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

Sexual and Reproductive Health in HIV Serodiscordant Couples

Serodiscordant couples are a significant source of new HIV infection in sub-Sahara Africa. The prevention of HIV transmission to the uninfected partner should be an integral part of their health care. Serodiscordant couples desire pregnancy, treatment for infertility, effective family planning services, sexual health screening, and so on. This paper reviews the sexual and reproductive health needs of heterosexual serodiscordant couples, based on current evidence and recommendations.Les couples sérodiscordants sont une source importante de nouvelles infections du VIH en Afrique sub-saharienne. La prévention de la transmission du VIH au partenaire non infecté doit être une partie intégrante de leurs soins de santé. Les couples sérodiscordants désirent une grossesse, le traitement de la stérilité, des services de planification familiale efficaces, le dépistage de la santé sexuelle et ainsi de suite. Ce document passe en revue les besoins en matière de santé sexuelle et reproductive des couples hétérosexuels sérodiscordants, fondées sur des preuves et des recommandations en vigueur

The role of inflammation in the metabolic syndrome

Aims and Objectives: The aim of this study is to determine the plasma levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNFα) and C-reactive protein (CRP) in adult Nigerians with the metabolic syndrome and to determine the relationship between components of the metabolic syndrome and CRP in adult Nigerians. Materials and Methods: This was a cross-sectional analytical study of 50 adult men and women with metabolic syndrome and 50 age- and sex-matched men and women without metabolic syndrome. Metabolic syndrome was defined based on the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. Written informed consent was obtained from the participants. Blood pressure and anthropometric measurements were taken and venous blood was collected after an overnight fast. The Ethics Committee of the Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria approved the study protocol. Comparisons of the continuous variables and the categorical variables were done using the Student's t-test and Chi-square test, respectively. Regression analysis was used to determine the associations between the variables. Statistical significance was set at P < 0.05. Results: The study subjects differed in some clinical and laboratory parameters such as diastolic blood pressure (P = 0.048), waist circumference (P = 0.002), body mass index (BMI) (P = 0.012), waist/hip ratio (P = 0.023), high-density lipoprotein (HDL) (P = 0.012), and insulin resistance (P = 0.042). There was a statistically significant increase in the inflammatory marker, CRP (P = 0.019), cytokines, IL-6 (P = 0.040), and TNFα (P = 0.031) between the subjects with and without metabolic syndrome. There was also a positive significant association between CRP, waist circumference, and insulin resistance and a negative significant association between CRP and HDL in metabolic syndrome (P < 0.05). Conclusion: This study reports increased plasma levels of the inflammatory cytokines, IL-6, TNFα and in the inflammatory marker and CRP in metabolic syndrome. Understanding the role of inflammation in the metabolic syndrome may provide novel strategies for the management of metabolic syndrome and related disorders

Preliminary report on plasma homocysteine and hormonal variations in infertile women in Lagos, Nigeria

Background: The relationship between infertility and hormonal variations has been variously documented, but little has been reported on the interactions between hormonal factors, homocysteine (Hcy), and female infertility. Objective: This study aimed to evaluate the relationship between plasma Hcy levels and hormonal variations in infertile women. Materials and Methods: This descriptive cross-sectional study was carried out among eligible infertile and fertile women seeking care at the Lagos University Teaching Hospital, Lagos, Nigeria. The subjects were 100 women referred for management of infertility, and the controls were 50 fertile women who had given birth within the past year. Fasting plasma levels of Hcy were estimated using enzyme immunoassay. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, prolactin, and progesterone were measured using  Access 2 (Immunoassay systems-beckman coulter, inc.250S.Kraemer blvd.Brea, ca 92821. U.S.A). Results: Mean plasma Hcy levels for subjects and controls were 9.50 ± 1.88 μmol/L and 9.44 ± 1.85 μmol/L, respectively, with no significant variation (P = 0.952). Plasma Hcy was not significantly associated with infertility and hormone levels. The mean serum levels of LH, FSH, and prolactin were significantly higher among subjects compared to controls. Conclusion: Hormonal variations observed in infertile women did not appear to significantly alter plasma Hcy levels, and hyperhomocysteinemia (HHcy) may not have significantly contributed to female infertility in our environment