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

Antidiarrheal and antioxidant activities of Ajuga iva (L.) leave extract

We studied the effect of Ajuga iva leaves extract (AIE) on the intestinal absorption, motricity and its antioxidant capacity against diarrhea. Wistar rats were divided and received either: castor oil (CO), CO and loperamide or CO and different doses of AIE. AIE prevented dose-dependently CO-induced diarrhea. AIE at 800 mg/kg showed inhibition efficiency on defecation and diarrhea. The pro-oxidant effect of the CO in the small intestine was inhibited significantly in presence of AIE: increasing glutathione peroxidase (GPx) activity and lowering oxygen free radicals (OH°, O2°-), carbonyl protein and malondialdehyde (MDA) levels. However, co-administration of AIE in castor oil-exposed groups significantly increased the intestinal contents of calcium and magnesium. AIE exhibits significant anti-diarrheal activity, related in part to its antioxidant properties. Our investigation also provides experimental evidence for the traditional use of this medicinal plant in the treatment of diarrhea

Preparation and characterization of Ni-doped ZnO–SnO₂ nanocomposites: Application in photocatalysis

The paper reports on the synthesis of nickel-doped ZnO-SnO2 nanocomposites with a molar ratio Zn:Sn of 2:1 using the hydrothermal method followed by calcination at 700 °C. The resulting nanocomposites were characterized using X-ray diffraction (XRD) patterns, transmission electron microscopy (TEM), high-resolution transmission electron microscopy (HRTEM) and Energy-dispersive X-ray spectroscopy (EDX). The results revealed that the Ni/ZnO-SnO2 material consists of aggregated cassiterite SnO2 and wurtzite ZnO nanoparticles (NPs) with a size ranging from 14 to 40 nm. Furthermore, they show that Ni adding induces a dominant effect on the optical, structural and morphological properties of ZnO-SnO2 NPs. The photocatalytic behavior of the synthesized nanocomposites is investigated using rhodamine B (RhB) as model organic pollutant. A maximum degradation efficiency of 96% is achieved under visible light irradiation. While nickel doping did not enhance the photocatalytic activity of ZnO-SnO2 NPs, the photocatalytic performance of Ni/ZnO-SnO2 NPs is much higher than that of Ni-doped ZnO NPs. The photodegradation mechanism is believed to occur through photosensitization

Cultivating C4 crops in a changing climate: sugarcane in Ghana

Over the next few decades, it is expected that increasing fossil fuel prices will lead to a proliferation of energy crop cultivation initiatives. The environmental sustainability of these activities is thus a pressing issue—particularly when they take place in vulnerable regions, such as West Africa. In more general terms, the effect of increased CO2 concentrations and higher temperatures on biomass production and evapotranspiration affects the evolution of the global hydrological and carbon cycles. Investigating these processes for a C4 crop, such as sugarcane, thus provides an opportunity both to extend our understanding of the impact of climate change, and to assess our capacity to model the underpinning processes. This paper applies a process-based crop model to sugarcane in Ghana (where cultivation is planned), and the São Paulo region of Brazil (which has a well-established sugarcane industry). We show that, in the Daka River region of Ghana, provided there is sufficient irrigation, it is possible to generate approximately 75% of the yield achieved in the São Paulo region. In the final part of the study, the production of sugarcane under an idealized temperature increase climate change scenario is explored. It is shown that doubling CO2 mitigates the degree of water stress associated with a 4 °C increase in temperature