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

Screening Plant Genetic Resources under Organic Management for Breeding

The breeding research of pea (Pisum sativum L.) and faba bean (Vicia faba L.) crops began in 2013 because of priority for these species to be produced organically in Turkey. Nurseries were set up to cultivate landraces of pea and faba bean for regeneration, multiplication and observation of agro-morphological characters in autumn season (November 2013) at Organic Open Field Experimental Area of Aegean Agricultural Research Institute (AARI) located in the Mediterranean Region. Cowpea (Vigna unguilucata L.) and soybean (Glycine max L.) trials were also included by AARI for comparing grain legume crops of organic breeding programme of COBRA (Coordinating Organic Plant Breeding Activities for Diversity) project. For this purpose, nurseries of pea (24 populations), faba bean (17 populations) and drought tolerant cowpea (11 populations) were used for single plant selections for breeding purposes. The accessions were regenerated, multiplied and conserved at the National Seed Gene Bank of AARI. In addition, trials of advanced lines of faba bean and soybean genotypes were set up in 2013. The trials of 8 faba bean and 6 soybean genotypes in year 1 showed that grain yield and some of yield components such as number of pod per plant, number of seed per pod, plant height, number of days to flowering were significantly different and superior to standard registered varieties

Outcomes of open tibial shaft fractures treated by external fixation method

Tibia is vulnerable to open fractures due to its relative inadequacy of soft tissue coverage. The optimal treatment method of open tibial fractures is still controversial. External fixators are widely used as a definitive treatment method for open fractures. The aim of the current study was to evaluate the outcomes of external fixators applied for open tibial shaft fractures. All open tibial fractures treated with external fixators between December 1999 and October 2008 were reviewed retrospectively. 48 limbs of 47 patients were included in this study. Fractures were classified as Type I in 4 (8.3%), Type II in 18 (37.5%), and Type III in 26 (54.2%) according to Gustilo-Anderson classification. The mean follow-up period was 58.3 months. 28 patients (29 limbs) underwent unilateral external fixation, and 19 patients received Ilizarov ring fixator. Fracture healing rates were 100% in Type I fractures, 88.9% in Type II fractures, 81.8% in Type IIIA fractures, 28.6% in Type IIIB fractures, and 62% in Type IIIC fractures. The mean time for removal of the external fixator was 24.06±12.44 weeks. The mean time to fracture union was 27.27±13.19 weeks. According to Karlstrom and Olerud criteria, the mean functional score was 31.04±3.77. Functional results were excellent in 6 limbs (12.5 %), good in 16 limbs (33.3 %), acceptable in 8 limbs (16.7%), moderate in 10 limbs (20.8%), and poor in 8 limbs (16.7%). Deep tissue infection developed in 5 limbs (10.4%). Osteomyelitis developed in 4 limbs (8.3%). The findings of our study suggest that satisfactory results can be obtained by using external fixators for the treatment of open tibial shaft fractures. [Med-Science 2022; 11(1.000): 254-8

Screening of Soybean (Glycine max L.) Advanced Lines under Organic Management in Turkey

The breeding research of soybean (Glycine max L.) began with advanced lines of “Soybean Breeding Project” supported by MFAL-GDAR in 2013 under organic management for comparing grain legume crops of organic breeding programme of COBRA (Coordinating Organic Plant Breeding Activities for Diversity) project because of priority for this species to be produced organically in Turkey for organic sector at Organic Open Field Experimental Area of AARI located in the Mediterranean Region. Main objective of the research is screening the advanced lines of soybean genotypes under organic management to determine appropriate, adapted and stable line/s of breeding programme. For this purpose, trials of 6 advanced lines of second crop soybean genotypes were set up successive two years in 2013 and 2014 during summer season. The trials of 6 soybean lines and 2 registered varieties in year 1 and 2 showed that many lines in terms of grain yield and some of yield components such as 100-seed weight, number of pod per plant, plant height, and number of days to flowering, number of lateral branch were significantly different and superior to standard registered varieties of AARI which have been produced in different parts of Turkey mainly in Aegean and South East Anatolia Regions. Additionally, min. and max. seed protein contents of soybean lines ranged as 31.8-41.2% in 2013 and 32.9-43.1% in 2014, respectively. Protein contents were found remarkable in terms of advanced lines especially for three genotypes which were showed higher contents than registered varieties although data was not determined significantly different, statistically. It is found that there is strong possibility and encouraging results to obtain high yielding and quality soybean varieties suitable for organic farming

Surgeon-Specific Infection Rates and Risk Factors for Prosthetic Joint Infections

Objective: Prosthetic joint infections (PJIs) can lead to extended hospital stays, necessitate additional surgeries, and require antimicrobial treatment, thereby increasing costs and causing significant morbidity. This study aims to ascertain surgeon-specific infection rates and identify risk factors associated with PJIs. Materials and Methods:This research was conducted with two study arms between January 1, 2017, and February 28, 2019. In the first arm, all cases undergoing primary total knee and hip arthroplasty by the same surgeon were prospectively included and monitored for the development of PJIs. In the second arm, all patients admitted to the same surgeon due to PJI were included.Results: The first arm comprised 152 patients, of whom five developed PJIs (3.2%). Risk factors for PJI development included diabetes mellitus (p=0.030), rheumatoid arthritis (p=0.014), superficial surgical wound infections in the same joint (p=0.001), and postoperative hematomas (p=0.008). In the second arm, 23 patients with PJIs were included. Gram-positive microorganisms (84.6%) were the most frequently isolated pathogens. The overall treatment success rate stood at 76%, with a treatment success rate of 72.2% for patients receiving daptomycin.Conclusion: Effective measures such as perioperative glycemic control, regulation of immunosuppressive drugs, management of anticoagulant therapy, postoperative wound care by trained personnel, adherence to infection control protocols, and tailoring of PJI treatments based on local surveillance data are crucial for preventing PJIs and achieving treatment success

Long-Term Immunogenicity and Safety of a Homologous Third Dose Booster Vaccination with TURKOVAC: Phase 2 Clinical Study Findings with 32-Week Post-Booster Follow-Up

Vaccine-induced immunity wanes over time and warrants booster doses. We investigated the long-term (32 weeks) immunogenicity and safety of a third, homologous, open-label booster dose of TURKOVAC, administered 12 weeks after completion of the primary series in a randomized, controlled, double-blind, phase 2 study. Forty-two participants included in the analysis were evaluated for neutralizing antibodies (NAbs) (with microneutralization (MNT50) and focus reduction (FRNT50) tests), SARS-CoV-2 S1 RBD (Spike S1 Receptor Binding Domain), and whole SARS-CoV-2 (with ELISA) IgGs on the day of booster injection and at weeks 1, 2, 4, 8, 16, 24, and 32 thereafter. Antibody titers increased significantly from week 1 and remained higher than the pre-booster titers until at least week 4 (week 8 for whole SARS-CoV-2) (p 50: 6-fold; FRNT50: 5.4-fold) for NAbs and 32 weeks for S1 RBD (7.9-fold) and whole SARS-CoV-2 (9.4-fold) IgGs. Nine participants (20.9%) tested positive for SARS-CoV-2 RT-PCR between weeks 8 and 32 of booster vaccination; none of them were hospitalized or died. These findings suggest that boosting with TURKOVAC can provide effective protection against COVID-19 for at least 8 weeks and reduce the severity of the disease