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

Risk of Staphylococcus aureus Isolated from Poultry Meat of Chicken with Arthritis in Poultry Farms

Staphylococcus aureus is a major pathogen that affects both people and animals. Staphylococcus aureus causes food poisoning in addition to invasive diseases as arthritis and septicemia. This study was done on 70 chicken samples obtained from 7 different farms of chickens with symptoms of arthritis in Kafr El-sheikh government, Egypt. In this study out of 70 samples of chickens from different farms, 37 (52.8%) samples were recognized as coagulase-positive staphylococci (CoPS) and 33 (47.1%) were recognized as coagulase-negative staphylococci (CoNS). By using the microtitre plate method, seven out of 37 (18.9%) CoPS were positive for biofilm production with variable degrees. The pattern of antibacterial sensitivity of 7 Staphylococcus aureus isolates against 12 commercially available antibiotic discs showed 100 % resistance to oxytetracycline then Amoxicillin (71.43%), Erythromycin (57.14%), Norfloxacin (14.29%), Tetracycline (42.86), Sulphamethoxazole (42.86%), Gentamicin (42.86%), Ampicillin (42.86%), kanamycin (28.57), cephatotin (28.57), doxycycline (0%) and the least was observed with chloramphenicol (0%). seven of positive S. aureus isolates were introduced in order to identify the staphylococcal enterotoxin genes, SEA, SEB, SEC, SED, and SEE and integron by PCR test Which 4 out of 7 isolates (57.1 %) were positive for SEB and SED only while were other isolate were negative for all SE gene. Class 1 integron cassettes were detected in 6 isolates from 7 (85.7%) of tested isolates. In conclusion, this is the first study to report the detection and identification of enterotoxin and class 1 integron in S. aureus isolated from poultry meat of chicken that suffered from arthritis.

Enhancing the Potentiality of <i>Trichoderma harzianum</i> against <i>Pythium</i> Pathogen of Beans Using Chamomile (<i>Matricaria chamomilla</i>, L.) Flower Extract

Our present study was designed to investigate the role of both Trichoderma harzianum and chamomile (Matricaria chamomilla L.) flower extract in mutual reaction against growth of Pythium ultimum. In vitro, the activity of chamomile extract was found to reduce the radial growth of Pythium ultimum up to 30% compared to the control. Whereas, the radial growth reduction effect of T. harzianum against P. ultimum reached 81.6% after 120 h. Data also showed the productivity of total phenolics and total flavonoids by T. harzianum, was 12.18 and 6.33 mg QE/100 mL culture filtrate, respectively. However, these compounds were determined in chamomile flower extract at concentrations of 75.33 and 24.29 mg QE/100 mL, respectively. The fractionation of aqueous extract of chamomile flower using HPLC provided several polyphenolic compounds such as pyrogallol, myricetin, rosemarinic acid, catechol, p-coumaric acid, benzoic acid, chlorogenic acid and other minor compounds. In vivo, the potentiality of T. harzianum with chamomile flower extract against Pythium pathogen of bean was investigated. Data obtained showed a reduction in the percentage of rotted seed and infected seedling up to 28 and 8%, respectively. Whereas, the survival increased up to 64% compared to other ones. There was also a significant promotion in growth features, total chlorophyll, carotenoids, total polyphenols and flavonoids, polyphenol-oxidase and peroxidase enzymes compared to other ones. To the best of our knowledge, there are no reported studies that included the mutual association of fungus, T. harzianum with the extract taken from the chamomile flower against P. ultimum, either in vitro or in vivo. In conclusion, the application of both T. harzianum and/or M. chamomilla extracts in the control of bean Pythium pathogen showed significant results