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

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

Efficiency and reliability of serum hepcidin level measurement in evaluation of disease activation in patients with ulcerative colitis.

Purpose: The study is to examine the relationship between hepcidin and inflammation markers and disease severity Materials and methods: Hepcidin levels are determined in 108 Ulcerative Colitis patients and 56 control subjects, a total of 164 subjects, equally active and in remission. Correlations between hepcidin levels and Age, Gender, ESR, CRP, WBC Hb levels are determined in the data. The relationship between hepcidin level of active UC patients and Age, Gender, ESR, CRP, WBC, Hb, Truelove-Witts score and Mayo score is evaluated by regression analysis. Results: ESR, CRP and Hepcidin levels in the Active Ulcerative Colitis group are statistically significantly higher than in the remission and control groups; ESR, CRP, Hepcidin levels are found to be statistically significantly higher in the entire ulcerative colitis group compared to the control group. In addition, a statistically significant positive correlation is found between the hepcidin level and the Truelove Witts score and the Mayo score in the AUC group (p0.05).In the regression analysis perform to determine the factors affecting hepcidin level in ulcerative colitis patients, increase in Age (B=0.143, p0.05), increase in Truelove Witts Score (B=5.224, p0.001) increased Hepcidin level, whereas increase in Erythrocyte Sedimentation Rate decreased hepcidin level (B=-0.160, p0.05) is determined. Conclusion: It is promising that serum hepcidin level can enter into clinical use as a marker that can be used to evaluate not only disease activation but also the severity of activation. © 2024, Pamukkale University. All rights reserved

Exome-wide association study to identify rare variants influencing COVID-19 outcomes: Results from the Host Genetics Initiative.

Host genetics is a key determinant of COVID-19 outcomes. Previously, the COVID-19 Host Genetics Initiative genome-wide association study used common variants to identify multiple loci associated with COVID-19 outcomes. However, variants with the largest impact on COVID-19 outcomes are expected to be rare in the population. Hence, studying rare variants may provide additional insights into disease susceptibility and pathogenesis, thereby informing therapeutics development. Here, we combined whole-exome and whole-genome sequencing from 21 cohorts across 12 countries and performed rare variant exome-wide burden analyses for COVID-19 outcomes. In an analysis of 5,085 severe disease cases and 571,737 controls, we observed that carrying a rare deleterious variant in the SARS-CoV-2 sensor toll-like receptor TLR7 (on chromosome X) was associated with a 5.3-fold increase in severe disease (95% CI: 2.75-10.05, p = 5.41x10-7). This association was consistent across sexes. These results further support TLR7 as a genetic determinant of severe disease and suggest that larger studies on rare variants influencing COVID-19 outcomes could provide additional insights