Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Central Pontine Myelinolysis, Osmotic Demyelination Syndrome Due to Rapidly Decreased Fluid Intake in a Schizophrenic Patient with Psychogenic Polydipsia: A Case report and Review of The Literature

Central pontine myelinolysis is a rare entity of osmotic demyelinating disease that mostly affects the basis pontis in brainstem. The clinical picture of central pontine myelinolysis can be variable and mixed, manifestations such as pseudobulbar palsy, various degrees of spastic paraparesis and tetraparesis, ataxia and diminished deep tendon reflexes can all occur. Etiology of central pontine myelinolysis has been reported to be mostly attributed by rapid changes in serum osmolality. Magnetic Resonance Imaging is the only way to confirm the diagnosis of central pontine myelinolysis. In this report, we describe an unusual case of central pontine myelinolysis in a 39 years old male patient who had a long-standing history of psychogenic polydipsia, compulsive water intake associated with schizophrenia that was referred to our hospital for deteriorating level of consciousness and generalized weakness after a sudden decrease in his oral water intake and sudden withdrawal of lithium treatment. We review this uncommon etiology of central pontine myelinolysis in the patient as well as pathophysiological mechanisms involved

Renovascular Hypertension with Superimposed Aortic Arch Baroreceptor Failure: Case Report and Review of Literature

Background. Atherosclerotic renal artery diseases are among the most common causes of secondary hypertension. Baroreceptors, as carotid and aortic, are important regulatory mechanisms of blood pressure; their disruption can lead to labile blood pressure due to sympathetic overactivity: an entity called neurogenic hypertension. A disease such as aortic dissection can lead to a challenging combined etiology of secondary hypertension. It can affect both or one of the renal arteries leading to a renovascular pathology that can cause hypertension through RAAS activation. Also, surgical repair of the dissected aortic arch can disrupt baroreceptors leading to neurogenic hypertension. Case Report. We report a case of an 83-year-old female patient investigated for recurrent episodes of aphasia. She has a history of hypertension and coronary artery disease. Surgical history is significant for aortic valve replacement complicated by type A aortic dissection requiring surgical repair. Following surgery, the patient developed difficult-to-control and labile blood pressure. Workup included a CT angiogram of the abdominal aorta that showed an infrarenal dominant abdominal aortic aneurysm with juxtarenal aortic dissection; these findings were similar to previous findings. A diagnosis of aortic baroreceptor failure following aortic dissection repair was established, which lead to labile hypertension with superimposed renovascular pathology due to unilateral compromised renal artery blood flow following aortic dissection and thrombosis. Conclusions. This report highlights the importance of accurate diagnosis of secondary hypertension and its underlying mechanisms, as this has a huge impact on the choice of therapy to avoid undertreatment or overtreatment of hypertension

Renovascular Hypertension with Superimposed Aortic Arch Baroreceptor Failure: Case Report and Review of Literature

Background. Atherosclerotic renal artery diseases are among the most common causes of secondary hypertension. Baroreceptors, as carotid and aortic, are important regulatory mechanisms of blood pressure; their disruption can lead to labile blood pressure due to sympathetic overactivity: an entity called neurogenic hypertension. A disease such as aortic dissection can lead to a challenging combined etiology of secondary hypertension. It can affect both or one of the renal arteries leading to a renovascular pathology that can cause hypertension through RAAS activation. Also, surgical repair of the dissected aortic arch can disrupt baroreceptors leading to neurogenic hypertension. Case Report. We report a case of an 83-year-old female patient investigated for recurrent episodes of aphasia. She has a history of hypertension and coronary artery disease. Surgical history is significant for aortic valve replacement complicated by type A aortic dissection requiring surgical repair. Following surgery, the patient developed difficult-to-control and labile blood pressure. Workup included a CT angiogram of the abdominal aorta that showed an infrarenal dominant abdominal aortic aneurysm with juxtarenal aortic dissection; these findings were similar to previous findings. A diagnosis of aortic baroreceptor failure following aortic dissection repair was established, which lead to labile hypertension with superimposed renovascular pathology due to unilateral compromised renal artery blood flow following aortic dissection and thrombosis. Conclusions. This report highlights the importance of accurate diagnosis of secondary hypertension and its underlying mechanisms, as this has a huge impact on the choice of therapy to avoid undertreatment or overtreatment of hypertension.</jats:p

