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

AN ENDOCRINOLOGICAL APPROACH IN INDIVIDUALS WITH GENDER DYSPHORIA

Gender identity is defined as the acceptation and perception of an individual's body and identity within a certain gender. Individuals with gender dysphoria, as diagnosed by psychiatrists, should also be evaluated in terms of endocrinologic measures, and certain underlying conditions/diseases regarding gender dysphoria must be excluded. Prior to initiation of hormonal and irreversible therapies, it is important for an individual to live suitably with the preferred gender identity as to acquire real life experience. The individual's ability to live in the desired gender is tested in this manner, and whether there is sufficient social, economic, psychological support. Treatment can be initiated for a transgender individual after three months of real-life experience. Before initiation, the reversible and permanent effects must be informed, and the treatment should be individualized. Fertility preservation should be explained prior to hormone therapy, and in those who want to, ovarian preservation in women and sperm preservation in men should be suggested and informed consent obtained. Feminization signs, serum testosterone and estradiol levels, drug side effects, routine cancer screening for breast, colon and prostate cancer and osteoporosis risk factors should be assessed in transgender women. Transgender men, on the other hand, should be screened for virilization signs, serum testosterone levels, drug side effects, annual PAP-smear if uterus is intact and mammography if breast tissue is intact, and osteoporosis risk factors. Surgery can only be proposed to individuals over 18 years of age who have completed 1 year of real-life experience with the usage of hormone therapy for at least 3 months during this period. However, it should be punctuated that surgical procedures constitute irreversible changes and they are not obligatory. Over long-term follow-up, transgender individuals who have undergone surgical procedures are reported to have increased suicide rates and psychiatric morbidities

ERUPTIVE XANTHOMA: A MARKER OF HYPERTRIGLYCERIDEMIA

Eruptive xanthomas are benign lesions which are found in extensor surfaces of the extremities and are often associated with hypertriglyceridemia and/or uncontrolled diabetes. In this case report, we present a patient with hypertriglyceridemia, type 2 diabetes mellitus and eruptive xanthomas who recovers fully after treatment. A 37-year-old male patient presented to our clinic with reddish yellow lesions on his elbows. His body mass index was 30 kg/m(2) and his laboratory results showed high serum triglyceride and glucose levels (triglyceride 6548 mg/dL, glucose 245 mg/dL), his hemoglobin A1c was 11.2%. Although eruptive xanthomas have a benign nature, they are associated with disease which often need lifelong treatment

Simple and convenient preparation of novel 6,8-disubstituted quinoline derivatives and their promising anticancer activities

Okten, Salih/0000-0001-9656-1803; Erenler, Ramazan/0000-0002-0505-3190WOS: 000326936200005A short and easy route is described for 6,8-disubstituted derivatives of quinoline and 1,2,3,4-tetrahydroquinoline from 6,8-dibromoquinolines 2 and 7 by various substitution reactions. While copper-promoted substitution of 6,8-dibromide 2 produced monomethoxides 3 and 4, a prolonged reaction time mainly afforded dimethoxide 6 instead of 5, whose aromatization with DDQ and substitution reaction of dibromide 7 with NaOMe in the presence of CuI also gave rise to dimethoxide 6. Several 6,8-disubstituted quinolines were obtained by treatment of 6,8-dibromoquinoline (7) with n-BuLi followed by trapping with an electrophile [Si(Me)(3)Cl, S-2(Me)(2), and DMF]. Furthermore, 7 was also converted to mono and dicyano derivatives. The anticancer activities of compounds 2, 7, 6, 12, 13, 15, and 16 against HeLa, HT29, and C6 tumor cell lines were tested, and 6,8-dibromo-1,2,3,4-tetrahydroquinoline (2) and 6,8-dimethoxyquinoline (6) showed significant anticancer activities against the tumor cell lines.Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [112T394]This study was supported by grants from the Scientific and Technological Research Council of Turkey (TUBITAK, Project number: 112T394)

Are neutrophil-lymphocyte and platelet-lymphocyte ratios valuable in predicting prostate cancer?

Introduction and Hypothesis: We retrospectively evaluated the prognostic impact of neutrophil-lymphocyte ratio (NLR) as a marker for inflammatory and immune state in men with prostate cancer. Materials and Methods: This retrospective study was conducted in a single urology clinic to review the medical data of 558 patients who underwent transrectal prostate needle biopsies between 2007 and 2014. Prior to transrectal prostate needle biopsies, patient histories, physical examinations, and routine laboratory tests including blood biochemistry, urinaly- sis and urine cultures, free PSA and total PSA, rectal examination, transrectal ultrasound findings, and pathology results were evaluated. Results: Benign biopsy results were found in 287 patients (Group 1) using neutrophil / lymphocyte (NLR) and platelet / lymphocyte ratio (PLR). When calculating malignancy in 271 patients (Group 2), there was no significantly difference in NLR and PLR values between benign and malign prostate diseases (p=0.14 and p=0.369, respectively). Conclusion: With reference to the survey prior to the biopsy, NLR and PLR ratio values do not appear to be helpful in the differentiation of benign prostatic hyperplasia and prostate cancer. [Arch Clin Exp Surg 2016; 5(4.000): 194-199