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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Spectroscopic characterization of PEG-DNA biocomplexes by FTIR

Understanding the mode involved in the binding of certain molecules to DNA is of prime importance, and PEG offers wide-ranging applications in biological, medical and pharmaceutical contexts. FTIR spectroscopy has been used to characterize how the formed biocomplexes bind or dissociate to/from each other between PEG400-ctDNA under different conditions. Characterization and investigation of the effect of incubation time on PEG400-ctDNA biocomplexes formation were studied through spectroscopic technique FTIR. The influence of time duration and incubation on intermolecular interaction was analysed at three different selected times (Zero, 1hr, and 48 hrs.) at 1:1 PEG400-ctDNA monomer to nucleotide ratio. The experiment was carried out at room temperature 22 °C, with prior vortex stirrer of biocomplex for 10 min to improve homogeneity of sample. The results showed that the binding reaction of PEG400-ctDNA proceeds rapidly through DNA base pairs and phosphate DNA backbone, and complexation was reached after a maximum 1hr after mixing PEG400 and ctDNA at 1:1 ratio. FTIR spectroscopy results suggest that PEG400 binds with ctDNA by weak to moderate biocomplexes formation, with both hydrophilic and hydrophobic contact through DNA base pairs, with minor binding preference towards phosphate backbone of DNA helix. The mode of interaction most likely referred to an interaction through outside groove binding or electrostatic binding modes. FTIR highlighted the significant effect of incubation time on the stable biocomplexes of non-ionic PEG400 and ctDNA. Moreover, FTIR spectroscopy technique was rapid, showed good stability, and is a valuable tool for studying the biological properties of biocomplexes of PEG400 and ctDNA

Structure–property relationship studies of copper(I) complexes of nanosized hypodentate ligands and evaluation of their antitumor and antimicrobial activities

<div><p>We report the preparation of four nanosized isomers of <i>N</i>-benzoyl-<i>N′</i>-(hydroxyphenyl) thioureas by nanoprecipitation. Direct reactions with CuCl₂·2H₂O gave the corresponding complexes in good yields. The structures of the ligands and their copper complexes were characterized using different analytical and spectroscopic measurements. In all complexes, the data revealed non-electrolytic mononuclear three-coordinate copper(I) complexes, where the ligand is hypodentate to copper ion via thioamide sulfur. Thermal studies revealed high thermal stability of the complexes compared to their parent ligands and the mechanism of decomposition and the thermodynamic parameters were evaluated. The ligands and their complexes were screened against different pathogenic microorganisms, and subjected to <i>in vitro</i> antioxidant and cytotoxic activities against three human cell lines. Compared to other isomers, <i>N</i>-benzoyl-<i>N′</i>-(<i>o</i>-hydroxyphenyl) thiourea exhibited significant antimicrobial activity and had higher activity than the standard fungicides and bacteriocides. All copper complexes showed inhibitory potencies, however [Cu(H₂L²)₂Cl] exhibited remarkable inhibitory activities against the examined cancer cell lines as evident by the range of IC₅₀ values (4.0–7.4 μg/mL) and the percentage of cell viability. The results obtained can find medical applications as new therapeutic nanoparticle agents.</p></div

Sunscreen behaviors among Libyan society survey

Sunscreen products are available in wide scale for consumers, the topical use products act by either absorbing or scattering the UV radiation. Excessive UV radiation exposure have been shown to be associated with a series of dermatologic disorders, which symptoms may appear instantly, or even developed few years later in life. The objective of this study is to assess the behaviors, application and use- base of sunscreen. A questionnaire-based study was conducted in Tripoli province, Libya. The questionnaire included four broad categories, developed to explore and highlight the main behaviors during the use and application of sunscreen. Questionnaire circulated inside dermatology follow-up clinics and outside hospital. Respondent characteristics pattern reported as a percentages. Data were analyzed from 385 participants who had complete information regarding behaviors and use of sunscreen at Libyan society. With at least 70% of participants using and applying sunscreen, the majority of users were female 87.8%, and their age ranges from 20 to29 years, with frequent use more than 2 times per week. Whereas 57% of participants applied sunscreen as personal protection of their skin. In this survey, the questionnaire-based study provided valuable information about the behaviors and habits of applying sunscreen products. The majority of participants applied sunscreen to protect their skin, the market drives the users about the type of sunscreen and most of the participants gave the medical counsel and recommendation low attention

Effects of physical forcing on COastal ZOoplankton community structure: study of the unusual case of a MEDiterranean ecosystem under strong tidal influence (Project COZOMED-MERMEX).

International audienceThe COZOMED-MERMEX project aims at understanding how hydrodynamic forcing (currents, tides, winds)combine with anthropogenic forcing and climate to affect the variability of coastal Mediterranean zooplanktoncommunities under contrasting tidal influence. This study includes (i) a zero state of knowledge via a literaturereview of existing data and (ii) a case study on the system Boughrara lagoon - Gulf of Gabes. This ecosystemgives major services for Tunisia (about 65% of national fish production) but is weakened by its situation in aheavily anthropized area and under influence of urban, industrial and agricultural inputs. Besides this regionis subject to specific climate forcing (Sahelian winds, scorching heat, intense evaporation, flooding) whichpossible changes will be considered. The expected issues are (i) to improve our knowledge of hydrodynamicforcing on zooplankton and ultimately on the functioning of coastal Mediterranean ecosystems impacted byanthropogenic and climatic effects and (ii) to elaborate management tools to help preserving good ecologicalstatus of these ecosystems: hydrodynamic circulation model, mapping of isochrones of residence times, mappingof the areas of highest zooplankton abundances (swarms), and sensitive areas, etc. This project strengthensexisting scientific collaborations within the MERMEX program (The MerMex Group, 2011) and in the frameof an international joint laboratory (COSYS-Med) created in 2014. A first field mulidisciplinary campaign wasperformed in October 2016. The strategy combined measurements of sea level and currents (mooring of ADCP,Argonaute and tidal gauges), hydrological description of water masses (horizontal and vertical transect with aMinibat equipped with CTD, fluorescence and turbidity sensors) and discrete sampling of nutrients, DOC, POC,pico, nano, microphytoplankton and mesozooplankton. The first results allow a description of water currents andshows a good coupling between tidal cycles (ebb-flood and spring tide neap tide) and the dynamics of planktoniccompartments in the lagoon