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Wearable technologies are becoming pervasive in our society, and their development continues to accelerate the untapped potential of continuous and ubiquitous sensing, coupled with big data analysis and interpretation, has only just begun to unfold. However, existing wearable devices are still bulky (mainly due to batteries and electronics) and have suboptimal skin contact. In this work, we propose a novel approach based on a sensor network produced through inkjet printing of nanofunctional inks onto a semipermeable substrate. This network enables real-time monitoring of critical physiological parameters, including temperature, humidity, and muscle contraction. Remarkably, our system operates under battery-free and wireless near-field communication (NFC) technology for data readout via smartphones. Moreover, two of the three sensors were integrated onto a naturally adhesive bioinspired membrane. This membrane, developed using an eco-friendly, high-throughput process, draws inspiration from the remarkable adhesive properties of mussel-inspired molecules. The resulting ultra-conformable membrane adheres effortlessly to the skin, ensuring reliable and continuous data collection. The urgency of effective monitoring systems cannot be overstated, especially in the context of rising heat stroke incidents attributed to climate change and high-risk occupations. Heat stroke manifests as elevated skin temperature, lack of sweating, and seizures. Swift intervention is crucial to prevent progression to coma or fatality. Therefore, our proposed system holds immense promise for the monitoring of these parameters on the field, benefiting both the general population and high-risk workers, such as firefighters.

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The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.

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Introducción: El golpe de calor es una enfermedad que fue descrita hace más de 2000 años, sin embargo, los cambios climáticos que se han presentado en las últimas décadas han permitido que su prevalencia esté en aumento. Se considera una entidad compleja en la cual existe un compromiso importante de la termorregulación corporal y, en consecuencia, del resto de sistemas. Objetivos: Orientar al abordaje adecuado y óptimo de conceptos clínicos, epidemiológicos, factores el riesgo, presentación clínica y repercusión sobre los diferentes sistemas. Métodos: Se realizó una revisión de la literatura científica de personas con golpe de calor, en quienes se evaluaron sus factores asociados, métodos diagnósticos y manejos terapéuticos. Se realizó una búsqueda de la literatura en las siguientes bases de datos: Pubmed/Medline, Science Direct, Scopus, DOAJ, Embase, Cochrane, Direme, Redalyc y SciELO. Conclusiones: El golpe de calor es una urgencia médica que implica un manejo rápido y óptimo dado su morbilidad y mortalidad, lo cual puede minimizarse si se cumplen los objetivos de tratamiento. El enfriamiento por inmersión en agua helada, por convección o evaporación son las medias más usadas. Evitar la falla multiorgánica es el segundo objetivo terapéutico(AU)

Introduction: Heat stroke is a disease described more than 2000 years ago; however, the climatic changes that have occurred in recent decades have allowed an increase in its prevalence. It is considered a complex entity in which there is an important compromise of body thermoregulation and, consequently, of the rest of the systems. Objectives: To define important concepts concerning heat stroke, risk factors, clinical presentation and repercussions on the different systems, as well as to guide an appropriate and optimal management. Methods: A review of the scientific literature about people with heat stroke was carried out to assess its associated factors, diagnostic methods and therapeutic management. A literature search was performed in the following databases: Pubmed/Medline, Science Direct, Scopus, DOAJ, Embase, Cochrane, Bireme, Redalyc, and SciELO. Conclusions: Heat stroke is a medical emergency that requires rapid and optimal management given its morbidity and mortality, which can be minimized if management goals are met. Cooling by immersion into ice water, convection or evaporation are the most commonly used measures. Avoidance of multiorgan failure is the second therapeutic objective(AU)

