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

Effects of gender on stress ulcer formation in rats

In the experimental stress literature, the results of investigations have not shown a specific sex-dependent vulnerability to stress ulceration. The aim of this study was to evaluate the importance of sex differences on stress ulcer development. Related to gender, the contributing factors for stress ulcer production such as luminal acidity, sialic acid as an marker of gastric mucosal protection, oxygen (O-2)-derived free radicals and endogenous antioxidant defence mechanisms were also investigated. Fifty Wistar Albino rats weighing about 230 g and aged 7 or 8 months were divided equally into five groups: Group I normal male rats, group II castrated male rats, group III normal female rats in estrus phase, group IV normal female rats in diestrus phase and group V castrated female rats. Cold restraint model was used for 6 hours to produce stress ulcer. No statistically significant difference was found out between groups in view of gross and histopathologic damage. There was no significant difference between groups according to gastric luminal acidity, gastric mucosal sialic acid, gastric malonaldehyde (MDA) and catalase values. Gastric superoxide dismutase (SOD) activity was significantly lower in Group I in comparison to those of Group III and IV. Sex differences do not interfere stress ulcer formation. SOD activity in rat gastric tissue has varied significantly by hormonal milieu. - gender; ulcer; sialic acid; free radical (C) 2002 Tohoku University Medical Press

Formulation, Characterization, and Clinical Evaluation of Microemulsion Containing Clotrimazole for Topical Delivery

The objective of the present study was to formulate and evaluate microemulsion systems for topical delivery of clotrimazole (CTM). The solubility of CTM in various oils was determined to select the oil phase of the microemulsion systems. Pseudoternary phase diagrams were constructed to identify the area of microemulsion existence. Five CTM microemulsion formulations (M1–M5) were prepared and evaluated for their thermodynamic stability, pH, refractive index, droplet size, viscosity, and in vitro release across cellulose membrane. Among the prepared microemulsion formulations, M3 (lemon oil/Tween 80/n-butanol/water) and M4 (isopropyl myristate/Tween 80/n-butanol/water) microemulsion systems were found to be promising according to their physical properties and CTM cumulative percentage release. Gel form of M3 and M4 were prepared using 1% Carbopol 940 as the hydrogel matrix. Both formulations were evaluated in the liquid and gel forms for drug retention in the skin in comparison to the marketed CTM topical cream and their stability examined after storage at 40°C for 6 months. Microemulsion formulations achieved significantly higher skin retention for CTM over the CTM cream. Stability studies showed that M4 preparations were more stable than M3. The in vitro anti-fungal activity of M4 against Candida albicans was higher than that of the conventional cream. Moreover, clinical evaluation proved the efficacy and tolerability of this preparation in the treatment of various topical fungal infections