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

Effects of the ethanolic extract of Daucus carota L. seeds on acetaminophen-induced uremia and antiandrogenicity in male rats

This study determined both the secondary metabolites in ethanolic extract of Daucus carota seeds (EEDCS) and its effects on acetaminophen-induced uremia and antiandrogenicity in male Wistar rats. Twenty male rats (161.20 ± 6.02 g) were assigned into four groups (U1, U2, U3 and U4) such that animals in U1 and U2 received orally, 0.5 ml each of olive oil and 500 mg/kg body weight of the extract once daily for 21 days while those in U3 and U4 both received orally, 600 mg/kg body weight of acetaminophen for 10 days and thereafter administered 0.5 ml of olive oil and 500 mg/kg body weight of the extract respectively for additional 11 days.The extract contained alkaloids, flavonoids, phenolics, saponins, steroids and terpenoids. Administration of acetaminophen alone significantly (p<0.05) increased the levels of sodium ions, potassium ions, creatinine, uric acid and urea in the serum of the animals, whereas, the levels of testosterone, glycogen, cholesterol, total protein and sialic acid as well as the activities of alkaline phosphatase and acid phosphatase, lactate dehydrogenase and gamma glutamyl transferase decreased significantly in the testes of the animals. The extract reversed the acetaminophen-treatment related changes in a manner that was comparable with the rats treated with olive oil and EEDCS only. The study concludes that the ethanolic extract of D. carota seeds has some bioactive principles that conferred antiuremic properties and restored androgenic activities in the animals. Thus, the plant can be explored in the management of uremia and androgen related deficiencies.Keywords: Acetaminophen, Anti-androgenic, Antiuremia, Apiaceae, Daucus carot

In vitro

The in vitro antimicrobial and in vivo heavy metal abatement properties of aqueous extracts of Garcinia kola Heckel (bitter cola) were investigated using opportunistic pathogens and Wistar rats as experimental models. A marked inhibitory activity against Aspergillus niger, Aspergillus flavus and Candida albicans was recorded at 100 mg/ml of the crude relative to ketoconozole and fluconazole drugs. Similarly, different concentrations (25 mg/ml, 50 mg/ml and 100 mg/ml) of the crude extracts of bitter cola inhibited species of Escherichia coli and Pseudomonas aeruginosa almost as effectively as the control drug of streptomycine used. Chronic lead acetate poisoned wistar rats in groups B, C, D, E exposed to G. kola supplemented feed and water ad libitum showed variable decrease in the serum alkaline phosphatase level while aspartate and alanine aminotransferases level reduces in C and D groups compared to the negative control group. The kidney biomarkers; serum creatinine and urea concentrations were not significantly different at P â¤Â 0.05 for rat groups C, D, E when compared with the positive and negative control groups respectively. Mild infiltration and cell distortion were observed in the liver and kidney sections of the rats exposed to uncoated bitter cola supplemented feed while suggesting an overriding effect from the nut coats. The study reaffirms the medicinal potential of coated and uncoated bitter cola to act as abatement of lead toxicity and alternative antimicrobial. Furthermore, G. kola could be a double-edged drug for the spontaneous amelioration of lead toxicity and secondary infections due to lead poisoning. Keywords: Garcinia kola, Antimicrobial, Lead abatement, Histopathology, Opportunistic pathogen

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran