Non-communicable diseases in humanitarian settings: ten essential questions.

Non-communicable diseases (NCDs) represent the primary cause of morbidity and mortality worldwide. Specific attention needs to be given in fragile and crisis-affected contexts, where health systems have even more difficulties in addressing and managing these diseases. Humanitarian actors intervening in crisis situations increasingly include NCD management in the services they support and provide. This review aims at presenting a series of questions that humanitarian agencies could consider when addressing NCDs in humanitarian crises. They include, among others, what conditions to address and for which target population, how to ensure continuity of care, which guidelines and medications to use, and what can be done beyond classical management of NCDs.Research and evidence are lacking on how to address care effectively for NCDs in emergencies. Therefore, advocacy is needed for NCD-oriented research so as to make interventions more effective and sustainable. No government or single agency can address NCDs in humanitarian crises alone. Strong leadership and partnerships between humanitarian actors, health providers, government bodies, research and academic institutions are required. Only a coordinated multi-disciplinary and multi-stakeholder approach will achieve the required impact for affected populations.

[Value of abdominal ultrasonography for indication of cholecystectomy]. / Valeur de l'ultrasonographie abdominale dans l'indication à une cholécystectomie.

A review of the gall-bladder content of the 193 patients that underwent a cholecystectomy at the University Hospital of Lausanne, Switzerland, in 1977, was done in order to find out the diagnostic accuracy of sonographic examination of the gall-bladder, oral cholecystography and intravenous cholangiography. Sonographic examination of the gall-bladder proofed to be accurate in 92.5% of 109 cases. We found a false negative rate of 4.5% (5 cases) and a false positive rate of 1% (1 case) as well as an indeterminate rate of 2% (2 cases). In 37% (46 cases) of the 124 patients that underwent oral cholecystography and/or intravenous cholangiography the gall-bladder was not visualized. Sonographic examination of gall-bladder is free of side effects and can be done on emergency, on jaundiced or pregnant patients, and it is enough reliable for the surgeon to make a decision to operate the gall-bladder. Low cost of the procedure is another point in favour of sonographic examination of the gall-bladder.