EFFECT OF CORTISOL TREATMENT ON HORMONAL RELATIONSHIPS IN CONGENITAL ADRENAL HYPERPLASIA

The temporal relationship between administration of cortisol and serum 17Α-hydroxyprogesterone was investigated in five patients aged 9-19 years with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. There was marked variability in the 17Α-hydroxyprogesterone response (determined hourly for 24 h) of individual patients to administration of cortisol. Mean concentration was less than 0.030 Μmol/l in one patient but 0.519Μ mol/l in another. Levels were higher in all patients while off treatment, and were greatest in those with salt-losing adrenal hyperplasia. Growth hormone secretion was not suppressed by treatment with cortisol. Withdrawal of cortisol for 3 days resulted in a significant decrease in the mean serum FSH/LH ratio and a rise in serum testosterone in all subjects. Episodic release of gonadotrophins persisted in the adolescent patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75713/1/j.1365-2265.1977.tb02002.x.pd

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

Reusable concrete debris as aggregate replacement on the properties of green concrete

The sustainability of renewable resources is affected by the rapid booming of the construction sector. The massive production of construction and demolition waste by this sector has given drawbacks to the environment as well. An environmentally friendly approach to overcome the disposal of waste materials is via the recycling process. The main objective of this study is to investigate the properties of concrete made by Coarse Aggregate Associated with Concrete Production (CAACP) and Fine Aggregate Associated with Concrete Production (FAACP). Both CAACP and FAACP were obtained from concrete debris from crushed concrete. Some percentage of the concrete debris will be used as an aggregate replacement for concrete production. Six different concrete mixes containing 10, 20 and 30% of coarse and fine aggregate replacement were prepared accordingly. The concrete samples were tested for its strength at 3,7 and 28 days of curing age. The physical properties of the recycle aggregate were also carried out in order to investigate the possible factor that may affect the fresh and hardened concrete. It can finally be concluded that green concrete can be produced by FAACP or CAACP and possibly to produce higher strength compared to the conventional concrete strength