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 MULTI DRUG RESISTANT STRAINS ON TOUCH SCREEN OF AUTOMATED TELLER MACHINE

Multiple drug resistant (MDR) bacteria have spread globally even on non-porous surfaces such as mobile phones, computers, public telephone booths,keypads and touch screens of automatic teller machine (ATM). In this study, occurrence of different groups of MDR bacteria from metallic keypad andtouch screens of ATM machine was examined. The samples were collected from different ATMs located in Vellore, Tamil Nadu. Swabs were taken from47 ATMs and 488 isolates were identified as Escherichia coli (49%), Klebsiella sp., (30%), Pseudomonas sp., (16%), Acinetobacter sp., (3%) and Proteussp., (1%) and they were subjected to antibiotic susceptibility testing with ampicillin, cefotaxime, ceftriaxone, ceftizidime and meropenem of which 46isolates showed high level of resistance toward cefotaxime, and meropenem by plate assay. Further polymerase chain reaction amplification of NDM-1and CTX-M genes for all 46 isolates showed no amplified product, which showed the possibility for the presence of other types of extended spectrumβ-lactamases or metallo beta-lactamase. Our results showed the prevalence of MDR bacteria in ATM centers and most importantly awareness towardthe public regarding the spread of pathogenic bacteria in the environment.Keywords: Multiple drug resistance, Automatic teller machine centers, Public health, Antibiotic susceptibility pattern, Resistance gene

PHYTOCHEMICAL ANALYSIS AND ANTIOXIDANT PROPERTIES OF LEAF EXTRACTS OF CARICA PAPAYA

Objective: The objective of the present study aimed at investigating the phytochemical and antioxidant properties of Carica papaya leaf extracts. Methods: As phytochemicals are biologically active compounds and a powerful group of plant chemicals, believed to stimulate the immune system along with antioxidants, the molecules which hinder oxidation of other molecules by the process of inhibiting or by generating the oxidizing chain reactions and preventing diseases. The total phenolic content (TPC) was determined by Folin-Ciocalteu method and total flavonoid contents (TFC) were determined aluminum chloride method and antioxidant by 2,2,1-diphenyl-1-picrylhydrazyl method. Results: The results of phytochemical screening revealed the presence of bioactive compounds such as alkaloid, carbohydrates, and amino acids and TPC and TFC varied among the different solvent extracts, in which methanolic extracts showed highest amount of phytochemicals and TPC and TFC and antioxidants compared to other solvents. Conclusion: The isolation and purification of specific bioactive compound may account as natural and promising medicines in exploration of new drug

Baseline findings of a multicentric ambispective cohort study (2021–2022) among hospitalised mucormycosis patients in India

In India, the incidence of mucormycosis reached high levels during 2021–2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March–July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease’s clinical progression and help frame standard treatment guidelines

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