The Effects of Ethanolic Extract of Handal (Citrullus colocynthis L.) Fruit Pulp on Blood Glucose level in Normal Fasting Rats

Background: Citrullus colocynthis L. is a member of the family Cucurbitaceae. It is widely available in Sudan and traditionally used for treatment of skin infections, diabetes and constipation worldwide. Objectives: This study aimed to investigate the effects of ethanolic extract of C. colocynthis fruit pulp on blood glucose level in normal fasting rats. Method: Two groups of rats, each of twenty one were used to study the effects of the extract (300 mg/kg/ml) on fasting blood glucose level (BGL) and glucose tolerance test (GTT). Results: The oral administration of ethanolic extract of C. colocynthis fruit pulp resulted in a sudden drop in BGL of normal fasting rats after four hours. This was accompanied by some toxic effects appeared as severe diarrhea, followed by deaths of some rats (2/7). Moreover, the administration of the extract did not exhibit a remarkable reduction or improvement in the induced hyperglycemia.  Conclusion: This study showed that, ethanolic extract of C. colocynthis fruit pulp reduced the BGL without significant hypoglycemic effect and the extract appeared to be highly toxic.

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