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

LONG TERM FOLLOW UP OF ESOPHAGEAL VARICES PATIENTS' AFTER ENDOSCOPIC BAND LIGATION PLUS ARGON PLASMA COAGULATION: 3 YEARS FOLLOW-UP

Background: Endoscopic band ligation (EBL) is an established maneuver for secondary prevention of variceal bleeding. However, recurrence of varices and postbanding ulcers are frequent problems. This is the first retrospective study that determined the the long-term re-bleeding rate in patients with esophageal varices who had done endoscopic Argon plasma photocoagulation (APC) after endoscopic band ligation. Aim: To determine the long-term re-bleeding rate of APC after endoscopic band ligation versus endoscopic band ligation alone for eradication of esophageal varices. Methods: Two hundred patients with cirrhosis, and had performed endoscopic band ligation for eradication of varices were randomized to either argon plasma coagulation after band ligation or observation. Endoscopy was performed every 3 months to check for recurrence of varices in both groups. If varices were unremarkable twice, patients were moved to every six months throughout the whole period of the study. Results: The 1-year, 2-year and 3-years rebleeding rates in the group of APC were 1%, 3% and 3%, respectively. While, rebleeding rates in the control group were 26%, 29% and 29% at 1-year, 2-years and 3-years respectively. Conclusions: The present study confirms the effectiveness of APC in significantly reducing the rate of rebleeding after endoscopic band ligation

Assessment of postpartum uterine involution and progesterone profile in Nubian goats (Capra hircus)

A total number of 12 postpartum (pp) Nubian goats were included in the study to measure the uterine involution by ultrasonography from day 3 to 31 pp. Coinciding with ultrasonography, blood samples were collected at every 3 days to monitor the ovarian activity by measuring plasma progesterone (P4) concentration using progesterone radio-immuno-assay (RIA). Uterine diameter (UD) and uterine lumen (UL) were maximum on day 3, and minimum on day 31 pp. More than 50% of uterine involution occurred between day 3 and day 14 pp. The end of uterine involution was characterized by small UD and absence of lochia in the UL. The maximum (0.87±0.4 ng/mL) and minimum (0.54±0.2 ng/mL) plasma P4 levels were reported on day 27 and day 7 pp, respectively. Completion of uterine involution was recorded at 22±3.3 days pp. There was a negative correlation between P4 level and uterine parameters (UD and UL). It can be concluded that ultrasonography is a reliable tool to determine uterine involution in Nubian goats

Regression of fibrosis by cilostazol in a rat model of thioacetamide-induced liver fibrosis: Up regulation of hepatic cAMP, and modulation of inflammatory, oxidative stress and apoptotic biomarkers.

In liver fibrosis, conversion of fibroblasts to profibrogenic myofibroblasts significantly drives the development of the disease. A crucial role of cyclic adenosine monophosphate (cAMP) in regulation of fibroblast function has been reported. Increase in cAMP levels has been found to decrease fibroblast proliferation, inhibit their conversion to myofibroblast, and stimulate their death. cAMP is generated by adenyl cyclase (AC), and degraded by cyclic nucleotide phosphodiesterase (PDE). In this study, the antifibrotic effect of a PDE inhibitor, cilostazol (Cilo), on a rat model of liver fibrosis induced by thioacetamide (TAA) was investigated. Four groups of rats were used; the first group received the vehicles and served as the normal control group, while liver fibrosis was induced in the other groups using (TAA, 200 mg/kg/biweekly for 8 successive weeks, ip). The last two groups were treated with Cilo (50 and 100 mg/kg/day, po, respectively). Induction of liver fibrosis in TAA-treated rats was observed as evidenced by the biochemical and histopathological findings. On the other hand, a potent antifibrotic effect was observed in the groups treated with Cilo, with preference to the higher dose. In these groups, a significant increase in the liver content of cAMP was demonstrated that was accompanied by reduction in the hepatic expression of key fibrogenic cytokines, growth factors, and inflammatory biomarkers, including interleukin-6, tumor necrosis factor-alpha, nuclear factor kappa B, and transforming growth factor-beta as compared to TAA group. Moreover, amelioration of TAA-induced oxidative stress and apoptosis in the liver has been observed. These findings reveal the antifibrotic effect of Cilo against TAA-induced liver fibrosis in rats, and suggest regulation of cAMP pathway, together with the modulation of oxidative stress, inflammation, and apoptosis as mechanistic cassette underlines this effect

