High Altitude Illness: Knowledge, Practice, and Attitudes of Porters in Nepal.

INTRODUCTION: Porters working at high altitude face a number of preventable health risks ranging from frostbite to potentially fatal high-altitude pulmonary and cerebral edema. Porters are often recruited from impoverished low-altitude areas, poorly equipped in terms of protective clothing, and tasked with carrying loads that equal or exceed their body mass to high elevations. Despite a large population of porters working throughout mountainous parts of the world, there is little documentation regarding knowledge levels, attitudes, and practices related to the prevention of altitude illness in this population. Much of the literature focuses on biomechanics of load carrying for porters or altitude issues for trekkers. METHODS: A cross-sectional survey was developed using a modified Delphi technique. The survey was administered to a convenience sample of porters (n=146) from diverse cultural groups between Lukla (2774 m) and Everest Base Camp (5361 m). RESULTS: Many of the porters started at a young age, carried heavy loads, and had difficulty identifying symptoms of high altitude illness, and less than 20% correctly identified preventive measures for high-altitude illness. CONCLUSIONS: Porters in the Khumbu region continue to face hazards in their working environment. Future research and health education campaigns should address knowledge deficits and help with the design of tailored interventions.

Comparison of Scapular Manipulation With External Rotation Method of Reduction of Acute Anterior Shoulder Dislocation for Sedation Requirements and Success Rates.

BACKGROUND: Anterior shoulder dislocation is a common sports-related musculoskeletal injury. Various methods have been described for reduction of the dislocation. A method that requires less sedation without compromising the success rate is likely to be highly useful in austere and prehospital settings. This study compares scapular manipulation with external rotation method for requirement of sedation and success rates. METHODS: Forty-six patients with anterior shoulder dislocation were allocated alternatively to reduction using either scapular manipulation (SMM) or external rotation (ERM) techniques. The groups were compared for sedation requirements, pain scores, and success rates. RESULTS: Reductions using SMM had fewer requirements for sedation (13% versus 39%; p < .05) and higher first-pass success rates (87% versus 61%; p < .05) as compared with ERM for anterior shoulder dislocation reduction. The numeric rating score of pain during reduction procedures was less in SMM (mean, 1.65 [standard deviation, 1.6]) than in ERM group (mean, 4.30 [standard deviation, 1.8]; p < .01). CONCLUSION: The SMM required less sedation and had higher first-pass success rates than ERM for reduction of anterior shoulder dislocation. The SMM is thus likely to be of advantage in resource-limited austere settings.

Yarsagumba Fungus: Health Problems in the Himalayan Gold Rush.

INTRODUCTION: Seasonal migration of people in search of Yarsagumba fungus creates a population of collectors that faces hardship and health risks in austere high-altitude settings. METHODS: In 2016, our 4-person team performed a 2-day health-needs survey of people collecting Yarsagumba fungus near the village of Yak Kharka (4020 m) in the Manang District of Nepal. RESULTS: There were approximately 800 people, both male and female, from age 10 to over 60, collecting Yarsagumba fungus. They had paid high prices for permits, hoping to recoup the cost and make a profit by selling specimens of Yarsagumba, but the fungus seemed scarce in 2016, resulting in a bleak economic forecast. Most collectors were living in austere conditions, walking long hours to the collection areas early in the morning and returning in the late afternoon. Most were subsisting on 1 daily meal. Health problems, including acute mountain sickness as well as respiratory and gastrointestinal illnesses, were common. Yarsagumba has become harder to find in recent years, increasing hardships and risk of injury. Medical care was almost nonexistent. CONCLUSION: As abundance decreases and demand increases, there is increasing pressure on collectors to find Yarsagumba. The collectors are an economically disadvantaged population who live in austere conditions at high altitude with poor shelter and sanitation, strenuous work, and limited availability of food. Health care resources are very limited. There are significant risks of illness, injury, and death. Targeted efforts by government entities and nongovernmental organizations might be beneficial in meeting the health needs.

Retinal Hemorrhage in a High-Altitude Aid Post Volunteer Doctor: A Case Report.

Bhandari, Sanjeeb Sudarshan, Pranawa Koirala, Nirajan Regmi, and Sushil Pant. Retinal hemorrhage in a high-altitude aid post volunteer doctor: a case report. High Alt Med Biol. 18: 285-287, 2017.-High-altitude retinal hemorrhages (HARHs) are seen at altitudes more than 3000 m, are usually multiple, flame shaped, and adjacent to blood vessels. Development near the macula causes blurring of vision, otherwise, they are symptomless and self-limiting. They often develop during the first few days after ascent to high altitude and subjects often suffer from acute mountain sickness (AMS) or high-altitude cerebral edema (HACE). People going to high altitude for the first time are more susceptible to retinal hemorrhages than experienced climbers and high-altitude dwellers. We present a case of a 31-year-old male doctor who developed sudden unilateral blurring of vision without any other symptoms after 6 weeks of volunteering at a high-altitude aid post in Nepal. There were no features suggestive of AMS or HACE. All examinations were normal except for fundoscopic examination in the left eye, which determined macular retinal hemorrhage. Although he was reluctant to descend, he was counseled to descend and refrained from further ascent to higher altitude, which could accentuate hypoxemia and any strenuous activities that increase intraocular pressure. He recovered his vision after few weeks in Kathmandu and his retinal hemorrhages regressed. Hypoxia exacerbated by repeated bouts of rapid ascent to further higher altitudes may have contributed to his HARH. This suggests that unilateral retinal hemorrhages can develop even after several weeks at high altitude without concomitant AMS or HACE. People going to high altitude are reluctant to retreat, before reaching their target, when they suffer from HARH. The same is shown by a physician. So it is very important for healthcare professionals working at high altitudes especially in the Himalayas of Nepal to have a good knowledge about HARH and its proper treatment.

Breathlessness at High Altitude: First Episode of Bronchoconstriction in an Otherwise Healthy Sojourner.

Bhandari, Sanjeeb Sudarshan, Pranawa Koirala, Sadichhya Lohani, Pratibha Phuyal, and Buddha Basnyat. Breathlessness at high altitude: first episode of bronchoconstriction in an otherwise healthy sojourner. High Alt Med Biol.. 18:179-181, 2017-High-altitude illness is a collective term for less severe acute mountain sickness and more severe high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema, which we can experience while traveling to high altitude. These get better when we get down to the lower altitudes. People with many comorbidities also have been traveling to high altitudes from the dawn of civilization. Obstructive airway diseases can be confused with HAPE at high altitude. Asthma is one of those obstructive pulmonary diseases, but it is shown to get better with travel to the altitudes higher than the residing altitude. We present a case of 55-year-old nonsmoker, athletic, female, a lowland resident who developed difficulty breathing for the first time at high altitude. She did not get better with the descent to lower altitude and timely intake of acetazolamide. Her pulmonary function test showed obstructive airway pattern, which got better with salbutamol/ipratropium nebulization and oxygen.