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

Islets in the body are never flat: transitioning from two-dimensional (2D) monolayer culture to three-dimensional (3D) spheroid for better efficiency in the generation of functional hPSC-derived pancreatic β cells in vitro

Abstract Diabetes mellitus (DM), currently affecting more than 537 million people worldwide is a chronic disease characterized by impaired glucose metabolism resulting from a defect in insulin secretion, action, or both due to the loss or dysfunction of pancreatic β cells. Since cadaveric islet transplantation using Edmonton protocol has served as an effective intervention to restore normoglycaemia in T1D patients for months, stem cell-derived β cells have been explored for cell replacement therapy for diabetes. Thus, great effort has been concentrated by scientists on developing in vitro differentiation protocols to realize the therapeutic potential of hPSC-derived β cells. However, most of the 2D traditional monolayer culture could mainly generate insulin-producing β cells with immature phenotype. In the body, pancreatic islets are 3D cell arrangements with complex cell–cell and cell–ECM interactions. Therefore, it is important to consider the spatial organization of the cell in the culture environment. More recently, 3D cell culture platforms have emerged as powerful tools with huge translational potential, particularly for stem cell research. 3D protocols provide a better model to recapitulate not only the in vivo morphology, but also the cell connectivity, polarity, and gene expression mimicking more physiologically the in vivo cell niche. Therefore, the 3D culture constitutes a more relevant model that may help to fill the gap between in vitro and in vivo models. Interestingly, most of the 2D planar methodologies that successfully generated functional hPSC-derived β cells have switched to a 3D arrangement of cells from pancreatic progenitor stage either as suspension clusters or as aggregates, suggesting the effect of 3D on β cell functionality. In this review we highlight the role of dimensionality (2D vs 3D) on the differentiation efficiency for generation of hPSC-derived insulin-producing β cells in vitro. Consequently, how transitioning from 2D monolayer culture to 3D spheroid would provide a better model for an efficient generation of fully functional hPSC-derived β cells mimicking in vivo islet niche for diabetes therapy or drug screening. Video Abstrac

Study The Effect of Industrial Waste (Industrial Water) on The Engineering Properties of Expansive Clayey Soil

This Research deals with the effect of industrial waste on the engineering properties of clayey soil .The investigated soil was obtained from (1.0) meter depth Al- Yarmook district in Mosul City. The soil can be described as light brown stiff clay, in organic clay with high plasticity (CH), and it contains (38%) clay size particles (≤ 0.002 mm). The soil was treated with four types of industrial waters, taken from several factories located in Mosul city and from fertilizers factory in Baiji region. The Results, show that the industrial waters caused a little reduction in the liquid limit and Increased the plasticity index, except the fertilizers factors Industrial waters where plasticity index of the soil decrease with increasing the addition of this type of industrial waters. As far as the effect of industrial waters on the compaction characteristics, the result showed that the maximum dry density of the soil increased with the addition of industrial waters and the optimum moisture content decreased. The industrial waters increased the unconfined compressive strength and the shear strength parameters (angle of internal friction (φ’ ) and cohesion (c’)) , except the industrial waters from sugar and yeast factories decreased the angle of internal friction . The study, showed that the swelling percentage and swelling pressure increased with increasing the concentration of industrial waters, except the industrial waters of the fertilizers factory, where the swelling characteristics decreased.The results of consolidation test showed that the compression Index (cc) and coefficient of consolidation (cv) increased when the soil was treated with industrial waters. The results of chemical tests showed that the values of cat ion exchange capacity and organic matter content increased while the (pH- value) decreased for treated soil, except the Industrial waters of fertilizers factory, which caused an increase in the (pH- value)

Willingness to Receive the COVID-19 and Seasonal Influenza Vaccines among the Saudi Population and Vaccine Uptake during the Initial Stage of the National Vaccination Campaign: A Cross-Sectional Survey

This study aimed to assess the willingness to receive the coronavirus disease 2019 (COVID-19) and seasonal influenza vaccines and vaccine uptake during the early stage of the national vaccination campaign in Saudi Arabia. A cross-sectional online survey was conducted among adult Saudis between 20 January and 20 March 2021. The questionnaire addressed vaccine hesitancy, perceived risk, willingness, and vaccine uptake. Approximately 39% of the participants expressed vaccine hesitancy, and 29.8% and 24% felt highly vulnerable to contracting COVID-19 and seasonal influenza, respectively. The majority (59.5%) were willing to receive the COVID-19 vaccine, although only 31.7% were willing to receive the flu vaccine. Adjusted analysis showed that vaccine hesitancy (OR 0.34, 95% CI 0.27–0.43) and the perception of being at high risk (OR 2.78, 95% CI 1.68–4.60) independently affected the intention to be vaccinated. Vaccine hesitancy was similar among those who were willing to be vaccinated (29.8%) and those who had already been vaccinated (33.1%). The perceived risk was significantly higher among those who had been vaccinated (48.1%) than among those who were willing to be vaccinated but had not yet been vaccinated (29.1%). In conclusion, the acceptance of the COVID-19 vaccine in Saudi Arabia is high. Saudis who received the vaccine had a similar level of vaccine hesitancy and a higher level of perceived risk

Irritable Bowel Syndrome: Assessment of Prevalence and Risk Factors in Saudi University Students Using Rome IV Criteria

The main objective of this study was to determine the prevalence of Irritable Bowel Syndrome (IBS) and its associated factors among University students in Saudi Arabia, as little is known about this issue in our country. This cross-sectional study was conducted between 13 March and 21 May of the Academic Year 2017-2018 at Jazan University, Saudi Arabia, involving a random sample of 890 students, selected using the stratified multistage method. IBS prevalence was determined using the Rome IV diagnostic Criteria. The overall prevalence of IBS was 8.8%. According to the results of the multivariate logistic regression, the most important independent predictors of IBS were being a student in a medical college (OR = 10.42; 95%CI: 3.45-31.51) and a scientific college (OR = 5.16; 95%CI: 1.64-16.22), cigarettes smoking (OR = 2.74; 95%CI: 1.24-6.07), emotional stress (OR = 2.53; 95%CI: 1.28-5.00), and food intolerance (OR = 2.15; 95%CI: 1.11-4.16). The present study revealed a prevalence rate of 8.8%. The main predictors of IBS were being a medical student, a scientific college student, cigarette smoker, and having emotional stress and food intolerance. No significant association was found between IBS and anxiety and depression

Improved outcome for children with acute lymphoblastic leukemia after risk-adjusted intensive therapy : A single-institution experience

Background and Objective: Because of the need for more comprehensive information on the least toxic and most effective forms of therapy for children with acute lymphoblastic leukemia (ALL), we reviewed our ex--perience in the treatment of children with ALL at King Faisal Specialist Hospital and Research Centre (KFSH&RC) and King Fahad National Center for Children′s Cancer and Research (KFNCCC&R) over a period of 18 years with a focus on patient characteristics and outcome. Methods: During the period of 1981 to 1998, records of children with ALL were retrospectively reviewed with respect to clinical presentation, laboratory findings, risk factors, stratification, therapy and outcome. The protocols used in treatment included 4 local protocols (KFSH 81, 84, 87 and 90), and subsequently, Children′s Cancer Group (CCG) protocols, and these were grouped as Era 1 (1981-1992) and Era 2 (1993-1998). Results: Of 509 children with ALL treated during this period, 316 were treated using local protocols and 193 using CCG protocols. Drugs used in Era 1 included a 4-drug induction using etoposid (VP-16) instead of L-asparaginase. Consolidation was based on high dose methotrexate (MTX) 1g/m 2 and maintenance was based on oral mercaptopurine (6-MP) and MTX with periodic pulses using intravenous teniposide (VM-26), Ara-C, L-asparaginase, adriamycin, prednisone, VP-16 and cyclophosphamide. International protocols were introduced in Era 2, which was also marked by intensification of early treatment, a wider selection of cytoreductive agents, and the alternating use of non-cross-resistant pairs of drugs during the post-remission period. The end-of-induc--tion remission rate improved from 90% in Era 1 to 95% in Era 2, which was of borderline statistical signifi--cance (P=.049). The 5-year event-free survival (EFS) improved from 30.6% in Era 1 to 64.2% in Era 2 (P< .001). Improvement in outcome was achieved without any significant increase in morbidity or mortality, due to im--provement in both systemic therapy and supportive care. The most important independent prognostic factors were intensity of therapy, poor risk category assignment and CNS disease at diagnosis. Conclusion: Outcome in children with ALL has improved because of intensification of treatment protocols and better supportive care

