High Altitude Pathology Institute

Human Adaptation to High Altitude and Sea Level

2009-08-28T18:56:00.005+02:00

Here goes the link (click below) to my dissertation that I have been repeatedly asked to publish on-line:

http://www.altitudeclinic.com/Copenhagen/Dissertation10b.pdf

It has novel things about adaptation of high altitude residents to sea level and future space travel. Hope you enjoy them.

Prof. Dr. Gustavo Zubieta-Calleja
High Altitude Pathology Institute
Celebrating our 39th Anniversary!!
Web: AltitudeClinic.com
Email: zubieta@altitudeclinic.com
Phone: (591-2) 224-5394

IPPA 39th Anniversary

2009-07-04T19:16:00.007+02:00

Please click here to view the blog

High Altitude Pathology Institute
Clinica IPPA
Instituto de Patologia en la Altura

The Argentinian football team lost to Bolivia in La Paz, due to the high altitude fear factor

2009-04-13T17:07:00.002+02:00

Please click here to read the full article

Prof. Dr. Gustavo Zubieta-Castillo the Director of the High Altitude Pathology Institute affirmed in a newspaper interview that the Argentinian Soccer team took its worst defeat in world Cup qualifying play, 6 - 1 to the Bolivian Soccer team in La Paz. due to "fear of high altitude". He affirmed "The fear factor played a crucial role. Fear uses up more energy than physical exercise."

Para leer en Español:

From: http://lapatriaenlinea.com/index.php?option=com_content&task=view&id=2967&Itemid=92

Life is possible at the hypoxic levels of the summit of Mt. Everest

2009-03-11T09:26:00.002+01:00

Click here to read this article

Photo from Wikipedia

New publications on ophthalmological studies and altitude adaptation

2009-03-11T08:57:00.002+01:00

The effect of High to Low Altitude Adaptation on the

Multifocal Electroretinogram.

Kofoed PK, Sander B, Zubieta-Calleja G, Kessel L, Klemp K, Larsen M.

Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
High Altitude Pathology Institute, La Paz, Bolivia; Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark

click here to view the Abstract

Invest Ophthalmol Vis Sci. 2009 Feb 21.

extracted from:

http://www.ncbi.nlm.nih.gov/pubmed/19234353

L'Internaute website: Football at 6542 m

2009-03-09T16:35:00.001+01:00

The website L'Internaute Sport has published a series of
incredible Sports experiences.

Among them:

floating tennis courts,
marathon in space,
tennis heliport in Dubai,
mountain biking,
golf on snow,
tennis on top of water,
Ski in the dessert,
Cricket in the Himalayas,
tennis in a boat
and the football (soccer) game played on the summit of Mt. Sajama at 6542 m. that the High the Altitude Pathology Institute organized in August 2001.

Click here to view the photos.

Click here to read about the Sajama football game.

Article of the AIPS regarding the FIFA's high altitude soccer limitations

2009-02-22T17:32:00.005+01:00

FIFA's high altitude decision "a violation of rights"

Nemesio Camacho el Campín Stadium, Bogotá, Colombia

By Oscar Munevar Forero
Acord Colombia

The decision taken by FIFA president Joseph S. Blatter, to suspend the matches played at an altitude higher than 2,500 meters above sea level, violates the Association’s rights, in particular the South American associations. The Olympic stadium Hernando Siles Suazo of La Paz (capital of Bolivia), the Olympic stadium Atahualpa of Quito (capital of Ecuador) and the stadium Nemesio Camacho el Campín of Bogotá (capital of Colombia) that are at altitudes of 3576, 2850 and 2600 meters above sea level, respectively, are the most affected by the decision taken by the “tsar” of the football world.

We looked for opinions from some experts such as Dr. Gustavo Zubieta Castillo, who is the author of an article on this subject entitled “Pulmones y altura: funcion respiratoria y adaptación” (The lungs and high altitude: respiratory function and adaptation.

It is stated in the introduction that “No animal species ascends beyond its endurance capacity and above its genetic security conferred by the nature. For humans, however, altitude has always represented a challenge. His eagerness to conquer all the surroundings, to prove and increase his endurance, overcome any barrier or obstacle. One of the bigger constraints is undoubtedly acute exposure to hypoxia. The organism has to overcome this reduction in environmental oxygen pressure by involving many mechanisms in order to reach its target: the supply of enough oxygen to the tissues”.

As we know, high altitude training makes athletes perform better. As Zubieta Castillo said: “when a perfect adaptation is needed, the human body reacts accordingly”.

The Bolivian scientist adds: “The mechanisms of adaptation, in relation to time, have two stages: acute adaptation and chronic adaptation. Acute adaptation is manifested by a big energy expenditure directly related to the level of high altitude. The decrease of the atmospheric air pressure is compensated for by the pneumodynamic pump, that gives rise to a fast air renewal: increase of the respiratory frequency (RF) and the tidal volume (VT). The hemodynamic pump increases proportionally the blood flow to the lungs: increase of the cardiac frequency (CF) and the systolic volume (VS). Both mechanisms are readily observed but require a complex neurohumoral control. The changes occur in different systems, binding oxygen to hemoglobin and eliminating the carbonic anhydride, at a normal pH 7.40.”

Therefore, all seems to indicate that FIFA took the decision without thinking it through. Few people are affected by the decision, but it benefits many more.
However, no survey has been carried out proving that playing at high altitude affects the human body. What is evident is once again the fear of the big countries of South America (Argentina, Brazil, Uruguay, and Paraguay) to face smaller countries.