The impact of probiotics on gut microbiota and non-alcoholic fatty liver disease (NAFLD) progression based on controlled attenuated parameter (CAP) elastography: Randomized controlled trial

Background: The gut–liver axis has many implications in non-alcoholic fatty liver disease onset as the major contributor of intestinal dysbiosis. Gut microbiota have an important role in intestinal barrier function and reversal of leaky gut. Probiotics may restore intestinal barrier integrity and contribute to hepatic functions recovery and alleviating inflammatory and fibrogenic processes. We aimed to evaluate the impact of probiotics on gut microbiota and non-alcoholic fatty liver disease progression. Results: Sixty non-alcoholic fatty liver disease patients (30 non-alcoholic fatty liver and 30 non-alcoholic steatohepatitis patients) were included in this open label randomized controlled study. Half of the patients of each group were randomized to receive probiotics in addition to classic management. The patients were followed-up for 6 months. The non-alcoholic fatty liver disease patients in the probiotic group experienced significant improvement in their Alanine aminotransferase, triglycerides, liver steatosis, and fibrosis stages, fecal pathological bacterial growth and Lactobacillus acidophilus abundance (P= 0.05, 0.029, 0.012, 0.013, 0.034, <0.001 and 0.005 respectively). Waist circumference and low density lipoprotein improvements were more pronounced in non-alcoholic fatty liver patients. Conclusion: Adding probiotic therapy to classical management of non-alcoholic fatty liver disease may help in improving intestinal dysbiosis, liver steatosis and fibrosis

Epidemiology of liver cancer in Nile delta over a decade: A single-center study

Background: In Egypt, there has been a remarkable increase in the proportion of hepatocellular carcinoma (HCC) among chronic liver diseases patients. This rising proportion may be explained by the increasing risk factors as hepatitis C virus (HCV) infection, hepatitis B virus (HBV) infection, improvement of the diagnostic tools of HCC as well as the extended survival among patients with cirrhosis to allow time for some of them to develop HCC. The aim of this study was to study the epidemiology of HCC in Nile delta over the last decade. Methods: The study was carried out on patients diagnosed as HCC in liver cancer clinic in Tanta University Hospital, Egypt, from January 2005 to January 2015. This retrospective study reviewed the files of HCC patients with special stress on age, sex, residence, occupation, smoking, and viral markers. Results: Over the last decade, 1440 HCC patients were diagnosed or referred to liver cancer clinic in Tropical Medicine Department in Tanta University Hospital from January 2005 to January 2015. The mean age of HCC patients was 56.13 ± 9.53 years. Nearly, half of the patients with HCC were smokers and quarter of HCC patients were diabetics. HBV surface antigen-positive patients were only 3.26%, and the majority of patients were HCV-Ab positive (94.86% of patients). Conclusions: In Nile delta, hepatitis C rather than hepatitis B was linked to the development of HCC in our region which may be related to the high prevalence of HCV in this area

Quadruple Therapy Offers High SVR Rates in Patients with HCV Genotype 4 with Previous Treatment Failure

Background and Aims. Direct-acting antivirals (DAAs) have made a revolution in hepatitis C virus (HCV) treatment with promising reduction of HCV infection and disease morbidities. However, unfortunately, treatment failure still occurs in about 5–15% of patients treated with DAA‐based combination regimens. The primary aim of the study was to assess the efficacy and safety of a quadruple regimen of (sofosbuvir, daclatasvir, and simeprevir with a weight-based ribavirin) in chronic HCV DAAs-experienced patients. Methods. This observational, open-label prospective study was carried out on 103 genotype 4 hepatitis C virus-infected patients who failed to achieve SVR12 after sofosbuvir-daclatasvir with or without ribavirin. Patients were treated for three months with sofosbuvir (400 mg), daclatasvir (60 mg), and simeprevir (150 mg) with a weight-based ribavirin dosage (1000–1200 mg/d). Response to treatment was determined by quantitative PCR for HCV at 3 months after the end of treatment (SVR12), and adverse events during the treatment were recorded. Results. SVR was achieved in 100 patients (97.1%) at week 12 after treatment. No dangerous or life-threatening adverse events were recorded. Conclusions. Retreatment of HCV genotype 4 patients with quadruple therapy is a good therapeutic option and achieves high response rates with minimal side effects