Auranofin Modulates Thioredoxin Reductase/Nrf2 Signaling in Peripheral Immune Cells and the CNS in a Mouse Model of Relapsing–Remitting EAE

Multiple sclerosis (MS) is one of the most prevalent chronic inflammatory autoimmune diseases. It causes the demyelination of neurons and the subsequent degeneration of the central nervous system (CNS). The infiltration of leukocytes of both myeloid and lymphoid origins from the systemic circulation into the CNS triggers autoimmune reactions through the release of multiple mediators. These mediators include oxidants, pro-inflammatory cytokines, and chemokines which ultimately cause the characteristic plaques observed in MS. Thioredoxin reductase (TrxR) and nuclear factor erythroid 2-related factor 2 (Nrf2) signaling plays a crucial role in the regulation of inflammation by modulating the transcription of antioxidants and the suppression of inflammatory cytokines. The gold compound auranofin (AFN) is known to activate Nrf2 through the inhibition of TrxR; however, the effects of this compound have not been explored in a mouse model of relapsing–remitting MS (RRMS). Therefore, this study explored the influence of AFN on clinical features, TrxR/Nrf2 signaling [heme oxygenase 1 (HO-1), superoxide dismutase 1 (SOD-1)] and oxidative/inflammatory mediators [IL-6, IL-17A, inducible nitric oxide synthase (iNOS), myeloperoxidase (MPO), nitrotyrosine] in peripheral immune cells and the CNS of mice with the RR type of EAE. Our results showed an increase in TrxR activity and a decrease in Nrf2 signaling in SJL/J mice with RR-EAE. The treatment with AFN caused the amelioration of the clinical features of RR-EAE through the elevation of Nrf2 signaling and the subsequent upregulation of the levels of antioxidants as well as the downregulation of oxidative/pro-inflammatory mediators in peripheral immune cells and the CNS. These data suggest that AFN may be beneficial in the treatment of RRMS

Nursing profession in the light of Social Perception in the Middle East

Nursing is a noble profession and worldwide healthcare systems are giving it as important as the backbone of the healthcare systems. While social perception refers to the own identity of professional transmission. In the special context of the nursing profession, the historical perspective signified social stigmatization instead of giving it noble status. Thus, this bibliography-based literature review was conducted to highlight the social perception of the ways of expression through social stigmatization. This bibliographic review was conducted by focusing literature on different databases such as WHO, PubMed, Google Scholar, and CINAHL Plus by using Bool terms and keywords. A set of 38 articles was reflected and viewed. After using inclusion criteria, articles with the last 5 years were included only with the interest and aim of the study. Findings of results revealed that social perception regarding the nursing profession holds social stereotypes and stigmatization such as an attractive model, small autonomy, weakness, faintness, unfair compensation, and other stereotypes in were found in the Middle East, especially in Saudi Arabia. It was concluded that, despite myths, stereotypes, and irrational beliefs are rooted in the general community of the Region, the profession of nursing is the backbone and only field of strong characterization with a noble identity that must be transmitted to the communities and beliefs systems of the general population in the region

Burden of diarrhea in the eastern mediterranean region, 1990-2013: Findings from the global burden of disease study 2013

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low-and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.</p