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

Autoimmune Hemolytic Anemia Developing Secondary to Epstein-Barr Virus Infection: A case report

Infectious mononucleosis (EM) is a disease characterized by irradiation of the Epstein-Barr virus (EBV). The clinical manifestation is characterized by tonsillopharyngitis, lym-phadenopathy and atypical lymphocytosis. We describe a young patient developing hemolytic anemia during follow-up in our clinic due to tonsillopharyngitis secondary to EBV and general condition disorder.Enfeksiyöz mononükleoz (EM), Epstein-Barr virüsünün (EBV) yayılması ile karakterize bir hastalıktır. Klinik bulgular tonsillofarenjit, lenfadenopati ve atipik lenfositoz ile karakterizedir. EBV'ye sekonder tonsillofarenjit ve genel durum bozukluğu nedeniyle kliniğimizde takip sırasında hemolitik anemi gelişen genç bir hastayı tanımladık

The effects of mammalian hormones in the regulation of growth and virulence in Campylobacter jejuni

<p>Campylobacter jejuni is the most common cause of bacterial food borne disease, but studies on its pathogenesis are still limited. The effects of various mammalian hormones such as, norepinephrine, epinephrine, serotonin, corticosterone, cortisol and cortisone on growth and different virulence mechanisms of Campylobacter were reported previously.</p><p>In this study, the possible effects of norepinephrine, melatonin, estradiol, progesterone and insulin on growth, adhesion and invasion of C. jejuni were investigated in human adenocarcinoma colon cell (HT-29) line. Moreover, the alterations on biofilm formation on abiotic surfaces and response to stress conditions were investigated. We also aimed to analyze the effects of hormones and C. jejuni, together or separately, on viability of human adenocarcinoma colon (HT-29) cells. Growth alterations were determined spectrophotometrically. Adhesive/invasive bacterial counts were evaluated by colony counting method. Biofilm formation was analyzed using a microtiter plate assay. The alterations of HT-29 cell viability were determined via methyl thiazolyl diphenyltetrazolium bromide assay.</p><p>According to ourresults, growth of C. jejuniwas decreased in the presence of hormones in a dose and time-dependent manner (p<0.05). Each hormone at all concentrations reduced the adhesion of bacteria (p<0.0001). The invasion of C. jejuni was increased in the presence of progesterone and insulin at all concentrations; which were statistically significant (p<0.0001). The effects of hormones on biofilm formation were variable. Hormones did not affect C. jejuni growth in oxidative and nitrosative conditions (p>0.05). Each hormone and C. jejuni infection have separately decreased the viability of cells after 24 hours incubation (p<0.005). In 48 hours, viability of cells was significantly increased in the presence of low-level estradiol (p<0.0001) and high-level progesterone (p<0.0005). The hormones were found to be significantly more effective on viability of infected HT-29 cells than non-infected cells.</p><p>In conclusions, these findings once more showed that hormones affect C. jejuni during infectious processes.</p&gt

Development of end-stage renal disease at a young age in two cases with joubert syndrome

PubMedID: 25818971Joubert syndrome (JS) is an autosomal recessive genetic disorder. To date, mutations in 20 genes of the genetically heterogeneous JS and JS-related disorders (JSRD) have been reported. Renal involvement occurs in 2-20% of JS cases. Identified renal abnormalities are cystic dysplasia and nephronophthisis. Here we report the clinical course and management of renal failure in early childhood. We present two cases diagnosed with JS that developed end-stage renal disease at young ages. In the genetic studies, a c.5668G>T (p.G1890*) homozygous stop mutation was identified in the CEP290 gene of one of the patients and a c.1303C>G (p.R435G) homozygous mutation in the INPP5E gene of the other. It has been emphasized that it is important to evaluate patients in terms of renal disease when monitoring the progress of Joubert syndrome, a condition that predominantly causes mental and motor development retardation. © 2014, Turkish Journal of Pediatrics. All rights reserved