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

Prevalence of non-thyroidal illness syndrome in COPD exacerbation and effect of hypoxaemia and hypercapnia on thyroid functions

OZCELIK, Neslihan/0000-0002-4672-6179WOS: 000535373200001PubMed: 32367619Introduction Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease showing acute exacerbations during its course. Comorbidities often accompany. Non-thyroidal illness syndrome (NTIS) occurs because of the functional impairment in the hypothalamic-pituitary-thyroid axis in severe critical cases. the objective of the current study is to determine the prevalence of NTIS among hospitalised patients due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and to reveal the factors affecting thyroid functions. Materials and methods A total of 132 patients hospitalised for AECOPD were enroled. Arterial blood gas samples at room air and venous blood samples for thyroid function tests were obtained within 24 hours following hospitalisation. Results the mean age was 69.3 +/- 9.6 years with male predominance (M/F:130/2). the prevalence of NTIS was 55%. Subgroups of NTIS cases were analysed. Low TSH levels were the most common pathology (55%). Patients with NTIS had significantly lower PaO2 and SaO(2) levels compared with those without NTIS (P = 0.045 and P = 0.022, respectively). in addition, a positive correlation was found between PaO2 and free thyroxine (fT4) (P < 0.001, r = 0.313). A statistically significant negative correlation between PaCO2 and fT4 was found (P < 0.001, r = -0.393). and a statistically significant negative correlation between PaCO2 and free triiodothyronine (fT3) values were found (P = 0.040, r = -0.183). Conclusion NTIS is a very common condition during AECOPD. We believe that hypoxemia causing functional impairment in the hypothalamic-pituitary-thyroid axis is the main mechanism in NTIS development and hypercapnia disrupts freeT3 and freeT4 production and secretion

A rare case of interrupted inferior vena cava with azygos continuation

WOS: 000512915500003The identification of vascular pathologies of the mediastinum is very important for the prevention of complications during the interventional procedure. A rare developmental anomaly of inferior vena cava (IVC): the interrupted IVC continues with azygos vein in thorax. and then, the azygos vein merges with the superior vena cava (SVC) and pours into the right atrium. the incidence is reported to be 0.6%. It is a crucial application to distinguish the enlarged azygos vein from the right paratracheal mass and lymph node radiologically and clinically

Idiopathic Pulmonary Hemosiderosis with Celiac Disease; Lane-Hamilton Syndrome

WOS: 000396416600009A 21-year-old male patient presented to our emergency department with the complaints of bloody sputum, respiratory difficulty, lethargy, and fatigue persisting for the previous two days. Fingertip oxygen saturation was 92%, while other vital signs were normal. Bilateral ground-glass opacities were present at thoracic computerized tomography. Laboratory findings were hemoglobin: 8.85g/dL, hematocrit: 28.7%. PT and aPTT values were normal. All rheumatologic laboratory tests were negative. Bronchoalveolar lavage was mildly hemorrhagic and "hemosiderin-laden macrophages" were observed in pathology specimens. the case diagnosed withidiopathic pulmonary hemosiderosis (IPH). Gastroduodenoscopy revealed nodularity in the duodenum, and mucosal biopsies taken from these duedonal regionswere reported as "villous atrophy in mucosal tissues in the duodenum compatible with celiac disease". the only recommended treatment was a gluten-free diet. At follow-up approximately 6 months later, complete remission was achieved. in conclusion, we should be aware, when seeing alveolar hemorrhage related to IPH, that celiac disease can accompany IPH. the concurrence of IPH and celiac disease is known as Lane-Hamilton syndrome. Complete remission in Lane-Hamilton syndrome can be achieved with a gluten-free diet

The role of serum bilirubin levels in determining venous thromboembolism

duman, hakan/0000-0002-1441-7320WOS: 000491548200004PubMed: 30922986Objective: Venous thromboembolism (VTE) is a disease that includes both deep venous thrombosis (DVT) and pulmonary embolism (PE). Bilirubin is an endogenous anti-inflammatory marker associated with atherothrombosis. the purpose of our study was to investigate the association of serum bilirubin levels with the presence of VTE. Methods: A total of 103 patients with VTE (distal DVT, n = 34; proximal DVT, n = 30; PE, n = 39) and 50 control patients were cross-sectionally enrolled. Peripheral venous duplex ultrasound and computed tomography were used for the diagnosis of VTE. Fasting blood samples were drawn for biochemical analyses. Results: Baseline characteristics were not different between groups. the VTE group had lower bilirubin level (9.0 +/- 2.6 mu mol/L vs 7.3 +/- 3 mu mol/L; P = .001) and higher high-sensitivity C-reactive protein (hs-CRP) concentration (0.8 [0.3-2] mg/L vs 1.1 [0.2-3] mg/L; P = .008) and white blood cell count (7.4 +/- 1.5 x 10(9)/L vs 8.2 +/- 2.7 x 10(9)/L; P = .02) compared with control patients. in the analysis of variance, the levels of total direct bilirubin and hs-CRP were clearly different between the control group and VTE subgroups (distal and proximal DVT and PE). the receiver operating characteristic curve analysis showed a cutoff value of 8.9 mu mol/L for total bilirubin (sensitivity, 74%; specificity, 55%) and an area under the curve of 0.659 (P < .001). Conclusions: Bilirubin level, hs-CRP concentration, and white blood cell count were independently associated with VTE

The Effects of a Postural Balance Training Program on Balance, Gait and Health-Related Quality of Life in Patients with Essential Tremor

Objective: Although the effectiveness of postural balance training on balance and gait impairment has been proven as an effective treatment approach in several patient and healthy populations, its effectiveness in patients with essential tremor (ET) is yet unknown. The aim was to examine the effects of postural balance training program on balance and gait performance, and health-related quality of life in patients with ET

Neutrophil gelatinase-associated lipocalin as a potential biomarker for pulmonary thromboembolism

WOS: 000525736100007Objective: Pulmonary thromboembolism (PTE) is a clinical condition that can be lethal unless promptly diagnosed and treated. the objective was to evaluate the significance of scrum neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of PTE. Materials and methods: in this study, 60 patients hospitalized for acute PTE between May 2015 and December 2016 were enrolled. PTE was diagnosed using spiral computed tomography angiography of the thorax. Cardiac enzyme levels, arterial blood gas, and echocardiography measurements were performed. Whole blood samples were drawn to measure serum NGAL before treatment. Results: the PTE group comprised 34 women and 26 men, and the healthy control group included 22 women and 18 men. the mean ages of the patient and control groups were 70.3 +/- 14.4 years and 69.0 +/- 10.2 years, respectively. Serum NGAL was significantly higher in the patients than in the controls (88.6 +/- 33.6 vs. 31.7 +/- 10.0 ng/mL, p 50 ng/mL, the sensitivity was 100%, specificity was 98.3%, the negative predictive value was 100%, and the positive predictive value was 68%. Conclusion: Scrum NGAL is a new biomarker with high sensitivity and specificity to detect, diagnose, and exclude PTE