A serious study should be carried out in order to reach a balance, otherwise the stadiums of Colombia, Ecuador, Bolivia and the countries themselves are almost obliged to disappear. The football fans of those countries are censored, violating the right of equality.
For the full Spanish text please click here.

from:
http://www.aipsmedia.com/index.php/index.php?page=news&cod=1185&tp=n

II Chronic Hypoxia Symposium

2008-12-25T17:41:00.002+01:00

The follow-up on the successful

II Chronic Hypoxia Symposium

Titicaca Lake 3800 m

is now on-line.

Read about the events, the locations, see pictures, who came, the subjects and more:

click here

Send your titles Chronic Hypoxia Symposium

2008-03-11T12:05:00.000+01:00

Dear distinguished colleagues:

We are now elaborating the preliminary program for the II Symposium on the effect of Chronic Hypoxia on Diseases at High Altitude. Some of you are in our lists of scientists that have expressed their interest in participating. If you have not, our apologies.

Please send us the titles of your talks. Remember that the themes are:

Adaptation and acclimatization to high altitude

Adaptation of highlanders to sea level

Soccer and other sports at high altitude

Diving at high altitude

Chronic Mountain Sickness

Adaptation to extreme hypoxia

The carotid body at high altitude

High altitude ophthalmology

Aviation hypoxia

High Altitude Anthropology

Other high altitude diseases

However some of you have expressed their interest in presenting other hypoxia related subjects. You are most welcome!

We will have oral and poster presentations, so please specify which you prefer. If you are ready to send your abstract, please do so at:
http://zuniv.net/symposium2/abstract.html

Your photograph ("head shot") will be greatly appreciated. But of course, you are free to send any picture you prefer.

This symposium is open and unrestricted. You are free to express your ideas and to discuss them. Our principles of Science, Honor and Truth stand as originally expressed in our philosophy of science. It will be a pleasure to share this environment with you in an outstanding natural setting at high altitude. Each one of you is respected for your points of view. We want to listen to what you have to say.

All the best,

The organizers
http://hypoxia.zuniv.net
--

Recent publications in high altitude medicine

2007-12-18T13:10:00.000+01:00

Dear colleagues and friends:

The organizing committee thanks all of those that expressed their interest in participating. We look forward to everyones participation with their interesting scientific work. You are all welcome.

We would like to inform you that some of our most recent publications are among the themes to be addressed at our forthcoming symposium:

Paulev PE, Zubieta-Calleja G.

High altitude diving depths.

Res Sports Med. 2007 Jul-Sep;15(3):213-23.

PMID: 17987509
http://dx.doi.org/10.1080/15438620701526795
Our pre-print copy can be read here

Thorsen HC, Zubieta-Calleja G, Paulev PE.

Decompression sickness following seawater hunting using underwater scooters.

Res Sports Med. 2007 Jul-Sep;15(3):225-39.

PMID: 17987510

Paulev PE, Siggaard-Andersen O.

Clinical application of the pO(2)-pCO(2) diagram.

Acta Anaesthesiol Scand. 2004 Oct;48(9):1105-14.

PMID: 15352956 [PubMed - indexed for MEDLINE]

Paulev PE, Zubieta-Calleja GR.

Essentials in the diagnosis of acid-base disorders and their high altitude application.

J Physiol Pharmacol. 2005 Sep;56 Suppl 4:155-70.

PMID: 16204789
Full pdf article. Read it here

Zubieta-Calleja GR, Paulev PE, Zubieta-Calleja L, Zubieta-Calleja N, Zubieta-Castillo G.

Hypoventilation in chronic mountain sickness: a mechanism to preserve energy.

J Physiol Pharmacol. 2006 Sep;57 Suppl 4:425-30.

PMID: 17072073
Full pdf article. Read it here

Zubieta-Castillo G Sr, Zubieta-Calleja GR Jr, Zubieta-Calleja L.

Chronic mountain sickness: the reaction of physical disorders to chronic hypoxia.

J Physiol Pharmacol. 2006 Sep;57 Suppl 4:431-42.

PMID: 17072074
Full pdf article. Read it here

Zubieta-Castillo G, Zubieta-Calleja GR, Zubieta-Calleja L, Zubieta-Calleja, Nancy.

Adaptation to life at the altitude of the summit of Everest.

Fiziol Zh. 2003;49(3):110-7. Review.

PMID: 12918259
Full pdf article. Read it here

Hope you enjoy them,

MERRY CHRISTMAS and a HAPPY NEW YEAR !!

Poul-Erik Paulev, Gustavo Zubieta-Calleja and Gustavo Zubieta-Castillo (Sr).

Space Travel

2007-12-14T13:07:00.000+01:00

Energy-efficient space travel alternative:

Hypobaric cabin pressure?

Gustavo Zubieta-Calleja (Jr)

The Panum Institute, Faculty of Health Sciences, University of Copenhagen

High Altitude Pathology Institute, Clinica IPPA. http://www.Altitudeclinic.com. La Paz, Bolivia

The following comments are conclusions of a “Doctor of Medical Sciences” dissertation, presented to the University of Copenhagen, entitled “Human Adaptation to High Altitude and Sea Level; Acid-Base Equilibrium, Ventilation and Circulation in Chronic Hypoxia” accepted for assessment on Sept 7^th, 2007.

Based on 36 years of research related to high altitude polycythemia with Prof. Gustavo Zubieta-Castillo (Sr) in Bolivia and recently high altitude to sea level adaptation with Prof. Poul-Erik Paulev in Denmark, a greater understanding of the hematologic response to inspired oxygen pressure changes has led to the following:

Astronauts in the micro-gravity environment of space suffer many changes and among those anemia [1]. Thus far unexplained, neocytolisis has been described as the possible underlying mechanism [2, 3]. The adaptation to micro-gravity involves less use of muscle work and changes in ventilation and perfusion at lung level that the organism finds convenient to reduce the hematocrit following the least energy expenditure concept [4]. The knowledge and understanding of physiologic polycythemia (now known as polyerythrocythemia) upon ascent to high altitude and relative anemia following descent of high altitude residents to sea level [5, 6], allows for a logical proposal to bloodletting of high altitude residents on travel to sea level for periods longer than 20 days (an outstanding humanitarian blood resource) and similarly in astronauts when going into space. The logic is that they would economize energy avoiding the destructive hemolytic phase of adaptation. However, in astronauts, upon return to sea level, re-infusion of the phlebotomized blood could return the hematocrit to normal levels, although blood transfusion efficiency has lately been questioned. Erythropoyetine administration is also a possibility but less physiologic, more complicated and time limited.

Original space flights were carried out in a pure oxygen environment and one third the sea level pressure until serious fire accidents were encountered. Currently, the cabin pressure is normal sea level pressure at 760 mmHg with 20 % oxygen and 80 % nitrogen [7].

An alternative to the complication of space travel anemia would be to reduce the ambient oxygen tension within space vehicles, down to 2/3 the sea level pressure to around 495 mmHg (similar to the altitude of the city of La Paz with over 1.5 million inhabitants), in order to maintain a hypoxic stimulus and sustain the number of red blood cells for re-entry to Earth. Furthermore, the weightlessness space conditions require less oxygen consumption as there is less muscular use and hence tolerance to hypoxia can be increased. After an uncomplicated acute adaptation phase to hypoxia, with the adequate procedures, the astronauts can proceed with their normal routine during space travel. Upon return to sea level and the “relative hyperoxia”, the blood count should remain unchanged. This would create important advantages as there would be lower need for oxygen generation and pressure build-up, both high energy consumption processes. Likewise the Extravehicular Mobility Unit could benefit from a lower oxygen tension, less pressure difference with the space capsule, a speedier preparation and additionally more autonomy. Long space flights in the near future, would require less wasted resources in excess oxygen production and pressure. The return to the normal (relative hyperoxic) environment of sea level, would ease adaptation, as there would have been no reduction of the hematocrit during space flight [8]. Man faces future space travel where oxygen tensions will be a crucial life saving variable, and this proposal provides a physiological and physical energy-efficient alternative.

References

[1] Tavassoli M. Anemia of spaceflight. Blood. 1982 Nov;60(5):1059-67.

[2] De Santo NG, Cirillo M, Kirsch KA, Correale G, Drummer C, Frassl W, et al. Anemia and erythropoietin in space flights. Semin Nephrol. 2005 Nov;25(6):379-87.

[3] Rice L, Alfrey CP. The negative regulation of red cell mass by neocytolysis: physiologic and pathophysiologic manifestations. Cell Physiol Biochem. 2005;15(6):245-50.

[4] Zubieta-Calleja GR, Paulev PE, Zubieta-Calleja L, Zubieta-Calleja N, Zubieta-Castillo G. Hypoventilation in chronic mountain sickness: a mechanism to preserve energy. J Physiol Pharmacol. 2006 Sep;57 Suppl 4:425-30.

[5] Zubieta-Calleja GR, Paulev P-E, Zubieta-Calleja L, Zubieta-Castillo G. Altitude adaptation through hematocrit changes. J of Physiol and Pharmacol. 2007;58(Supplement in print).

[6] Zubieta-Castillo G, Sr., Zubieta-Calleja GR, Jr., Zubieta-Calleja L. Chronic mountain sickness: the reaction of physical disorders to chronic hypoxia. J Physiol Pharmacol. 2006 Sep;57 Suppl 4(2):431-42.

[7] NASA. Crew Compartment Cabin Pressurization. [cited 2007 June15, 2007]; Available from: http://spaceflight.nasa.gov/shuttle/reference/shutref/orbiter/eclss/cabinpress.html

[8] Zubieta-Calleja GR. Human adaptation to high altitude and to sea level: Acid-base equilibrium, ventilation, and circulation in chronic hypoxia. [Dissertation]. Copenhagen: University of Copenhagen; Sept 7th, 2007.

Photo courtesy of NASA, downloaded from http://www.geekphilosopher.com/MainPage/bkgStars.htm

The new Poul-Erik High Altitude Diving Laboratory

2007-12-06T10:06:00.000+01:00

The Zubieta University proudly presents the new

Poul-Erik Paulev High Altitude Diving Laboratory,

open to anyone interested in pursuing research related to high altitude diving in the Lake Titicaca (1 hour from La Paz) and also up to Lake Licancabur "the highest diving lagoon in the world". We welcome theoretical studies and discussions with Prof. Paulev, for the constant improvement of diving science.
Visit the website....

