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

The Health System’s Response to and the Impact of COVID-19 on Health Services, Providers, and Seekers: A Rapid Review in the Wake of the Pandemic

Background: The COVID-19 pandemic disrupted global healthcare systems, requiring rapid adaptations. This study evaluates the impact on health systems and services in India during the peak of the first wave and its aftermath. It analyses disruptions, adaptive measures, and challenges faced by healthcare providers and seekers to enhance future preparedness. Methods: Primary studies conducted in India exploring the impact of COVID-19 on health services provision, utilisation, availability, and the well-being of providers and seekers were included. Electronic searches were conducted in six databases: PubMed, MEDLINE, Embase, Global Health, CINAHL, and the WHO database on COVID-19. The results were analysed using narrative synthesis. Results and Conclusion: The review examined 38 articles with 22,502 subjects. Health service provision, utilisation, and availability were significantly impacted, particularly in outpatient departments (n = 19) and elective services (n = 16), while emergency services remained sub-optimal (n = 20). Adaptations were made in precautionary measures, protocols, staff allocation, training, personal protective equipment (PPE), infrastructure, and resources. Providers faced mental health challenges including depression, stress (n = 14), fear of infection (n = 9), stigmatisation (n = 5), and financial repercussions (n = 5). Seekers also encountered notable challenges (n = 13). Future preparedness necessitates improved healthcare infrastructure, resource optimisation, and comprehensive protocols. Lessons should inform strategies to mitigate disruptions and prioritise the well-being of providers and seekers in future outbreaks

Room temperature hydrogen sensing with polyaniline/SnO2/Pd nanocomposites

In this work, we report unique hybrid composite film fabricated with the amalgamation of metal, semiconductor and polymers for hydrogen sensing application at room temperature. Fabrication of a novel nanocomposite film based on tin oxide (SnO2) nanosheets with polyaniline (PANI) doped with palladium (Pd) is performed using the hydrothermal synthesis technique. Functional aspects of the fabricated films are investigated with XRD, Raman spectra, FESEM, and FTIR spectral analysis. Interactions of the H2 gas molecules with SnO2, SnO2-Pd, PANI, PANI-SnO2, PANI-SnO2-Pd nanocomposite are also theoretically studied. Using first-principles density functional theory, the effects of gas adsorption on the electronic and transport properties of the sensor are examined. The computations show that the sensitivity of the SnO2 to the H2 gas molecules is considerably improved after hybridisation with Pd and, the sensitivity of the PANI to the H2gas molecules is considerably improved after hybridisation with SnO2.Gas sensing characteristics of fabricated films of SnO2, PANI and composite of SnO2/PANI/Pd are also experimentally investigated at room temperature with varying concentration level ranging from 50 to 400 ppm. The highest sensitivity among all the films at room temperature has been observed as ~540% for the SnO2/Pd film at 0.4% of the target gas and performance factor (the ratio of response percentage to total cycle time) is evaluated highest in Pd doped PANI-SnO2 film. Our results reveal the promising future of SnO2, PANI and Pd associated hybrid films in the development of ultra-high sensitive gas sensors

Evaluation on the responses of succinate dehydrogenase, isocitrate dehydrogenase, malate dehydrogenase and glucose-6-phosphate dehydrogenase to acid shock generated acid tolerance in Escherichia coli

Background: Escherichia coli have an optimum pH range of 6-7 for growth and survival that′s why, called neutrophiles. The ∆pH across the cytoplasmic membrane is linked to cellular bioenergetics and metabolism of the body which is the major supplier of the proton motive force, so homeostasis of cellular pH is essential. When challenged by low pH, protons enter the cytoplasm; as a result, mechanisms are required to alleviate the effects of lowered cytoplasmic pH. Materials and Methods: The activities of Succinate dehydrogenase, isocitrate dehydrogenase, malate dehydrogenase and glucose-6-phosphate dehydrogenase in acid shocked cells of E. coli DH5 α and E. coli W3110 subjected to pH 3, 4, and 5 by two types of acidification, like external (using 0.1 N HCl), external along with the monensin (1 μM) and cytoplasmic acidification using the sodium benzoate as an acid permeant (20 mM) which is coupled to the electron transport chain by the reducing power, as yet another system possessed by E. coli as an armor against harsh acidic environments. Result: Results showed that an exposure to acidic environment (pH 3, 4 and 5) for a short period of time increased the activities of these dehydrogenases in all types of acidification except cytoplasmic acidification, which shows that higher recycling of reducing power results in pumping out of protons from the cytoplasm through the electron transport chain complexes, thereby restoring the cytoplasmic pH of the bacteria in the range of 7.4-7.8. Conclusion: Study indicates that acid shocked E. coli for a period of 2 h can survive for a sustained period

