Advice on acetazolamide use was recalled by 188/277 (67.8%) subjects, hydration by 90/277 (32.4%), limiting physical activity by 86/277 (31.0%), changing diet habits by 23/277 (8.3%), alcohol abstinence by 20/277 (7.2%), gradual ascent by 16/277 (5.8%), use of coca products by 15/277 (5.4%), and 12/277 (4.3%) were not able to recall any advice. Most travelers LY294002 supplier (718/985, 72.9%) reported using at least

one measure to prevent AMS. The median number of preventive measures used was 2 (IQR = 1–3 measures). Acetazolamide was used by 163/980 (16.6%) participants and by 118/284 (41.5%) of those who received advice on AMS prevention. The most common non-pharmacologic measures used were limiting physical activity during the MG 132 first hours after arrival (387/983, 39.4%), modifying diet (167/983, 17.0%), and visiting cities at lower altitudes first (87/983, 8.9%). Coca leaf products including drinking leaf infusions, chewing leaves, and eating coca leaf candy were used by 617/983 (62.8%). A medication containing acetyl salicylic acid and caffeine (Sorojchi pills®) sold over the counter in Cusco to prevent and treat AMS

was used by 53/983 (5.4%). Headache was reported by 580/961 (60.3%), gastrointestinal symptoms including poor appetite, nausea, and/or vomiting were reported by 303/960 (31.6%), fatigue or weakness were reported by 678/960 (70.6%), dizziness or lightheadedness were reported by 365/960 (38.0%), and difficulty sleeping was reported by 443/960 (46.1%). Overall, 466/960 (48.5%) reported symptoms compatible

Dynein with AMS (LLCS ≥ 3) and the median LLCS among these travelers was 5 (IQR 4–6). The LLCS ranged from 3 to 13 among those with AMS. Out of 960 subjects, 164 (17.1%) subjects had severe AMS (LLCS ≥ 6). Travel plans were affected in 91/449 (20.2%) subjects with AMS. They had to stay in bed due to symptoms (68/449, 15.1%), cancel tours (20/449, 4.4%), and change their itineraries (16/449, 3.6%). Other types of travel plan disruptions were reported by 6/449 (1.3%) and 19/449 (4.2%) reported more than one travel plan disruption. Those meeting criteria for AMS were more likely to alter their travel plans compared to those without AMS [91/449 vs 26/343, OR = 3 (1.9–4.9)]. Subjects with AMS reporting disruptions of travel plans were more likely to have higher LLCS compared to those without disruptions (Pearson χ2 = 57.6, p < 0.01). Adjusted odds ratios for characteristics and preventive measures associated with AMS among participants are shown in Table 2. Age over 60 years, visiting a high altitude destination in the previous 2 months, visiting lower altitude cities before arriving to Cusco, limiting physical activity soon after arrival, modifying the diet on arrival, using acetazolamide prophylaxis, and using coca leaf products were retained by the backwards logistic regression analysis (likelihood ratio χ2 = 70.2, df 7, p < 0.01, Cox and Snell R2 = 0.077).