Universal health coverage evolution, ongoing trend, and future challenge: A conceptual and historical policy review

The goal of universal health coverage (UHC) from the United Nations (UN) has metamorphized from its early phase of primary health care (PHC) to the recent sustainable development goal (SDG). In this context, we aimed to document theoretical and philosophical efforts, historical analysis, financial and political aspects in various eras, and an assessment of coverage during those eras in relation to UHC in a global scenario. Searching with broad keywords circumadjacent to UHC with scope and inter-disciplinary linkages in conceptual analysis, we further narrated the review with the historical development of UHC in different time periods. We proposed, chronologically, these frames as eras of PHC, the millennium development goal (MDG), and the ongoing sustainable development goal (SDG). Literature showed that modern healthcare access and coverage were in extension stages during the PHC era flagshipped with "health for all (HFA)", prolifically achieving vaccination, communicable disease control, and the use of modern contraceptive methods. Following the PHC era, the MDG era markedly reduced maternal, neonatal, and child mortalities mainly in developing countries. Importantly, UHC has shifted its philosophic stand of HFA to a strategic health insurance and its extension. After 2015, the concept of SDG has evolved. The strategy was further reframed as service and financial assurance. Strategies for further resource allocation, integration of health service with social health protection, human resources for health, strategic community participation, and the challenges of financial securities in some global public health concerns like the public health emergency and travelers' and migrants' health are further discussed. Some policy departures such as global partnership, research collaboration, and experience sharing are broadly discussed for recommendation.

Arthroscopic Debridement for Mucoid Degeneration of Anterior Cruciate Ligament - A Single Institution Experience from Nepal

Background Mucoid degeneration of anterior cruciate ligament is characterized by infiltration of mucoid-like material scattered throughout the anterior cruciate ligament substance. It is an uncommon condition, but previously, underdiagnosed or often misdiagnosed as an anterior cruciate ligament tear. Objective To present our early experiences with mucoid degeneration of anterior cruciate ligament in last five years in terms of clinical presentation and the outcomes of arthroscopic management. Method This was a retrospective descriptive cross-sectional study on patient who received arthroscopic debridement for mucoid degeneration of anterior cruciate ligament in Dhulikhel Hospital over five years period (2017 May to 2022 April). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale that has been translated and validated to be used in local (Nepali) language and context was used for evaluation of outcome evaluation. Result Twenty-one patients of mean age 44.21 years, predominantly females (18), were managed in five years period. The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 16.33±10.47 with a range of 0 to 36 (11.57 to 21.09 at 95% confidence interval). The mean Western Ontario and McMaster Universities Osteoarthritis Index score converted on a scale of 0 to 100 was 17. Thirteen patients had isolated Mucoid degeneration of anterior cruciate ligament whereas nine others had associated either meniscal tear or chondral lesions. Conclusion Mucoid degeneration of anterior cruciate ligament could be a cause of knee pain in middle-aged patients and arthroscopic debridement can improve the patient's symptoms and provide a good functional outcome.

Bending of pinned dust-ion acoustic solitary waves in presence of charged space debris

We consider a low temperature plasma environment in the low Earth orbital region in the presence of charged space debris particles. The dynamics of (2+1)-dimensional nonlinear dust-ion acoustic waves with weak transverse perturbation, generated in the system, is found to be governed by a forced Kadomtsev-Petviashvili equation, where the forcing term depends on charged space debris function. The bending phenomena of some exact dust-ion acoustic solitary wave solutions in the x-t and x-y planes are shown; they result from the consideration of different types of possible localized debris functions. A family of exact pinned accelerated solitary wave solutions has been obtained where the velocity changes over time but the amplitude remains constant. The shape of the debris function also changes during its propagation. Also, a special exact solitary wave solution has been derived for the dust-ion acoustic wave that gets curved in spatial dimensions with the curvature depending upon the nature of the forcing debris function. Such intricate solitary wave solutions may be useful in modeling real experimental data.

Development assistance for health given to Nepal by China and India: a comparative study

BACKGROUND

Development assistance for health (DAH) promotes health development in low and middle income countries. China and India, as emerging donors, have scaled-up their DAH programs during the recent years. Nepal, as a neighboring country to China and India, has witnessed the history and development of China's and India's DAH.

METHODS

This research uses a literature review and in-depth individual interviewing to compare the history and forms of DAH given from China and India to Nepal.

RESULTS

During 60-years of DAH to Nepal, China and India have gradually increased the scale and forms of DAH, and both focus on dispatching medical teams or faculty, building health facilities and gifting medicines and equipment. However, the inclusiveness of Nepalese culture, diplomatic interests, and Nepal's cultural, linguistic and geographical closeness to India make the DAH of India different from that of China. India's DAH also includes support to grass roots NGOs and public health interventions.