Two Danish Physiologist and one Bolivian support soccer at high altitude

2007-06-24T22:11:00.000+02:00

FIFA (Fédération Internationale de Football Association), Football's governing body, has once more banned international matches from being played at more than 2,500m (8,200ft) above sea level. It then changed to 3000 m. They said the decision was made because of concerns over players' health and possible distortion of competition.

Just want to pass along a letter mailed this week to Bolivia's president, Evo Morales, by my colleague Gustavo Zubieta of the Institute of High Altitude Pathology in La Paz, in reference to the recent FIFA effort to ban high altitude soccer games.

Dr. Zubieta, one of the world's leading authorities on high altitude physiology, is presently at the University of Copenhagen. The letter is also signed by Prof. Jens Bangsbo, an international authority on soccer physiology and Prof. Poul-Erik Paulev exercise physiologist from the University of Copenhagen.

The letter specifically notes that "based on extensive knowledge over many years of work in research on exercise, pressure changes, environmental changes and different conditions that the human body can tolerate during the practice of sports", that "the world games of soccer can and should be played in the high altitude cities of La Paz."

You can download a copy by clicking on the image above or accesing this link:

http://www.altitudeclinic.com/images/Bolivian%20President.pdf

En Español:
http://www.altitudeclinic.com/images/Traduccion_futbol_altura.pdf

Michael Moretti
High Altitude Medical Anthropologist
La Paz, Bolivia

June 24, 2007

2007-06-10T20:09:00.001+02:00

Dear Colleagues and friends from around the globe:

We are proud to send this 1st Announcement of the forthcoming:

Lake Titicaca 3800 m. One place of the itinerant symposium.

II Symposium

THE EFFECT OF CHRONIC HYPOXIA
ON DISEASES AT HIGH ALTITUDE
Aug 2-9, 2008

La Paz, Bolivia

Lake Titicaca 3800 m. Part of the itinerant symposium

Please visit our website:
http://zuniv.net/symposium2

We look forward to seeing you in 2008 !!!

Prof. Dr. Gustavo Zubieta-Castillo (Sr) and Prof. Dr. Gustavo Zubieta-Calleja (Jr)
http://altitudeclinic.com

Hanns-Christian Gunga visits La Paz

2007-03-29T00:53:00.000+02:00

Once more our good friend Hanns-Christian Gunga was in La Paz in Dec, 2006 and we had a wonderful visit at the High Altitude Pathology Clinic and a great dinner at a local ***** restaurant. This time he came with Prof. Karl Kirsch of the Department of Physiology, Charite-Universitatsmedizin and Center of Space Medicine, Berlin, Germany. We made plans for joint research in our Pyramid in Chacaltaya.
This photo is in the waiting room of IPPA.

Seminar at the Centre for Cardiovascular Research Czech Republic

2006-11-15T23:20:00.000+01:00

by Prof. Dr. Gustavo Zubieta-Calleja

On Nov 14th, 2006, I visited the Centre for Cardiovascular Research of the Czech Republic Academy of Sciences at Prague. I was very favorably impressed with the long standing pioneer work on the protective effect of chronic hypoxia with regards to myocardial infarction. After the publications of Hurtado in Peru(1950) affirming a lower incidence of myocardial infarction in people living at altitude, Kopecky and Daum (1958) and Poupa (1966) performed the first experimental studies using a model of high altitude hypoxia in a hypobaric chamber. Prof. Poupa was described by Prof. Bohuslav Ostadal, his succesor, as a true renaissance man that not only was extraordinary with the science but also multiple in his interests which included oil paintings.
Prof. Ostadal, transformed the center into an international renown Center of Excellence. In 2003 he was granted the Norman Alpert Award for his outstanding achievements in the area of Cardiovascular Science and Medicine.

Shown above, the solid II World War German hypobaric chamber that is in current use with rats exposed to 5 500 m of altitude as shown on the next picture. The simuloated altitude is quite similar to the altitude of the Chacaltaya high altitude pyramid laboratory.

Prof. Frantisek Kolar, shown at left, the current director, has boosted the research and in this opportunity kindly invited me to give a seminar entitled " Cardiovascular and pulmonary physiological changes during exercise in high altitude residents: remarkable adaptation to chronic hypoxia."
This talk presented the work performed at IPPA in relation to high altitude and particularly to the work of Prof. Dr. Gustavo Zubieta-Castillo (Sr) and his theory of adaptation to life at the hypoxic levels of the summit of Mt. Everest .
The research being performed at the centre is most interesting and promising for practical solutions to the prevention of myocardial infarction through exposure to chronic hypoxia. The equipment used is high tech and on the leading edge in this type of research.

The work they perform is indeed of worlwide interest as there is a current worldwide scientific wave of interest on the effects of high altitude protective effects particularly in the coronary circulation. Prof. Emilio Marticorena of Peru has also greatly contributed to these modern concepts showing how high altitude helps with the rehabilitation of cardiac patients.

Dr. Ivana Ostadalova in charge of developmental cardiological research at the Centre.

The hypoxic chamber where rats are placed in an enviroment with a 10 % oxygen concentration. This chamber is similar to the chamber we have that is called Hyperoxic/Hypoxic Adaptation Chamber

We use it to treat patients with high altitude disease and also to perform research in humans at different altitudes.
Special thanks to Jan Neckar, a young enthusiastic and distinguished scientist of the Centre for the photographs here presented.

We also visited the echocardiography department where echocardiographic observation of myocardial infarcts in rats' hearts is shown. This is highly complicated and requires much knowledge in the area. They are about to receive the latest techonolgy in this area and this will further boost their prestige in this important area of human health care.

Back to the High Altitude Pathology Institute

Poland Pneumology Conference 2006

2006-09-14T11:05:00.000+02:00

Poland Pneumology Conferences 2006 with Prof. Mieczyslaw Pokorski
At the University of Opole
Click here to go to the conference website

Back to the High Altitude Pathology Institute home page

photos courtesy of the Pneumology Conference auditorium engineer.

6th World High Altitude congress in China 2005

2006-09-14T10:44:00.001+02:00

6th World Congress on Mountain Medicine and Physiology in Xining, China and Lasha, Tibet. 2004

Prof. Dr. Gustavo Zubieta-Castillo (left) and Prof. Dr. Gustavo Zubieta Calleja (right) in Lhasa, Tibet during the visit to one of the hospitals. Shown here are three tibetan monks.

Prof. Dr. Gustavo Zubieta-Castillo, a Tibetan Monk and Prof. Dale McMcall on the foreground in front of the Potala Palace in Lhasa, Tibet, considered one of the marvels of the world.

On the background Prof. Univ. Dr. Hanns-Christian Gunga.

Back to the High Altitude Pathology Institute website

Berlin Frei University Fisiology Conference

2006-09-14T10:40:00.000+02:00

Berlin Fiziology conference 2005 at The Department of Physiology of Berlin Frei University.
Center for Space Medicine under the direction of Prof. Dr. Univ. Hanns-Christian Gunga

Prof. Poul-Erik Paulev and Prof. Gustavo Zubieta-Calleja gave talks representing the Univ. of Copenhagen and the High Altitude Pathology Institute in La Paz, Bolivia

Back to the High Altitude Pathology Institute home page

2006-09-14T10:28:00.000+02:00

Conferences at Vejle, Denmark on Blood Gases sponsored by Radiometer 2005

Prof. Paulev dictating on his research experience in hyperbarica and hypobaric medicine. Prof. Zubieta-Calleja dictating a conference on Blood Gases and high altitude

Back to the High Altitude Pathology Institute website

Cape Canaveral moved to Bolivian Altiplano

2006-08-31T22:37:00.000+02:00

MOVING CAPE CANAVERAL TO THE BOLIVIAN ALTIPLANO

Considering that Cape Canaveral is subject to ever increasing storms and bad weather that has already ended in accidents with the Space Shuttle, a new place for launching into space is mandatory.

Cape Canaveral has a Latitude of 29 N and Longitude 79 E
The Bolivian Altiplano has a Latitude of 16 S and Longitude 68 W

Note that it is closer to the Equator.

Furthermore it is at 4000 m above sea level. This is a highly significant energy saving for launching vehicles into space.

It is called Altiplano which stands for "high plateau". This extense flat surface is of great advantage for the logistics of development of a launching pad.
The surrounding mountains can be used for coverage and protection and for building the rocket structures.

Finally, the weather is much more benign at high altitude, with no serious storms.

This would also mean a development pole for Bolivia, a beautiful and pleasant country in much need of sincere collaboration.

COMMON SENSE DICTATES THESE IDEAS

Back to the High Altitude Pathology Institute home page

Symposium on the Effect of Chronic Hypoxia on Diseases at High Altitude

2005-10-25T10:21:00.000+02:00

Symposium on the Effect of Chronic Hypoxia on Diseases at High Altitude

Oct 1- 8, 2005

La Paz, Bolivia

Link to the symposium web page

Back to the High Altitude Pathology Institute IPPA's Home Page

(From left to right) Gustavo Gonzalez, Robert Dale McCall, Hanns-Christian Gunga, Michiro Nakashima, Georgette Begin, Paul Begin, Elydia Mujica, Gustavo Zubieta-Castillo, Julio Araujo, Gustavo Zubieta-Calleja. Note that not all speakers are present in this picture.

This follow-up of the symposium will give insight into the actual event and how it evolved. It had a unique style since it was an itinerant meeting where the conferences were carried out in different cities and environments in order to show our visitors life at high altitude.

The city of La Paz (3510 m) was the starting point, continued by the ruins of Tiahuanacu (a pre-Inca civilization 3870 m), followed by the meeting at the Lake Titicaca (3800 m) and visit to the High Altitude Diving Center of the Bolivian Navy and finally a visit to the city of Potosi (4000 m), all on schedule. To carry out such a program in an underdeveloped country with many social and political conflicts was indeed a challenge that turned out perfect, thanks to careful planning considering multiple variables and a profound knowledge of the social and weather conditions, in Bolivia.

The overall evaluation gives as a result: an extraordinary success. For one it received the support of important international institutions such as the UNESCO and the Third World Academy of Sciences along with the High Altitude Pathology Institute and Zubieta University in La Paz, Bolivia. Furthermore, the support of the Bolivian Military Academy and Navy and last but not least the participation and support of the Vice-Chancellor of Bolivia, Prof. Dr. Jorge Asín-Capriles. The presence of prestigious scientists from different countries provided high quality science in Bolivia.

All the program was completed as planned, the opening and closing dinners were lively and enjoyed by everyone with interviews by the local press. The conferences conveyed outstanding scientists from top institutions in the world: Denmark, Canada, US, Germany, Japan, India, Australia, Peru and Bolivia. The talks were of high quality and followed by very stimulating discussions and gave rise to many new ideas.

