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

Exploration for Uranium and Thorium Mineralizations at Wadi Um Laseifa Area, Central Eastern Desert, Egypt: Using Remote Sensing Technique

Abstract: This research aims at integrating airborne radiometric and remote sensing satellite data to prospect for radioactivity of the rocks at W adi Um Laseifa area, located in the Central Eastern Desert of Egypt. The study recorded several uranium anomalies along NNE-SSW trending fault zones within the granitic rocks. These occurrences are associated with alkali monzogranites, pegmatitic and manganese veins, trachytic dykes (Gabal Hamrat Ghanam, Gabal El Delihmi, Gabal Nusla and Gabal Abu El Tiyur). Gamma ray spectrometer measurements for representative samples indicate the presence of U up to 17.2 ppm in the trachytic dykes, 12 ppm in the pegmatites and 9 ppm in the manganese veins. Results demonstrate the accuracy of airborne radiometric data and the suitability of remote sensing techniques as a powerful tool in exploration for radioactive materials

Allopurinol as a Potential Therapeutic Agent for Recurrent Herpes Labialis

Recurrent herpes labialis (RHL) occurs in up to 40% of the population. Although the disease is usually self-limiting, patients seek treatment because of the significant pain and visibility of the lesion. Xanthine oxidase inhibitors (XOI) have been reported to have a potent antiviral effect against influenza-A virus. We examined the effect of the systemic xanthine oxidase inhibitor, allopurinol, on RHL duration of illness, severity of symptoms, number and frequency of recurrence during a 4-year follow up period in Egyptian patients. Duration of illness was shortened by about 25%, early disappearance of pain and other symptoms occurred. Also, aborted episodes were noticed when allopurinol was given just after beginning of common colds, at the prodromal stage of RHL or during severe stress conditions. Patients receiving 3 courses of treatment had markedly decreased recurrences during the follow up period. Ex vivo experiments to examine virus-induced plaque formation on Vero cells in the absence or presence of different concentrations of the drug could not prove any direct anti herpetic effect of the drug. However, allopurinol seems to be safe and effective in reducing duration of RHL and to abort lesion or prevent its appearance in treated patients even when they experience immunosuppressive conditions

EFFECT OF DIFFERENT TREATMENTS ON CELLULOSE TOWARD CARBOXYLATION AND ITS APPLICATION FOR METAL ION ABSORPTION

Carboxylation of cotton linters was investigated relative to its use in ion exchange. The effects of different treatments of cotton linters, such as alkali, acid, and activating agents, e.g. LiCl, on the molecular structure and carboxylation of cotton linters were taken in our consideration. The absence or presence of a crosslinking was considered, and the efficiency of these prepared carboxylated cotton linters toward metal ions uptake, as well as thermal analysis of treated and carboxylated cotton linters, was investigated. It was found that treatment of cotton linters with alkali and activating agent decreased the crystallinity index (band intensity at 1425/band intensity at 890 cm-1). On the other hand, the prepared carboxylated cotton linters had lower crystallinity index than uncarboxylated linters. Thermal analysis of the treated and carboxylated cotton linters allowed calculation of the activation energy of thermally treated materials. It was found that the crosslinked and acid treated cotton linters had a higher activation

Spectroscopic and ion exchange studies on modified cotton linters

1003-1009Cation exchange resin was prepared by phosphorylation of cotton linters. The effect of different treatments (alkali or acid) of cotton linters on phosphorylation process was studied. This treatment increases the efficiency of the produced resin toward metal ions uptake (Cu, Fe, Mn, Ni, Pb, Zn). The effect of pH value of metal ion solution on the efficiency of ion exchanger was investigated. The efficiency of the resin toward metal ion uptake was affected by soaking time and weight of resin. Infrared spectroscopy of the cotton linters and its modification was investigated. A new band was seen at wave number 980 cm-1 and 1194 cm-1 due to the C-O-P band

On the Wavy Behaviour of Grain Growth in Sprayed Thin Films

Tin oxide films were prepared by spray pyrolysis technique with different deposition times (60 - 240 s) while the substrate temperature (773 K), the deposition rate (0.22 ml/s) and the concentration (0.2 M) of tin chloride (hydrous) solution were kept constant. Variation of grain size with film thickness (deposition time) is found useful to model a mechanism for film growth. Depending on the mode of layer growth followed by 3D crystallite growth (Stranski and Krastaniv, SK) as well as on the variation of the standard deviation of pole densities, a proposed model of growth mechanism of thin film was suggested. Consider the fact that what you see depends on how you look , a wavy nature was suggested for the variation of the mean grain size with the film thickness using XRD analysis and SEM/AFM images. The discrepancy between the present result and others was understood on the basis of either the definition of the grain size measured by the different techniques (XRD or SEM) or the proposed wavy behaviour of the grain growth with the film thickness. Interpretation of the results of the grain size variation that extracted from the combined use of XRD and SEM/AFM can provide useful information about the growth mechanism

Generation of green electricity from sludge using photo-stimulated bacterial consortium as a sustainable technology

Abstract Microbial fuel cell (MFC) is a bio-electrical energy generator that uses respiring microbes to transform organic matter present in sludge into electrical energy. The primary goal of this work was to introduce a new approach to the green electricity generation technology. In this context a total of 6 bacterial isolates were recovered from sludge samples collected from El-Sheikh Zayed water purification plant, Egypt, and screened for their electrogenic potential. The most promising isolates were identified according to 16S rRNA sequencing as Escherichia coli and Enterobacter cloacae, promising results were achieved on using them in consortium at optimized values of pH (7.5), temperature (30°C) and substrate (glucose/pyruvate 1%). Low level red laser (λ = 632.8nm, 8mW) was utilized to promote the electrogenic efficiency of the bacterial consortium, maximum growth was attained at 210 sec exposure interval. In an application of adding standard inoculum (107 cfu/mL) of the photo-stimulated bacterial consortium to sludge based MFC a significant increase in the output potential difference values were recorded, the electricity generation was maintained by regular supply of external substrate. These results demonstrate the future development of the dual role of MFCs in renewable energy production and sludge recycling