GALLSTONES IN PATIENTS WITH INHERITED HEMOLYTIC DISEASES

The purpose is to provide an overview on the incidence of gallstone disease in patients with various types of inherited (chronic) hemolytic diseases at risk of cholelithiasis/choledocholithiasis with particular emphasis on its pathogenesis, genetic, risk factors and management. A detailed electronic literature search to determine the source of materials for this review article was done. The reported incidences of gallstones and choledocholithiasis vary according to the different types of inherited hemolytic diseases and the ethnicity of the studied populations. To date, no review article summarises the incidences of cholelithiasis in patients with various inherited haemolytic diseases was published. Regular ultrasound examination for the presence of gallstones recommended in patients with inherited haemolytic anaemias, particularly those with additional risk factors recommended. Further studies for evaluating the reasons for the higher incidence of cholelithiasis in thalassemia major and sickle cell anemia compared to hereditary spherocytosis; the effect of co inheritance of alpha thalassaemia on decreasing bilirubin level in patients with sickle cell disease and beta thalassaemia; the effect of the co inheritance of UGT1A1 and ABCG8 gene mutation on the incidence of gallstones in other blood diseases such as Hb-H disease, autoimmune haemolytic anaemias, congenital dyserythropoietic anaemia, hereditary elliptocytosis, Southeast Asian Ovalocytosis, glucose-6-phosphate and pyruvate kinase deficiency are recommended. Evaluation of the potential role of the solubility of the mutant proteins and haemoglobin subunit in the red blood cells as an additional mechanism for the development of gallstones in patients with inherited haemolytic anaemias recommended

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

Gallstones in patients with inherited hemolytic diseases

The purpose is to provide an overview on the incidence of gallstone disease in patients with various types of inherited (chronic) hemolytic diseases at risk of cholelithiasis/choledocholithiasis with particular emphasis on its pathogenesis, genetic, risk factors and management. A detailed electronic literature search to determine the source of materials for this review article was done. The reported incidences of gallstones and choledocholithiasis vary according to the different types of inherited hemolytic diseases and the ethnicity of the studied populations. To date, no review article summarises the incidences of cholelithiasis in patients with various inherited haemolytic diseases was published. Regular ultrasound examination for the presence of gallstones recommended in patients with inherited haemolytic anaemias, particularly those with additional risk factors recommended. Further studies for evaluating the reasons for the higher incidence of cholelithiasis in thalassemia major and sickle cell anemia compared to hereditary spherocytosis; the effect of co inheritance of alpha thalassaemia on decreasing bilirubin level in patients with sickle cell disease and beta thalassaemia; the effect of the co inheritance of UGT1A1 and ABCG8 gene mutation on the incidence of gallstones in other blood diseases such as Hb-H disease, autoimmune haemolytic anaemias, congenital dyserythropoietic anaemia, hereditary elliptocytosis, Southeast Asian Ovalocytosis, glucose-6-phosphate and pyruvate kinase deficiency are recommended. Evaluation of the potential role of the solubility of the mutant proteins and haemoglobin subunit in the red blood cells as an additional mechanism for the development of gallstones in patients with inherited haemolytic anaemias recommended