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

Mitigating the Impact of Climate Change on Egyptian Cities: Sustainable Building and Construction as a Strategy/ التخفيف من أثر تغير المناخ في المدن المصرية: استراتيجية البناء والتشييد المستدام

Egypt faces a wide range of challenges, including the high increase in population, the Nile water crisis, desertification and the issue of solid waste and encroachment on agricultural lands, and the current negative impacts of the natural and built environments. The construction sector consumes 28% of the total energy produced in Egypt. The high energy consumption and rise in energy prices along with the aforementioned issues are few of several key factors that urge the need to study how consumed energy could be reduced in the construction sector and consequently limit the sector’s impact on the environment (Navigant Energy Germany GmbH, 2022). The paper calls for establishing sustainable cities through sustainable construction and building approaches and practices given the high significance of the construction sector, the excessive wasted resources, and the increase in construction waste, in addition to the deterioration in people’s health and the continued population growth. The paper sheds light on the need to join forces with experts amongst stakeholders in the construction sector for adopting assessment tools that exist globally on environmental performance within the Egyptian context. This adopted tool should be available for both the private and public sectors to enhance the performance of their construction operations and services and the identification of materials that lead to environmental hazards and affect the population’s health, safety, and productivity. Egyptian policymakers should thus consider sustainable building and construction as an interdisciplinary strategy to establish sustainable cities and hence the mitigation of the impact of climate change. The findings of this paper formulate three proposed policy options in an integrated strategy that are not standalone policy options but simply divided into stages of implementation. Policy option A is a long-term type of ‘greening’ existing building laws and developing national standards for sustainable construction materials. As for policy option B, it is a kind of short-term implementation and of rapid impact for providing finance and awareness campaigns to promote sustainable construction. The third and final policy option C is a medium-term implementation framework type that proposes establishing a national Sustainable Construction Working Group under the National Council for Climate Change (NCCC) to have representatives of the different stakeholders from the private and public sectors as well as key players from the construction sector and the community

Changes in antioxidant status and biochemical parameters after orally cadmium administration in females rats

The research was conducted to investigate the toxic effects of cadmium chloride (CdCl 2 ), administered during gestation period on female Wistar rats. Pregnant rats received CdCl 2 (20 mg/l, orally) from Day 6 to Day 19 of pregnancy. Results showed that Cd treatment induced a decrease in body weight gain. The relative liver weight increased significantly, with a marked decrease of glycogen and total lipids content. The administration of Cd induced hepatotoxicity as indicated by elevations in plasma alanine amino- transferase (ALT), aspartate aminotransferase and lactate dehydrogenase (LDH) activities ( p < 0.05). Treatment with CdCl 2 caused a significant ( p < 0.05) increase in glucose. A significant increase was observed in the level of MDA and 8-oxodGuo tissues in the cadmium-exposed group compared to the control group ( p < 0.05). Results showed that cadmium given to dams led to an oxidative stress and DNA damage in tissues of pregnant rat

Nanotoxicological evaluation of oxidative responses in rat nephrocytes induced by cadmium

Hamdi Trabelsi, In&egrave;s Azzouz, Soumaya Ferchichi, Olfa Tebourbi, Mohsen Sakly, Hafedh Abdelmelek Laboratory of Integrative Physiology, Faculty of Sciences of Bizerte, Carthage University, Jarzouna, Tunisia Abstract: The aim of this study was to investigate the interaction of cadmium chloride with mineral elements in rat nephrocytes in terms of the biosynthesis of nanocomplexes. The results show that selenium supplementation enhanced cadmium accumulation in kidneys. Analysis of the fluorescence revealed an increase in red fluorescence in the kidneys of rats co-exposed to cadmium and selenium. Interestingly, X-ray diffraction measurements carried out on kidney fractions of co-exposed rats point to the biosynthesis of cadmium selenide and/or sulfide nanoparticles (about 62 nm in size). Oxidative stress assays showed the ability of selenium to reduce lipid peroxidation and to restore glutathione peroxidase and superoxide dismutase activity in kidneys. Hence, cadmium complexation with selenium and sulfur at a nanoscale level could reduce oxidative stress induced by cadmium in kidneys. Keywords: nanoparticles, detoxification, oxidative stress, X-ray diffraction, fluorescence microscopy, kidney

Effects of sub‐acute co‐exposure to WIFI (2.45 GHz) and Pistacia lentiscus oil treatment on wound healing by primary intention in male rabbits

Abstract Background The bioeffects of WIFI on cutaneous wound healing remains unexplored. In addition, several medicinal plant products including lentisk oil have been shown to interfere with wound healing process. Since the use of this oil is increasing, the co‐exposure (WIFI‐Lentisk oil) assessment is of paramount importance. Objectives We aimed in the present study to investigate the effects of WIFI exposure as well as the application of Pistacia lentiscus oil on sutured wounds (SW). Methods New Zealand male rabbits (n = 24) were used and randomly divided into four groups of six animals each: a control group (SW) and three experimental groups (i) a first group exposed to WIFI (2.45 GHz, 6 h/day) during 16 days (SWW); (ii) a second group exposed to WIFI (2.45 GHz, 6 h/day) during 16 days and treated with lentisk oil (SWWL) and (iii) a third group not exposed to WIFI but treated with lentisk oil (SWL). The wound healing was evaluated by monitoring clinical parameters (temperature, food intake, relative weight variation, and macroscopic aspect) and histology. Results The mean food intake was higher in the SWWL group compared to the three other groups (p < 0.001) and higher in the SWL group compared to the SW group (p = 0.014). The exposition to WIFI (SWW group) or lentisk oil application (SWL group) can promote the collagen deposition and ameliorate the general aspect of wounds. By contrast, the co‐exposure to WIFI and lentisk oil (SWWL) results in antagonist effects and extends the inflammatory phase of wound healing. Conclusions Wounds treated topically with Pistacia lentiscus oil should not be exposed to WIFI

Oxidative stress and prevention of the adaptive response to chronic iron overload in the brain of young adult rats exposed to a 150 kilohertz electromagnetic field.

International audienceIron surcharge may induce an oxidative stress-based decline in several neurological functions. In addition, electromagnetic fields (EMF) of frequencies up to about 100 kHz, emitted by electric/electronic devices, have been suggested to enhance free radical production through an iron dependent pathway. The purpose of this study was therefore to determine a possible relationship between iron status, exposure to EMF, and brain oxidative stress in young adult rats. Samples were micro-dissected from prefrontal cortex, hippocampus, striatum, and cerebellum after chronic saline or iron overload (IO) as well as after chronic sham exposure or exposure to a 150 kHz EMF or after combining EMF exposure with IO. The brain samples were used to monitor oxidative stress-induced lipid peroxidation and activity of the antioxidant enzymes superoxide dismutase and catalase. While IO did not induce any oxidative stress in young adult rats, it stimulated antioxidant defenses in the cerebellum and prefrontal cortex in particular. On the contrary, EMF exposure stimulated lipid peroxidation mainly in the cerebellum, without affecting antioxidant defenses. When EMF was coapplied with IO, lipid peroxidation was further increased as compared to EMF alone while the increase in antioxidant defenses triggered by the sole IO was abolished. These data suggest that EMF exposure may be harmful in young adults by impairing the antioxidant defenses directed at preventing iron-induced oxidative stress

Interaction between nanoparticles generated by zinc chloride treatment and oxidative responses in rat liver

In&egrave;s Azzouz, Hamdi Trabelsi, Amel Hanini, Soumaya Ferchichi, Olfa Tebourbi, Mohsen Sakly, Hafedh AbdelmelekLaboratory of Integrative Physiology, Faculty of Sciences of Bizerte, Carthage University, TunisiaAbstract: The aim of the present study was to investigate the interaction of zinc chloride (3 mg/kg, intraperitoneally [ip]) in rat liver in terms of the biosynthesis of nanoparticles. Zinc treatment increased zinc content in rat liver. Analysis of fluorescence revealed the presence of red fluorescence in the liver following zinc treatment. Interestingly, the co-exposure to zinc (3 mg/kg, ip) and selenium (0.20 mg/L, per os [by mouth]) led to a higher intensity of red fluorescence compared to zinc-treated rats. In addition, X-ray diffraction measurements carried out on liver fractions of zinc-treated rats point to the biosynthesis of zinc sulfide and/or selenide nanocomplexes at nearly 51.60 nm in size. Moreover, co-exposure led to nanocomplexes of about 72.60 nm in size. The interaction of zinc with other mineral elements (S, Se) generates several nanocomplexes, such as ZnS and/or ZnSe. The nanocomplex ZnX could interact directly with enzyme activity or indirectly by the disruption of mineral elements&#39; bioavailability in cells. Subacute zinc or selenium treatment decreased malondialdehyde levels, indicating a drop in lipid peroxidation. In addition, antioxidant enzyme assays showed that treatment with zinc or co-treatment with zinc and selenium increased the activities of glutathione peroxidase, catalase, and superoxide dismutase. Consequently, zinc complexation with sulfur and/or selenium at nanoscale level could enhance antioxidative responses, which is correlated to the ratio of number of ZnX nanoparticles (X=sulfur or X=selenium) to malondialdehyde level in rat liver.Keywords: nanocomplexes biosynthesis, antioxidative responses, X-ray diffraction, fluorescence microscopy, live