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

La Méditerrannée, lieu d'échanges de mots. L'exemple des mots de marine. XIIIe-XVIIe siècles

Entre le XIIIe siècle et le XVIIe siècle, se constitue un vocabulaire nautique spécifique, celui de la marine du Levant, différent de celui de la marine du Ponant utilisé en Atlantique. Ce vocabulaire est né du voyage dans le temps des mots provenant de l indo-européen, du latin et du grec, mais sa spécificité vient des échanges, du voyage des mots dans tous l espace méditerranéen qui permet à toutes les langues méditerranéennes de s enrichir mutuellement. Les récits de voyage à Jérusalem constituent une source importante car ils sont rédigés par des hommes qui n ont jamais auparavant vu la mer et qui vivent leur première expérience de navigation ; ils ont tout à apprendre pour pouvoir transmettre leur expérience à leurs lecteurs. Le métissage linguistique méditerranéen est le fait des marins qui transmettent aux marchands et aux voyageurs qui sillonnent la Méditerranée. Quand un mot domine et se répand dans d autres langues cela signifie qu il appartient à une langue d une nation dominante soit dans ses techniques de navigation, soit par sa puissance maritime.Les écrivains voyageurs racontent leur navigation en montrant leurs sentiments, en exprimant leur admiration pour les spectacles nouveaux qu ils découvrent. Comme la mer est un élément inconnu, elle engendre très souvent la peur qu il faut surmonter, le voyage est une épreuve nécessaire et enrichissante. La constitution d un vocabulaire spécifique montre qu au delà des guerres, de la course, des fortunes de mer, des hommes se sont parlés, se sont entendus, ont construitensemble les outils nécessaires pour nommer les chose, c est-à-dire les comprendre et se comprendre.Between the XIIIth century and the XVIIth century, a specific nautical vocabulary is building, vocabulary of Levant navy of the different from Ponant one used in the Atlantic. This vocabulary come from the travel, in all the Mediterranean space, of the words in the time, from Indo-European, Latin and Greek languages. This exchanges allow all languages Mediterranean learn from each other. Travel stories in Jerusalem constitute an important source because they are drafted by men who never have seen previously sea and who live their first experience of sailing; they have to learn everything to be able to transmit their experience to their readers. The Mediterranean linguistic crossbreeding is the fact of the sailors who transmit to the traders and to the travelers who cross the Mediterranean Sea. The writers-travelers tell their navigation by showing their feelings, by expressing their admiration for the new spectacles which they discover. As sea is an unknown element, it very often generates fear. The sailing time is a necessary and rewarding event. The constitution of a specific vocabulary shows that beyond wars, corsairs, perils of sea, the men spoke to each other, built together the necessary tools to name things, it means understand its and understand each other.TOULON-Bibliotheque electronique (830629901) / SudocSudocFranceF

The causal relationship between O2:K7:H6 extra-intestinal pathogenic Escherichia coli (ExPEC) and native valve endocarditis: a case report.

BACKGROUND: Native valves infective endocarditis due to Escherichia coli is still a rare disease and a particular virulence of some E.coli isolate may be suspected. CASE PRESENTATION: A 79-year-old woman presented during the post-operative period of an orthopedic surgery a urinary tract infection following obstructive ureteral lithiasis. E. coli was isolated from a pure culture of urine and blood sampled simultaneously. After evidence of sustained E.coli septicemia, further investigations revealed acute cholecystitis with the same micro-organism in biliary drainage and a native valve mitral endocarditis. E.coli was identified as O2:K7:H6, phylogenetic group B2, ST141, and presented several putative and proven virulence genes. The present isolate can be classified as both extra-intestinal pathogenic E.coli (ExPECJJ) and uropathogenic E. coli (UPECHM). CONCLUSIONS: The relationship between the virulent factors present in ExPEC strains and some serotypes of E. coli that could facilitate the adherence to cardiac valves warrants further investigation

Exophiala (Wangiella) dermatitidis and cystic fibrosis - Prevalence and risk factors

