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

Nocturnal Enuresis in Primary Schools Children (6-12 Years) of Tabuk City, Saudi Arabia

Background: Regardless of the significance and the disturbing magnitudes of NE, this problem remains under-reported in Tabuk, Saudi Arabia and comprehensive studies in this regard are considerably lacking in that region. This study aimed to discuss the prevalence and associated risk factors of NE among children in Saudi Arabia.&#x0D; Methodology: A cross sectional study design was adopted in Tabuk, KSA using a self-administered questionnaire for data collection distributed online on social media sites to be filled out personally. All data were collected, tabulated, and statistically analyzed using SPSS 23.0 for windows (SPSS Inc., Chicago, IL, USA).&#x0D; Results: The study included 431 participants. (37.4%) of children aged between six and seven years old, (32.7%) between eight and nine years old, and (17.2%) between ten and twelve years old. (58.9%) of children were males and (41.1%) females. Average frequency various from (53.8%) one time to two times per week, (31.3%) three times to four times per week, (14.8% five times to seven times per week. Enuresis was at night only in (77.5%) while (22.5%) at day or night. (64.5%) don’t seek to medical advice, while (35.5%) getting medical advice. (48.5%) of children getting behavioral therapy to treat this condition, (15.8%) exercise to strengthen bladder muscles, (14.6%) getting medical treatment, (10%) getting urination alarm, (0.5%) doing surgical intervention. There was a significant relationship between frequency per week of enuresis with mother educational level, number of family member, age of child (6-7) years old, sex of child (female), family history of nocturnal enuresis and delayed growth. Also, there was a significant relation between timing of enuresis during night or day and night with parents suffering from nocturnal enuresis, father’s education level, mother’s education level, and caring of parents to awaken the child.&#x0D; Conclusion: Nocturnal enuresis associated factors and parenteral knowledge of definition and causes of it were among universal reported figures. Referral to a pediatric urologist can be indicated for children with primary enuresis refractory to standard and combination therapies, and for children with some secondary causes of enuresis, including urinary tract malformations, recurrent urinary tract infections, or neurologic disorders.</jats:p

Visnagin and benzofuran scaffold-based molecules as selective cyclooxygenase-2 inhibitors with anti-inflammatory and analgesic properties: design, synthesis and molecular docking

A series of new visnagin and benzofuran scaffold-based molecules was designed and synthesized as anti-inflammatory and analgesic agents. Biological screening of these compounds showed that they exhibit potent anti-inflammatory/analgesic activity with a safer side effect profile in in vivo mouse models. In vitro cyclooxygenase (COX) inhibition assay showed that the compounds elicit their function through selective COX-2 inhibition. Molecular docking study also revealed the ability of the compounds to correctly recognize the active site and achieve noncovalent binding interactions with key residues therein. The best combined profile of anti-inflammatory, analgesic and COX-2 selective inhibition properties in association with low gastrotoxicity was displayed by the analogs 8, 11b and 19d, which can be considered as promising leads for further future optimization. </jats:p

Torilis arvensis ethanolic extract: Phytochemical analysis, antifungal efficacy, and cytotoxicity properties

The aim of the current study is to assess the phytochemical contents, antifungal activity, and cytotoxicity characteristics of an ethanolic extract derived from the entire Torilis arvensis plant. High-performance liquid chromatography examination of the extract revealed that the primary phenolic components were benzoic, o-coumaric, and vanillic acids with concentrations of 259.1, 220.4, and 111.3 µg/g of extract, respectively. The highest flavonoids were catechol (117.9 µg/g) and kaempferol (108.7 µg/g). The extract is notable for its high concentration of long-chain saturated and unsaturated fatty acids, as well as its presence of 17 gas chromatography-mass spectrometry bioactive chemicals. Three soil-borne pathogenic fungi, Rhizoctonia solani, Fusarium solani, and Fusarium oxysporum, were molecularly identified and assessed for the antifungal activity of the extract. The extract showed the highest growth inhibition against R. solani, F. oxysporum, and F. solani at 300 µg/mL, with inhibition rates of 88.9, 71.5, and 67.8%, respectively. T. arvensis treatments were generally non-toxic after proceeding with cytotoxicity assay on the onion root tip cells, with no chromosomal abnormalities detected even at the highest concentration (300 µg/mL). These findings highlight the potential of T. arvensis extract as a safe and effective antifungal agent with a rich phytochemical profile

Torilis arvensis ethanolic extract: Phytochemical analysis, antifungal efficacy, and cytotoxicity properties

TORILIS ARVENSIS ETHANOLIC EXTRACT: PHYTOCHEMICAL ANALYSIS, ANTIFUNGAL EFFICACY, AND CYTOTOXICITY PROPERTIES Open chemistry (Rights reserved) (-) Torilis arvensis ethanolic extract: Phytochemical analysis, antifungal efficacy, and cytotoxicity properties / Khalil, Abdallah (CC BY) (-

The Second Life of Citrus: Phytochemical Characterization and Antifungal Activity Bioprospection of C. limon and C. sinensis Peel Extracts Against Potato Rot Disease

Purpose: Citrus peel is known to contain a number of secondary metabolites effective against some phytopathogenic fungi affecting crop production both in the field and during storage. As fruit peels from the production of citrus juice are secondary waste that accounts up to the 40–50% of the total product biomass, the recycling of these by-products for the extraction of natural fungicides perfectly accomplishes the concept of circular economy in the food supply chain. Methods: We obtained essential oils and aqueous extracts from dried peel of Citrus limon and C. sinensis, determined the residual phytochemical profile and assessed their biological activity against Fusarium solani and Pythium ultimum, etiological agents of potato rot disease. Aqueous extracts composition was characterized by GC–MS, while essential oils were characterized with HPLC–DAD. Results: Five main compounds (quinic acid, protocatechuic acid, caffeic acid, rutin and kaempferol) were found to differentiate the two citrus peels, while syringic acid detected as main compound in C. sinensis was not found in C. limon. The antifungal activity, evaluated in term of both spore germination inhibition and mycelial development impairment, showed a lower antifungal potential of C. sinensis extracts with respect to C. limon. Conclusions: C. limon peels possibly obtained from recycled food waste could be therefore considered for sustainable agriculture and food conservation purposes against potato rots fungi