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 Unity of Religion and Politics from the Viewpoint of Ruza al-Aqul (The Grand Marzban-Nameh of the Sassanid Era)

Abstract Marzban-nameh is one of the most imperative works written by Marzban bin Rostam bin Shahriar during the Sultanate of Rum dynasty. This valuable literary work which is considered as one of the most magnificent literary works of Persian and Tabari languages is translated and edited by Mohammad bin Ghazi Malatavi and has been titled as "Ruza-al Aqul”. The concept of the book contains stories told by animals bearing ethical and didactic morals which are narrated in a specific technical and literary manner. The heroes of these stories are often animals, plants, and creatures that play the symbolic role of the characters in the story; moreover, at times, humans are also applied as symbols of the actual personalities of the stories.  One of the concepts mentioned in this book is the unification of religion and politics which embodies the ancient theme of divine monarch theory. This library-based research with a descriptive-analytic approach explores the descriptive themes of monarchy with four approaches: religion and monarchy, Far-e-Izadi (divine divinity) and Zel-e-Elahi (divine reverence), dominion awe and wisdom in the stories of Ruza-al Aqul. Finally, the results of this study indicate that Malatavi explicitly refers to the connection between religion and monarchy in the Ruza-al Aqul; however, in the overall analysis, this aspect of the divine theory of monarchy is seen with the least frequency. Therefore, from his point of view, the sultan's policy, before it bears a strong connection with religion, must have the characteristics Far-e-Izadi (divine divinity) and Zel-e-Elahi (divine reverence), dominion awe and wisdom which will sustain the structure and create popularity among all

Chemical composition, antioxidant and antimicrobial activities of essential oil obtained from wild and cultivated Moroccan Thymus species

Thymus broussonetii, Thymus maroccanus and Thymus satureioides, are endemic Moroccan species that are intensively utilized because of their wide ranging medicinal and culinary properties. In an effort to preserve these over-exploited species, the effect of cultivation on the essential oil chemical composition, antioxidant and antimicrobial activities were investigated. The hydrodistilled oils obtained from wild and cultivated thyme species were analyzed by GC–MS. In total, 41 components were identified representing more than 98% of the oils, with carvacrol (26.0–71.6%), borneol (5.0–20.1%), γ-terpinene (4.0–8.9%) and p-cymene (5.2–10.3%) as the main constituents. Similar oil profiles were obtained from wild and cultivated T. maroccanus, whereas some quantitative differences were noted between oils obtained from wild and cultivated T. broussonetii and T. satureioides. The antioxidant and antimicrobial assays revealed that all oils tested from wild and cultivated studied thyme species showed strong activities

Pre-implantation genetic diagnosis in an Iranian family with a novel mutation in MUT gene

Methylmalonic acidemia (MMA), which is an autosomal recessive metabolic disorder, is caused by mutations in methylmalonyl-CoA mutase (MUT) gene. As a result, the conversion of methylmalonyl-CoA to succinyl-CoA is impaired in this disorder, leading to a wide range of clinical manifestations varying from no signs or symptoms to severe lethargy and metabolic crisis in newborn infants. Since identification of novel mutations in MUT gene can help discover the exact pathogenesis of MMA and also use these disease-causing mutations in prenatal diagnosis, this study was conducted to uncover the possible mutations in an Iranian couple with a deceased offspring clinically diagnosed as having organic acidemia. Moreover, to prevent the occurrence of the mutation in the next pregnancy, we took the advantage of pre-implantation genetic diagnosis (PGD), which resulted in a successful pregnancy. The affected individual was a 15-month-old boy who passed away due to aspiration pneumonia. The child presented at the age of 3 months with lethargy, protracted vomiting, hypotonia, and decreased level of consciousness. To find the mutated gene, Next Generation Sequencing (NGS) was performed as carrier testing for the parents and the results revealed a novel (private) heterozygous missense mutation in MUT gene (c.1055A > G, p.Q352R). After performing PGD on three blastomeres, one was identified as being homozygous wild-type that was followed by successful pregnancy. Our study identified a novel, deleterious, heterozygous missense mutation in MUT gene in a couple and helps to consider the genetic counselling and prenatal diagnosis more seriously for this family with clinical phenotypes of organic acidemia