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Resumo Introdução: a legislação brasileira determina que se monitore o Índice de Bulbo Úmido Termômetro de Globo (IBUTG) nos ambientes de trabalho em que o calor possa representar risco à saúde dos trabalhadores. Porém, esse monitoramento e a adoção de medidas preventivas não são comumente observados. Objetivo: identificar e mapear a influência da intensidade do trabalho na extrapolação potencial de limites de sobrecarga térmica para trabalhadores em atividade a céu aberto em áreas rurais do Nordeste do Brasil. Métodos: com base na Norma Regulamentadora nº 15 e em dados do Instituto Nacional de Meteorologia, o software Sobrecarga Térmica foi utilizado para estimar os índices de IBUTG na região, no período de 1º de setembro de 2016 a 31 de agosto de 2017. Resultados: dos 132 pontos geográficos investigados, a extrapolação dos limites de sobrecarga térmica foi identificada em 48% dos trabalhos pesados e em 14% dos trabalhos moderados, indicando a necessidade de paradas para descanso em mais de 50% do tempo analisado. Discussão: a diminuição da intensidade do trabalho resulta em redução expressiva da sobrecarga térmica. Nas localidades historicamente reconhecidas pelo alto risco de exposição ao calor, deveria ser adotada, como medida efetiva de prevenção, a restrição ao estímulo de atividades extenuantes, sobretudo as promovidas pela remuneração atrelada à produtividade.

Abstract Introduction: Brazilian law requires the use of Wet-Bulb Globe Temperature (WBGT) to monitor work environments where heat may pose a risk to workers' health; however, such monitoring is often not observed and preventive measures are not taken. Objective: to identify and map the influence of labor intensity on the potential extrapolation of heat exposure threshold limits for outdoor workers in rural areas of northeastern Brazil. Methods: based on Brazil's Labor Regulatory Standard no. 15 and data from the Brazilian Institute of Meteorology, the software Sobrecarga Térmica (Thermal Overload) was used to estimate WBGT index in the territory from September 1st, 2016 to August 31, 2017. Results: the extrapolation of thermal overload limits was characterized for heavy work in 48%, and for moderate work in 14% of the 132 geographic points investigated, indicating the need for rest stops in more than 50% of the analyzed period. Discussion: decreasing work intensity results in an expressive reduction in thermal overload rates. The restriction to the stimulation of strenuous activities - especially remunerated ones linked to production - in regions historically recognized for their high risk of heat exposure should be implemented as an effective preventive measure for heat stress.

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CONTEXT: Ideal and acceptable cooling rates in hyperthermic athletes have been established in average-sized participants. Football linemen (FBs) have a small body surface area (BSA)-to-mass ratio compared with smaller athletes, which hinders heat dissipation. OBJECTIVE: To determine cooling rates using cold-water immersion in hyperthermic FBs and cross-country runners (CCs). DESIGN: Cohort study. SETTING: Controlled university laboratory. PATIENTS OR OTHER PARTICIPANTS: Nine FBs (age = 21.7 ± 1.7 years, height = 188.7 ± 4 cm, mass = 128.1 ± 18 kg, body fat = 28.9% ± 7.1%, lean body mass [LBM] = 86.9 ± 19 kg, BSA = 2.54 ± 0.13 m2, BSA/mass = 201 ± 21.3 cm2/kg, and BSA/LBM = 276.4 ± 19.7 cm2/kg) and 7 CCs (age = 20 ± 1.8 years, height = 176 ± 4.1 cm, mass = 68.7 ± 6.5 kg, body fat = 10.2% ± 1.6%, LBM = 61.7 ± 5.3 kg, BSA = 1.84 ± 0.1 m2, BSA/mass = 268.3 ± 11.7 cm2/kg, and BSA/LBM = 298.4 ± 11.7 cm2/kg). INTERVENTION(S): Participants ingested an intestinal sensor, exercised in a climatic chamber (39°C, 40% relative humidity) until either target core temperature (Tgi) was 39.5°C or volitional exhaustion was reached, and were immediately immersed in a 10°C circulated bath until Tgi declined to 37.5°C. A general linear model repeated-measures analysis of variance and independent t tests were calculated, with P < .05. MAIN OUTCOME MEASURE(S): Physical characteristics, maximal Tgi, time to reach 37.5°C, and cooling rate. RESULTS: Physical characteristics were different between groups. No differences existed in environmental measures or maximal Tgi (FBs = 39.12°C ± 0.39°C, CCs = 39.38°C ± 0.19°C; P = .12). Cooling times required to reach 37.5°C (FBs = 11.4 ± 4 minutes, CCs = 7.7 ± 0.06 minutes; P < .002) and therefore cooling rates (FBs = 0.156°C·min-1 ± 0.06°C·min-1, CCs = .255°C·min-1 ± 0.05°C·min-1; P < .002) were different. Strong correlations were found between cooling rate and body mass (r = -0.76, P < .001), total BSA (r = -0.74, P < .001), BSA/mass (r = 0.73, P < .001), LBM/mass (r = 0.72, P < .002), and LBM (r = -0.72, P < .002). CONCLUSIONS: With cold-water immersion, the cooling rate in CCs (0.255°C·min-1) was greater than in FBs (0.156°C·min-1); however, both were considered ideal (≥0.155°C·min-1). Athletic trainers should realize that it likely takes considerably longer to cool large hyperthermic American-football players (>11 minutes) than smaller, leaner athletes (7.7 minutes). Cooling rates varied widely from 0.332°C·min-1 in a small runner to only 0.101°C·min-1 in a lineman, supporting the use of rectal temperature for monitoring during cooling.

