RESUMO
The International Cardio-Metabolic Forum held a plenary session to establish a multinational consensus on the challenges faced in diabetes management within lower-middle-income countries (LMICs) and their potential solutions. Stakeholders, including patients, family/caretakers, healthcare professionals, and healthcare policymakers & organizations, participated in discussions. The audience of 280 doctors from 15 different countries (Pakistan, Qatar, Sri Lanka, Kenya, Myanmar, Georgia, Nigeria, Philippines, Uzbekistan, Iraq, Tanzania, Cambodia, Kazakhstan, South Sudan and Libya) was divided into 4 groups led by Group Leaders to represent each stakeholder group. Questionnaires addressing key challenges and solutions specific to each group were used to facilitate consensus development. Participants voted on relevant options based on their clinical experience. SLIDO software was used for polling, generating separate results for each group. The insights shared by healthcare professionals highlighted the importance of improving medication accessibility and cost-effectiveness for patients, emphasizing the need for adherence to treatment plans and lifestyle modifications. The significance of balanced nutrition with low glycemic index food for enhancing quality of life was recognized. Caregivers of diabetic patients with comorbidities face increasing demands for care, particularly in relation to age-related milestones. Healthcare professionals emphasized the challenges posed by cultural beliefs and health awareness, underscoring the importance of teamwork and early referral for managing comorbidities. Healthcare policymakers need to focus on disease education, awareness programs, screening guidelines, and advocacy for community and clinical screening. By addressing these challenges, a more comprehensive and effective approach to diabetes management can be achieved in LMICs, ultimately improving outcomes for individuals with diabetes.
RESUMO
INTRODUCTION: Renal ectopia or ectopic kidney is a congenital anomaly in which one or both kidneys are located in an unusual position. It results from the kidney failing to ascend properly from its origin in the true pelvis. In some cases, one kidney may cross over (crossed renal ectopia) so that both kidneys are on the same side of the body. When a crossover occurs, the two kidneys may grow together and become fused (crossed fused renal ectopia). Renal ectopia is generally uncommon; its coexistence with nephrolithiasis is even rarer. Due to its variable presentations, it is usually discovered incidentally, especially when investigating patients for abdominal pain. Treatment may be conservative when renal function is preserved and no complication is associated. CASE REPORT: we highlight the unusual occurrence of renal ectopia with nephrolithiasis in a 34 year-old Nigerian businessman who presented to the renal clinic of our hospital with a three-month history of intermittent dull right flank pain radiating to the right groin. Physical examination revealed right lumbar tenderness without guarding. The rest of the examination was unremarkable. An abdominal ultrasound scan done revealed a linear calculus in the right renal collecting system but the left kidney was not visualised. An intravenous urogram (IVU) showed a crossed ectopic kidney with nephrolithiasis. The patient was treated conservatively and his kidney function has remained stable. CONCLUSION: This case report describes the relatively uncommon finding of crossed renal ectopia associated with nephrolithiasis.