The conferences were, although in different topics all related and the environment of free discussion and comments was strongly supported. Many interesting proposals were performed. There was true scientific democracy as all speakers were chairmen on some session thereby giving equal opportunities to everyone.

Every speaker and participant was able to arrive to La Paz feel the effects of hypoxia yet adapt adequately the first 48 hours as planned, with the exception of two scientists that arrived a little later. No one suffered from Acute Mountain Sickness except one of the colleagues that had a mild headache as he arrived late. No one suffered any other type of disease since hygiene was strongly controlled, throughout the whole week. The final ascent to the city of Potosí likewise was uneventful.

Organizers

Prof. Gustavo Zubieta-Castillo
Chairman

Prof. Jorge Asín
International Relations

K.S. Parthasarthy Partha
Member Organizing Committee India

Dr. Luis Zubieta-Calleja
General Assistance

Claudia Aguilar
Coordinator

Jorge Castillo and Mónica Rivera
Medical Student affairs

Viviana Calleja
Tourist and hotel coordinator

Rosayda Bersatti
General support

Prof. Gustavo Zubieta-Calleja
Scientific Committe

Prof. Venkatesh Thuppil
Member Organizing Committee India

Lic. Nancy Zubieta
Coordination

Maria Eugenia Quiroga Multiple support

Clotilde Calleja
Nutricionist advice

Michael Moretti
Arrow-Marketing Group

Rafaela and Natalia Zubieta
General support

Opening Speech

Prof. Dr. Gustavo Zubieta-Castillo,

Chairman of the symposium

Oct 3, 2005

Distinguished guests and colleagues:

In 1994 we organized the 1^st World Congress of High Altitude Medicine and Physiology. It was a great success, because we had the presence of the most distinguished scientists in the field of high altitude science to which we have dedicated our knowledge and our lives.

Today we are again together with you who missed the first world congress due to different circumstances except a very few. Since that time we made great progress in the research of: high altitude medical problems we have to solve and the impact of hypoxia in permanent residents of high altitude or those that come to live from the low lands.

Today we are here with the same goal: to take one step further and open new frontiers. This is a big challenge we impose on ourselves and we are sure and predict that with your participation, with your outstanding quality as scientists and humanists, we will open a new era. In this symposium, we will give you equal opportunities for your talks and time to express freely your points of view, sometimes controversial but full of questions and answers, since this is how science can progress.

You are visiting a country full of contrast in geography and people who live in this beautiful land. The world, as never before is in permanent global conflict where people, paradoxically, are ever more intelligent, with greater knowledge, easily accessible, yet with increasing difficulties in order to understand each other. Everyone is going in different directions with different philosophical concepts and religions, different politics and economy.

You are in this building of Zubieta University, which is only the skeleton of many things still to do, but with the positive spirit of optimism. We are sure that in the near future, it will develop because the finality is to provide: a real academic environment with principles that time and knowledge demand today and an open hospitality to international scientists dedicated to high altitude problems.

The adequate solution to all that the world faces today is based on Science, Honor and Truth.

We will do our best to make your stay as pleasant as possible.

Gustavo Zubieta-Castillo

Chairman

Details of the Conferences (Oct 3-8, 2005)

One of the goals of this itinerant meeting was to show how life is carried out at high altitude, at several locations. In La Paz, the talks were centered around Chronic Mountain Sickness. The first talk was by Prof. Michiro Nakashima from Japan. He explained about high altitude research of his Japanese colleagues and then showed photographs of the retina of climbers. The first ascent was marked by points of hemorrhage however he observed that on repeated ascents this no longer happened and hence suggested that these hemorrhages were benign and left no secuelae.

Then Prof. Dr. Gustavo Zubieta-Castillo from Bolivia, talked about his experience with Chronic Mountain Sickness (CMS) of over 50 years of medical practice at high altitude in the city of La Paz. He introduced a new term to what was previously known as increased polycythemia or erythrocytosis: Polyerythrocythemia, that precisely describes the increased of red blood cells in CMS, without an identifiable ethiopathogenic pathology and solely as a sign of disease. He then explained the triggers of CMS as being located in multiple organs with direct relation to the brain and the respiratory center. He showed that CMS patients carry out a normal life provided they receive adequate periodical medical care. He finished by explaining the importance of the Triple Hypoxia Syndrome as an entity of transcendental importance in the outcome of these patients. The discussion was open and conclusive in stressing the fact that polyerythrocythemia is an adaptation of patients with diverse pulmonary disease to high altitude, allowing them to carry out a normal life.

At left, Prof. Poul-Erik Paulev (Denmark) and Prof. Vidysagar Casikar (Australia) chairing a session. Prof. Gustavo Gonzales from Peru gave an extensive talk about the weight of the newborn and late fetal death at high altitude, showing no lineal correlation between altitude and low birth weight, finding lower birth weights at cities located lower than those at higher altitude. This was discussed as due to other variables such as poor sanitary conditions, lower quality of medical assistance, different degree of education.

