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

Development and validation an HPLC-UV method for determination of esomeprazole and pirfenidone simultaneously in rat plasma: Application to a drug monitoring study

Background and Aims: It has been observed that the combined treatment of esomeprazole and pirfenidone provides increased efficacy in the treatment of pulmonary fibrosis disease, recently. The aim of this study is to develop a simple, sensitive, and reliable high-performance liquid chromatography method to be used in drug monitoring to increase the effectiveness of esomeprazole and pirfenidone in treatment and to reduce their adverse effects. Methods: Separation was conducted with a C18 reverse-phase column (4.6 mm x 250 mm, 5 mu m) used as a mobile phase prepared with the phosphate buffer (10 mM KH2PO4 and 10 mM K2HPO4) and acetonitrile (60:40, v/v) by an isocratic flow (1 mL/min). Mobile phase pH was adjusted to 3.0. Ultraviolet detection was accomplished at 305 nm. The column oven was held at 35 degrees C to ensure an efficient analytical separation. Results: Analytical recovery of esomeprazole was between 92.43 and 105.36% and for pirfenidone it was found between 89.56 and 104.32%. Accuracy values of esomeprazole and pirfenidone were determined between (-2.90) - 4.22 and (-4.45) - 5.78, respectively. Precision (RSD%) was <= 7.89. The quantification limit was determined as 0.58 and 0.36 ng/mL. Plasma esomeprazole and pirfenidone levels were found as 0.87-8296.87 ng/mL (612.99 +/- 2212.20, mean +/- standard deviation) and 0.45-238.60 ng/mL (61.44 +/- 76.35, mean +/- standard deviation), respectively. Conclusion: Unexpectedly high RSD values were observed in both plasma (360.88%) and dose-rated results (89.61%) of esomeprazole, and pirfenidone were thought to be related to individual metabolism differences.Cumhuriyet Universit

Determination of sunset yellow, allura red, and fast green using a novel magnetic nanoadsorbent modified with Elaeagnus angustifolia based on magnetic solid-phase extraction by HPLC

Sunset yellow (SY), allura red (AR) and fast green (FG) are frequently used in commercial food products, although they are considered to be hazardous to public health due to their toxic efficacy and high exposure risk potency. In this study, a new, rapid, and reliable method based on a magnetic solid-phase extraction (MSPE) was developed for the simultaneous determination of SY, AR, and FG. Fe3O4&nbsp;modified with Elaeagnus angustifolia was used for the first time as an adsorbent (Fe3O4-EA) in MSPE. It was characterized with scanning electron microscopy, Brunauer Emmet Teller surface area analysis and X-ray diffraction. MSPE parameters were optimized in terms of pH, adsorption, and elution time and elution volume. High-performance liquid chromatography was used for dye quantitation. Analytical separation was performed by applying ammonium acetate buffer, acetonitrile, and methanol as the mobile phase to a C18&nbsp;reverse-phase analytical column. Intraday and inter-day repeatability of the method performed at the concentration of 0.2, 1.0 and 2.0 µg/mL exhibited &lt;8.1% RSD (n=3). The limit of detection values was between 0.05-0.1 µg/mL. The adsorption data of SY, AR and FG on Fe3O4-EA were fitted with the Langmuir model with qmax&nbsp;values of 45.0, 70.4 and 73.0 mg/g, respectively

Determination of sunset yellow, allura red, and fast green using a novel magnetic nanoadsorbent modified with Elaeagnus angustifolia based on magnetic solid-phase extraction by HPLC

Sunset yellow (SY), allura red (AR) and fast green (FG) are frequently used in commercial food products, although they are considered to be hazardous to public health due to their toxic efficacy and high exposure risk potency. In this study, a new, rapid, and reliable method based on a magnetic solid-phase extraction (MSPE) was developed for the simultaneous determination of SY, AR, and FG. Fe3O4&nbsp;modified with Elaeagnus angustifolia was used for the first time as an adsorbent (Fe3O4-EA) in MSPE. It was characterized with scanning electron microscopy, Brunauer Emmet Teller surface area analysis and X-ray diffraction. MSPE parameters were optimized in terms of pH, adsorption, and elution time and elution volume. High-performance liquid chromatography was used for dye quantitation. Analytical separation was performed by applying ammonium acetate buffer, acetonitrile, and methanol as the mobile phase to a C18&nbsp;reverse-phase analytical column. Intraday and inter-day repeatability of the method performed at the concentration of 0.2, 1.0 and 2.0 µg/mL exhibited &lt;8.1% RSD (n=3). The limit of detection values was between 0.05-0.1 µg/mL. The adsorption data of SY, AR and FG on Fe3O4-EA were fitted with the Langmuir model with qmax&nbsp;values of 45.0, 70.4 and 73.0 mg/g, respectively

