Haemato-biochemical and trichographic studies on mucocutaneous lesions in dogs

The present study was carried out with the objective of assessment of haematobiochemical and trichographic features of mucocutaneous lesions in dogs. Dogs presented with mucocutaneous lesions associated with various dermatological conditions were included in the study. Mange, atopic dermatitis, dermatophytosis, juvenile cellulitis, pyoderma and hypothyroidism with secondary Malassezia dermatitis were presented with mucocutaneous lesions in the perioral, periorbital and in the nostrils with least involvement of anogenital region. Haemato-biochemical analysis revealed anaemia, non-significant increase in total leucocyte count, neutrophilia, eosinophilia, elevated platelet count, hyperproteinaemia and hypoalbuminaemia. Elevated serum C-reactive protein was evident in all cases. Trichographic features revealed that highest number of hairs were included in the telogen phase of hair cycle with greater number of primary hairs. Hair fractures were evident in 20.8 per cent of hairs and trichoptilosis of hair tip was observed in 50.8 per cent of hairs studied. Demodex mites could be detected by hair pluck examination in all cases of demodicosis

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