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

Plants prescribed for both preventive and therapeutic purposes by the traditional healers of the bede community residing by the turag river, dhaka district

The Bede community people are an indigenous community of Bangladesh and because of their preference for living and travelling on boats are also known as the river gypsies. They seldom reside for long at any given place but travel constantly on the waterways to ply their trade at various riverside villages. The community keeps mostly to themselves except when interacting with village people to sell sundry items, catch snakes, and practice their traditional medicinal system, which consists of cupping (drawing blood) and selling medicinal products containing plant, animal or fish parts. Medicinal plants form the chief item in their formulations for treatment of diverse ailments. The community has various professional groups within them based on their profession, among which one such group being the Dhanantari Vaidyas, who supposedly are able to cure all diseases. In recent times, the Government is trying to settle them by various riversides so as to enable them to get access to education and modern health care. The older generation, however, still prefer their traditional medicines to allopathic medicines. One such Bede group was located by the Turag River in Kamar Para village on the outskirts of Dhaka city in Dhaka district, Bangladesh. During the course of an ethnomedicinal survey among this community, it was observed that the Dhanantari Vaidyas advocated consumption of a number of plants in the cooked form for not only therapeutic but also preventive purposes. It was the objective of the present study to document the use of these plants. It was observed that 32 plant species were prescribed by the Vaidyas for regular consumption (preventive) or consumption during times when a particular disease occurred (therapeutic). These species were distributed into 20 families; the Fabaceae family contributed 4 species, while the Amaranthaceae, Asteraceae, and Cucurbitaceae families provided 3 plants each. Most of the plants were leafy vegetables with their leaves and stems prescribed for consumption following cooking; however, a few of them had their roots or fruits prescribed for consumption without cooking. Four plants (Allium cepa, Allium sativum, Capsicum frutescens and Coriandrum sativum) were used as accessories when cooking other plants. Among these four plants, Allium sativum was also used by itself for prevention and treatment of any type of dysentery and stomach problems, and Coriandrum sativum used by itself for prevention and treatment of gastrointestinal disorders and to increase appetite. Only two plant (Eclipta alba and Curcuma longa) parts were administered topically. Consumption of plants or plant parts for preventive purposes can be a cost-effective form of health care. As such, the plants prescribed for consumption by the Dhantari Vaidyas of the Bedes merit further scientific studies to assess their full curative potentials

Novel Treatments for Melanoma Brain Metastases

Background: The development of brain metastases is common in patients with melanoma and is associated with a poor prognosis. Treating patients with melanoma brain metastases (MBMs) is a major therapeutic challenge. Standard approaches with conventional chemotherapy are disappointing, while surgery and radiotherapy have improved outcomes. Methods: In this article, we discuss the biology of MBMs, briefly outline current treatment approaches, and emphasize novel and emerging therapies for MBMs. Results: The mechanisms that underlie the metastases of melanoma to the brain are unknown; therefore, it is necessary to identify pathways to target MBMs. Most patients with MBMs have short survival times. Recent use of immune-based and targeted therapies has changed the natural history of metastatic melanoma and may be effective for the treatment of patients with MBMs. Conclusions: Developing a better understanding of the factors responsible for MBMs will lead to improved management of this disease. In addition, determining the optimal treatments for MBMs and how they can be optimized or combined with other therapies, along with appropriate patient selection, are challenges for the management of this disease