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

Management of sunflower charcoal-rot and maize late-wilt diseases using the aqueous extract of vermicompost (vermitea) and environmental-safe biochar derivative (wood vinegar)

Abstract In Egypt, sunflower charcoal-rot caused by Macrophomina phaseolina and maize late-wilt caused by Magnaporthiopsis maydis are the most prevalent, and can lead to huge yield losses of both crops under epidemic conditions. In this study, the potential use of vermitea and wood vinegar for management of both diseases was investigated. Data revealed that, among the 17 bacterial strains obtained from vermitea, three strains named VCB-2, VCB-7 and VCB-11 were chosen for having the greatest in vitro inhibitory effect against M. phaseolina and M. maydis, with fungal inhibition values of 54.2; 61.7, 65.2; 74.0 and 57.1; 87.0% against both pathogens, respectively. These strains were identified as Bacillus amyloliquefaciens, Serratia marcescens and Bacillus velezensis, respectively. Wood vinegar significantly reduced the colony diameter of M. phaseolina and M. maydis in in vitro trials conducted on potato dextrose agar medium amended with the desired concentrations of 0.5, 1.0, 1.5, 2.0, and 2.5%. The efficiency increased with increasing wood vinegar concentration, and 2.0% was the most effective (100% suppression). Data from greenhouse experiments showed that the application of vermitea or wood vinegar tended to decrease the incidence (% dead plants) of sunflower charcoal-rot (by 61.1 and 66.7%) and maize late-wilt (by 70.6%). These treatments had positive impacts on the plant growth parameters, photosynthetic pigments and antioxidative enzymes of sunflower and maize plants. Data from field experiments showed that the application of vermitea or wood vinegar decreased the incidence of charcoal-rot (by 72.8 and 72.0%) and late-wilt (by 88.7 and 87.0%) as well as increased the production sunflower and maize plants

Maximizing the efficacy of Trichoderma to control Cephalosporium maydis, causing maize late wilt disease, using freshwater microalgae extracts

Abstract The main goal of this study was enhancing the biocontrol activity of Trichoderma spp. (T. harzianum, T. koningii, T. viride, and T. virens) against Cephalosporium maydis, the cause of late wilt disease in maize. Five isolates of C. maydis were isolated from diseased maize plants, showing late wilt symptoms, and were collected from infected maize fields in Gharbia Governorate, Egypt. Pathogenicity test revealed that all C. maydis isolates were able to attack maize plants (cv. Baladi), which cause late wilt disease. Isolate 3 (Cm3) was the most virulent of them. In in vitro experiments, vegetative growth of the mycelium of C. maydis was highly inhibited after opposite sides’ treatment by Trichoderma species on Potato Dextrose Agar plates amended with Chlorella vulgaris extracts (cool and hot extracts) than unamended one. Formulation of C. vulgaris extracts and Trichoderma spp. were prepared. The formulations maintained the capacity of Trichoderma spp. to inhibit growth of the pathogen for up to 1 year when stored at both room temperature or at 7 °C. These formulations (3-day-old) were examined for biological control activities against late wilt disease of maize. Under greenhouse and field conditions, all treatments reduced late wilt incidence compared to the untreated control. Treatments involved Trichoderma spp., and C. vulgaris extracts were more effective than that used individually. Both of the C. vulgaris extracts, with each of T. virens and T. koningii, were the most effective treatments in this respect. Under greenhouse conditions, formulation treatments (C. vulgaris extracts and Trichoderma spp.) significantly increase the plant growth of maize plants, i.e., plant height and plant dry weight as compared to the non-treated control either in infested or in un-infested soil with C. maydis. Under field conditions, these formulations increased the grain yield as well as ear parameters as compared with either C. vulgaris extracts or Trichoderma spp. alone as well as non-treated control. This study suggests that the efficacy of Trichoderma spp. was enhanced with C. vulgaris extracts and these formulations can be developed as bio-fungicides for minimizing the late wilt disease caused by C. maydis in maize

Management of strawberry leaf blight disease caused by Phomopsis obscurans using silicate salts under field conditions

Abstract Background Due to the increased economic and social benefits of the strawberry crop yield in Egypt, more attention has been paid to control its pests and diseases. Leaf blight, caused by the fungus Phomopsis obscurans, is one of the important diseases of strawberry plants. Therefore, effect of silicon and potassium, sodium and calcium silicates, and a fungicide on Phomopsis leaf blight of strawberry under laboratory and field conditions was examined. Results Four concentrations, i.e., 0, 2, 4, and 6 g/l of silicon as well as potassium, sodium and calcium silicates could significantly reduce the linear growth of tested fungus in the laboratory test where complete inhibition of linear growth was obtained with 6 g/l. The other concentrations showed less but favorable effects. The highest reduction of disease severity was obtained with potassium silicate and calcium silicate separately applied as soil treatment combined with foliar spray which reduced the disease incidence by 83.3 and 86.7%, respectively. Other treatments showed significant (P ≤ 0.05) but less effect. The highest yield increase was obtained with potassium silicate and calcium silicate applied as soil treatment combined with foliar spray which increased fruit yield by 60 and 53.8%, respectively. All tested treatments increased (P ≤ 0.05) the activities of the peroxidase, polyphenol oxidase, and chitinase enzymes. Conclusions All tested concentrations of silicon salts have suppressed the fungal growth and disease spread but with different degrees. The more the concentration, the better it suppresses the fungal growth and consequent effect on damaging strawberry plants. Potassium silicate and calcium silicate separately applied as soil treatment combined with foliar spray were the best in reducing the disease incidence and increasing crop yield. Potential implications of silicate salts on enhancing activities of the tested enzymes reflected their role in protection against such a plant disease

Reduction of Stromatinia cepivora inocula and control of white rot disease in onion and garlic crops by repeated soil applications with sclerotial germination stimulants

The effect of soil-applied Allium crop products on the Stromatinia cepivora viability and the incidence of white rot in subsequent onion and garlic crops were evaluated in this work. The tested products were onion powder, garlic powder, onion oil, garlic oil and Allium waste (onion and garlic) that are described as sclerotial germination stimulants. Under in vitro conditions, data revealed that more than 80% of the sclerotia died in the soil treated with sclerotial germination stimulants. Under greenhouse conditions, soil-artificially infested with sclerotia of S. cepivora and treated with sclerotial germination stimulants for 6-months before cultivation, significantly reduced the incidence of white rot on onion and garlic. Onion oil, garlic oil and Allium waste were the most effective treatments, decreasing disease incidence by 78.6% in onion and 80.0% in garlic. Under field conditions, sclerotial germination stimulants were incorporated into the soil in commercial fields naturally infested with S. cepivora. Two fields were chosen based on differential sclerotial density. Within 6 months after treatment, more than 70% of the sclerotia died in the plots treated with sclerotial germination stimulants. In subsequent onion and garlic crops planted approximately one year after soil treatment, sclerotial germination stimulants were more effective than the control in reducing white rot symptoms coupled with low inoculum density (45.9 sclerotia/kg of soil). Reduction of white rot disease was accompanied by increased of growth and bulbs yield of onion and garlic plants. Despite the efficacy of sclerotial germination stimulants to reduce populations of viable sclerotia in soil with a high inoculum density (594.7 sclerotia/kg of soil), the pathogen caused substantial white rot and yield losses in subsequent onion and garlic crops planted approximately one year after soil treatment

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks

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