EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

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

ECONOMIC EVALUATION FOR IMPACT OF ENVIRONMENTAL FACTORS ON EGYPTIAN COTTON PRODUCTION

Cotton in Egypt has an important economic situation. Thus the study aimed to evaluate the expected economic effects and productivity of environmental factors on Egyptian cotton production. This comes by predicting production yield value and evaluating its return due to cultural and environmental desired and undesired variables. So, convenient production pattern could be determined to obtain maximum yield under these variables effect. The study clarified that expected cotton yield under desired environmental variables will be ranges between 4169-4336 thousand quintar, with an average equal 4253 thousand quintar. This production will realize national net income ranges between 429.37- 474.68 million L.E., with an average equal 452.03 million L. E. Meanwhile, the expected cotton yield under undesired environmental variables ranges between 3171- 3338 thousand quintar with an average equals 3255 thousand quintar. This yield will realize national net income ranges between 33.37- 78.60 million L. E. with an average equals 55.99 million L.E. The study also indicated that cotton crop is one of the extremely affected crops by the environmental and cultural variables extended in its production zones due its long life period. This is detected by its decrease in the production value undesired environmental factors, where this decrease ranges between 23.02% to 23.94% of th

Nano ZnO/amine composites antimicrobial additives to acrylic paints

Nano ZnO has been widely used as an antimicrobial agent not only for food packaging purposes but also in many coating processes. The present work is meant to enhance such functions through the preparation of sustainable and safe conduct of nano ZnO composites with amine derivatives that are characterized by their antimicrobial and anti-fouling functional activities. The results obtained revealed a more comprehensive approach to the antimicrobial function based on the reported active oxide species role. The oxide/amine composites and the acrylic emulsion paint were characterized chemically and structurally through FT-IR, TGA and TEM supported by biological assessment of each ZnO/amine composite action. Results of the study concluded that equilibrium between the nano ZnO particles size, their dispersion form, and amine ability to stabilize the actively produced oxygen species responsible for the antimicrobial function, should all be accounted for when persistence of antimicrobial agent efficiency is regarded