Prof. Gustavo Zubieta-Calleja from Bolivia but currently a resident in Denmark, talked about some general aspects of disease at high altitude, including the oxyhemoglobin dissociation curve and different altitudes, Acute Mountain Sickness, High Altitude Pulmonary Edema, High Altitude Cerebral Edema and Chronic Mountain Sickness. A Case report along with test results was presented and followed up by new Charts for Acid-Base correction at different altitudes (an adaptation of the Siggard-Andersen Charts used at sea level). This novel material will allow for precise correction at high altitude intensive care units, a subject that had been overlooked up to now and created an additional hazard in critical care. Charts for interpretation of the nine Van Slyke conditions for 2000-2999 m, 3000-3999m and 4000-5000 m were presented. The fundamental message was that the high altitude residents are well adapted to their environment and hence corrections of acid-base status should return them to their permanent high altitude values and not to sea level values.

Prof. Hanns-Christian Gunga from Germany exposed his results (right) on the studies of long term isolation/confinement with respect to fluid and electrolyte balance. He showed that Sodium gradually accumulates in the dermis in an inactive form. This unusual finding had no clear explanation but has great importance in space travel and opened new venues of research in the area in relation to high altitude. The inactive sodium typically reached a plateau at around 40 days.

This conference closed the first session and then a poster presentation by medical students was lively discussed by our distinguished visitors with questions, observations, comments and suggestions.

The opening dinner (below) was addressed by Prof. Jorge Asín, Economical Vice-Minister of the Office of Foreign Relations of Bolivia, who gave his impressions of the meeting, wished a successful meeting and a toast to science at high altitude. The local press performed questions to several assistants and plenty of photos were taken to be later published in local newspapers.

(Starting from left and going clockwise) Manuel Bueno, Robert Dale Mccall, Jorge Asín-Capriles, Antonieta De Urioste, Rie Ogiwara, Michiro Nakashima, Poul-Erik Paulev, Ambassador of Denmark Mogens Pedersen Kirsten Paulev, Nancy De Urioste de Bueno.

The next day all the assistants traveled to Tiahuanacu ruins (below), where the pre-Inca civilizations dating over 4000 years and resident at 3870 m, first got established. The auditorium of the museum served for an environment of discussion of the themes on the session on Carotid Body, Genetics and Diseases at high altitude.

(Standing from left to right) Gustavo Zubieta-Calleja (Jr), Poul-Erik Paulev, Thuppil Venkatesh, Vidyasagar Casikar, José Aliaga Arauco, Elydia Mujica, Paul Begin, Kirsten Paulev, Gustavo Gonzalez, Benedicte Brujs, Rene Vasquez, Hanns-Christian Gunga.
(First row) Michiro Nakashima, Gustavo Zubieta-Castillo (Sr), Maria Eugenia Quiroga, Rosayda Bersatti.

Prof. Robert Dale McCall opened with his talk on genetics of Hypoxic Exercise Tolerance. He showed that he was able to detect super mice that are able to tolerate hypoxic exercise much longer than the controls. He was able to isolate the genes, by long and careful cross-breeding of mice. This process he explained thoroughly and his results clearly showed that some genes provide an extraordinary capacity to hypoxic exercise in this breed of mice.

Prof. Dr. Gustavo Zubieta-Castillo then talked about the adaptation of man to severe hypoxia equivalent to the summit of Mount Everest. He first showed that normal life is possible in the city of La Paz where there is a population of over 1.5 million living between 3100 and 4100 m. He then showed the Chacaltaya pyramid laboratory at 5300 m where permanent life is evident. Next he showed the extraordinary capacity of the Aymara natives to play a soccer match at 6542 m. Finally, he showed the photo of a CMS patient that lives with a PaO2 (arterial partial oxygen tension) of 30 mmHg (Normal at 3600 is 60 mmHg and at sea level 95 mmHg). This man tolerates extreme hypoxia comparable to that found at the summit of Mt. Everest. Likewise, human embrios tolerate similar arterial oxygen tensions. Hence adaptation to live at that extreme altitude is possible in one generation by gradual and slow ascent and with adequate housing with heating and appropriate food supplies. He also presented a normal 9 month baby born in the city of La Paz with a 4.2 Kg of weight, that later went to the city of Potosí uneventfully.

Prof. Vidyasagar Casikar from Australia gave a talk showing that he observed that the olfactory areas played a role in adaptation to high altitude. He first questioned if there was increased brain blood flow at high altitude. Following a Doppler study he concluded that the lumen of carotid arteries decreased with increasing altitude. The same occurred with carotid blood flow. He explained the results of mice that had the olfactory bulbectomy which had more difficulties when exposed to high altitude, since there was endocrine disturbance that affected the Urea, renal, cytosolic and mitochondrial enzymes. He also showed electron microscope photographs of oxidative stress on neurons showing formation of blebs following a hypoxic exposure.

The session ended and the assistants returned to the city of La Paz.

The following day the Conference moved to the Lake Titicaca located two hours from La Paz at 3800 m. The morning was dedicated to visiting the High Altitude Diving Center of the Bolivian Navy in Tiquina (Left). Commander Pedro Vargas gave a talk on the objectives, organization, goals, and difficulties faced by this unit. Dives to 42 meters during 5 minutes are made with the basic Scuba equipment as part of the training. Some decompression sickness accidents were reported with one death included. The recompression hyperbaric chambers are located in the city of La Paz at around 2 hours drive in an ambulance with regular traffic. Hence, Prof. Thuppil Venkatesh immediately suggested the use of a high altitude hyperbaric bag known as HAPO, similar to a Gamow bag during the transport of those afflicted with decompression sickness. This would significantly reduce the complications and he immediately affirmed that he would donate one of these bags to the Navy unit upon return to India. This is considered by the organizers of the symposium an extraordinary contribution with an original idea of using a High Altitude device used to treat High Altitude Cerebral Edema and High Altitude Pulmonary Edema in the mountain and furthermore very effective with the actual donation of one of these bags.

Following a good lunch at a Hotel on the coast of the Titicaca Lake, the conferences continued at the auditorium.

Prof. Thuppil Venkatesh from India exposed his experience with high altitude by presenting a review of biochemical changes with strong emphasis on the respiratory system. He analyzed the different types of hypoxia including Hypobaric hypoxia, Hyperbaric hypoxia, Hypoxic Hypoxia, histotoxic hypoxia and the low temperature and low humidity conditions faced at high altitude. His analysis included the role of regulated respiration which he referred to as “Pranayama” and affirmed that “Regulated breathing alter or revert biochemical parameters caused by altered environmental changes”, a hypothesis by Vidyasagar Casikar & Thuppil Venkatesh.

Prof. Dr. Gustavo Zubieta-Calleja then gave a talk on the role of the hematocrit in the adaptation process challenging when the adaptation to high altitude was complete. He initially talked about the formula of Adaptation to high altitude where:

He then showed a graph of the studies performed on himself following his return to sea level after several months. The complete adaptation was shown to be achieved when the hematocrit reaches the optimal level of the hematocrit. This was around 40 days however he explained that this was variable depending on several factors which included individual characteristics, length of stay at sea level, high altitude changes and physical activity.

The session on the presentations of high altitude diving were then started by Prof. Paul Begin from Canada then gave an extense review of diving at the highest lakes on the planet including the Himalayas, and Licancabur on the border between Bolivian and Chile. He stressed the importance of the equipment and risk of cold water diving. His talk recounted the diving in Lake Titicaca by Jacques Costeau, and then went on to question some of the reports of high altitude lake diving in the medical literature. His talk gave a practical approach to diving at high altitude.

Prof. Poul-Erik Paulev, began with a brief description of his past experience and research related to Submarine Escape training and air embolism in Norway, Japanese AMA pearl divers, to then expose a new concept related to Acid-Base status which is the Titratable Hydrogen Ion Difference and the high altitude application. He then presented the new concept of Standarized Equivalent Ocean Dive (SEOD) factor for use during high altitude diving. Mathematically the formula considers the Nitrogen and Density ratio at different altitudes and easily adjusts to allow the use of common sea level diving tables. Hence a 30 m dive in Lake Titicaca corresponds to 47.8 m at sea level.

Finally Prof. Robert Dale McCall exposed his experience on the genetics of high pressure nervous syndrome in mice. He carefully described the genetic techniques of isolation of the loci with precise mathematical modeling thereby precisely locating the chromosomes with qualitative interpretation. The results showed evident differences and exact classification in a work of many years involving the analysis of data using mathematical and statistical techniques. Consequently the genetics of the high pressure nervous syndrome become better understood.

This final session was greatly stimulated by a lively and clever discussion of many aspects of diving at high altitude, a subject that will in the future bring many experts together. The conclusions arrived will allow for improved and safer diving in the high altitude lakes of the world.

The final trip to Potosí was enjoyed by those present, with a temporary stop to visit the Church in the village of Kalamarca
(Standing from left) Clotilde Zubieta, Gustavo Zubieta-Calleja (Sr.) Robert Dale McCall, Michiro Nakashima, Thuppil Venkatesh, Vidyasagar Casikar, Luis Zubieta-Calleja, Kirsten Paulev, Poul-Erik Paulev, Elydia Mujica, Rosayda Bersatti, the guide (Front row) a boy form the town, Sebastian Zubieta, Claudia Aguilar, Luis Andres Zubieta

where colonial times paintings of angels carrying weapons were admired. The lunch at Oruro, followed where continued discussions on the subjects presented were common. The arrival to Potosí at 4000 m in the evening was followed by a good night sleep by all participants to then next day visit the Casa de la Moneda Museum where the Spanish made the silver coins that were then transported to Spain in the colonial times and followed by a lunch and wine tasting and visit to an Hacienda with very old furniture and a library worth a fortune with very ancient books including authors such as Voltaire and Cervantes. The next day the silver mine of Potosí was visited where each participant entered the mine and was able to appreciate the rudimentary exploitation of minerals under very harsh conditions (Right). Prof. Venkatesh again provided us with interesting suggestions and observations regarding contamination by metals and the hazards to good health. He also took a water sample from the local river for mineral and chemical analysis upon return to India.

The return to La Paz was the closing event and a farewell to good friends and great scientists from around the world that shared their knowledge and appreciated our local medical experience giving them a broader and better understanding of high altitude medicine and how life is not only possible but also completely normal at high altitude.

Suggestions for the future:

The organizers feel that such meetings give light to the health problems of local residents. They are a true social help in order to improve the quality of life at high altitude, a subject strongly overlooked by sea level residents from around the world.

Many of the participants were surprised by Bolivia and expressed they wished to return in order to make further observations and research in different places at high altitude. Therefore there is a strong possibility of organizing a similar symposium in the near future.

Furthermore, it is necessary that institutions like ours receive further support in order to promote investigation and cooperate with high altitude societies around the world.

Prof. Dr. Gustavo Zubieta-Castillo
Chairman
La Paz, Bolivia
High Altitude Pathology Institute

Prof. Dr. Gustavo Zubieta-Calleja
Scientific Chairman
Copenhagen, Denmark and La Paz, Bolivia