A Randomized, Controlled Trial Comparing White-Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification during Total Thyroidectomy

Background: Parathyroid glands are difficult to identify during total thyroidectomies and accidental resection can lead to problematic post-operative hypocalcemia. Our main goals were to evaluate the effectiveness of using near-infrared light (NIRL) auto-fluorescence intra-operatively for parathyroid-gland identification; and to measure its impact on postoperative hypocalcemia incidence.Study Design Total thyroidectomies were performed on 170 patients with different thyroid pathologies, block-randomized (1:1) into 2 equal groups. Among controls, traditional overhead white light (WL) was used throughout. In the experimental group, NIRL was used to enhance parathyroid gland recognition before thyroid dissection. The number of parathyroid glands identified was compared after thyroid dissection in controls using WL vs pre-dissection in the experimental using NIRL and with WL vs NIRL before thyroid dissection in the experimental group. Postoperative serum calcium levels and hypocalcemia rates were compared. Results: The mean number of parathyroid glands identified pre-dissection with NIRL was the same identified post-dissection with WL (3.5 vs 3.6). In the experimental group, converting from WL to NIRL increased the number of glands detected from 2.6 to 3.5 (p < 0.001), and revealed at least 1 previously missed gland in 67.1% of patients. Calcium levels ≤7.5 mg/dL were one-tenth as common in the NIRL group (p = 0.005). The adjusted odds of hypocalcemia developing increased by 15% for every 5-g increase in thyroid gland weight (odds ratio 1.15; 95% CI 1.06 to 1.25). All hypocalcemia resolved within 6 months. Conclusions: Using NIRL during thyroidectomy increases intraoperative identification of parathyroid glands, enhances their detection before thyroid dissection, and decreases the incidence of postoperative hypocalcemia.Fil: Dip, Fernando. instituto Argentino de Diagnóstico y Tratamiento; ArgentinaFil: Falco, Jorge. Instituto Argentino de Diagnóstico y Tratamiento; ArgentinaFil: Verna, Silvina. Instituto Argentino de Diagnóstico y Tratamiento; ArgentinaFil: Prunello, Marcos Miguel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Cs.bioquimicas y Farmaceuticas. Departamento de Matematica y Estadistica.; ArgentinaFil: Loccisano, Matias. Instituto Argentino de Diagnóstico y Tratamiento; ArgentinaFil: Quadri, Pablo. Instituto Argentino de Diagnóstico y Tratamiento; ArgentinaFil: White, Kevin. Scienceright Research Consultations; CanadáFil: Rosenthal, Raul. Cleveland Clinic Florida; Estados Unido

Chlorpyrifos and persistent organic pollutants in feathers of the near threatened Olrog's Gull in southeastern Buenos Aires Province, Argentina

The use of bird feathers to assess environmental contamination has steadily increased in ecotoxicological monitoring programs over the past decade. The Olrog's Gull (Larus atlanticus) is a species endemic to the Atlantic coast of southern South America, constituting one of the three threatened gull species listed in the entire American continent. The aim of this study was to assess the exposure to Persistent Organic Pollutants (POPs) and chlorpyrifos in the Near Threatened Olrog's Gull through the analysis of body feathers sampled at the Mar Chiquita coastal lagoon, the main wintering area of the species in Argentina, controlling for sex and age class. Chlorpyrifos showed the highest concentrations among all contaminants and groups of individuals (X¯ = 263 ng g−1), while among POPs the concentration of organochlorine pesticides was higher than polychlorinated biphenyls and polybrominated diphenyl ethers, likely indicating the current use of these agricultural contaminant in the region. The highest values of total POP concentrations (males X¯ = 280 ng g−1, females X¯ = 301 ng g−1) were found in juvenile gulls, likely as a consequence of the incorporation of pollutants during the breeding season. Subadult and adult birds showed difference between sexes in the concentration of contaminants, with higher levels in males than females. The results highlight the need to include birds of different sex and age classes in order to better understand the variation in pollutants loads. The present study provides relevant information to improve the conservation status of the Olrog's Gull and new insights about the environmental health of the Mar Chiquita coastal lagoon, Argentina, a MAB-UNESCO World Biosphere Reserve. However, there is a continued need for long-term monitoring programs focusing on this threatened species to understand the effects of pollutants on its population.Fil: Quadri Adrogué, Agustina. Universidad Nacional de Mar del Plata; ArgentinaFil: Seco Pon, Juan Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: García, Germán Oscar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Castano, Melina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Copello, Sofía. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Favero, Marco. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Miglioranza, Karina Silvia Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; Argentin

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