Role of NGOs and CBOs in waste management

Developing cities like Khulna, the third largest metropolitan city in Bangladesh, have now begun to confess the environmental and public health risks associated with uncontrolled dumping of solid wastes mainly due to the active participation of non-governmental organizations [NGOs] and community-based organizations [CBOs] in municipal solid waste [MSW] management. A survey was conducted to observe the present scenarios of secondary disposal site [SDS], ultimate disposal site [UDS], composting plants, medical wastes management and NGOs and CBOs MSW management activities. A total of 22 NGOs and CBOs are involved in MSW management in 31 wards of Khulna City Corporation. About 9 to 12% of total generated wastes are collected by door-to-door collection system provided by mainly NGOs and CBOs using 71 non-motorized rickshaw vans. A major portion of collected wastes is disposed to the nearest SDS by these organizations and then transferred to UDS or to private low-lying lands from there by the city authority. A small portion of organic wastes is going to the composting plants of NGOs. The participation of NGOs and CBOs has improved the overall MSW management system, especially waste collection process from sources and able to motivate the residents to store the waste properly and to keep clean the premises

Successful surgical resection of advanced gastrointestinal stromal tumor post neoadjuvent therapy

We report a case of a 48-year-old Indian male who presented with swelling and firmness in his left upper part of the abdomen of one month duration with anorexia and weight loss. Initial examination revealed an intra abdominal mass of around 16.8x11.0x24.5cm with minimal left sided pleural effusion. A biopsy from the mass confirmed the diagnosis of gastrointestinal stromal tumour [GISTs] as supported by immmunohistochemistry results which showed strong positivity for c-kit while stains for smooth muscle actin, desmin, myoglobin, S100 Protein and cytokerstin remained negative. The patient was not suitable for surgical intervention in view of advanced tumor, and Imatinib Mesylate 400mg daily was started with the aim of making the tumor operable. Such therapy lasted for twenty months and was tolerated well by the patient. It then resulted in gradual tumor regression, following which the patient underwent successful tumor resection. Post surgical resection patient had no radiological evidence of intra abdominal tumor but mild left sided pleural effusion with left lower lobe atelectasis. The patient had uneventful post operative recovery and he is currently on Imatinib mesylate and tolerating treatment well with mild skin rash. The experience with preoperative imatinib on surgical resection rates and post operative outcomes is limited especially with primary locally advanced GISTs. In our case successful surgical resection was possible for a huge locally advanced GIST with unusually prolonged treatment of twenty months with imatinib preoperatively

Repair of inguinal hernia as day care [ambularoty] vs inpatient [routine] surgery, study at Mayo Hospital, Lahore

This cross sectional, comparative study carried out in the Department of Surgery, Mayo Hospital, Lahore over a period of one year. Study include 80 patients divided in two equal groups i.e., day care [ambulatory] and inpatient [routine]. To compare postoperative complication, economic benefits, routine daily activity and also to evaluate acceptance of day surgery in our set up. Those belonging to day surgery were worked up on OPD basis and in combination and procedures performed were herniotomy or herniorrhaphy. The final results were conclusive enough to show that day care hernia can be successfully performed in one set up and comparable results in terms of operative and postoperative complications can be obtained and are matchable to any hernia centre. Hospital stay and expenses of treatment on hospital resources are significantly reduced

Anesthesia and congestive heart failure: pathology, medical and surgical management

Congestive heart failure [CHF] is increasingly being recognized as a health problem in the United States. It is estimated that the lifetime risk for CHF is 1 in 5. The clinical anesthesiologist can expect to see several cases involving patients suffering from CHF. Because of the danger associated with surgery in a patient with CHF, a thorough knowledge of the disorder and the potential effects on the delivery of anesthetics must be considered. In addition, knowledge of the disease process and its manifestations is required for smooth guidance of the patient through the perioperative period. The understanding of current pharmacotherapies, surgical procedures and their implications related to interactions with anesthetics are all discussed