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

Protection Against Fusarium Head Blight: Important Defense Mechanisms Studied in Three Regenerated Egyptian Wheat Cultivars

Fusarium graminearum is one of the major global pathogens of cereals and is considered the main causal agent of Fusarium head blight (FHB) disease in wheat. F. graminearum leads to severe losses in grain yield and quality of wheat. In the present study, immature embryos of three Egyptian wheat cultivars (Giza 164, Sids 1 and Bani Suef 6) have been used to highlight the physiological changes in wheat plants in response to treatment with different concentrations of Fugal Culture Filtrate (5%, 10%, 20% and 40%). Samples were taken at 5, 10 and 15 days after inoculation. The three studied wheat cultivars exhibited different responses for inoculation with different concentrations of FCF. However, inoculation with 20% FCF significantly increased the activities of antioxidant enzymes (catalase, peroxidase and ascorbate peroxidase) in shoots of wheat cultivars compared with uninoculated ones. In addition, proline and secondary metabolites (total phenol and flavonoids) significantly increased throughout the experimental period. Our results also proved that in addition to the common protective mechanisms detected in all the infected cultivars there are cultivar – dependent physiological changes exhibited by wheat plant during abiotic stress