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

Psoriasis and Hashimoto's thyroiditis in a child with down syndrome

Down syndrome (DS), or trisomy 21, is the most common chromosomal disorder. DS has been associated with autoimmune diseases including autoimmune thyroiditis, Type 1 diabetes mellitus, celiac disease, autoimmune chronic active hepatitis, alopecia, vitiligo, hypoparathyroidism, psoriasis, and psoriatic arthritis. To our knowledge, we herein report the first concurrence of psoriasis and Hashimoto's thyroiditis in an individual with DS, emphasizing the predisposition of DS individuals to autoimmune diseases

Effect of praziquantel on Dicrocoelium dendriticum in naturally infected sheep

Dicrocoeliosis is poorly known and often underestimated by studies and practitioners in many countries. The prophylaxis of Dicrocoelium has been difficult and unsatisfactory to date due to the complexity of its biological life cycle and epidemiology (Otranto and Traversa, 2002). This study was performed to evaluate the efficacy of praziquantel at 50 mg/kg b.w. against D. dendriticum. Thirty-four sheep (11 male + 13 female), naturally infected with D. dendriticum, were allocated to two groups as follows: Treatment group 50.0 mg/kg b.w., n=14; Control group, n=10. Sheep were around 8-12-months-old. Sheep were randomized with equal groups based on mean weight and sex. Feces were collected two times before treatment and 2-7 days after treatment and just before slaughter. During the study feces were examined for parasite eggs microscopically. Equal numbers of animals (3 from each group) were slaughtered 9, 10, 11 and 12 days after treatment and livers with the bile sack and small intestine contents examined for the presence of parasites. It was concluded that praziquantel at the dose rates used in the study was 95.9% effective against D. dendriticum

COVID-19: vaccination vs. hospitalization

Objective Vaccination is the most efficient way to control the coronavirus disease 2019 (COVID-19) pandemic, but vaccination rates remain below the target level in most countries. This multicenter study aimed to evaluate the vaccination status of hospitalized patients and compare two different booster vaccine protocols. Setting Inoculation in Turkey began in mid-January 2021. Sinovac was the only available vaccine until April 2021, when BioNTech was added. At the beginning of July 2021, the government offered a third booster dose to healthcare workers and people aged > 50 years who had received the two doses of Sinovac. Of the participants who received a booster, most chose BioNTech as the third dose. Methods We collected data from 25 hospitals in 16 cities. Patients hospitalized between August 1 and 10, 2021, were included and categorized into eight groups according to their vaccination status. Results We identified 1401 patients, of which 529 (37.7%) were admitted to intensive care units. Nearly half (47.8%) of the patients were not vaccinated, and those with two doses of Sinovac formed the second largest group (32.9%). Hospitalizations were lower in the group which received 2 doses of Sinovac and a booster dose of BioNTech than in the group which received 3 doses of Sinovac. Conclusion Effective vaccinations decreased COVID-19-related hospitalizations. The efficacy after two doses of Sinovac may decrease over time; however, it may be enhanced by adding a booster dose. Moreover, unvaccinated patients may be persuaded to undergo vaccination