Abstract. The extent and distribution of permafrost in the mountainous parts of the Hindu Kush Himalayan (HKH) region are largely unknown. A long tradition of permafrost research, predominantly on rather gentle relief, exists only on the Tibetan Plateau. Two permafrost maps are available digitally that cover the HKH and provide estimates of permafrost extent, i.e., the areal proportion of permafrost: the manually delineated Circum-Arctic Map of Permafrost and Ground Ice Conditions (Brown et al., 1998) and the Global Permafrost Zonation Index, based on a computer model (Gruber, 2012). This article provides a first-order assessment of these permafrost maps in the HKH region based on the mapping of rock glaciers. Rock glaciers were used as a proxy, because they are visual indicators of permafrost, can occur near the lowermost regional occurrence of permafrost in mountains, and can be delineated based on high-resolution remote sensing imagery freely available on Google Earth. For the mapping, 4000 square samples (~ 30 km2) were randomly distributed over the HKH region. Every sample was investigated and rock glaciers were mapped by two independent researchers following precise mapping instructions. Samples with insufficient image quality were recorded but not mapped. We use the mapping of rock glaciers in Google Earth as first-order evidence for permafrost in mountain areas with severely limited ground truth. The minimum elevation of rock glaciers varies between 3500 and 5500 m a.s.l. within the region. The Circum-Arctic Map of Permafrost and Ground Ice Conditions does not reproduce mapped conditions in the HKH region adequately, whereas the Global Permafrost Zonation Index does so with more success. Based on this study, the Permafrost Zonation Index is inferred to be a reasonable first-order prediction of permafrost in the HKH. In the central part of the region a considerable deviation exists that needs further investigations.
Background Intravenous thrombolysis has been recently introduced in Nepal for the management of acute ischemic stroke. Pre-hospital delay is one of the main reasons that hinder thrombolytic therapy. The objective of this study was to evaluate the status of prehospital delay and thrombolysis in Nepal. Methods Data were prospectively collected from patients of both genders, age > 18 years who arrived at the emergency department (ED) with symptoms and neuroimaging findings consistent with an ischemic stroke. Patient data were obtained from ED form and standard questionnaires were used to assess factors resulting in prehospital delay. Modified Rankin scale and National Institute of Health stroke scale were used to assess the degree of disability and severity of stroke respectively. Results A total of 228 patients were enrolled in the study between August 2017 and August 2018. Only 46 (20.17%) patients arrived within the time frame for thrombolysis. Onset at daytime (OR: 4.07; 95% CI: 1.65–10.1; p = 0.001), stroke symptoms facial deviation (OR: 5.03; 95% CI: 2.47 to 10.26; p = 0.000) and speech disturbances (OR: 2.34; 95% CI: 1.06 to 5.1; p = 0.021), identification of stroke (OR: 22.36; 95% CI: 9.42–53.04; p = 0.000), rushing to ED after onset of symptoms (OR: 2.93; 95% CI: 1.5–5.7; p = 0.001), awareness of treatment of stroke (OR: 10.21; 95% CI: 4.8–21.6; p = 0.000), direct presentation (OR: 4.2; 95% CI: 2.09–8.66; p = 0.000), the distance less than 20 km (OR: 7.9; 95% CI: 3.8–16.5; p = 0.000), and education above high school (OR:4.85; 95% CI: 2.2–10.5; p = 0.000) were associated with early arrival. Heavy traffic, income below 1000 USD per annum and diabetes mellitus were associated with delayed arrival to ED. Out of 46 early arrival patients, only 30 patients (13.15%) received tissue plasminogen activator during the study period, while others were deprived because of their inability to afford the treatment cost. Conclusion Community-based intervention to spread awareness, establishing comprehensive stroke centers, training specialists, improving emergency services, establishment of telestroke facilities and encouraging the use of low-cost tenecteplase as an alternative to alteplase can help improve care for stroke patients in Nepal.
Abstract. The extent and distribution of permafrost in the mountainous parts of the Hindu Kush–Himalayan (HKH) region have barely been investigated and are largely unknown. Only on the Tibetan Plateau a long tradition of permafrost research on rather gentle relief exists. Two permafrost maps are available that cover the HKH and provide estimates of permafrost extent, i.e. the areal proportion of permafrost: the manually delineated Circum-Arctic Map of Permafrost and Ground Ice Conditions (Brown et al., 1998) and the Global Permafrost Zonation Index, based on a computer model (Gruber, 2012). This article provides first-order assessment of permafrost maps of the HKH region based on the mapping of rock glaciers. Rock glaciers were used as a proxy, because they are visual indicators of permafrost, often occurring near the lowermost regional occurrence of permafrost in mountains, and because they can be delineated based on high-resolution remote sensing imagery freely available on Google Earth. For the mapping 4000 square samples (approx. 30 km2) were randomly distributed over the HKH region. Every sample was investigated and rock glaciers were mapped by two independent researchers following precise mapping instructions. Samples with insufficient image quality were recorded but not mapped. It is shown that mapping of rock glaciers in Google Earth can be used as first-order evidence for permafrost in mountain areas with severely limited ground truth. The minimum elevation of rock glaciers varies between 3500 and 5500 m a.s.l. within the region. The Circum-Arctic Map of Permafrost and Ground Ice Conditions does not reproduce mapped conditions in the HKH region adequately, whereas the Global Permafrost Zonation Index appears to be a reasonable first-order prediction of permafrost in the HKH. Only in the central part of the region a considerable deviation exists that needs further investigations.
BackgroundAnxiety and depression are usually under diagnosed among the patients with Chronic Obstructive Pulmonary Disease (COPD), which has a negative impact on patient quality of life through restriction of activities, loss of independence, and decreased social functioning. The purpose of this study was to describe the levels and characteristics of anxiety and depression in patients with COPD in Nepal as compared to the general population.MethodsA hospital-based observational comparative analytical study was conducted in the United Mission Hospital, Tansen and the Okhaldhunga Community Hospital, Okhaldhunga, Nepal from June 1st 2015 to April 15th 2016. A convenience sample of two groups of participants were recruited: patients with COPD (study group) and visitors to the facility (comparison group). Anxiety and depression were measured with the Beck Anxiety and Depression Inventory Scale.ResultsA total of 198 individuals participated in the study; 93 with COPD and 105 from the general population. The mean age of the respondents was 58.24 ± 12.04 (40-82) years. The mean scores for anxiety and depression in COPD group were 23.76± 9.51 and 27.72± 9.37 respectively, while in comparison group, the mean score for anxiety was 8.01± 6.83 and depression was 11.60 ± 8.42. Both anxiety and depression scores were statistically significant between the groups with p value <0.001.ConclusionsAnxiety and depression were almost three times more common in COPD patients compared to the participants from the general population. Early assessment and multi-model treatment of anxiety and depression should be part of management in COPD.
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