Fascia iliaca compartment block in dislocated hip reduction

Femoral dislocation constitutes an orthopaedic emergency. For pain control in these cases, apart from procedural sedation, a regional block can be applied. Case report: A 26-year old male was brought to the emergency centre after being struck by a motor vehicle. Dislocation of the left femur was determined on direct radiograph. It was decided to apply a fascia iliaca compartment block instead of procedural sedation due to the risk of side effects. After sufficient anaesthesia was provided, the dislocation was successfully reduced on the first attempt with the Allis technique. Conclusion: The fascia iliaca compartment block (FICB) can be performed easily and successfully under ultrasound guidance. The pain associated with femoral dislocation is decreased and the reduction procedure can be achieved successfully. In many cases, FICB is easy to apply and carries a low risk of side effects

Simultaneous Headspace-GC-FID Analysis for Methanol and Ethanol in Blood, Saliva and Urine: Validation of Method and Comparison of Specimens

WOS: 000292808700001This study presents a headspace gas chromatography method with flame ionization detection (GC-FID) for the determination of ethanol and methanol content in biological fluids such as blood, urine and saliva, emphasizing matrix effects onto headspace analytical results. In this context, a simultaneous procedure was established and validated, and it was revealed that headspace GC for methanol and ethanol determination in all routinely available biological fluids is applicable as a reference method and also in routine diagnostics and monitoring. GC was performed with a run time of 6 min. The method showed linearity in the range of 50-400 mg/dL both for methanol and ethanol (r(2) = 0.998 and r(2) = 0.999, respectively) in all specimens with a detection and quantification limits less than 1.5 mg/dL and 2 mg/dL, respectively, as well as with good repeatability. Relative standard deviation (RSD) and percent bias were calculated for interday and intraday accuracy and precision at three concentrations (low 50 mg/dL, medium 200 mg/dL and high 400 mg/dL) for each biological fluid. A recovery rate of over 90% was obtained. Due to matrix effects of specimens, slight variations in validation data were presented and compared. The method and the obtained results suggest that the use of headspace GC could be extended from confirmatory analyses to routine application in toxicology laboratories.Ankara University Institute of BiotechnologyAnkara University [2004-118]This study was supported by grants from the Ankara University Institute of Biotechnology Research Fund, project number 2004-118

Simultaneous Headspace-GC-FID Analysis for Methanol and Ethanol in Blood, Saliva, and Urine: Validation of Method and Comparison of Specimens

WOS: 000280249200005This study presents a headspace gas chromatography method with flame ionization detection (GC-FID) for the determination of ethanol and methanol content in biological fluids such as blood, urine, and saliva, emphasizing matrix effects onto headspace analytical results. In this context, a simultaneous procedure was established and validated, and it was revealed that headspace GC for methanol and ethanol determination in all routinely available biological fluids is applicable as a reference method and also in routine diagnostics and monitoring. GC was performed with a run time of 6 min. The method showed linearity in the range of 50-400 mg/dL both for methanol and ethanol (r(2) = 0.998 and r(2) = 0.999, respectively) in all specimens with a detection and quantification limits less than 1.5 mg/dL and 2 mg/dL, respectively, as well as with good repeatability. Relative standard deviation and percent bias were calculated for interday and intraday accuracy and precision at three concentrations (low 50 mg/dL, medium 200 mg/dL, and high 400 mg/dL) for each biological fluid. A recovery rate of over 90% was obtained. Due to matrix effects of specimens, slight variations in validation data were presented and compared. The method and the obtained results suggest that the use of headspace GC could be extended from confirmatory analyses to routine application in toxicology laboratories.'Ankara University Institute of Biotechnology Research FundAnkara University [2004-118]This study was supported by grants from the Ankara University Institute of Biotechnology Research Fund, project number 2004-118