The objective of this prospective study was to assess the prevalence of Exophiala dermatitidis in respiratory secretions of patients with cystic fibrosis (CF) and to identify risk factors for its presence. The results of all cultures performed over a 2-year period in non lung-transplant patients in our CF clinic were included in the study. Samples consisted of sputum (whenever possible) or deep pharyngeal aspirate after a session of physiotherapy. Specimens were inoculated onto Sabouraud gentamicin-chloramphenicol agar (SGCA) medium (Becton-Dickinson) and incubated at 35°C for 2 days and then at ambient temperature (15-25°C) for 3 weeks. The whole study group included 154 patients (mean age ± SD: 18.5 y ± 11.69). E. dermatitidis was isolated from 58 specimens (2.8%) of nine patients (5.8%) out of total of 2065 cultures prepared during the study period. All E. dermatitidis culture-positive patients were pancreatic insufficient and ≥12 y of age. Almost all (8/9) were homozygous for the F508 del mutation. Aspergillus fumigatus colonization and genotype seemed to be predisposing factors. No other significant characteristic was identified in this group, either in terms of predominant bacterial pathogen or treatment. A distinct comparative study performed over 3 months in our laboratory revealed that the use of SGCA yielded identical isolation rates of E. dermatitidis as erythritol-chloramphenicol agar (ECA)

récurrence d'une leishmaniose viscerale et muco-cutanée chez un patient sous traitement immunosuppresseué

Background: Leishmaniasis is a protozoan disease caused by parasites of the genus Leishmania, transmitted to humans by sandflies. The diagnosis of leishmaniasis is often challenging as it mimics many other infectious or alignant diseases. The disease can present in three ways: cutaneous, mucocutaneous, or visceral leishmaniasis, which rarely occur together or consecutively. Case presentation: The patient was a 52 years old immunosuppressed Belgian woman with a long history of severe rheumatoid arthritis. She underwent bone marrow biopsy to explore thrombocytopenia. Diagnosis of visceral leishmaniasis was made by identification of Leishman Donovan (LD) bodies in macrophages. Treatment with liposomal amphotericin B was successful. She later developed cutaneous leishmaniasis treated with amphotericin B lipid complex. She next presented with relapsing cutaneous lesions followed by rapidly progressing lymphadenopathies. Biopsy confirmed the diagnosis of leishmaniasis. Treatments by miltefosine, amphotericin B, N-methyl-glucamine antimoniate were subsequently initiated. She later presented a recurrent bone marrow involvement treated with intramuscular paromomycin and miltefosine. She died two years later from leukemia. At the time of death, she presented with a mucosal destruction of the nose. A Leishmania-specific PCR (Polymerase Chain Reaction) identified L. infantum as etiological agent. Conclusions: Clinicians should be aware of the potential concomitant or sequential involvement of multiple anatomic localizations of Leishmania in immunosuppressed patients

Surfactin-Triggered Small Vesicle Formation of Negatively Charged Membranes: A Novel Membrane-Lysis Mechanism

The molecular mode of action of the lipopeptide SF with zwitterionic and negatively charged model membranes has been investigated with solid-state NMR, light scattering, and electron microscopy. It has been found that this acidic lipopeptide (negatively charged) induces a strong destabilization of negatively charged micrometer-scale liposomes, leading to the formation of small unilamellar vesicles of a few 10s of nanometers. This transformation is detected for very low doses of SF (Ri = 200) and is complete for Ri = 50. The phenomenon has been observed for several membrane mixtures containing phosphatidylglycerol or phosphatidylserine. The vesicularization is not observed when the lipid negative charges are neutralized and a cholesterol-like effect is then evidenced, i.e., increase of gel membrane dynamics and decrease of fluid membrane microfluidity. The mechanism for small vesicle formation thus appears to be linked to severe changes in membrane curvature and could be described by a two-step action: 1), peptide insertion into membranes because of favorable van der Waals forces between the rather rigid cyclic and lipophilic part of SF and lipid chains and 2), electrostatic repulsion between like charges borne by lipid headgroups and the negatively charged SF amino acids. This might provide the basis for a novel mode of action of negatively charged lipopeptides