CONCLUSION

China's and India's insistence on a recipient-driven mechanism keeps the aid programs aligned with Nepal's health development plan and respects Nepal's "ownership". China can learn from India to start the development assistance for health related NGOs and public health intervention.

Unexplained apnoea and loss of consciousness during sub arachnoid block for caesarean section

Sub arachnoid block (SAB) is often perceived safe by many anesthesiologists and other faculties but is also not completely safe choice especially in pregnant females, as the incidence of complications and local anaesthetic agent toxicity is high in these groups of patients. Here we present four such cases out of the seventeen patients over a period of six months, who developed apnea and transient loss of consciousness after spinal anesthesia for lower segment caesarean section. Typically all these patients after spinal anesthesia developed difficulty in breathing, became apnoea and had loss of consciousness for about a minute or two. The apnea was relieved with bag and mask ventilation following which the patient regained consciousness and start breathing normally. The rest of the procedure was uneventful. We presented these cases with aim of sharing similar experiences, and to aware about the possibility of such events as these events do occur frequently but case reports and literatures are unavailable.

Blind nasal intubation in a child with ankylosis of temporomandibular joint

Blind nasal intubation has been one of the favoured methods of intubating the trachea in patients with restricted mouth opening and thus a difficult laryngoscopy and oro-tracheal intubation. Here, we describe airway management of patient who presented with traumatic ankylosis of the right temporomandibular joint and reduced mouth opening that was planned for elective release of the ankylosis and temporalis fascia flap. Successful blind nasotracheal intubation was done and after the surgery was completed, awake extubation was done and mouth opening was significantly increased. The recovery and the post-operative periods were uneventful.

Application of "the Sequential Organ Failure Assessment (SOFA) score" in predicting outcome in ICU patients with SIRS

BACKGROUND

Various scoring systems have been developed to prioritize patient admission and management in ICU. The objective of this prospective, observational cohort study was to evaluate application of one such system, the Sequential Organ Failure Assessment (SOFA) Score in predicting outcome in ICU patients with SIRS.

PATIENTS AND METHODS

Fifty patients admitted to a six bed multidisciplinary ICU with SIRS were consecutively enrolled in the study and SOFA scores were calculated at zero hour, after 48 hrs, and after 96 hrs and patients followed till discharge from hospital.

RESULTS

When compared to outcome, the non survivors had high initial, mean and highest SOFA scores as compared to survivors. (p value = 0.002, <0.001, <0.001 respectively). Delta SOFA was not significantly associated with outcome. (p value= 0.117). The initial SOFA score > 11 predicted a mortality of 90%. (OR 23.72, 95%CI2.68-209.78, p=0.004). Similarly, mean SOFA score of > 7 predicted a mortality of 73.9% (OR 22.7, 95%CI 5.0 - 103.5, p<0.001) and high SOFA score > 11 predicted a mortality of 87.5% (OR 32.66, 95%CI 5.82-183.179, p< 0.001). Area under receiver operating characteristic (ROC) curve for mean SOFA was 0.825, for high SOFA was 0.817 and for initial SOFA was 0.708. Thus mean, high and initial SOFA scores were helpful in predicting between the survivors and the non survivors.

CONCLUSION

The SOFA scoring system is useful in predicting outcomes in ICU and thus help in proper utilization of ICU resources.

A case of left atrial myxoma: anaesthetic management

Left Atrial Myxomas are notorious for their varied presentations. We describe one such case which initially presented with hemiparesis and seizures and was diagnosed as cerebral infarction and treated accordingly and decompression craniotomy with hinge flap was done for raised ICP and impending brain herniation. The main cause was a left atrial myxoma, which was diagnosed only in follow up. The myxoma has embolised to give rise to cerebral infarction. The LA myxoma was then successfully operated under general anaesthesia and Cardiopulmonary bypass (CPB).

Antimalarials. 3. 3-Substituted 1-naphthalenemethanols

The synthesis and antimalarial activity of 22 3-substituted 1-naphthalenemethanols whose substitution was patterned after the antimalarial 2-substituted 4-quinolinemethanols are described. The compounds were active against Plasmodium berghei in mice, the most active being 6-chloro-alpha-(dibutylaminomethyl)-3-(3,4-dichlorophenyl)-1-naphthalenemethanol hydrochloride (3b). The naphthalenemethanols tested, 1b and 2b, were not photosensitizing to albino mice. Structure-activity relationships between the naphthalene and quinoline isosteres are discussed.