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

تقییم السیاسات الزراعیة لآهم محاصیل الحبوب بإستخدام مصفوفة تحلیل السیاسات

- تبین من نتائج قیاس تحلیل مصفوفة السیاسات الزراعیة لمحصولی الدراسة أن معامل الحمایة الأسمی لمستلزمات الإنتاج قد بلغ حوإلی 0.915، 0.915 لکل من القمح والأرز خلال الفترة 2013- 2017، الأمر الذی یشیر إلی عدم وجود دعم لمستلزمات الإنتاج. - کما تبین أن معامل الحمایة الإسمی للنواتج من محصولی القمح والأرز علی الترتیب خلال فترة الدراسة قد بلغ حوإلی 0.771، 0.746، الأمر الذی یوضح إلی عدم وجود سیاسة إنتاجیة عادلة وذلک لقیام الدولة بفرض ضرائب مباشرة وغیر مباشرة علی المنتج وتقدیم دعم للمستهلک. - کما تبین من النتائج إلی وجود میزة نسبیة لمحاصیل الدراسة خلال نفس الفترة ، الأمر الذی یعنی إلی ان معامل المیزة النسبیة أقل من الواحد الصحیح. - کما تبین ان بمقارنة التقییم المإلی والتقییم الاقتصادی لکل من أجور الآلات، ثمن التقاوی، ثمن السماد الکیماوی، ثمن المبیدات، نجد أن التقییم المإلی یقل عن التقییم الاقتصادی لهذه البنود مما یدل على أنها مدعومة من جانب الدولة لمزارعی القمح. - کما تبین ان بمقارنة التقییم المإلی والاقتصادی لکل من إیجار الأرض، أجور الحیوانات، ثمن السماد البلدی، والمصاریف العمومیة یتبین أنهما متساویان مما یدل على عدم تدخل الدولة فی أسعار هذه البنود. - کما تبین ان بمقارنة التقییم المإلی والتقییم الاقتصادی لکل من أجور الآلات، ثمن التقاوی، ثمن السماد الکیماوی، ثمن المبیدات، نجد أن التقییم المإلی یقل عن التقییم الاقتصادی لهذه البنود مما یدل على أنها مدعومة من جانب الدولة لمزارعی الأرز. - کما تبین ان بمقارنة التقییم المإلی والاقتصادی لکل من إیجار الأرض، أجور الحیوانات، ثمن السماد البلدی، والمصاریف العمومیة یتبین أنهما متساویان مما یدل على عدم تدخل الدولة فی أسعار هذه البنود. - کما تبین من النتائج إلی أن قیمة معامل الحمایة الفعال لمحصول القمح بلغت حوإلی 0.756 خلال فترة الدراسة، مما یعنی أن محصول القمح لم یتمتع بحمایة حکومیة خلال تلک الفترة. - کما تبین من النتائج أن قیمة معامل الحمایة الفعال لمحصول الارز بلغت حوإلی 0.723 خلال فترة الدراسة، مما یعنی أن محصول الأرز لم یتمتع بحمایة حکومیة خلال تلک الفترة

A Standard Study to Estimate the Demand and Supply of Maize in Egypt

The agricultural sector is the main pillar of the Egyptian economic structure, as it represents main source of food and clothing. In addition, it contributes to of the national income and Egypt faces a deficit in agricultural production, on the other hand consumption exceeds local production, and food is considered a vital necessity for people that cannot be dispensed. This research includes the statistical assessment of the macroeconomic econometric model of the variables of demand and supply of maize during the period (2005-2019), and the problem has become one of the most important problems threatening development in Egypt It has dangerous dimensions for the agricultural sector in particular and for the Egyptian economy in general, and that Egypt is still suffering from a food gap in most food commodities in a way that threatens Egyptian food security, as the equation of imports of corn shows that the volume of imports decreases by about 0.31%, 0.70% each An increase in the import price in dollars per ton, the average per capita production of the current year by 1%, meaning that the most influential variable in the volume of imports of corn in a particular year was the import price in dollars per ton, the average per capita production. It was also found that about 65% of the changes in imports of corn are due to the change in the independent variables under study, and that the average imports, production, and consumption of maize during the same period is 10.39, 6.67, 17.60 million tons, respectively, 15 % increase in the import price causes decreased in the quantity imported by 0.31%, The average of imports, production, and consumption of maize during the same period was 10.66, 7.70 and 17.80 million tons, respectively

Reproductive Performance of Barki Rams Fed on Different Omega-6: Omega-3 Ratios

The current experiment intended to investigate the impact of various dietary omega- 6/ omega -3 fatty acids ratios (FAs) on the reproductive performance and  serum lipid profile  in male Barki sheep over two months' experimental period. Twelve males were randomly allotted into 4 equal groups receiving 4 different ratios of omega-6/ omega- 3 FAs including 5.40 (higher ratio, HR), 4.56 (medium ratio, MR), 3.13 (lower ratio, LR) and 1.76 (very low ratio, VLR):1.  Feeding rams on diets with HR or VLR did not exhibit substantial impact on the sperm motility, sperm viability and testosterone hormone, however these parameters were non-significantly improved in the MR and LR- fed rams. The semen volume was significantly increased (P < 0.05) with the MR in comparison with the remaining groups.  Serum biochemical parameters, including total lipids, HDL concentrations did not exhibit significant differences (P> 0.05) among the different ratios. VLR- fed rams showed the higher serum total cholesterol, triglyceride, LDL and VLDL (P< 0.05), while the MR fed rams showed the highest CHO/HDL ratio (P< 0.05) in comparison with the other ratios. In summary, Barki rams fed different omega-6/ omega- 3 PUFA ratios (5.4, 4.56, 3.13 and 1.76:1) containing diets exhibited no significant difference in their reproductive performance parameters, however the medium (4.56:1) and low (3.13:1) ratios showed potential improving effect