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

Research Trends in the Field of Special Education in Saudi Scientific Journals: A Bibliometric Analysis

This study aims to identify the current status of publishing special education researches in Saudi scientific journals in the period of (2015 - 2021) and provides an analysis of research trends concerning the topics published. The study also sheds light on the variation of topics tackled in the published researches, according to specific criteria which include the research methodology, disabilities categories covered by the studies, samples, academic stages, where studies were geographically conducted, type of participation in publishing, study levels, and research financing. The analysis includes (359) researches from (32) Saudi scientific journals, which are analyzed by using the bibliometric approach. The study arrives at that the percentage of publishing the special education researches has reached (6.97%) of the total studies published in (2015 – 2021). The results indicated the top scientific journals that publishing researches in special education in the targeted period, determining the most studied disability categories, and type of research methods that used in these studies. The findings show the most special education researches have been applied in the main cities in the Kingdom. In terms of the types of authorship, it has been found that researchers are considerably inclined to the individual publication, and only a small number of studies have received financial support. Based on the results of the analysis, recommendations were made to direct scientific research in the field of special education in the future

Knowledge, Attitudes, and Use of Protein Supplements among Saudi Adults: Gender Differences

Saudi Arabia has witnessed recent reforms and positive socio-political changes that have led to increased opportunities for women to participate in fitness centers. This study investigated protein supplement consumption among Saudi females compared with that among males and examined the knowledge and attitudes of the participants toward protein supplement use. A cross-sectional study was conducted in Riyadh using a previously validated, self-administered online survey. The questionnaire included items related to the prevalence, knowledge, attitudes, and practice of protein supplementation. The participants were 354 adults (58.2% were females). The results showed that over 47% of the participants attended fitness centers with more male (80.3%) than female (41%) attendees. Nearly 50% of the participants consumed protein supplements, with males (68.7%) using significantly (p < 0.001) more protein supplements than females (35.6%). The powdered form was most commonly consumed. The percentage of gym attendees (67.8%) who used protein supplements was higher than that among non-gym attendees (32.2%). Gaining muscles (56.1%) followed by compensating for protein deficiency (28.6%) were the reasons for taking protein supplements, with a significant gender difference (p < 0.001). Coaches provided the most information on protein supplements. The participants appeared to be knowledgeable about protein supplements. Although over 68% of protein supplement users suffered from various symptoms, only 20% of the participants thought that there was no risk in taking protein supplements, with significant gender differences. It was concluded that Saudi male participants are twice more likely to attend the gym and consume protein supplements compared with females. Of both genders, those attending the gym consumed more protein supplements than non-gym attendees

Determination of macro, essential trace elements, toxic heavy metal concentrations, crude oil extracts and ash composition from Saudi Arabian fruits and vegetables having medicinal values

The concentrations of essential elements (Mg, Ca, Na, K, Fe, Zn, Se, Al, Ni, and Cu) and toxic heavy metals (Pb, As, Cr, Cd, and Cr) from Saudi Arabian fruits and vegetables were determined by inductively coupled plasma optical emission spectrophotometry (ICP/OES). Two types of butters, Caralluma munbayana and Caralluma hesperidum, Vigna (Vigna unguiculata), common fig (Ficus carica), Annona seeds (Annonaceae seeds), Annona fruits (Annonaceae fruits), Fennel (Foeniculum vulgare), and Fennel flowers (Nigella sativa) were investigated, because they are used by indigenous groups as traditional medicines with Soxhlet-extraction and dry-ashing protocol. The estimated daily dietary element intake in food samples was further calculated in order to evaluate the element dietary intake and fruit and vegetable consumption pattern of the indigenes of Saudi Arabia. The crude oil and ash compositions varied widely, but suggested that most of the foods were good sources of oils and minerals. The figures-of-merit of the ICP-OES calibration curves were excellent with good linearity (R2 > 0.9921). The use of ICP-OES in this study allowed the accurate analysis and the detection of the elements at low levels. Essential elements (K, Ca, Na, and Mg) had the highest concentrations while toxic heavy metals (As, Pb, and Cd) had the lowest in the foods. Essential element pairs (Mg-Na, Mg-Ca, Fe-Al) were highly correlated, suggesting that these foods are sources of multiple nutrients. Toxic element pairs (Pb-Cd, Pb-As, and Cd-As), however, were poorly correlated in the foods, suggesting that these elements do not have a common source in these foods. Average consumption of these foods should provide the recommended daily allowances of essential elements, but will not expose consumers to toxic heavy metals. The ICP-OES method was validated by determining method detection limits and percent recoveries of laboratory-fortified blanks, which were generally 90–100%

Genomic Analysis of Multidrug-Resistant Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae Strain Lacking the Hypermucoviscous Regulators (rmpA/rmpA2)