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Environmental injuries can result in serious neurologic morbidity. This chapter reviews neurologic complications of thermal burns, smoke inhalation, lightning strikes, electric injury, near drowning, decompression illness, as well as heat stroke and accidental hypothermia. Knowing the pathophysiology and clinical presentation of such injuries is essential to proper management of primary and secondary medical complications. This chapter highlights the most frequently encountered neurologic injuries secondary to common environmental hazards, divided into the topics: injuries related to fire, electricity, water, and the extremes of temperature.

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INTRODUCTION: Provisions of medical direction and clinical services for ultramarathons require specific attention to heat illness. Heat stress can affect athlete performance negatively, and heat accumulation without acclimatization is associated with the development of exertional heat stroke (EHS). In order to potentially mitigate the risk of this safety concern, the Jungle Marathon (Para, Brazil) instituted mandatory rest periods during the first two days of this 7-day, staged, Brazilian ultramarathon. METHODS: Race records were reviewed retrospectively to determine the number of runners that suffered an emergency medical complication related to heat stress and did not finish (DNF) the race. Review of records included three years before and three years after the institution of these mandatory rest periods. RESULTS: A total of 326 runners competed in the Jungle Marathon during the 2008-2013 period of study. During the pre-intervention years, a total of 46 athletes (21%) DNF the full race with 25 (54.3%) cases attributed to heat-related factors. During the post-intervention years, a total of 26 athletes (24.3%) DNF the full race with four (15.4%) cases attributed to heat-related factors. CONCLUSION: Mandatory rest stops during extreme running events in hot or tropical environments, like the Jungle Marathon, are likely to improve athlete safety and improve the heat acclimatization process.

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BACKGROUND: Heat stroke has been associated with stress-induced cardiomyopathy and electrocardiogram ST segment elevation and depression. Laboratory studies with dogs have demonstrated heat stroke-induced sinoatrial node dysfunction in the setting of hyperkalemia. No prior case report has described heat stroke-induced complete sinoatrial node dysfunction that resolved in the emergency department. CASE REPORT: An 87-year-old female presented to the emergency department with heat stroke and severe bradycardia. Initial electrocardiogram demonstrated complete sinoatrial node dysfunction. The bradycardia responded to external cardiac pacing and the sinoatrial node dysfunction resolved with aggressive cooling. Emergency physicians should be aware that heat stroke can cause complete sinoatrial node dysfunction and that this bradydysthrmia can be treated with aggressive cooling.

