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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Bionomics of ticks collected from the Sinai Peninsula, Egypt. I. Biology of Hyalomma schulzei (Olenev) (Acari: Ixodidae) under laboratory conditions

Egyptian Journal of Biology Vol.2 2000: 49-5

Zaprionus indiana (Diptera: Drosophilidae) in Saudi Arabia and the effect of temperature on the life cycle

Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh II451, Saudi ArabiaDuring August and November 1988 a number of drosophilid flies Zaprionus indiana Gupta 1970. were collected from the pomegranate fruit at Taif area in Saudi Arabia. The effects of 25°C, 30°C and 35°C on developmental period and survival of different stages in the life cycle of the fly were investigated at 75% relative humidity and under continuous light. The mean egg incubation period, larval and pupal duration periods and adult longevity decreased with an increase in temperature from 25°C to 30°c. However. the mean hatching percentage, larval and pupal survival, weight of adults, cumulative percentage of adult mortality were increased. The reduction in mean adult longevity at 30°C rather than 25°C was associated with great reduction in the mean oviposition period and fecundity from 35.8 :!: 12.9 to 1.3 :!: 0.9 days; and 112.5 :!: 39.7 to 1.2 :!: 0.9 eggs, respectively, and all eggs laid at 30°C failed to hatch. Most of the eggs oviposited at 25°C were laid days 11 to 25 after emergence. At 35°C only the mean larval duration period was prolonged, but the mean incubation period and larval duration period were decreased, and all pupae failed to develop to an adult. The mean generation life span was 22.4 days at 25°C, shorter than 29.2 days at 30°C

Value chain analysis of Egyptian fish seed production

Expansion of Egypt’s aquaculture industry has been matched by the development of a large number of tilapia hatcheries all producing sex-reversed all-male fry and fingerlings. In order to map the fish seed value chain in Egypt, operators of fifty tilapia hatcheries in four governorates (Kafr el-Sheikh, Behera, Sharkia and Fayoum) were interviewed. Tilapia hatcheries use a range of technologies, from simple hapa-based systems in open ponds to heated, greenhouse-covered, tanks systems to advance and lengthen the spawning season. Most of the tilapia seed production (>95%) is sold as fry rather than fingerlings and sold directly to production farms 88%, while only 12% of seeds sold through fry/fingerling traders. Some of the hatcheries are part of an integrated fish farm with both hatchery and production systems. The average size of hatchery was 4.1feddans. Almost half of the hatcheries used some form of heating (solar or fuel-fired boiler) to extend the spawning season. The surveyed 50 hatcheries hold over 0.5 million broodstock and sold a total of 474 million fry in 2011 at an average price of LE 30 /1000 fry. Hatcheries also sold 21 million fingerlings at an average price of LE 114/1000. These prices are significantly lower than current prices in comparable countries and have dropped gradually over recent years in Egypt indicating that there is a high degree of competition in the market. The average surveyed Egyptian tilapia hatchery produces around 10 million seed and employs 4.5people Full-Time Equivalent (FTE), with 59% of the employees under 30 years old. Despite low seed prices, hatcheries appear to be highly profitable with an average total value added of LE 28,055 per million fry. Tilapia fry and fingerling traders play a limited role linking tilapia hatcheries with producers. Fry/fingerling traders generate relatively few jobs (0.55 FTE per million fry sales) but generate reasonable profit levels. The main subsector constraints were identified by hatchery operators and suggested solutions were discussed in detail in the current study

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.</p