Hypervirulent K. pneumoniae (hvKP) strains possess distinct characteristics such as hypermucoviscosity, unique serotypes, and virulence factors associated with high pathogenicity. To better understand the genomic characteristics and virulence profile of the isolated hvKP strain, genomic data were compared to the genomes of the hypervirulent and typical K. pneumoniae strains. The K. pneumoniae strain was isolated from a patient with a recurrent urinary tract infection, and then the string test was used for the detection of the hypermucoviscosity phenotype. Whole-genome sequencing was conducted using Illumina, and bioinformatics analysis was performed for the prediction of the isolate resistome, virulome, and phylogenetic analysis. The isolate was identified as hypermucoviscous, type 2 (K2) capsular polysaccharide, ST14, and multidrug-resistant (MDR), showing resistance to ciprofloxacin, ceftazidime, cefotaxime, trimethoprim-sulfamethoxazole, cephalexin, and nitrofurantoin. The isolate possessed four antimicrobial resistance plasmids (pKPN3-307_type B, pECW602, pMDR, and p3K157) that carried antimicrobial resistance genes (ARGs) (blaOXA-1,blaCTX-M-15, sul2, APH(3″)-Ib, APH(6)-Id, and AAC(6′)-Ib-cr6). Moreover, two chromosomally mediated ARGs (fosA6 and SHV-28) were identified. Virulome prediction revealed the presence of 19 fimbrial proteins, one aerobactin (iutA) and two salmochelin (iroE and iroN). Four secretion systems (T6SS-I (13), T6SS-II (9), T6SS-III (12), and Sci-I T6SS (1)) were identified. Interestingly, the isolate lacked the known hypermucoviscous regulators (rmpA/rmpA2) but showed the presence of other RcsAB capsule regulators (rcsA and rcsB). This study documented the presence of a rare MDR hvKP with hypermucoviscous regulators and lacking the common capsule regulators, which needs more focus to highlight their epidemiological role

Co-Occurrence of β-Lactam and Aminoglycoside Resistance Determinants among Clinical and Environmental Isolates of Klebsiella pneumoniae and Escherichia coli: A Genomic Approach

The presence of antimicrobial-resistance genes (ARGs) in mobile genetic elements (MGEs) facilitates the rapid development and dissemination of multidrug-resistant bacteria, which represents a serious problem for human health. This is a One Health study which aims to investigate the co-occurrence of antimicrobial resistance determinants among clinical and environmental isolates of K. pneumoniae and E. coli. Various bioinformatics tools were used to elucidate the bacterial strains’ ID, resistome, virulome, MGEs, and phylogeny for 42 isolates obtained from hospitalized patients (n = 20) and environmental sites (including fresh vegetables, fruits, and drinking water) (n = 22). The multilocus sequence typing (MLST) showed that K. pneumoniae belonged to ten sequence types (STs) while the E. coli belonged to seventeen STs. Multidrug-resistant isolates harbored β-lactam, aminoglycoside resistance determinants, and MGE were detected circulating in the environment (drinking water, fresh vegetables, and fruits) and in patients hospitalized with postoperative infections, neonatal sepsis, and urinary tract infection. Four K. pneumoniae environmental isolates (7E, 16EE, 1KE, and 19KE) were multidrug-resistant and were positive for different beta-lactam and aminoglycoside resistance determinants. blaCTX-M-15 in brackets of ISEc 9 and Tn 3 transposases was detected in isolates circulating in the pediatrics unit of Soba hospital and the environment. This study documented the presence of bacterial isolates harboring a similar pattern of antimicrobial resistance determinants circulating in hospitals and environments. A rapid response is needed from stakeholders to initiate a program for infection prevention and control measures to detect such clones disseminated in the communities and hospitals

Evaluation of tetracycline removal by magnetic metal organic framework from aqueous solutions: Adsorption isotherm, kinetics, thermodynamics, and Box-Behnken design optimization

In our current research, an intriguing magnetic nano sorbent Fe3O4@Zr-MOF was synthesized in the lab. We used this adsorbent for successfully removing tetracycline (TC) from water. We performed a number of experiments and studies to further support this, including the following: vibrating sample magnetometer (VSM), Fourier transform infrared spectroscopy (FTIR), energy-dispersive X-ray photoelectron spectroscopy (XPS), scanning electron microscope (SEM), X-ray diffraction (XRD), and Brunauer-Emmett-Teller surface area (BET). Our studies have determined that the Fe3O4@Zr-MOF boasts a considerable surface area of 868 m2/g with the highest adsorption capacity (qmax) of 942.12 mg/g. Study the factors that effect on adsorption process such as pH, TC concentration, adsorbent dose, and temperature. The adsorption isotherm was fitted to the Langmuir equation, whereas the kinetic isotherm to the pseudo-second-order equation. The adsorption process was chemisorption as well as the adsorption energy was 20 kJ/mol. Adsorption thermodynamics indicated that the adsorption process was both endothermic and spontaneous. As temperatures increased, the amounts of materials absorbed also increased. The Fe3O4@Zr-MOF has magnetic properties as it easily to remove from the solution after adsorption process. The adsorbent was used for five cycles with high efficiency and without change in the chemical composition as well as the XRD was the same before and after reusability. The mechanism of the interaction between Fe3O4@Zr-MOF and TC was expected on: Electrostatic interaction, π-π interaction, hydrogen bonding, and pore filling. The adsorption results were optimized using Box Behnken-design (BBD)