Global surgery is interpreted differently and may lack an in-depth understanding which is complicated by socio-economy and culture. Global surgery and global health have become part of health care service following the report of the Lancet Commission. Sustainability, ethical principles, and decolonization are some important ongoing issues for recipient societies. Incorporating societal dimensions, socio-cultural values, patients’ needs, and affordability requires a tailored approach and not blindly pursuing the best technology. The recent COVID-19 has exposed the unethical and inequity in terms of equitable healthcare, vaccine rollout and its access, and unprecedented high mortality observed in some societies. Surgery has been a neglected stepchild of global health and in addition global surgery must not be a slave of technology for the promotion of the ‘gold standard’, especially corporate-led commercialized services because a sustainable and effective surgical service at a reduced cost is desirable for all, be resource-rich or poor. Global surgery and global health include health security and universal health coverage. Stakeholders of global surgery need to be aware that ‘one size does not fit all’ and are required to consider the diverse conditions.
Introduction: Extracorporeal shockwave lithotripsy (ESWL) is a day care, less invasive procedure not requiring anesthesia for the treatment of renal and ureteric stones. Method: This was a cross sectional study of retrospectively collected data on ESWL during May 2018 to January 2020 at the department of Urology, Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal. The data on ESWL for renal and upper ureteric stone up to the size of 20 mm were included. Stone clearance was defined as stone fragment <4 mm on kidney ureter bladder (KUB) X-ray or ultrasonography (USG) during follow up at 1 - 3 mo. Ethical approval was obtained from NAMS ethical committee. Microsoft Excel was used for descriptive analysis of age, gender, stone size, density, location, hydronephrosis, and clearance. A Chi square test was used for association, and a p-value <0.05 considered statistically significant. Result: Out of 79 cases, overall stone clearance was 48(60.8%), 100% for <10 mm (14/14) and density <500 HU (5/5), and 80% for upper ureteric stone (4/5) and 74.1% for those without hydronephrosis (20/27). Patients in age group of 20-39 y accounted for 48(60.8%), males 52(65.8%), 52(65%) had 10-15 mm stones, 46(58.2%) in pelvis, 48(60.8%) density of 751-1000 HU, and mild hydronephrosis present in 44(55.7%). Conclusion: Stone clearance were highest (100%) for small stone <10 mm size and low density <500 HU. The stone clearance rate decreased as the size, density, and hydronephrosis increased.
Introduction: Features of Acid Peptic Disease (APD) have specific presentations from low to high altitudes. This study aims to compare the endoscopy findings of APD at low altitudes (Kathmandu Valley) and High Altitudes (Rasuwa District) of Nepal. Method: Endoscopy findings of APD patients from Nov 2017 to Dec 2021 at Manmohan Medical College and Teaching Hospital (MMTH) were reviewed from the data kept in the endoscopy unit to compare the findings in patients from low altitudes (Kathmandu valley) and high altitudes (Rasuwa district). Variables included were age, sex, and endoscopy findings of APD. Microsoft Excel was used for data analysis. Chi-square analysis was used for the association between APD findings and altitude. A p-value ≤0.05 was considered statistically significant. Result: Out of 2937 APD patients, 1560 (53.1%) were male and 1377(46.9%) female, age 48.5 years (range 16-81) with 2701(91.6%) having endoscopic findings of APD. Among 2701 APDs, 1448 (88.6%) were from the low altitude of Kathmandu valley, and 1253 (96.2%) from high altitude (Rasuwa district), p-value <0.0002. There were 736(50.8%) patients with gastritis from Kathmandu vs. 695 (55.46%) from Rasuwa, followed by gastro-duodenitis 219(15.1%) vs. 32 (2.5%), duodenitis 171 (11.8%) vs. 169(13.5%) respectively. Conclusion: The incidence of endoscopic findings of overall APD was high among patients from the high altitude of Rasuwa district compared to the low altitude Kathmandu valley of Nepal.
Hydatid cyst is a zoonotic disease caused by Echinococcus granulosus, transferred through the oral-fecal pathway by eating vegetables and food contaminated with dog stool containing eggs of the parasite. Hydatid cyst is most commonly found in the liver; however, dissemination can occur in other organs such as the lung and rarely in the heart, breast, thyroid, soft tissue of the neck, and kidney. The surgical approach remains the treatment of choice in hydatid. Meticulous handling of hydatid is important preoperatively and care should be taken against spillage of the contents and daughter cysts. In this case report, we report a case of recurrence of renal hydatidosis.
Introductions: Ureteropelvic junction obstruction (UPJO) is a common renal disease where flow of urine is obstructed from renal pelvis to ureter leading to renal function deterioration. This study analysed the functional outcome of patients after Anderson-Hynes (A-H) pyeloplasty for UPJO. Methods: Retrospective analysis was done for renal function outcome on patients who underwent either open or laparoscopic dismembered A-H pyeloplasty during 20 months period from May 2017 to November 2018 in the Department of Urology in Bir Hospital, National Academy of Medical Sciences (NAMS), Kathmandu, Nepal. Renal functional outcome was based on pre and post-operative glomerular filtration rate and split renal function. Ethical approval was obtained from institutional review board (IRB-NAMS). Descriptive analysis of data was performed. Results: Total 22 patients, 15 male and 7 females underwent dismembered pyeloplasty. The age ranged from 18 months to 65 years. Improvement of split renal functions was noted in 18 out of 22 (81.3%). Conclusions: A-H pyeloplasty is effective surgical option for functional renal improvement in patients with obstructive UPJO.
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