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

A STUDY OF PULMONARY FUNCTION TEST IN TYPE 2 DIABETES MELLITUS

Introduction: Type 2 Diabetes mellitus is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. These processes play the main role in causing impairments of collagen & elastin cross linkage, which thereby causes reduced elasticity of connective tissue. .The presence of abundant connective tissue and micro-vascular circulation in lung raises the possibility that in diabetic patients, lung could also be a “target organ”.Pulmonary function test is a useful test to assess involvement of lung connective tissues and micro vascular bed in diabetic patients. Methods: In this study, which was conducted in a tertiary care hospital of South Gujarat, we enrolled 65 subjects who were known cases diabetes mellitus. Result: Diabetes Mellitus in patients alters Various parameters of PFT like FVC, FEV1 which are reduced while FEV1/FVC increased showed restrictive pattern compared to normal individual. Conclusion: Diabetes mellitus patients have positive correlation with interpretation of PFT as with HbA1c increases a greater number of patients develop abnormal PFT in which Restrictive pattern is seen more commonly

UTILITY OF ANKLE BRACHIAL PRESSURE INDEX AS A SCREENING TEST TO DETECT PERIPHERAL ARTERIAL DISEASE IN DIABETES MELLITUS

Introduction: Chronic hyperglycemia in diabetic patients cause many microvascular and macrovascular changes in the body. PAD is considered to be an important macrovascular complication of diabetes mellitus, especially among those with prolonged duration of diabetes. As PAD can be asymptomatic initially, it can lead to important morbidities including amputation of limbs if not detected early. ABPI is a cheap, easy and useful tool to assess PAD even in asymptomatic diabetic patients. Methods: This is a randomized cross-sectional study of 120 diabetic patients, asymptomatic for peripheral arterial disease, attending Medicine OPD or admitted in our tertiary care hospital of South Gujarat. Pretested proforma was used to collect data after taking informed consent. Investigations including ABPI with sphygmomanometer and colour doppler as mentioned in the proforma was carried out. Final analysis has been done with the help of Open EPI and SPSS software. Results: 30.83 % of patients of our study population were found with abnormal ABPI. Our data shows PAD is directly associated with high HbA1c, duration of DM, and BMI. No correlation was found between age and gender. Out of 37 significant ABPI patients, 28 patients were found to have PAD by colour doppler also. Conclusion: Among diabetic patients, high HbA1c, prolong duration of DM and high BMI were associated with abnormal ABPI, which was suggestive of PAD

First detection of Varicella Zoster Virus clade 9 cases in India during mpox surveillance

AbstractBackground The multi-country mpox outbreak across the globe has led to the systematic surveillance of mpox cases in India. During the surveillance of mpox, we encountered cases of Varicella Zoster Virus (VZV) in suspected mpox cases amongst children & adults. This study focused on the genomic characterization of VZV in India.Methods A total of 331 mpox suspected cases were tested for VZV through real-time PCR, and the positive samples were subjected to next-generation sequencing to retrieve the whole genome of VZV using CLC genomics software. Phylogenetic analysis has been done in MEGA 11.0 software to identify circulating clades.Result Of the 331 suspected cases, 28 cases with vesicular rashes were found to be positive for VZV. The maximum genome could be retrieved from the clinical specimens of 16 cases with coverage greater than 98% when mapped with reference strain Dumas (NC 001348). The phylogenetic analyses of these sequences determined the circulation of clades 1, 5, and 9 in India. Further, the sequence analysis demonstrated non-synonymous single nucleotide polymorphism (SNPs) among specific ORF of VZV including ORF 14, ORF 22, ORF 36, ORF 37 and ORF 51. Although clade 1 and 5 has been reported earlier, the circulation of clade 9 of VZV has been determined for the first time in India.Conclusion Although the circulation of different clades of VZV was reported from India, the presence of clade 9 was detected for the first time during the mpox surveillance