The Effect of Ephedra Foeminea Extract as an Antimicrobial and Antifungal Agent

Drugs derived from natural sources play a significant role in the prevention and treatment of human diseases. In many developing countries, traditional medicine is an essential part of primary healthcare systems (Abdallah, 2011). Due to the emergence of drug-resistant bacteria, it is essential to investigate new drugs with lesser resistance especially ones that can be derived from natural resources like plants. Ephedra is likely one of the oldest medicinal plants that are still currently in use. Antimicrobial and antifungal activities of some ephedra species have been noticed in recent years (ZHANG Ben-Mei et al,2018). The aim of the study is to observe and understand the effects of E. foeminea extracts as antimicrobial and antifungal agents. It is an experimental study; four different types of bacteria including, Staphylococcus aureus, Pseudomonas aeruginosa, MRSA, and Escherichia coli as well as two different types of fungi including, Klebsiella pneumoniae and Candida albicans were used as test microorganisms. Maceration extraction technique (William P. Jones,2012) for the dried stem of E. foeminea will be used by methanol / water 90/10 for 2 days (Ali Parsaeimehr et el,2010). Three concentrations of the extract will be used on 30 plates for each type of microorganism in the laboratories of the University of Palestine. Antimicrobial activity will be tested by using plate methods in which a variable diameter of a growth inhibition zone in most types of bacteria will appear. The MIC values may also be evaluated using the broth serial dilution method according to standard methods (CLSI, 2012)

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