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

Open Fracture of the Forearm Bones due to Horse Bite

Introduction: Fractures have been described mainly following falling accidents in horse-related injuries. Horse bites are uncommon accidents. We present a case of open fracture of the forearm due to horse bite. Case Report: A 35-year-old male farm-worker presented to the emergency room with alleged history of horse bite to the right forearm about 2 hours prior to presentation while feeding the horse. There was deformity of the forearm with multiple puncture wounds, deep abrasions and small lacerations on the distal-third of the forearm. Copious irrigation with normal saline was done and he was administered anti-tetanus and post-exposure rabies prophylaxis. Prophylactic antibiotic therapy was commenced. Radiographs revealed fracture of radius and ulna in the mid-shaft region. He underwent emergency wound debridement, and the ulna was stabilised with an intra-medullary square nail. Seventy-two hours later, he underwent re-debridement and conversion osteosynthesis. He had an uneventful recovery and at three-month follow-up, the fractures had healed radiographically in anatomic alignment. At two-year follow-up, he is doing well, is pain free and has a normal range of motion compared to the contralateral side. Conclusion: Horse bites behave as compound fractures however rabies prophylaxis will be needed and careful observation is needed. Early radical debridement, preliminary skeletal stabilisation, re-debridement and conversion osteosynthesis to plate, and antibiotic prophylaxis were the key to the successful management of our patient. Keywords: Horse; animal bite; forearm; open fractur

Glomus tumor of the fingertips: A frequently missed diagnosis

Background: Glomus tumors present as painful lesions, most commonly in the fingertips. These can present to outpatient clinics of multiple specialties. Materials and Methods: Retrospective review was performed of 37 patients diagnosed as having glomus tumor in the thumb or fingertips over a 10-year period. The data collected included demographics, presenting symptoms, duration, previous treatment history, physical examination, treatment, and recurrence. The data were presented by means of descriptive statistics. Results: The mean duration of symptoms before presentation was 3.8 years (range 2 to 12 years). The mean age at presentation was 38 years (range 16 to 62 years), and female to male ratio was 21:16. Twenty-two patients had left-hand involvement; thumb 8, index finger 5, middle finger 5, ring finger 14, and little finger 5. Clinical and radiological assessments were made preoperatively. At presentation, 18 cases had nail changes, whereas 19 had no obvious nail changes – out of these, 4 had pulp involvement. The lesion involved the subungual region in 33 cases. The mean size of the lesion was 3.8 mm (range 2 to 10 mm). Thirty-six patients were found to have histopathologically proven glomus tumors, whereas in one no specific lesion was found on histopathological examination; this patient returned with recurrence of symptoms at 2-month follow-up. There was no other patient experienced recurrence of symptoms. Conclusion: Early diagnosis of glomus tumors is important to avoid lengthy treatment delays, chronic pain, disuse syndromes, and psychiatric misdiagnoses

Musculoskeletal disorders and associated risk factors in coaching students: A cross-sectional study

Background: Coaching institutes attract students aspiring for admission to professional courses and jobs. Physical stress during coaching includes poor study posture and sitting on chairs improperly in overcrowded classes for prolonged periods. Many students attending the coaching institutes report to outpatient clinics of multiple specialties with musculoskeletal disorders (MSD). Materials and Methods: We carried out a cross-sectional study of 500 coaching students. We ascertained the 12-month MSD (period prevalence) and last 7-day MSD (point prevalence) using the Nordic Musculoskeletal Questionnaire. The duration of attending classes, hours of daily study, and duration of sitting continuously at a stretch were also enquired. Results: A total of 488 responses were retrieved. Males and females accounted for 63.9% and 36.1%, respectively. The respondents' mean age was 18.6 ± 1.06 years; mean body mass index was 21.4; mean duration of attending classes was 15.6 ± 7.66 months; mean hours of daily study were 4.78 ± 1.71 hours; mean duration of sitting continuously at a stretch was 2.2 hours. The overall prevalence of MSD was 87.1%. The mean frequency of MSD per participant was 2.6. Most participants reported pain in the neck region and lower back (43%), followed by ankle/foot (36%), followed by upper back (32%), followed by shoulder (28%); knee, elbow, and wrist/hand were lesser than 20%, while hip/thigh pain was the least common symptom (8%). Conclusion: This study serves to sensitize the medical community to this largely under-reported problem in young individuals who are in the phase of life preparing for their future career while inadvertently risking their long-term health in the process