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

Rosemary extract ameliorates cadmium-induced histological changes and oxidative damage in the liver of albino rat

The oxidative damage and histological changes of liver of rats exposed to cadmium and the ameliorative effect of rosemary extract against cadmium hepatotoxicity were studied. The results showed that exposure to Cd (30 mg/kg b.w., 5 consecutive days/week for 8 weeks) led to an increase in the MDA levels and a decrease in activity of SOD, CAT and the concentration of GSH versus controls. In contrast, administration of rosemary aqueous extract restored the changes in these parameters to nearly the normal levels. Treating animals with Cd led to different histopathological changes such as loss of the normal structure of hepatic cells, blood congestion, leukocytic infiltrations and fatty degeneration. Ultra structure results revealed abnormality in the nucleus, swelling of mitochondria, degeneration of endoplasmic reticulum, and increase of lysosomes and appearance of fat droplets. On the other hand, animals treated with Cd and rosemary showed an improvement in these changes and the tissue appears with normal structures. The results suggested that the ameliorative effect of rosemary extract may be due to its antioxidant properties in combating free radical-induced oxidative stress and tissue injury resulting from cadmium chloride