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El golpe de calor es una entidad poco frecuente y subdiagnosticada. La elevación de la temperatura corporal es la que desencadena las disfunciones metabólicas que pueden incluso llevar a la muerte. Se presenta el caso de un militar que se encontraba realizando ejercicios de infantería, durante el mes de septiembre, en días donde se produjeron condiciones climáticas extremas y desarrolla un cuadro de Disfunción Orgánica Múltiple (DOM) primaria; fue llevado al Servicio de Emergencia del Hospital de Fray Bentos, Río Negro. La evolución inicial se caracterizó por deterioro de la función neurológica, respiratoria, necesidad de ventilación mecánica, falla renal aguda y disfunción hematológica; se establecieron los diagnósticos de golpe de calor, injuria renal, rabomiólisis, insuficiencia respiratoria aguda y coagulación intravascular diseminada (CID). A pesar del tratamiento y manejo de sostén tiene una mala evolución, falleciendo a las 48 horas del ingreso. El caso nos recuerda que la exposición a condiciones de calor por arriba de la temperatura corporal, deteriora los mecanismos de control de calor corporal y metabólico. Es necesario un diagnóstico rápido y un manejo de sostén para conseguir una evolución satisfactoria.

A heat stroke is a very rare and under diagnosed entity. The rise in the body’s temperature is the element that triggers the metabolic dysfunctions that can even lead to death. A case of a soldier is presented; this soldier was training, doing his infantry exercises routine, during September, in days were extreme climate situations were happening, installing a case of primary Multiple Organ Dysfunction (MOD) syndrome. The soldier was taken to the Emergency Service in Fray Bentos’ Hospital, in Rio Negro. The initial evolution was clumsy and slowly, and the neurologic and breathing functions were worsening, with acute renal failure, and also hematological dysfunction. In addition to this, the patient was in need of mechanic ventilation. The diagnosis of temperature shock, acute renal injury, Rhabdomyolysis, acute respiratory failure and disseminated intravascular coagulation (DIC) were established. Supportive care was given to the patient, with an un satisfactory development, leading to death 48 hours after the hospital admission. This case reminds us that, the exposure to weather conditions that are over the body temperature interferes in the metabolism and the body’s mechanisms for controlling heat. A quick diagnosis and supportive care are needed in order to achieve a satisfactory evolution.

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El golpe de calor es una emergencia médica y se debe entender como una forma de hipertermia asociada a una respuesta inflamatoria sistémica, que ocasiona falla multiorgánica y en la cual la disfunción del sistema nervioso central es predominante. Si no es tratada precozmente, puede ocasionar una alta mortalidad. El síndrome de Prader-Willi es un trastorno genético multisistémico secundario a una anormalidad en el brazo largo del cromosoma 15 (15q11-q13), caracterizado por hipotonía central neonatal, retraso del desarrollo psicomotor, hipogonadismo, hiperfagia y obesidad. Estos pacientes son proclives a presentar problemas de termorregulación. Se comunica el caso de una lactante de 5 meses en quien se estableció el diagnóstico de síndrome de Prader-Willi en el curso de un episodio febril sin foco conocido, que evolucionó con falla multiorgánica y rabdomiólisis secundaria a la hipertermia.

Heat stroke is a medical emergency characterized primarily by an elevated core temperature associated with a systemic inflammatory response, which causes multiple organ dysfunction in which encephalopathy predominates. If it is not early treated has high mortality. The Prader-Willi syndrome is a multisystem genetic disorder secondary to an abnormality in long arm chromosome 15 (15q11-q13), characterized by neonatal central hypotonia, developmental delay, hypogonadism, hyperphagia and obesity. These patients are susceptible to developing thermoregulatory problems. We report the case of a 5-month-old infant, in whom a diagnosis of Prader-Willi syndrome was established in the course of a febrile episode without known focus, who developed multiorganic failure and rhabdomyolysis secondary to hyperthermia.

