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Acetazolamide and N-acetylcysteine in the treatment of chronic mountain sickness (Monge's disease)

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dc.contributor.author Sharma, S.
dc.contributor.author Gralla, J.
dc.contributor.author Ordonez, J. G.
dc.contributor.author Hurtado, M. E.
dc.contributor.author Swenson, E. R.
dc.contributor.author Schoene, R. B.
dc.contributor.author Kelly, J. P.
dc.contributor.author Callacondo, D.
dc.contributor.author Rivard, C.
dc.contributor.author Roncal-Jimenez, C.
dc.contributor.author Sirota, J.
dc.contributor.author Fuquay, R.
dc.contributor.author Jackson, B. P.
dc.contributor.author Swenson, K. E.
dc.contributor.author Johnson, R. J.
dc.contributor.author Hurtado, A.
dc.contributor.author Escudero, E.
dc.date.accessioned 2019-01-25T16:36:30Z
dc.date.available 2019-01-25T16:36:30Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4859
dc.description.abstract Patients suffering from chronic mountain sickness (CMS) have excessive erythrocytosis. Low level cobalt toxicity as a likely contributor has been demonstrated in some subjects. We performed a randomized, placebo controlled clinical trial in Cerro de Pasco, Peru (4380 m), where 84 participants with a hematocrit (HCT) >= 65% and CMS score > 6, were assigned to four treatment groups of placebo, acetazolamide (ACZ, which stimulates respiration), N-acetylcysteine (NAC, an antioxidant that chelates cobalt) and combination of ACZ and NAC for 6 weeks. The primary outcome was change in hematocrit and secondary outcomes were changes in PaO2, PaCO2, CMS score, and serum and urine cobalt concentrations. The mean ( SD) hematocrit, CMS score and serum cobalt concentrations were 69 +/- 4%, 9.8 +/- 2.4 and 0.24 +/- 0.15 mu g/l, respectively for the 66 participants. The ACZ arm had a relative reduction in HCT of 6.6% vs. 2.7% (p = 0.048) and the CMS score fell by 34.9% vs. 14.8% (p = 0.014) compared to placebo, while the reduction in PaCO2 was 10.5% vs. an increase of 0.6% = 0.003), with a relative increase in PaO2 of 13.6% vs. 3.0%. NAC reduced CMS score compared to placebo (relative reduction of 34.0% vs. 14.8%, p = 0.017), while changes in other parameters failed to reach statistical significance. The combination of ACZ and NAC was no better than ACZ alone. No changes in serum and urine cobalt concentrations were seen within any treatment arms. ACZ reduced polycythemia and CMS score, while NAC improved CMS score without significantly lowering hematocrit. Only a small proportion of subjects had cobalt toxicity, which may relate to the closing of contaminated water sources and several other environmental protection measures. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof urn:issn:1878-1519
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject polycythemia en_US
dc.subject erythropoietin en_US
dc.subject hypoxia en_US
dc.subject adaptation en_US
dc.subject high-altitude en_US
dc.subject antioxidant en_US
dc.subject Respiratory System en_US
dc.subject prevention en_US
dc.subject stress en_US
dc.subject Physiology en_US
dc.subject Acetazolamide en_US
dc.subject Chronic mountain sickness en_US
dc.subject cobalt en_US
dc.subject Cobalt poisoning en_US
dc.subject excretion en_US
dc.subject N-Acetylcysteine en_US
dc.subject Oxidative stress en_US
dc.title Acetazolamide and N-acetylcysteine in the treatment of chronic mountain sickness (Monge's disease) en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.resp.2017.07.005
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.01.08
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.01.04
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.07


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