Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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

Análisis molecular de dos poblaciones de guajolotes nativos mexicanos y una línea comercial de pavos por rapd¸s

Even though native turkey (Maleagris gallopavo) is an economically and culturally important poultry species in Mexico, very little genomic information is available. In this study an approach to determine genetic fingerprints of native turkey and of "Big-6 Large White" commercial line was carried out. DNA from 20 individuals from two native populations (Posta Veterinaria and Puruarán) and from 10 of commercial line "Big-6 Large White" was isolated from blood samples and amplified through the RAPD method. A high degree of polymorphic fragments were observed between populations. Three highly conserved bands 920, 702 and 686 base pairs (bp) in size are suggested to be used as multilocus dominant markers. Analysis of 1198, 1282 and 462 bp bands suggest that the population from Puruarán, supposed to be native, probably developed from native x commercial crosses. Some other bands are present exclusively in commercial lines, and could be related to productivity traits.A pesar de que los guajolotes (Meleagris gallopavo) son aves de importancia económica y cultural en nuestro país, hay poca información sobre su genoma. En este trabajo se realizó un avance sobre el establecimiento de la huella de ADN de guajolotes nativos (M. gallopavo) y de la línea comercial "Big-6 Large White". A partir de muestras de sangre, se aisló el ADN de 20 individuos de dos poblaciones de guajolotes nativos (Puruarán y Posta Veterinaria) y de 10 individuos de una población de pavos de la línea comercial "Big-6 Large White", y se realizaron ensayos tipo RAPD. Los resultados mostraron un alto nivel de fragmentos polimórficos entre las poblaciones. Se encontraron tres bandas con un tamaño de 920, 702 y 686 pares de bases (pb), altamente conservadas, que podrían ser utilizadas como marcadores dominantes multilocus. El análisis de bandas con un tamaño de 1198, 1282 y 462 pb, sugiere que la supuesta población nativa de Puruarán puede ser el resultado de una cruza entre guajolotes nativos y pavos comerciales. Adicionalmente, algunas de las bandas presentes en los pavos comerciales, pueden estar relacionadas con características específicas de interés comercial

Brucella spondylitis complicated by an infected abdominal aortic aneurysm and deep venous thrombosis: case report and review of the literature

Brucellosis is a common zoonosis, which still remains as a major health problem in certain parts of the world. Spondylodiscitis is the most frequent osteoarticular complication of brucellosis. Herein is reported an uncommon case of a middle-aged male treated for brucellosis who developed 2 years after the treatment brucellar spondylo-discitis complicated by a psoas muscle abscess, an infected abdominal aorta aneurysm and deep venous thrombosis of IVC, common iliac, external iliac and common femoral veins. CT and CT angiography were the imaging modalities depicting the findings. After an endovascular stent graft placement in abdominal aorta aneurysm, a CT guided drainage of retroperitoneal abscess revealed Brucella melitensis as the pathogen microorganism. Diagnosis of spondylodiscitis and contiguous psoas abscess is usually simple but aortic involvement is difficult to identify and can be easily overlooked. A high degree of suspicion is essential to reduce the delay for the treatment

SARS-CoV-2 vaccination modelling for safe surgery to save lives: Data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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 coprioritized 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