Health Care Waste generation rates and patterns: The case of Lebanon

The objective of this study is to analyze Infectious Health Care Waste generation rates and patterns in Lebanon. Therefore, the quantities generated during five years by 57 hospitals from a total of 163 in the country have been analyzed. The seasonal evolution of Infectious Health Care Waste production and the evolution of the evaluation of the trends over years have been studied. Besides, the generation per capita have been estimated and compared to other countries. The variance between categories and the correlation between number of beds and Infectious Health Care Waste generation have been analyzed. The obtained results showed that the large private hospitals (over 200 beds) are characterized by their high generation rate: an average of 2.45 kg per occupied bed^-1 day^-1, whereas the average generation rate for other categories is 0.94 kg per occupied bed^-1 day^-1. The weighted mean is 1.14 per occupied kg bed^-1 day^-1. Small public hospitals (i.e. less than 100 beds) have the smallest standard deviation: 0.13, whereas large private hospitals (i.e. over than 200 beds) have the highest standard deviation: 0.40. Infectious Health Care Waste generation has been estimated to 1.42 kg/capita/year. The correlation between the numbers of hospitals beds in hospitals and the generation rate per bed is weak. The correlation between Infectious Health Care Waste generation per day and beds number is stronger. The total quantity produced by hospitals has increased over the five past years. These results suggest that the quantities of medical waste are not well controlled, and that hospitals have a defective monitoring management system of their waste. Annual peaks are observed in June, July, and December. Thus, this study, for the first time in Lebanon, has provided information on the infectious waste generation, allowing benchmarking between hospitals and between countrie

Indicators of Sustainable Development for Health Care Waste Treatment Industry

Sustainable development is more and more considered as a key parameter and a driving strategy for sustainable performance. Today, numerous organizations develop their own performance indicators as no standard set of performance indicators could be generalized as meaningful in terms of sustainability performance. Particularly, the context of developing countries, where the concept of sustainability is not well diffused yet and where economic difficulties and constraints result most of the times in underestimation of environmental and social considerations, requires specifically adapted indicators. Specially, the sector of health care waste management lacks of sustainability indicators. This sector ensures the treatment, before disposal, of hazardous health care waste generated by health care centers (hospitals, clinics, and others). The evaluation system is designed for monitoring the pace of gaining sustainability within this sector. The objective of this article is to propose a sustainability evaluation system adapted to the needs and situation of developing countries, based on meaningful, practical, easily measurable and applicable indicators for the Infectious Health Care Waste (IHCW) Treatment sector

The creation and monitoring of a network for solid healthcare waste management

Healthcare waste mismanagement constitutes a serious environmental and sanitary problem, especially in developing countries. This article describes the strategy and the methodology of the implementation of a national network for healthcare waste management by a non-profit organisation in Lebanon, taking into consideration environmental, social and economic issues. It presents a holistic description of the main aspects of this crucial sustainable development topic: the elaboration of the strategy and the selection of the optimal treatment technique based on an analysis of the context; the training on waste minimisation and waste management issues inside hospitals; the waste transportation and treatment procedures; the quality management of the process; the evaluation and the monitoring of the produced quantities and the established system; the optimisation of sterilisation parameters and process in order to reduce sterilisation time and fuel consumption

Comparison of steam sterilization conditions efficiency in the treatment of Infectious Health Care Waste

Many studies show that the treatment of Infectious Health Care Waste (IHCW) in steam sterilization devices at usual operating standards does not allow for proper treatment of Infectious Health Care Waste (IHCW). Including a grinding component before sterilization allows better waste sterilization, but any hard metal object in the waste can damage the shredder. The first objective of the study is to verify that efficient IHCW treatment can occur at standard operating parameters defined by the contact time–temperature couple in steam treatment systems without a pre-mixing/fragmenting or pre-shredding step. The second objective is to establish scientifically whether the standard operation conditions for a steam treatment system including a step of pre-mixing/fragmenting were sufficient to destroy the bacterial spores in IHCW known to be the most difficult to treat. Results show that for efficient sterilization of dialysis cartridges in a pilot 60L steam treatment system, the process would require more than 20 min at 144 °C without a pre-mixing/fragmenting step. In a 720L steam treatment system including pre-mixing/fragmenting paddles, only 10 min at 144 °C are required to sterilize IHCW proved to be sterilization challenges such as dialysis cartridges and diapers in normal conditions of rolling

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Telomere Biology and Thoracic Aortic Aneurysm

Ascending aortic aneurysms are mostly asymptomatic and present a great risk of aortic dissection or perforation. Consequently, ascending aortic aneurysms are a source of lethality with increased age. Biological aging results in progressive attrition of telomeres, which are the repetitive DNA sequences at the end of chromosomes. These telomeres play an important role in protection of genomic DNA from end-to-end fusions. Telomere maintenance and telomere attrition-associated senescence of endothelial and smooth muscle cells have been indicated to be part of the pathogenesis of degenerative vascular diseases. This systematic review provides an overview of telomeres, telomere-associated proteins and telomerase to the formation and progression of aneurysms of the thoracic ascending aorta. A better understanding of telomere regulation in the vascular pathology might provide new therapeutic approaches. Measurements of telomere length and telomerase activity could be potential prognostic biomarkers for increased risk of death in elderly patients suffering from an aortic aneurysm

Hematopoietic-Derived Galectin-3 Causes Cellular and Systemic Insulin Resistance

In obesity, macrophages and other immune cells accumulate in insulin target tissues, promoting a chronic inflammatory state and insulin resistance. Galectin-3 (Gal3), a lectin mainly secreted by macrophages, is elevated in both obese subjects and mice. Administration of Gal3 to mice causes insulin resistance and glucose intolerance, whereas inhibition of Gal3, through either genetic or pharmacologic loss of function, improved insulin sensitivity in obese mice. In vitro treatment with Gal3 directly enhanced macrophage chemotaxis, reduced insulin stimulated glucose uptake in myocytes and 3T3-L1 adipocytes and impaired insulin-mediated suppression of glucose output in primary mouse hepatocytes. Importantly, we found that Gal3 can bind directly to the insulin receptor (IR) and inhibit downstream IR signaling. These observations elucidate a novel role for Gal3 in hepatocytes, adipocytes and myocyte insulin resistance, suggesting that Gal3 can link inflammation to decreased insulin sensitivity. Inhibition of Gal3 could be a new approach to treat insulin resistance

Type 1 Diabetes in People Hospitalized for COVID-19: New Insights From the CORONADO Study

International audienc

The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)

International audienceAbstract Background It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. Methods We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020—October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. Results Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83–2.45 with an I 2 of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29–1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31–0.75], I 2 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40–0.68], I 2 37%) were significantly lower for people with previous macrovascular disease. Conclusions This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup