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

Flight Time Optimization and Modeling of a Hybrid Gasoline–Electric Multirotor Drone: An Experimental Study

Drones have evolved rapidly over the decades, but the limited flight time inhibits multirotor drones from performing long-duration tasks. Batteries that power drones are considered an inadequate power source due to their low energy density. As gasoline is an energy-dense source, combining an electric propulsion system with gasoline engines should be considered. This paper proposes a novel hybrid multirotor drone design using two gasoline engines to provide the majority of the lift force and four electric motors to stabilize the drone. These propulsion systems have been characterized and optimized to exploit their respective advantages, which reduce the total energy consumption rate and increase flight time. Simulation and experimental results show that the hybrid gas–electric multirotor drone can achieve more than three times the flight time of the fully electric drone

Artificial neural networks for dihedral angles prediction in enzyme loops: a novel approach

Structure prediction of proteins is considered a limiting step and determining factor in drug development and in the introduction of new therapies. Since the 3D structures of proteins determine their functionalities, prediction of dihedral angles remains an open and important problem in bioinformatics, as well as a major step in discovering tertiary structures. This work presents a method that predicts values of the dihedral angles φ and ψ for enzyme loops based on data derived from amino acid sequences. The prediction of dihedral angles is implemented through a neural network based mining mechanism. The amino acid sequence data represents 6342 enzyme loop chains with 18,882 residues. The initial neural network input was a selection of 115 features and the outputs were the predicted dihedral angles φ and ψ. The simulation results yielded a 0.64 Pearson\u27s correlation coefficient. After feature selection through determining insignificant features, the input feature vector size was reduced to 45, while maintaining close to identical performance

In vitro cytotoxic and antioxidant activities of phenolic components of Algerian Achillea odorata leaves

In this study, methanol extract from Achillea odorata was evaluated for its phenolic contents using Folin–Ciocalteu reagent, and antioxidant activity using: 1,1-diphenyl-2-picrylhidrazyl (DPPH) radical scavenging activity, reducing activity of H2O2 and ferric reducing power assay. The total phenolic content was determined as gallic acid (GAE) equivalent. Flavonoids and flavonols contents were determined as quercetin (QE) equivalents. The cytotoxicity of the plant extract was tested against three tumor cell lines: MCF-7, Hep2 and WEHI using 3-(4,5-dimethyl thiazol-2-yl)-2,5-diphynyl tetrazolium bromide (MTT) assay. Preliminary screening was concluded in the presence of substances with large therapeutic values. The total phenolic content confirmed the presence of total phenolics in the extract and showed strong association with antioxidant activity. An important content of flavonoids and flavonols was also detected. The results of the antioxidant activities obtained indicate that A. odorata recorded a good capacity. For the cytotoxic activity, the results showed the plant extract significantly inhibited tumor cell growth and colony formation at various concentrations

The Impact of Covid-19 Infection and Vaccinations on the Menstrual Cycle

Background: Coronavirus disease-19 (COVID-19 infection) might present with no clinical symptoms or with mild to severe clinical symptoms. Menstrual cycle issues are one of the long-term clinical characteristics of COVID-19. The menstrual cycle is a biologically important cycle for females, regulated closely by endocrine, autocrine, and paracrine mechanisms, with substantial fluctuation in length (21-35 days) and hormone levels during the cycle. Inactivated viral vaccine, recombinant viral vaccine, subunit vaccine, DNA vaccine, and attenuated vaccine have all been tested for Co-V-19 vaccine efficacy. Few females suffered menstrual problems after immunization, such as Menorrhagia, Metrorrhagia, Polymenorrhea, and Postmenopausal bleeding. Vaccine-associated thrombocytopenia could be one of the causes. Aim: To document menstrual changes in female participants following COVID-19 infection and Covid-19 vaccination with one to two doses and to study the impact of the Corona vaccine on the cycle. Methods: This retrospective investigation occurred in two phases. The first phase recruited 547 females, with an average age of 35 years and who were infected with COVID-19 to complete a questionnaire to record menstrual changes in women after COVID-19 infection without vaccination, while phase two enrolled 673 females with an average age of 33 years (21-49) and who received the vaccine before the study to record menstrual disturbances after vaccination for COVID-19 , at Prince Rashid military hospital, Irbid, JORDAN, during the period March 2020-Apr 2022. A questionnaire with 6 sections was constructed to determine the influence of COVID-19 infection and Covid-19 vaccination on the menstrual cycle. Results: In phase one: 46.98% (257/547) had changes in the number of days between two following periods and in the volume of blood loss. 42.41% of subjects (232/547) had an increase or reduction in the length of menses. In phase two: 24.96% (168/673) of subjects experienced higher volume and 15.6% (105/673) experienced decreased volume. 23.03% (155/673) experienced delayed periods and 53.2% (358/673) experienced no changes. Conclusion: COVID-19 infection might influence the menstrual cycle. There was a discrepancy in menstrual profile after vaccination, irrespective of vaccine type or the number of doses given. However, our study is cross-sectional, and these findings need further investigations or clinical trials to demonstrate the effect of Covid -19 infection or vaccinations on menstrual cycle

Molecular recognition of tripeptides containing tryptophan by cucurbit[8]uril: A computational study

In this work, molecular dynamics (MD) simulations and time-dependent density functional theory (TD-DFT) calculations were applied to study the formation of binary and ternary complexes between cucurbit[8]uril (CB8) and three tryptophan-containing tripeptides (WGG, GWG, and GGW), as well as heteroternary complexes of the tripeptides in the presence of methyl viologen (MV) as an auxiliary ligand. All complexes were stable in water, and exhibited encapsulation of the indole moiety of W. Analysis of the MD trajectories of the homoternary complexes revealed π-π stacking within the CB8 cavity between the indole rings. MM-PBSA analysis indicated higher binding energy for tripeptides containing W residue at the N-terminus. The heteroternary complexes showed two binding modes, one with MV fully included (and π-π stacked with the indole ring) and the other with MV mostly excluded. The computed UV–Visible spectra of the free guests and their heteroternary complexes exhibited new bands emerged in the spectra of the complexes, which resulted from the transitions from HOMO and HOMO–1 to LUMO related to W–MV charge transfer (CT) complexes

Effect of Treated Wastewater Irrigation on the Accumulation and Transfer of Heavy Metals in Lemon Trees Cultivated in Arid Environment

The Middle East is considered as one of the driest regions of the world and the use of municipal-treated wastewater (TWW) for agricultural purposes is needed. The aim of this study was to evaluate the effect of continuous irrigation of TWW in lemon orchards on the accumulation of heavy metals (HMs) in the soil, as well as their uptake and translocation to aerial parts of the trees. For this purpose, two lemon orchards were selected to be irrigated from two different water sources: TWW from a tertiary treatment plant and freshwater (SW) from Moses springs in Jordan. Continuous irrigation with TWW resulted in higher concentrations of nutrients and HM accumulation in the soil as compared to SW. However, HM accumulation in the soil was found to be within the acceptable range according to the standards of the WHO. On the contrary, the continuous irrigation with TWW resulted in the accumulation of HMs in plant parts when compared to SW irrigation; the fruits were clearly affected by the accumulation of high levels of Cd and Pb that exceed the maximum limits for the presence of HMs in plant tissues. The irrigation of lemon trees with TWW had a significant effect on the bioaccumulation factor and translocation factors (TF) of HMs into different lemon tree parts. Heavy metal accumulation coincided with high translocation rates to different tree parts, and this is considered to be a main challenge for long-term irrigation with TWW in arid environments

Effect of Treated Wastewater Irrigation on the Accumulation and Transfer of Heavy Metals in Lemon Trees Cultivated in Arid Environment

The Middle East is considered as one of the driest regions of the world and the use of municipal-treated wastewater (TWW) for agricultural purposes is needed. The aim of this study was to evaluate the effect of continuous irrigation of TWW in lemon orchards on the accumulation of heavy metals (HMs) in the soil, as well as their uptake and translocation to aerial parts of the trees. For this purpose, two lemon orchards were selected to be irrigated from two different water sources: TWW from a tertiary treatment plant and freshwater (SW) from Moses springs in Jordan. Continuous irrigation with TWW resulted in higher concentrations of nutrients and HM accumulation in the soil as compared to SW. However, HM accumulation in the soil was found to be within the acceptable range according to the standards of the WHO. On the contrary, the continuous irrigation with TWW resulted in the accumulation of HMs in plant parts when compared to SW irrigation; the fruits were clearly affected by the accumulation of high levels of Cd and Pb that exceed the maximum limits for the presence of HMs in plant tissues. The irrigation of lemon trees with TWW had a significant effect on the bioaccumulation factor and translocation factors (TF) of HMs into different lemon tree parts. Heavy metal accumulation coincided with high translocation rates to different tree parts, and this is considered to be a main challenge for long-term irrigation with TWW in arid environments

The Quantum Tunneling of Ions Model Can Explain the Pathophysiology of Tinnitus

Tinnitus is a well-known pathological entity in clinical practice. However, the pathophysiological mechanisms behind tinnitus seem to be elusive and cannot provide a comprehensive understanding of its pathogenesis and clinical manifestations. Hence, in the present study, we explore the mathematical model of ions’ quantum tunneling to propose an original pathophysiological mechanism for the sensation of tinnitus. The present model focuses on two major aspects: The first aspect is the ability of ions, including sodium, potassium, and calcium, to depolarize the membrane potential of inner hair cells and the neurons of the auditory pathway. This membrane depolarization is induced via the quantum tunneling of ions through closed voltage-gated channels. The state of membrane depolarization can be a state of hyper-excitability or hypo-excitability, depending on the degree of depolarization. Both of these states aid in understanding the pathophysiology of tinnitus. The second aspect is the quantum tunneling signals between the demyelinated neurons of the auditory pathway. These signals are mediated via the quantum tunneling of potassium ions, which exit to the extracellular fluid during an action potential event. These quantum signals can be viewed as a “quantum synapse” between neurons. The formation of quantum synapses results in hyper-excitability among the demyelinated neurons of the auditory pathway. Both of these aspects augment and amplify the electrical signals in the auditory pathway and result in a loss of the spatiotemporal fidelity of sound signals going to the brain centers. The brain interprets this hyper-excitability and loss of spatiotemporal fidelity as tinnitus. Herein, we show mathematically that the quantum tunneling of ions can depolarize the membrane potential of the inner hair cells and neurons of the auditory pathway. Moreover, we calculate the probability of action potential induction in the neurons of the auditory pathway generated by the quantum tunneling signals of potassium ions