The Effects of Climbing Sticks on Exertional Rhabdomyolysis Markers according to Mountain Climbing Pattern

The lack of information related to the best practices in responsible tourism is one of the causes to tourist behavior problems. This study aims to determine the behavior of tourists in hiking, the adoption of responsible tourism practices, and to compile a responsible tourism practices guidebook. The research method used is survey research by spreading the questionnaire. Based on Likert analysis, at the pre-ascending stage, the classification of attitudes indicated by the respondents for cost and transportation is quite agreeable, while for equipment, guide, and simaksi is agreed. The ascent stage, the indicator when going up the mountain is quite agree, camping is not agree, the cook is agree, and when down the mountain is strongly agree. The post-ascent stage shows quite agreeable attitude. The public test of the guidebook, for the aspect of size and language of submission shows an agreeable attitude, while for the design, thickness, and content of the book shows an agreeable attitude. The conclusion is that (1) Still found the behavior of tourists in mountain climbing that is not environmentally friendly, (2) The responsible tourism practices of mountaineering that includes pre-ascending, ascent, and post-ascent, not well implemented by tourists, and (3) The responsible tourism practices guidebook still lack both technical and substance. Keywords: responsible tourism, mountain hiking, guidebook, tourist behavior

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Severe non-exertional rhabdomyolysis from weight loss supplement in sickle cell trait: A perfect storm?

Case Reports in Internal Medicine ◽

10.5430/crim.v5n1p35 ◽

2018 ◽

Vol 5 (1) ◽

pp. 35

Author(s):

Titilope Olanipekun ◽

Valery Effoe ◽

Ganiat Adeogun ◽

Agniezka Gaertig ◽

Myrtle White ◽

...

Keyword(s):

Weight Loss ◽

Sickle Cell ◽

Sickle Cell Trait ◽

Elevated Serum ◽

African American Female ◽

Garcinia Cambogia ◽

Exertional Rhabdomyolysis ◽

Serum Creatine Phosphokinase ◽

History Of

Exertional rhabdomyolysis from sickle cell trait has been documented. Also, cases of rhabdomyolysis from the use of weight loss supplements in the setting of sickle cell trait and exertion have been described. However, the role of sickle cell trait in non-exertional rhabdomyolysis is not clear. We present a case of severe non-exertional rhabdomyolysis from weight loss supplement in a patient with sickle cell trait.A 45-year-old African American female with sickle cell trait presented to the emergency department with two days history of fatigue and mild breathlessness. She also reported diarrhea and vomiting for five days before presentation. She admitted to taking Garcinia cambogia (a dietary supplement) for weight loss one week prior to the onset of symptoms. She denied alcohol or drug use, rigorous physical activity or trauma.She was dehydrated on examination. Laboratory values revealed markedly elevated serum creatine phosphokinase (CPK) and creatinine levels. Garcinia cambogia was discontinued and she was hydrated with intravenous fluids. Her CPK and creatinine levels significantly trended down and she was discharged home with no apparent sequelae.Our patient had multiple episodes of diarrhea and vomiting likely from the use of Garcinia cambogia. We believe she suffered non-exertional rhabdomyolysis from dehydration in the setting of sickle cell trait. Though dietary weight loss supplements are marketed as generally safe, this case suggests otherwise. We emphasize that clinicians routinely inquire about use of these supplements and provide appropriate counseling to patients on the adverse effects, especially among those with sickle cell trait.

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