IntroductiondAlthough ultratrail races are increasing in popularity, there is a dearth of data regarding illnesses and medical care at these events. Data about injuries and illnesses for races taking place in the Himalayas, where the nearest medical facility can be hundreds of miles away, are even harder to find. This study aimed to describe the injuries and illnesses befalling the participants of a 7-stage 212 km (132 mi) trail race at high altitude. MethodsdEthical approval was obtained from Nepal Research Health Council. A retrospective study of the record of medical encounters among the 100 participants competing in the Manaslu trail race in Nepal from 2014 to 2016 was performed. Diagnoses were classified into various categories. Informed consent was taken from all participants. ResultsdAcute diarrhea was the most common ailment reported among the participants (18%), followed closely by musculoskeletal problems (17%). Altitude illness made up 6% of care provided. Approximately 35% of the athletes were using acetazolamide as prophylaxis for high altitude illnesses. The 1 case needing evacuation in the 3 iterations was high altitude pulmonary edema. ConclusionsdUltratrail races at high altitude pose a challenge in terms of provision of medical care in a remote setting with limited resources. However, most of the illnesses are minor in nature and easily managed by the race doctor. Knowledge of common illnesses among travelers to the area can help aid in preparation and provision of proper care, especially in remote settings with limited resources.

Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological entity characterised by seizure, headaches, visual symptoms, impaired consciousness and other focal neurological findings. It is caused by a wide variety of causes ultimately leading to a vasogenic cerebral oedema of occipital and parietal lobes of the brain. We present here a young woman with headache, generalised tonic–clonic seizures and cortical blindness in a late postpartum stage. Reversibility of the symptoms and characteristic imaging findings led us to a diagnosis of PRES in our patient.

Porters have accompanied trekkers and climbers to high altitude since the earliest expeditions in the Himalayas. As the existing body of knowledge on high altitude medicine expands, the focus remains on trekkers or climbers and published literature on medical problems in the large porter population remains sparse. It is well known that porters working at high altitude in the Nepal Himalayas are often lowland dwellers and are as prone to high altitude illnesses like acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE) as the trekkers. Other illnesses like diarrhea, respiratory illnesses and infections also occur in this population. In this review, studies reporting these findings will be discussed along with the local context of socio-economic barriers to adequate healthcare for these porters.

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