Peutz-Jeghers Syndrome presenting as Intussusception in a young female: A Case Report

Peutz-jeghers syndrome is rare condition with autosomal dominant inheritance. It is due to the mutation in a tumor suppressor gene SK 11 at chromosome no 9. It has a very characteristic presentation. Patient usually presents at a young age with intestinal obstruction due to polyps leading to intussusception. Also there is melanosis at perioral, digits and perineal regions. There is very strong association of cervical and breast carcinoma in females and testicular tumors in males. GIT, pancreatic and lung malignancies occur in both sexes. Regular follow up and screening are necessary for early detection of malignancies. We present a case of young girl who presented with intestinal obstruction along with other signs and symptoms of peutz-jeghers syndrome. Exploratory laparotomy revealed jejunoileal intussusception and hamartomatous polyps. Patient and other family members were advised screening studies of associated malignancies and regular follow up

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