransferase (OR = 0.978, 95% CI = 0.95–0.99) were both independent risk factors for prolonged MV in patients with HS (P = 0.025, P = 0.026). There were also differences between groups regarding creatine kinase-MB (P = 0.01) and Glasgow Coma Scale scores (P = 0.033). The patients with a higher cumulative fluid overload in the first 72 h had larger sequential organ failure assessment cores. Based on the receiver operating characteristic analysis, the cumulative fluid overload in the first 72 h predicted the need for invasive MV with the area under the curve of 0.869 (P < 0.0001, 95% CI: 0.779–0.958) at a cutoff value >1685 ml (sensitivity: 86%; specificity: 78%). Conclusions: Fluid overload in the first 72 h was a predictor of prolonged MV and ICU length of stay in surviving HS patients. Maintaining cautious about fluid resuscitation for HS patients may be critical for improving patient outcomes.

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Background: Air quality is known to aggravate cardiopulmonary disease. The aim of this work was to examine the extent to which air pollution, underlying illness, and age influenced 30-day inhospital mortality outcomes. Methods: All emergency medical admissions, between 2002 and 2018, to St. James's Hospital, Dublin, Ireland (113,807 episodes in 58,126 patients) and particulate matter (PM₁₀) level on the day of admission were studied; we determined 30-day mortality outcomes for older (≥70 years) persons and whether outcomes were conditionally dependent on the underlying illness severity or comorbidity score. We employed a logistic multiple variable regression model to calculate PM₁₀influence on the outcome adjusted for other predictors. Results: PM₁₀levels fell over time; the daily median was 15.8 μg/m³ (interquartile ranges [IQR]: 12.1, 21.0) prior to 2010 but 11.5 μg/m³ (IQR: 8.3, 15.7) in subsequent years. A higher admission day PM₁₀level predicted a worse 30-day mortality – odds ratios 1.09 (95% confidence intervals: 1.05, 1.2) for those >70 years, while for younger patients, this was not significant. The influence of PM on outcomes appeared largely confined to older persons; comparisons between increasing PM₁₀quintiles with Q1 median values of 7.5 μg/m³ had a model predicted mortality of 10.8% but 15.0% at Q5 median values of 29.3 μg/m³. An explanation for such difference in outcomes between older and younger may lie in the computed comorbidity and illness severity scores that were quantitatively markedly more severe with advancing age. Conclusion: PM₁₀levels on the day of admission predicted an increased 30-day in hospital mortality risk, with older patients identified to be more susceptible to poor air quality. The disproportionate impact on older persons may be due to their higher concomitant illness severity and comorbidity scores.

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