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

On the Classical Paranormed Sequence Spaces and Related Duals over the Non-Newtonian Complex Field

The studies on sequence spaces were extended by using the notion of associated multiplier sequences. A multiplier sequence can be used to accelerate the convergence of the sequences in some spaces. In some sense, it can be viewed as a catalyst, which is used to accelerate the process of chemical reaction. Sometimes the associated multiplier sequence delays the rate of convergence of a sequence. In the present paper, the classical paranormed sequence spaces have been introduced and proved that the spaces are star-complete. By using the notion of multiplier sequence, the alpha-, beta-, and gamma-duals of certain paranormed spaces have been computed and their basis has been constructed

Prevention of the harmful effects of free oxygen radicals by using N-acetylcysteine in testicular torsion

WOS:000538165900018PubMed: 31882389Introduction Testicular torsion is a urological emergency both in childhood and in adult life. Many studies on experimental testicular torsion have demonstrated biochemical and pathological ischemia reperfusion injury and the efficacy of some drugs have been investigated to prevent this damage. N-acetylcysteine (NAC) promotes glutathione synthesis and acts as a glutathione precursor because of the fact that it increases the glutathione-reductase activity by transporting sulfhydryl groups. Aim In this experimental study, the authors aimed to investigate the effectiveness of NAC in preventing ischemia-reperfusion injury following testicular torsion and detorsion. Study design For this experimental study, 36 albino Wistar-male rats were used. The rats were randomly divided into 4 groups: sham (n = 8), ischemia-reperfusion (n = 8), ischemia-NAC -reperfusion (n = 10), and ischemia-NAC-reperfusionNAC (n = 10) groups. Two hours of torsion and 4 h of detorsion were created in the left testis. After 4 h of detorsion, the rats were sacrificed. Each tissue was divided into two sections for biochemical and pathological examinations. Results There was a statistically significant difference between the study groups in terms of the total-sulfhydryl level, nitric oxide level, and the malondialdehyde values. Histopathological examination revealed that NAC was effective in preventing reperfusion injury in the testis but ineffective in preventing the reduction in the spermatid count. Discussion The results of this experimental study support that NAC can histopathologically maintain the structure of seminiferous tubules against ischemis reperfusion injury and prevent damage to the germinative cells. However, it was unable to prevent the reduction in spermatid count. There was no significant difference in the prevention of ischemiareperfusion injury between NAC administration during the first hour of ischemia and NAC administration during reperfusion. Although NAC can prevent tissue damage from ischemia reperfusion injury, it is not effective against the reduction in the spermatid count. Conclusion N-acetylcysteine may be biochemically effective in preventing ischemia-reperfusion injury after testicular torsion and detorsion. NAC is a readily available and easy to use agent that can be used during testicular ischemia

Comparison of growth factor levels in patients with normal and hypospadiac prepuce

Joint Congress of British-Association-of-Pediatric-Surgeons/European-Pediatric-Surgery-Association -- JUN 17-20, 2009 -- Graz, AUSTRIASoyer, Tutku/0000-0003-1505-6042WOS: 000288413100011Aim: To compare the growth factor levels in patients with normal and hypospadiac prepuce. Materials and methods: Patients who underwent hypospadias repair were included in the study. The prepuce was excised after achieving successful hypospadias repair with satisfactory functional and cosmetic appearance. The patients who underwent preputial reconstructions and complicated repairs were excluded. The control group consists of boys without hypospadias. Elective circumcision was performed to have normal preputial samples. The VEGF levels, VEGF receptor (VEGFR) and TGF-beta receptor (TGF-beta-R) expressions were evaluated in preputial tissues by immunohistochemical analysis. Results: Fifteen patients were included in each group. The mean age of patients with normal and hypospadiac prepuce was 4.33 +/- 1.39 and 4.07 +/- 1.58, respectively (P>0.05). Although VEGF, VEGFR, and TGF-beta-R levels were decreased in hypospadiac prepuce, statistical significance was detected only in VEGF levels (P<0.05, Mann-Whitney U test). Conclusion: The decreased levels of VEGF obtained from patients with hypospadiac prepuce suggest a structural anomaly related with angiogenesis. This structural difference can be considered one of the factors causing impaired wound healing and recurrent complications after preputial reconstructions in hypospadias repair.British Assoc Pediatr Surg, European Pediatr Surg Asso

Role of Computed Tomography Severity Index in Acute Diagnosis and Follow-up of Acute Pancreatitis

We aimed to identify the role that computed tomography (CT) plays in the emergency services and during treatmentin the process of establishing an early diagnosis of acute pancreatitis and detecting potential complications that can emerge. Material and Method: Seventy-six patients who presented to a Training and Research Hospital's Emergency Department and diagnosed with acute pancreatitis (AP) were included in the study. Patients' files were evaluated retrospectively and their CT severity index (CTSI) values were obtained using Balthazar classification. Results: There was no significant difference between the ratio of patients with and without ultrasonographic features and patients whose CTSI was 3 and above. The ratio of being in the intensive care unit was significantly higher in patients with CTSI scores of 3-6 when compared to those with CTSI scores of 0-2. Two patients who died had CTSI scores in the range of 7-10. Discussion: CT plays an important role in the diagnosis of AP and the follow-up of patients diagnosed with the disease. Thus, CT can be an important parameter in the prediction of complications, as well as a preferred method for predicting the morbidity and mortality of patients diagnosed with AP

