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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 evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Seasonal Effects on Some Eco-Morphological and Physiological Characters of Tamarix nilotica (Ehrenb) Bunge Growing Naturally in Egyptian Northern Coastal Salt Marshes

Tamarix nilotica is a perennial halophyte growing naturally at the Mediterranean coastal salt marshes. Vegetative parts were collected in two successive winters and summers to investigate the seasonal effects on the ecomorphological and physiological responses of T. nilotica. The results indicated that either in winter or summer seasons, T. nilotica can reduce the effect of soil salinity by excreting salts outside its body through salt glands. Summer season was characterized by low content of soil moisture (due to rare rainfall), high soil EC, high light intensity and high temperature; there-fore, plant induced certain morphoanatomical changes in leaves and stem to face the previously mentioned adverse conditions. The most remarkable changes to reduce transpiration process was found by decreasing leaf area and increasing cuticle thickness and mesophyll tissue thickness. In addition, the most marked physiological changes in summer were the significant in-crease in total phenols, proline, free amino acids and total soluble sugars. These compounds can work as osmotic regulators and/or antioxidants. These features enhance the defensive mechanism against dehydration and permit T. nilotica to tolerate the stress conditions in salt marsh habitat

An Updated Review on the Role of Ginseng and Thyme Vulgaris in the Prevention and Control of Avian Viral Diseases with a Special Reference to Newcastle Disease Virus

Because of the growing dangers of viral infections, the use of herbal plant oils is gaining popularity among medical practitioners and large-scale livestock producers. Several studies have shown that herbal extracts could be used as an antiviral agent in animal feed or as a prophylaxis and remedy. Herbs, in addition to being a less expensive and safer alternative, may reduce the incidence of drug resistance and may modulate the immune system in the prevention of viral-related diseases. The main topic of this review is to focus on the antiviral and immunomodulatory potentials of thyme vulgaris and Ginseng, as well as their bioactive chemical components. The beneficial roles of the two herbaceous plant and their extracts upon avian viruses proofed in many earlier reports. Hence, the two herbs could have immune stimulant, antioxidant and anti-inflammatory benefits as well as adjuvant effects with poultry vaccines

Differential cellular localization of lectins in the testes of dromedary camel (Camelus dromedarius) during active and inactive breeding seasons

Abstract The reproductive activity of the male dromedary camel (Camelus dromedarius) as a seasonal breeder is affected by various seasonal changes that reflect on the reproductive performance. In the current study, we explored a differential cellular localization of lectins in eight dromedary camel testes utilizing lectin histochemistry (LHC). The glycoconjugates’ localizations were detected within the testicular tissue utilizing 13 biotin-labeled lectins (PNA, ConA, LCA, RCA120, GS IB4, WGA, BPL, DBA, ECA, PHA-E4, UEA-1, PTL-II, and SBA) distributed into six sets. The cellular structures revealed diverse lectins distribution that may reflect various glycoproteins’ structures and their compositional modifications during spermatogenesis. Some of the investigated lectins were restricted to acrosomes of spermatids that will help study different stages during the spermatogenic cycle of dromedary camel, particularly PNA, and ECA. The statistical analysis showed a marked positive correlation between the response intensity of various lectins and the breeding season (P < 0.05). We can conclude that lectins have a fundamental role during camel spermatogenesis and are associated with the reproductive activity of dromedary camel

Contrast enhanced digital mammography: Is it useful in detecting lesions in edematous breast?

Introduction: Breast edema can be caused by a variety of pathologic processes of benign or malignant diseases. Contrast enhanced digital mammogram (CEDM) has been shown to improve the probability of malignancy detection when compared with the conventional mammography alone. Patients and methods: This study was prospectively carried on 34 female patients with breast edema at the female imaging unit of the Radiology Department. The age range was 29–80 years. Bilateral conventional mammography (MX) and contrast-enhanced digital mammographic procedure (CEDM) were performed in approximately 7–10 min and followed by complementary ultrasound (US). Results: As regards enhancement patterns in our study, noncontrast uptake and diffuse parenchymal uptake were considered as benign and intense contrast uptake is considered malignant and ring enhancement in keeping with both benign and malignant lesions. The calculated sensitivity and specificity of dual energy contrast enhanced digital mammography were 95%, and 73% respectively, with a positive predictive value (PPV) of 88% and negative predictive value (NPV) of 88%. Conclusion: Dual-energy contrast-enhanced digital mammography is a useful technique in identification of lesions in mammographically dense edematous breasts and proved to be a useful tool in the follow-up of cases presenting by edema after conservative breast surgery and chemotherapy