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El golpe de calor es una emergencia médica y se debe entender como una forma de hipertermia asociada a una respuesta inflamatoria sistémica, que ocasiona falla multiorgánica y en la cual la disfunción del sistema nervioso central es predominante. Si no es tratada precozmente, puede ocasionar una alta mortalidad. El síndrome de Prader-Willi es un trastorno genético multisistémico secundario a una anormalidad en el brazo largo del cromosoma 15 (15q11-q13), caracterizado por hipotonía central neonatal, retraso del desarrollo psicomotor, hipogonadismo, hiperfagia y obesidad. Estos pacientes son proclives a presentar problemas de termorregulación. Se comunica el caso de una lactante de 5 meses en quien se estableció el diagnóstico de síndrome de Prader-Willi en el curso de un episodio febril sin foco conocido, que evolucionó con falla multiorgánica y rabdomiólisis secundaria a la hipertermia.(AU)

Heat stroke is a medical emergency characterized primarily by an elevated core temperature associated with a systemic inflammatory response, which causes multiple organ dysfunction in which encephalopathy predominates. If it is not early treated has high mortality. The Prader-Willi syndrome is a multisystem genetic disorder secondary to an abnormality in long arm chromosome 15 (15q11-q13), characterized by neonatal central hypotonia, developmental delay, hypogonadism, hyperphagia and obesity. These patients are susceptible to developing thermoregulatory problems. We report the case of a 5-month-old infant, in whom a diagnosis of Prader-Willi syndrome was established in the course of a febrile episode without known focus, who developed multiorganic failure and rhabdomyolysis secondary to hyperthermia.(AU)

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The net radiation (Rn) in agroecosystems is the amount of energy that is available in the environment to heating processes of living organisms, air and soil; perspiration of animals and plants; photosynthesis and water evaporation. The Rn defines the type of climate and weather conditions prevailing in a region affecting the availability and thermal water, the fundamental understanding of genotype-environment, which ultimately determine the productivity of the agricultural system. Rn usually is used in models of weather and climate studies. The sustainability and economic viability of zootechnical activity is dependent on the positive interaction between animal and environment. Environmental factors such as water, shading, thermal exchanges sensible heat (conduction, convection and radiation skin) and latent heat losses (evaporation and transpiration), conditioned by Rn, must be managed to provide the best results. The present study was conducted to develop and test models for accurate and precise radiation balance on the scales daily, monthly and seasonal ten-day for Jaboticabal - SP, due to the importance of estimates of net radiation for agricultural activities. We used daily meteorological data from weather station located in Jaboticabal, SP (coordinates: 21 14"05 "South, 48 17"09" West, 615m altitude) at Universidade Estadual Paulista "Júlio Mesquita Filho" - FCAV/UNES

O artigo não apresenta resumo em português.

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The net radiation (Rn) in agroecosystems is the amount of energy that is available in the environment to heating processes of living organisms, air and soil; perspiration of animals and plants; photosynthesis and water evaporation. The Rn defines the type of climate and weather conditions prevailing in a region affecting the availability and thermal water, the fundamental understanding of genotype-environment, which ultimately determine the productivity of the agricultural system. Rn usually is used in models of weather and climate studies. The sustainability and economic viability of zootechnical activity is dependent on the positive interaction between animal and environment. Environmental factors such as water, shading, thermal exchanges sensible heat (conduction, convection and radiation skin) and latent heat losses (evaporation and transpiration), conditioned by Rn, must be managed to provide the best results. The present study was conducted to develop and test models for accurate and precise radiation balance on the scales daily, monthly and seasonal ten-day for Jaboticabal - SP, due to the importance of estimates of net radiation for agricultural activities. We used daily meteorological data from weather station located in Jaboticabal, SP (coordinates: 21 14"05 "South, 48 17"09" West, 615m altitude) at Universidade Estadual Paulista "Júlio Mesquita Filho" - FCAV/UNES

O artigo não apresenta resumo em português.

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Os distúrbios relacionados à homeostasia térmica são freqüentes na clínica de pequenos animais, sendo sua etiologia principalmente relacionada a processos infecciosos e inflamatórios. No entanto, há uma forma de hipertermia conhecida por intermação, onde o ponto referencial de temperatura no hipotálamo encontra-se normal e a termorregulação é perdida, devido à deficiência dos mecanismos responsáveis pela dissipação de calor. O excesso de calor produzido é responsável por elevações da temperatura corporal central que podem atingir 43ºC ou mais, resultando em lesão celular, morte celular, disfunções orgânicas e morte do animal, requerendo, dessa forma, intervenção emergencial(AU)

