Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Silver Sulfadiazine and Boric Acid Are Effective in Protecting the Stasis Zone From Secondary Ischemia

Suer, Muhammed Salih/0000-0002-1850-072XA burn wound is characterized by hyperemia on the outer layer, stasis in the middle zone, and coagulation zones in the innermost region due to thermal damage to the skin. It is crucial to provide prompt and adequate treatment to prevent further damage. The depth of the burn increases as ischemic indicators become more distinct in the stasis zone when the burn is not adequately treated, despite the absence of ischemic signs in the stasis zone at the initial stages of the wound. This study aims to assess the impact of silver sulfadiazine, boric acid, low-molecular-weight heparin, and glyceryl trinitrate on wound healing in the stasis zone. The study involved 4 intervention groups, each consisting of 6 rats, and a sham group. After 7 days of daily topical application of the active substances, the animals were sacrificed, and wound healing in the stasis zones was evaluated through macroscopic, histological, and immunohistochemical analysis. These findings demonstrate the effectiveness of these treatments in promoting wound healing. The results demonstrated that the boric acid and silver sulfadiazine groups exhibited the highest levels of wound healing, both macroscopically and histologically. Immunohistochemistry revealed significant differences, with the silver sulfadiazine group demonstrating superior results in MMP9 staining and the boric acid group in VEGF staining (P .05). These findings suggest that boric acid and silver sulfadiazine effectively prevent ischemia in the stasis zone. Boric acid, in particular, appears to have significant potential as a wound-healing agent due to its anti-inflammatory properties.This research was produced from the author's thesis, supported by funding from Hacettepe University BAP. Local ethical committee approval was obtained for this study. There are no conflicts of interest to declare. The authors declare that they have no conflicts of interest or disclosures to report.Hacettepe University BA

Noninvasive models to predict liver fibrosis in patients withchronic hepatitis B: a study from Turkey

Background: Manynoninvasive methods, including aspartateaminotransaminase (AST)/alanineaminotransaminase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), Bonacini cirrhosis discriminant score (CDS), fibrosis-4 (FIB4) index, and age-platelet index (API), have been described to determine the stage of hepatic fibrosis. However, thesemethodsare developed for patients with chronic hepatitisC(CHC) andproduce conflicting results in the prediction of liver fibrosis in patients with chronic hepatitis B (CHB). Objectives: The aim of this study was to evaluate the relationship between 7 noninvasive models, including AAR, APRI, CDS, API, FIB-4, neutrophil-to-lymphocyte ratio (NLR), and red cell distribution width (RDW)-to-platelet ratio (RPR) in patients with CHB. Methods: The study population included all patients with CHB, undergoing liver biopsy to determine HBsAg and HBV DNA positivity in more than 6 months. Results: A total of 2520 treatment-naive CHB patients from 40 different centers were included in the study. In total, 62.6% of the patients were male, and the mean age was 40.60 +/- 12.34 years (minimum, 18 years; maximum, 77 years). The Ishak fibrosis score was >= 3 in 29.8% of the patients, indicating significant fibrosis. The mean API, APRI, CDS, NLR, FIB4, and RPR scores in the noninvasive models were significantly different between the groups with significant and low fibrosis (P < 0.05). All the noninvave models (API, APRI, AAR, CDS, NLR, RPR, and FIB4) were found to be significant in the discrimination of cirrhosis (P < 0.05). In the multiple logistic regression analysis, CDS, albumin, alkaline phosphatase (ALP), total bilirubin, neutrophil count, NLR, mean platelet volume (MPV), and FIB4 were independent indices for cirrhosis. Conclusions: In the present study, the role of noninvasive tests in the prediction of liver fibrosis stage and cirrhosis was evaluated in a large cohort of CHB patients. Overall, noninvasive models are gradually becoming more promising. Accordingly, the need for liver biopsy can be reduced with a combination of noninvasive methods in the future