Revolutionizing goat milk gels: A central composite design approach for synthesizing ascorbic acid-functionalized iron oxide nanoparticles decorated alginate-chitosan nanoparticles fortified smart gels

Goat milk gels (GMGs) are popular food due to their high water content, low-calorie density, appealing taste, texture enhancers, stability, and satiety-enhancing characteristics, making them ideal for achieving food security and zero hunger. The GMGs were optimized using the central composite design matrix of response surface methodology using goat milk powder (35–55 g), whole milk powder (10–25 g), and potato powder (10–15 g) as independent variables. In contrast, complex modulus, flow stress, and forward extrudability were chosen as dependent variables. The maximum value of complex modulus 33670.9 N, good flow stress 7863.6 N, and good extrudability 65.32 N was achieved under optimal conditions. The optimized goat milk gel was fortified with ascorbic acid-coated iron oxide nanoparticle (magnetic nature) decorated alginate-chitosan nanoparticles (AA-MNP@CANPs), making it nutritionally rich in an economically feasible way—the decorated AA-MNP@CANPs characterized for size, shape, crystallinity, surface charge, and optical characteristics. Finally, the optimized fortified smart GMGs were further characterized via Scanning electron microscopy, Rheology, Texture profile analysis, Fourier transforms infrared (FTIR), and X-Ray Diffraction (XRD). The fortified smart GMGs carry more nutritional diversity, targeted iron delivery, and the fundamental sustainability development goal of food security

Chalcone Based Homodimeric PET Agent, ¹¹C‑(Chal)₂DEA-Me, for Beta Amyloid Imaging: Synthesis and Bioevaluation

Homodimeric chalcone based ¹¹C-PET radiotracer, ¹¹C-(Chal)₂DEA-Me, was synthesized, and binding affinity toward beta amyloid (Aβ) was evaluated. The computational studies revealed multiple binding of the tracer at the recognition sites of Aβ fibrils. The bivalent ligand ¹¹C-(Chal)₂DEA-Me displayed higher binding affinity compared to the corresponding monomer, ¹¹C-Chal-Me, and classical Aβ agents. The radiolabeling yield with carbon-11 was 40–55% (decay corrected) with specific activity of 65–90 GBq/μmol. A significant (<i>p</i> < 0.0001) improvement in the binding affinity of ¹¹C-(Chal)₂DEA-Me with synthetic Aβ42 aggregates over the monomer, ¹¹C-Chal-Me, demonstrates the utility of the bivalent approach. The PET imaging and biodistribution data displayed suitable brain pharmacokinetics of both ligands with higher brain uptake in the case of the bivalent ligand. Metabolite analysis of healthy ddY mouse brain homogenates exhibited high stability of the radiotracers in the brain with >93% intact tracer at 30 min post injection. Both chalcone derivatives were fluorescent in nature and demonstrated significant changes in the emission properties after binding with Aβ42. The preliminary analysis indicates high potential of ¹¹C-(Chal)₂DEA-Me as <i>in vivo</i> Aβ42 imaging tracer and highlights the significance of the bivalent approach to achieve a higher biological response for detection of early stages of amyloidosis

Colloid Cyst Presenting as Head Injury

Colloid cysts are mucous- or hyaloid-filled lesions with an outer fibrous layer. These are rare developmental and nonneoplastic malformation. They may be found incidentally, while some cases may present with intermittent headache, rapid neurologic deterioration, drop attacks, and even sudden death. Early recognition of this disease may result in lesser mortality. Here, we present a 22-year-old male with a history of fall while driving his two-wheeler. A diagnosis of colloid cyst of the third ventricle with a head injury was made. Colloid cyst presenting with a head injury is exceedingly rare with only five case reports in the literature. This report may help to support surgical intervention in an asymptomatic patient, as the cyst can predispose head injury with serious consequences. It also stresses the importance of a high degree of suspicion when there is any well-defined radiological abnormality in the region of the third ventricle. A colloid cyst may easily be confused with intracranial hemorrhage due to hyperdensity in head trauma. It can be distinguished by the presence of an accompanying traumatic lesion. The cyst usually has well-defined round margins, and the morphologic appearance and density do not change on a follow-up computed tomography (CT) scan, whereas in hemorrhage the density usually regresses with clinical improvement on serial imaging