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

Serum leptin and insulin levels during chronic diurnal fasting

Ramadan fasting is a unique model that is associated with restriction of the timing of food and fluid intake food from dawn to sunset and reduction in meal frequency and sleep duration. Leptin levels are thought to play a role in long-term regulation of caloric intake and fat deposition. However, the long-term changes in leptin levels during this pattern of fasting are not known. The study was conducted on lean (N=26, BMI = 22.5 ± 0.4) and obese (N=18, BMI=33.1±1.0) healthy female volunteers. Fasting serum levels of leptin, insulin and glucose were estimated at baseline (day 1), days 14 and 28 of the month of Ramadan and 2 weeks after Ramadan. Baseline serum levels of leptin were significantly higher in obese (13.5 ± 1.96μg/L, P<0.05) compared with lean subjects (9.60 ± 0.80 μg/L) and correlated positively with body fat (r = 0.82, P = 0.0004). Serum leptin levels exhibited a significant and comparable increase by 39% and 37% throughout the month in lean and obese subjects, respectively. In addition, a significant correlation (r = 0.52, P = 0.003)) was found between changes in serum leptin and serum insulin levels. We conclude that chronic diurnal fasting is associated with significant elevations in serum leptin. These elevations appear to be mediated by changes in serum levels of insulin. These data support the role of insulin in the long-term regulation of leptin secretion during chronic diurnal fasting followed by nocturnal eating during the month of Ramadan. Key Words: leptin, insulin, Ramadan fasting, obesity, Bahrain Introduction Leptin, the product of the ob gene, appears to play a key role in long-term regulation of body weight and energy homeostasis. It coveys information to the brain about the size of energy stores and stimulates the hypothalamic centers responsible for regulation of energy intake and expenditure. 1,2 Plasma leptin levels are elevated in obese humans and are positively correlated with the indices of body fatness. 3-5 Previous studies indicated that short-term total fasting 6 or chronic reduction in caloric intake 7,8 results in reduction of leptin down to 30-66 % of its basal levels. However, the reduction of leptin levels in these studies did not correlate with the changes in body fat mass. On the other hand, chronic overfeeding is associated with significantly elevated levels of leptin than would be expected by the increase in body mass index or percentage of body fat

Determinants of health-related quality of life among warfarin patients in Pakistan.

IntroductionThe effect of anticoagulation control on overall Health-Related Quality of Life (HRQoL) in patients taking warfarin in Pakistan has not been explored yet. Therefore, this study aimed to evaluate HRQoL among warfarin patients in Pakistan.MethodsThis cross-sectional study was conducted among patients on warfarin in Pakistan. By purposive sampling, data were collected using demographic data collection form and the World Health Organization Quality of Life: Brief Version (WHOQOL-BREF). The WHOQOL-BREF is comprised of four domains; physical, psychological, social relationships, and environment. Descriptive and inferential statistical analysis was done using SPSS version 22.ResultsOut of 295 warfarin patients, more females than males (ConclusionPatients had overall lower to moderate but satisfactory HRQoL scores in all four domains. Age, gender, employment status, education level, the indication of use and duration of warfarin therapy was associated with one or more domains of HRQoL among warfarin patients. The findings of this study would serve as a primary database for future studies. This study highlights how non-clinical factors could impact HRQoL in studied patients