Alterations in placental pendrin expression in pre-eclampsia

oktay, murat/0000-0002-0893-4444;WOS: 000333583100007PubMed: 23941406Introduction: Pendrin is an integral membrane protein and plays a key role in extracellular fluid volume and blood pressure control. We aimed to investigate the relationship between pendrin immunostaining intensity in normal and pre-eclamptic placental tissue. Methods: Fifty-six placental tissues, of which 26 were in pre-eclamptic, and 30 were in control group were evaluated by immunohistochemical staining. Positive immunostaining was evaluated using a semiquantitative score: 0, negative; +, mild; ++, moderate; and +++, intense. Results: There was more positive immunstaining in the pre-eclamptic placenta compared to the controls (p<0.001). A significant positive correlation was observed between immunostaining level and diastolic blood pressure (r = 0.533, p = 0.005) in the pre-eclamptic group. However, no significant correlation was observed between any condition and immunostaining level in the control group. Conclusions: Placentas in the pre-eclamptic group were significantly more immunostained with pendrin than were those in the control group. In addition, a positive correlation between immunostaining intensity with pendrin and both systolic and diastolic blood pressure were observed. Pendrin may play a role in the mechanism of severe hypertension in women with pre-eclampsia

The relationship between monocyte HDL-C ratio and reduced left ventricular systolic function in patients among acute myocarditis

Myocarditis contributes to the global burden of cardiovascular disease mainly through sudden death and chronic cardiomyopathy in young age groups. Monocyte/high-density lipoprotein cholesterol (HDL-C) ratio (MHR) has developed as a new inflammation biomarker. In this study has investigated that relationship between admission MHR levels and the reduced left ventricular systolic functions after acute myocarditis. The study included a total of 156 consecutive cases wanted by their doctors to undergo cardiovascular magnetic resonance imaging for acute myocarditis as the clinical diagnosis between 2009 and 2017 at our hospital. Study participants were split into two groups; group I patients (patients with LVEF [Med-Science 2021; 10(2.000): 304-9

Comparison of the effect of contrast medium, air, and ozone on ischemia/reperfusion injury due to experimental intussusception model

KISA, Ucler/0000-0002-8131-6810; Soyer, Tutku/0000-0003-1505-6042WOS: 000323609800025Aim: To compare effects of contrast medium, air, and ozone on ischemia/reperfusion injury due to intussusception. Materials and methods: Thirty Wistar rats were allocated into five groups (n = 6). In the control group (CG), 2 cm of colonic segment, 5 cm distal to ileocecal valve, was removed. Intussusception was performed at 5 cm distal to the ileocecal valve by pushing a proximal intestinal segment distally by stile in experimental groups. One hour later, in the sham-operated group (SG), manual reduction was performed. In the reduction groups, reduction of intussusception was performed by contrast medium (CMG, 1/1 diluted omnipaqueR, infusion rate 2 mL/min), by air (AG, Pmax = 60 mmHg), or by ozone (OG, 10 mu g/mL, 0.5 mg/kg, Pmax = 60 mmHg). One hour after reduction, 2 cm of colonic segment was removed. Colonic tissues were evaluated for histopathological grades and oxidative injury markers (malondialdehyde [MDA], nitric oxide [NO], and total sulfhydryl [T-SH] values). Results: Mucosal injury score was significantly higher in AG then in CG or SG (P 0.05). MDA levels were significantly higher and NO levels were significantly lower in CMG, OG, and AG than in CG (P 0.05). Conclusion: None of the reduction methods in intussusception have superiority over others in preventing ischemia/reperfusion injury.Kirikkale University Scientific Research CouncilKirikkale UniversityThis study was presented at the 29th National Congress of Turkish Pediatric Surgeons, in 2011 in Istanbul, Turkey, and was supported by the Kirikkale University Scientific Research Council

The effect of extracorporeal shock wave lithotripsy on distribution of interstitial cells of Cajal in rabbit renal pelvis and proximal ureter

Background/aim: An experimental study was performed to evaluate the effect of extracorporeal shock wave lithotripsy (ESWL) on the distribution of interstitial cells of Cajal (ICC) in rabbit renal pelvis and proximal ureter. Materials and methods: Six New Zealand rabbits were included. Right kidneys were exposed to a total of 3000 shock waves (14 kV) by using an electrohydraulic-type ESWL device. Right sides were allocated as the ESWL group (EG, n = 6) and left sides as the control group (CG, n = 6). Tissues were harvested on day 7. Tissues were examined histopathologically for the presence of edema, inflammation, congestion, hemorrhage, fibrosis, and vascularization. Mast cell tryptase and CD117 (c-kit) staining was performed for ICC distribution. Results: Although increased tissue edema in renal pelvises and increased inflammation in ureters were observed in EG, no statistical difference was detected between groups (P > 0.05). In CG, positive CD117 staining was detected in 2 renal pelvises and ureters. None of the EG samples showed CD117 staining and no statistical difference was detected between groups (P > 0.05). Conclusion: Rabbit does not appear to be a good model for investigating ICCs. ESWL may cause histopathological alterations in the renal pelvis and ureter. Since it has not been statistically proven, reduced contractility of the ureter after ESWL may not be attributed to altered distribution of ICCs in the renal pelvis and ureter