The Association between Zinc and Copper and Cardiometabolic Risk Factors in Adults

Cardiometabolic risk (CMR) factors increase the likelihood of developing cardiovascular diseases (CVD). In Qatar, 24% of the total deaths are attributed to CVDs. Several nutritional disturbances have been linked to high risk of CVD. Many studies have discussed the effects of zinc (Zn) and copper (Cu) on CMR factors; however, evidence has been controversial. This investigated the association between CMR factors and the status of Zn, Cu, and Zn/Cu ratio. A total of 575 Qatari adults (?18 years) were obtained from Qatar Biobank. Plasma levels of Zn and Cu were determined using inductively coupled plasma mass spectrometry (ICP-MS). Anthropometric data and CMR factors were determined using standard methods. Adjusted associations between minerals and CMR were estimated by logistic regression. The associations' strength was tested using partial correlation. Zn was not strongly correlated (p-value?0.01) or significantly associated with CMR factors and metabolic syndrome (MetS). Cu levels correlated positively with body mass index (BMI) (0.23; p?0.001), pulse rate (PR) (0.18; p?0.001), total cholesterol (0.13; p=0.01), and high-density lipoproteins (HDL) (0.27; p?0.001); and negatively with diastolic blood pressure (DBP) (?0.13; p=0.01). High Cu significantly decreased the risk of MetS (0.121; p?0.001). Furthermore, Zn/Cu ratio positively correlated with waist circumference (0.13; p=0.01), systolic blood pressure (0.13; p?0.01), and DBP (0.14; p?0.01); and negatively with BMI (?0.19; p?0.001), PR (?0.17; p?0.001), and HDL (?0.27; p?0.001). High Zn/Cu ratio increased the prevalence of low HDL (4.508; p?0.001) and MetS (5.570; p?0.01). These findings suggest that high Cu levels are associated with a protective effect on DBP, HDL, and MetS and that high plasma Zn/Cu ratio is associated with the risk of low HDL and MetS. We recommend future studies to focus on minerals status among abdominally obese and prediabetic subjects because of the probable link between low serum Zn and Cu and insulin resistance and CVD

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