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

Serum serotonin in rheumatoid arthritis patients: Relation to rheumatoid factor positivity, clinical manifestations and fibromyalgia

Aim of the work: To estimate serum level of serotonin in rheumatoid arthritis (RA) patients and study its relation with various clinical data, radiographic scores and fibromyalgia. Patients and methods: This study involved eighty RA patients divided equally according to rheumatoid factor (RF) positivity. Modified Health Assessment Questionnaire, disease activity score in 28-joints (DAS 28), visual analogue scale of pain, Short Form Health Survey for mental and physical health, fibromyalgia questionnaire, RA Articular Damage score and radiological joint damage by van der Heijde modification were assessed. Serum level for serotonin was measured for all patients. Results: The mean age of seronegative patients was 41.7 ± 10.7 years; 36 females and 4 males and of seropositive (44.9 ± 12.9 years and were 34 females and 6 males). Serum serotonin level was high in RA patients compared to control (129.8 ± 99.1 ng/ml vs 79.6 ± 54.5 ng/ml respectively, p = 0.001). Serum serotonin was higher in seropositive than seronegative (155.9 ± 93.2 vs 101.5 ± 99.4 ng/ml respectively, p = 0.007). Fibromyalgia syndrome (FMS) was associated with a significant lower serotonin level in both groups (p < 0.005). High serotonin level was associated with combined disease modifying antirheumatic drugs (p = 0.04) in seronegative patients. A lower serotonin level was associated with corticosteroids administration and dry eye (p = 0.03, p = 0.004 respectively) in seropositive cases. A significant correlation was present between serotonin level with erythrocyte sedimentation rate, vitality energy and mental health (r = 0.4, p < 0.05) in seropositive patients. Conclusion: Serum serotonin level was high in RA, especially in seropositive patients. It demonstrated central antidepressant and peripheral pro-inflammatory role. The SSRI could be of benefit only in RA with FMS. Keywords: Rheumatoid arthritis, Serotonin, Rheumatoid factor positivity, Fibromyalgi

Effect of early treatment with disease-modifying anti-rheumatic drugs and treatment adherence on disease outcome in rheumatoid arthritis patients

Aim of the work: To evaluate the effects of early and regular treatment with Disease Modifying Anti-Rheumatic Drugs (DMARDs) on disease outcome in rheumatoid arthritis (RA) patients and factors affecting adherence to treatment. Patients and methods: Sixty-four RA patients (83% females, mean age 42.9 ± 11.9 and disease duration 4.5 ± 2 years) were divided into Group A (n = 31) who received DMARDs within 6 months of symptom onset and Group B (n = 33) who received DMARDs later in the disease course. Patients were assessed by the disease activity score DAS28, the Modified Health Assessment Questionnaire-Disability Index (MHAQ-DI), the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-36 and scoring of radiological damage by modified Larsen’s method. Adherence was assessed by self-report and physician judgment. A questionnaire including the most important factors that may affect early and regular treatment by DMARDs/appointment keeping of follow up visits was administered to the patients. Results: The adherence rate was 62.5%. Group A patients had significantly lower DAS28, MHAQ-DI, radiological scores (P = 0.001 for all), higher PCS (P = 0.001) and MCS (P = 0.003) scores than group B patients. Among groups A and B, adherent patients had significantly lower DAS28 (P = 0.001 for both) and higher PCS (P = 0.002 and 0.04, respectively) than non-adherent patients. Rural residence, lack of awareness about the disease and lack of belief in medication effectiveness were the most important factors associated with non-adherence (p = 0.04, 0.03 and 0.045, respectively). Conclusion: Early treatment and adherence to DMARDs have an important impact on disease outcome in RA patients

IGF1R, IGFALS, and IGFBP3 gene copy number variations in a group of non-syndromic Egyptian short children

Abstract Background Insulin-like growth factor-1 (IGF-1) is required for normal intrauterine and postnatal growth, and this action is mediated through IGF1 receptor (IGF1R). IGF1R copy number variants (CNVs) can cause pre- and postnatal growth restriction, affecting an individual’s height. In this study, we used multiplex ligation-dependent probe amplification (MLPA) to detect CNVs in IGF1R, IGFALS, and IGFBP3 genes in the diagnostic workup of short stature for 40 Egyptian children with short stature. Results We detected a heterozygous deletion of IGF1R (exons 4 through 21) in 1 out of the 40 studied children (2.5%). Meanwhile, we did not detect any CNVs in either IGFALS or IGFBP3. Conclusion The diagnostic workup of short stature using MLPA for CNVs of IGF1R and other recognized height-related genes, such as SHOX and GH, in non-syndromic short stature children can be a fast and inexpensive diagnostic tool to recognize a subcategory of patients in which growth hormone treatment can be considered

Fabrication and Application of Zeolite/Acanthophora Spicifera Nanoporous Composite for Adsorption of Congo Red Dye from Wastewater

Systematic investigations involving laboratory, analytical, and field trials were carried out to obtain the most efficient adsorbent for the removal of congo red (CR) dye from industrial effluent. Modification of the zeolite (Z) by the Acanthophora Spicifera algae (AS; marine algae) was evaluated in terms of adsorption capability of the zeolite to remove CR dye from aqueous solution. The zeolite/algae composite (ZAS) was fabricated using the wet impregnation technique. The AS, Z, and the synthesized ZAS composite were analyzed utilizing various characterization techniques. The newly synthesized ZAS composite has an adsorption capacity that is significantly higher than that of Z and AS, particularly at low CR concentrations. Batch experiments were carried out to explore the effects of different experimental factors, as well as the dye adsorption isotherms and kinetics. Owing to the presence of intermolecular interactions, the computational analysis showed that the adsorption of the CR molecule on zeolite surfaces is exothermic, energetically favorable, and spontaneous. Furthermore, growing the zeolite surface area has no discernible effect on the adsorption energies in all configurations. The ZAS composite may be used as a low-cost substitute adsorbent for the removal of anionic dyes from industrial wastewater at lower dye concentrations, according to the experimental results. Adsorption of CR dye onto Z, AS, and ZAS adsorbents was adequately explained by pseudo-second-order kinetics and the Langmuir isotherm. The sorption mechanism was also evaluated using Weber’s intra-particle diffusion module. Finally, field testing revealed that the newly synthesized adsorbent was 98.0% efficient at extracting dyes from industrial wastewater, proving the foundation of modern eco-friendly materials that aid in the reuse of industrial wastewater

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially