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

A Framework for Smart e-Trader System for UAE Stock Markets

Abstract- The fast development in computing and communication has strongly changed the dynamics of financial markets. More people are trading online through the Web instead of using full-service brokerages. Many online financial services have given investors new opportunities to trade stocks and access real-time market information efficient way. But, very few investors in UAE are familiar and use these services. A survey was conducted in Dubai Financial Market (DFM) to study the need for such service and found a strong demand for it, especially among women investors. A new system architecture is being proposed, called smart trader, to accommodate investors ’ needs and profiles. Smart trader is a web-based application that provides a real time stock market information and personalized stock recommendation. It is suggested that deploying a smart stock trading applications in DFM would assist investors make an informative investment decision as well as help them streamline their stock trading transactions. Keywords: Online trading, Stock market, Recommendation system, Client-server architecture. A financial market is a place where firms and individuals enter into contracts to sell or buy a specific product such as a stock, bond, or futures contract. Buyers seek to buy at the lowest available price an

Harvesting multiple optical energies using ZnPc/CdS-QDs hybrid organic/inorganic semiconductors

The substitution of inorganic-based electronics by organic semiconducting materials is a current trend in science and technology for its economic and environmental benefits, but it is hardly progressing. The reason thereof is the lack of improved efficiency, which affects the organic semiconductors performance in many devices when compared with their inorganic-based counterparts. A recent peculiar idea of using heterostructures consisting of both organic and inorganic materials has become an auspicious solution. To this end, the ability to synthesize hybrid organic/inorganic semiconductors targeting different applications is of utmost importance. We hereby present a successful simple route to synthesize a stable homogenous hybrid organic/inorganic system consisting of zinc phthalocyanine (ZnPc) oligomers as the organic base, and Cadmium sulfide quantum dots (CdS QDs) as the inorganic part. The structural and optical characterizations of the prepared samples demonstrate new optical absorption transitions for the hybrids in the red region belonging to the ZnPc molecules, besides the original blue band absorption of the CdS QDs. This is combined with a reduced radiative emission of the whole system. Thus, the hybrid materials are capable of harvesting multiple frequencies within the visible spectra more efficiently than pure QDs, while relaxing non-radiatively rather than by emitting electrons or heat. These qualities favor the use of these hybrids as solar cell or thermal-power active materials.AE and IM are acknowledging the funding provided by the joint Russian Egyptian STDF Project No. 13756. AE is also grateful for the general administration of Missions at the Ministry of High Education in Egypt for funding the mission trip to Centro de Fisica de Materiales on 2016. CR and EO are grateful for funding from the Spanish Ministry of Economy and Competitiveness (Grant MAT2016-78293-C6-5-R, including FEDER funds) and the Interreg POCTEFA V-A Spain–France–Andorra Program (EFA 194/16/TNSI) partly fnanced by ERDF funds

Tuning Paramagnetic effect of Co-Doped CdS diluted magnetic semiconductor quantum dots

Diluted magnetic semiconductor quantum dots (DMS-QDs) are known for their outstanding optical and magnetic properties. II–VI DMS-QDs, in particular, are interesting for spintronics, nonvolatile memory, and magneto-optical devices. Therefore, studying the optical and magnetic properties of different II-VI semiconductors doped with transition metal atoms is of great importance. Tuning II-VI QDs optical properties can be mastered by changing the QDs particle size and/or structure. However tuning the magnetic properties of DMS-QDs is still within trial and error verification, although it is crucial in targeting different applications in spintronics. We hereby demonstrate, the ability to tune the paramagnetic effect of homogeneous Co-doped CdS QDs following a co-precipitation synthesis route with different Co2+ concentrations. The structural, optical and magnetic properties have been comprehensively studied. The dopant cobalt atoms concentration and chemical-configuration were precisely tracked by x-ray photoemission spectroscopy. Excitingly, the different Co-concentrations of 2, 5 and 10% significantly improve the magnetic properties of the CdS QDs, which exhibit a paramagnetic concentration-dependent effect. With 10% of Co atoms, we were able to achieve ~ 200 x 10(-6) molar susceptibility, that is, the same value to that of pure CoS. Thus we could obtain the highest possible paramagnetic effect in the CdS semiconducting matrix exhibiting 2.76 eV band gap, i.e. in the visible range. This efficacious result encourages the use of the present method in preparing DMS-QDs materials targeting various spintronics applications.AE and IM are acknowledging the funding provided by the joint Russian Egyptian STDF project no. 13756. AE is also grateful also for the general administration of Missions at the Ministry of High Education in Egypt for funding the mission trip to Centro de Fisica de Materiales on 2016. CR and EO are grateful for funding from the Spanish Ministry of Economy and Competitiveness (grant MAT2016-78293-C6-5-R, including FEDER funds), the Basque Government (grant IT-1255-19) and the Interreg POCTEFA V-A Spain–France–Andorra Program (EFA 194/16/TNSI) partly financed by ERDF funds.Peer reviewe

Enhanced Deep Learning Model for Classification of Retinal Optical Coherence Tomography Images

Retinal optical coherence tomography (OCT) imaging is a valuable tool for assessing the condition of the back part of the eye. The condition has a great effect on the specificity of diagnosis, the monitoring of many physiological and pathological procedures, and the response and evaluation of therapeutic effectiveness in various fields of clinical practices, including primary eye diseases and systemic diseases such as diabetes. Therefore, precise diagnosis, classification, and automated image analysis models are crucial. In this paper, we propose an enhanced optical coherence tomography (EOCT) model to classify retinal OCT based on modified ResNet (50) and random forest algorithms, which are used in the proposed study’s training strategy to enhance performance. The Adam optimizer is applied during the training process to increase the efficiency of the ResNet (50) model compared with the common pre-trained models, such as spatial separable convolutions and visual geometry group (VGG) (16). The experimentation results show that the sensitivity, specificity, precision, negative predictive value, false discovery rate, false negative rate accuracy, and Matthew’s correlation coefficient are 0.9836, 0.9615, 0.9740, 0.9756, 0.0385, 0.0260, 0.0164, 0.9747, 0.9788, and 0.9474, respectively

STUDIU PRIVITOR LA FACTORII DE RISC POTENȚIALI PENTRU SUSCEPTIBILITATEA DE INSUFICIENȚĂ RENALĂ CRONICĂ, ÎN REGIUNEA HAIL, REGATUL ARABIEI SAUDITE

BACKGROUND: Chronic kidney disease (CKD) is a worldwide health alarm that is rising for the most part of the world as the result of increasing incidences of diabetes, hypertension and other cardiovascular diseases. Therefore, the aim of this pilot study was to provide data about risk factors for CKD in Hail region, KSA to plan for a comprehensive survey in the area.METHODS: A survey was performed, employing household visits, covered 300 individuals, selected from two areas in Hail region to fulfill the planned sample for this pilot setting. A questionnaire was used to obtained information about CKD risk factors. Results: High percentages of risk factors were indicated in a family history (FH) of DM representing 72%, followed by family history of hypertension, recurrent urinary tract infection, DM, family history of renal disease, hypertension, and analgesic abuse, constituting 65%, 59%, 26%,26%, 25%, and 22%, respectively. Conclusion: This study shows increased risk factors for CKD in Hail area. There is an urgent need for more detailed measurement for these risk factors through a comprehensive survey to evaluate individuals with risk factors, to enable earlier detection, and risk factor reduction through rising of awareness. CONTEXT: Insuficiența renală cronică (IRC) constituie  o alarmă de sănătate la nivel mondial, care este în creștere, în cea mai mare parte a lumii, ca rezultat al incidenţei crescute a cazurilor de diabet zaharat, hipertensiune arterială și alte boli cardiovasculare. Prin urmare, scopul acestui studiu pilot a fost de a furniza date cu privire la factorii de risc pentru IRC din regiunea Hail, Regatul Arabiei Saudite, pentru  planificarea unui studiu cuprinzător în zona.METODE: Studiul a fost efectuat folosind vizitele în gospodării, acoperind 300 de persoane selectate din două zone din regiunea Hail, pentru a completa eşantionul planificat pentru această testare pilot. A fost utilizat un chestionar pentru obținerea de informații cu privire la factorii de risc ai IRC.REZULTATE: Un procent ridicat de factori de risc au fost identificaţi într-un istoric familial (IF) de DZ, reprezentând 72%, urmat de antecedente familiale de hipertensiune arterială, infecții recurente ale tractului urinar, DZ, antecedente familiale de boli renale, hipertensiune arterială, și abuz de analgezice, constituind 65 %,  59%,  26%, 2 6%,  25%, și respectiv 22%.CONCLUZIE: Acest studiu identifică factorii de risc crescut pentru IRC în zona Hail. Este o nevoie urgentă de măsurare mai detaliată a acestor factori de risc printr-un studiu cuprinzător pentru a evalua persoanele cu factori de risc, pentru a permite depistarea din timp, și reducerea factorilor de risc, prin creșterea gradului de conștientizare. Cuvinte cheie: boala cronică de rinichi, hipertensiune arterială, diabet zaharat, Hail

Incidence of non-syndromic orofacial cleft during the COVID-19 pandemic in Saudi Arabia

Abstract Objectives This is the first national study to investigate the incidence of non-syndromic oro-facial clefts (NSOFC) and Pierre-Robin-Sequence in Saudi Arabia over the Covid-19 pandemic period. Methods All maternity hospitals (30-hospitals) in the major regions and cities of Saudi from November 2020-to-2021 were included in the study. Patients were evaluated for cleft phenotype using the LASHAL-classification system. The incidence of NSOFC in Saudi Arabia was calculated by comparing the number of NSOFCs cases born out of all live births during the study period at the included hospitals. Clinical examination was performed and information was gathered using a validated data collection form. Results In one year, 140,380 live-infants were born at the selected hospitals. Of these, 177 were diagnosed with NSOFC giving an incidence of 1.26/1,000 live-births in Saudi Arabia and the highest incidence in Medina city (2.46/1000 live-births). The incidence of cleft lip-and-palate (0.67/1000 live-births) was higher than that of cleft-palate (0.37/1000 live-births) and cleft-lip (0.22/1000 live-births). Pierre-Robin Sequence incidence was (0.04/1000 live-births). There were 21(12.1) or 23(13.2%) of NSOFC’s mothers exposed or vaccinated with Covid-19, respectively. Conclusion The national incidence of NSOFC in Saudi Arabia was 1.26/1000 live births with variation between phenotypes and regions in the country. In addition, to reporting Covid-19 infection prevalence and vaccine exposure among NSOFC's mothers, this study represents the first of its type to evaluate NSOFC prevalence in Saudi Arabia on a national level

sj-docx-1-cpc-10.1177_10556656231224198 - Supplemental material for Maternal Exposure to Stress During Covid-19 and Non-Syndromic Orofacial Clefts: A Cohort Retrospective Study

Supplemental material, sj-docx-1-cpc-10.1177_10556656231224198 for Maternal Exposure to Stress During Covid-19 and Non-Syndromic Orofacial Clefts: A Cohort Retrospective Study by Heba Jafar Sabbagh, Mona Talal AlSharif, Fatma Dawood Abdulhameed, Aziza Johar Aljohar, Reema Mahdi Alhussain, Sultan Musaad Alghamdi, Najla Sulaiman Alrejaye, Latifa Yousef AlGudaibi, Bahaudbdin Ibraheem Sallout, Badi Shoaib Albaqawi, Eman Abdulbaset Alnamnakani, Lougin Khalid Brekeit, Osama Adel Basri, Manal Ibrahim Almalik, Norah Suliman Al Soqih, Ali Bakr Alshaikh, Abdullah Jameel Aburiziza, Faisal Ali Al Qahtani, Bushra Musaad Alghamdi, Asalah Khalid Alraddadi, Hadeel Hamza Khaja and Rana Abdullah Alamoudi in The Cleft Palate Craniofacial Journal</p

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially