Unlike other countries in South Asia, in Nepal research in the health sector has a relatively recent history. Most health research activities in the country are sponsored by international collaborative assemblages of aid agencies and universities. Data from Nepal Health Research Council shows that, officially, 1,212 health research activities have been carried out between 1991 and 2014. These range from addressing immediate health problems at the country level through operational research, to evaluations and programmatic interventions that are aimed at generating evidence, to more systematic research activities that inform global scientific and policy debates. Established in 1991, the Ethical Review Board of the Nepal Health Research Council (NHRC) is the central body that has the formal regulating authority of all the health research activities in country, granted through an act of parliament. Based on research conducted between 2010 and 2013, and a workshop on research ethics that the authors conducted in July 2012 in Nepal as a part of the on-going research, this article highlights the emerging regulatory and ethical fields in this low-income country that has witnessed these increased health research activities. Issues arising reflect this particular political economy of research (what constitutes health research, where resources come from, who defines the research agenda, culture of contract research, costs of review, developing Nepal's research capacity, through to the politics of publication of data/findings) and includes questions to emerging regulatory and ethical frameworks.

Ethical review by expert committee continues to be the first line of defence when it comes to protecting human subjects recruited into clinical trials. Drawing on a large scale study of biomedical experimentation across South Asia, and specifically on interviews with 24 ethical review committee [ERC] members across India, Sri Lanka and Nepal, this article identifies some of the tensions that emerge for ERC members as the capacity to conduct credible ethical review of clinical trials is developed across the region. The article draws attention to fundamental issues of scope and authority in the operation of ethical review. On the one hand, ERC members experience a powerful pull towards harmonisation and a strong alignment with international standards deemed necessary for the global pharmaceutical assemblage to consolidate and extend. On the other hand, they must deal with what is in effect the double jeopardy of ethical review in developing world contexts. ERC members must undertake review but are frequently made aware of their responsibility to protect interests that go beyond the 'human subject' and into the realms of development and national interest [for example, in relation to literacy and informed consent]. These dilemmas are indicative of broader questions about where ethical review sits in institutional terms and how it might develop to best ensure improved human subject protection given growth of industry-led research.

Introduction: The article presents early Outcomes in laparoscopic colorectal surgery according to tumour size, duration of surgery, duration of postoperative analgesic requirements, recovery of bowel function, postoperative complications, and mortality. Aim: The aim of the analysis is to describe the short-term outcomes of our patients who endured laparoscopic colonic surgery because of various colon pathologies. Study Design: A Retrospective Case Review cohort study. Methods: The surgical and clinical records of all laparoscopic assisted colon procedures were reviewed and selected for the study held in the Surgical department of Social Security Landhi Hospital Karachi for two years duration from June 2019 to June 2021. All patients underwent surgery under general anaesthesia. Results: During this period, 62 total laparoscopic assisted colon (LAC) procedures were achieved. 41were male and 21 females. 54 patients underwent cancer surgery out of which 51 patient had adenocarcinoma of colon, 2 patient had carcinoids of bowel , and 1 patient had Hodgkin’s lymphoma. Ileocecal tuberculosis was noted in 5 patients and submucosal polyps in one patient. Of these 54 procedures for colonic cancer , 12 were left hemicolectomy, 34 right hemicolectomy, 2 segmental splenic flexure resections, 3 segmental resection with transverse colostomy and 3 sigmoid colectomy The average time of LAC surgery was 140 minutes (range 60 to 250). The average duration of analgesic drugs was 3 days (range 3–6). The median time to the first movement in the bowel was 2.5 days (range 2–4) and the hospital stay was 6 days (range 5–10). Conclusions: Laparoscopically assisted colon procedures are associated with early return of bowel function, less analgesic consumption, short hospital stays, and a lower rate of post operative complication. Laparoscopic colorectal surgery is achievable with optimum operative time and is a logical advantage for good operative outcomes with advanced laparoscopic skills. Keywords: Laparoscopically assisted colon surgery, laparoscopy and Colon cancer.

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