Disorders related to thermal homeostasis are common in the small animal clinical, whose etiology is mainly related to infectious and inflammatory processes. However, there is a form of hyperthermia known Heat stroke where the reference point of the hypothalamic temperature is normal and thermoregulation is lost due to deficiency of the mechanisms responsible for heat dissipation. Excess heat is responsible for elevations in core body temperature that can reach 43 degrees or more, resulting in cell damage, cell death, organ dysfunction and death of the animal, requiring thus emergency intervention(AU)

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Os distúrbios relacionados à homeostasia térmica são freqüentes na clínica de pequenos animais, sendo sua etiologia principalmente relacionada a processos infecciosos e inflamatórios. No entanto, há uma forma de hipertermia conhecida por intermação, onde o ponto referencial de temperatura no hipotálamo encontra-se normal e a termorregulação é perdida, devido à deficiência dos mecanismos responsáveis pela dissipação de calor. O excesso de calor produzido é responsável por elevações da temperatura corporal central que podem atingir 43ºC ou mais, resultando em lesão celular, morte celular, disfunções orgânicas e morte do animal, requerendo, dessa forma, intervenção emergencial

Disorders related to thermal homeostasis are common in the small animal clinical, whose etiology is mainly related to infectious and inflammatory processes. However, there is a form of hyperthermia known Heat stroke where the reference point of the hypothalamic temperature is normal and thermoregulation is lost due to deficiency of the mechanisms responsible for heat dissipation. Excess heat is responsible for elevations in core body temperature that can reach 43 degrees or more, resulting in cell damage, cell death, organ dysfunction and death of the animal, requiring thus emergency intervention

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El golpe de calor es una entidad poco frecuente y subdiagnosticada. Se presenta relativamente más en los estados del norte del país, al exponerse los migrantes a condiciones climáticas extremas. La elevacion de la temperatura corporal es la que dispara las disfunciones metabólicas que pueden incluso llevar a la muerte. Se presenta el caso de un migrante chiapaneco que fue encontrado en el desierto de Altar, Sonora en malas condiciones generales; fue traído al Servicio de urgencias del Hospital General del Estado en Hermosillo, Sonora. La evolución inicial fue tórpida, con deterioro de la función respiratoria, infiltrados pulmonares, necesidad de ventilación mecánica, datos de falla renal y cifras muy elevadas de creatinincinasa; se establecieron los diagnósticos de golpe de calor, insuficiencia renal, rabdomiólisis, hemorragia pulmonar y SIRA. Se le dio manejo de sostén con buena evolución, egresó al 21° día de estancia hospitalaria por resolución del problema. El caso nos recuerda que la exposición a condiciones de calor por arriba de la temperatura corporal, lo cual es muy frecuente en las áreas desérticas del norte del país, deteriora los mecanismos de control de calor corporal y metabólico. Es necesario un diagnóstico rápido y un manejo de sostén para conseguir una evolución satisfactoria.

Heat stroke is a rare and underdiagnosed entity, it is more frequently seen in the northern states of Mexico after exposure to high environmental temperatures that induce elevation of the body temperature, triggering metabolic derangements that can result in death. We present the case of a 24 year old immigrant from the southeast state of Chiapas found in the Desert of Altar, in the northern state of Sonora; he was semiconscious, dehydrated and in poor general condition after attempting to cross the desert in his way to the border with the USA. He was brought to our hospital with labored breathing, hemoptysis, lung infiltrates and progressive deterioration of his blood gases. He was intubated and mechanically ventilated; the initial course was characterized by increased CPK levels suggestive of rabdomyolisis, acute renal failure, disseminated intravascular coagulation, lung hemorrhage and acute respiratory distress syndrome secondary to the heat stroke. He spent 14 days in the ICU receiving 4 courses of hemodyalisis, ventilatory support, iv fluids, antibiotics and monitoring of his respiratory, renal, cardiovascular, neurologic and metabolic parameters. He was discharged 21 days after admission. Heat stroke prevention is mandatory by public education; early diagnosis should avoid the full-blown systemic derangements; adequate support can reverse an otherwise potentially fatal course.