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

Molecular and Morphological Characterization of Anisakis simplex in Frozen and Smoked Herring and Mackerel Fish species in Egypt

Food-borne zoonoses are of serious public health concern, with a high risk on human health in both developed and developing countries. Thus, this study aimed to determine the prevalence of zoonotic anisakis larvae in smoked imported herring fish (Clupea harengus) and frozen mackerel (Scomber scomberus) from Assiut and Menoufia governorates, respectively in Egypt. All herring specimens were heavily infected with Anisakis larvae, while 9 out of 15 mackerel fish were infected. A total of 434 Anisakis larvae were collected from stomach, abdominal cavity, liver, between skin, muscles and gonads of 45 herring fish. In frozen mackerel, number of detected larvae was 78. Sequencing and phylogenetic analysis of internal transcribed spacer rDNA (ITS-rDNA) ribosomal DNA confirmed that the Anisakis larvae belonged to Anisakis simplex species. Furthermore, by employing light and scanning electron microscope, the morphological characters of Anisakis larvae were also determined. These findings highlight the importance of detecting health hazards in seafood products for helping in the management and prevention of anisakiasis.