Risk of Developing Depression among Breast Cancer Patients in Palestine

Abstract Background: Breast cancer (BC) is the most common cancer among women. Studies have shown that cancer patients can develop depression impacting their quality of life, treatment outcomes, and survival rates. This study aimed to determine the risk factors, severity and prevalence of depression among females diagnosed with BC in multiple hospitals across Palestine.Methods: a cross-sectional study was conducted at different cancer treatment centers in Palestine using a previously developed questionnaire consisting of 23 questions to assess the severity of major depressive disorder among females diagnosed with breast cancer. The Patient Health Questionnaire-9 (PHQ-9) was included in the questionnaire. Results: Out of 223 respondents, 79 (35.4%) have developed moderate to severe depression. Chi-square results revealed that the risk of developing moderate to severe depression was higher among females who suffer from side-effects related to BC treatment (P&lt;0.011), females who knew the BC stage at the diagnosis step (P&lt;0.031), and negative implications on BC patients in Palestine (P&lt;0.009).Conclusion: Breast cancer patients have an increased risk of developing major depressive disorder. Patient assessment and treatment for depression at the time of BC diagnosis, during the treatment journey, and monitoring after treatment completion is essential for patient quality of life and BC treatment outcomes.</jats:p

Risk of developing depression among breast cancer patients in Palestine

Abstract Background Breast cancer (BC) is the most common cancer among women. Studies have shown that cancer patients can develop depression impacting their quality of life, treatment outcomes, and survival rates. This study aimed to determine the risk factors, severity and prevalence of depression among females diagnosed with BC in multiple hospitals across Palestine. Methods A cross-sectional study was conducted at different cancer treatment centers in Palestine using a previously developed questionnaire consisting of 23 questions to assess the severity of major depressive disorder among females diagnosed with breast cancer. The Patient Health Questionnaire-9 (PHQ-9) was included in the questionnaire. Results Out of 223 respondents, 79 (35.4%) have developed moderate to severe depression. Chi-square results revealed that the risk of developing moderate to severe depression was higher among females who suffer from side-effects related to BC treatment (P &lt; 0.011), females who knew the BC stage at the diagnosis step (P &lt; 0.031), and negative implications on BC patients in Palestine (P &lt; 0.009). Conclusion Breast cancer patients have an increased risk of developing major depressive disorder. Patient assessment and treatment for depression at the time of BC diagnosis, during the treatment journey, and monitoring after treatment completion is essential for patient quality of life and BC treatment outcomes. </jats:sec

Modeling of Blockchain Assisted Intrusion Detection on IoT Healthcare System Using Ant Lion Optimizer With Hybrid Deep Learning

An IoT healthcare system refers to the use of Internet of Things (IoT) devices and technologies in the healthcare industry. It involves the integration of various interconnected devices, sensors, and systems to collect, monitor, and transmit health-related data for medical purposes. Blockchain-assisted intrusion detection on IoT healthcare systems is an innovative approach to enhancing the security and privacy of sensitive medical data. By combining the decentralized and immutable nature of blockchain technology with intrusion detection systems (IDS), it is possible to create a more robust and trustworthy security framework for IoT healthcare systems. With this motivation, this study presents Blockchain Assisted IoT Healthcare System using Ant Lion Optimizer with Hybrid Deep Learning (BHS-ALOHDL) technique. The presented BHS-ALOHDL technique enables IoT devices in the healthcare sector to transmit medical data securely and detects intrusions in the system. To accomplish this, the BHS-ALOHDL technique performs ALO based feature subset selection (ALO-FSS) system to produce a series of feature vectors. The HDL model integrates convolutional neural network (CNN) features and long short-term memory (LSTM) model for intrusion detection. Lastly, the flower pollination algorithm (FPA) is exploited for the optimal hyperparameter tuning of the HDL approach, which results in an enhanced detection rate. The experimental outcome of the BHS-ALOHDL system was tested on two benchmark datasets and the outcomes indicate the promising performance of the BHS-ALOHDL technique over other models