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

Turkish high school students’ conceptions of the nature of science

AbstractThe focus of this study is investigating the extent to which Turkish high school students understand the conceptions of nature of science (NOS). The paper describes the use of questionnaire of NOS and a semi-structured interview. The questionnaire was applied to 162 high school students. After the questionnaire was analyzed individually, six students were interviewed. Interview transcriptions were examined individually. Based on the results, students had some deficiencies on the conceptions of NOS. Students may still hold naive ideas about what data is. Hence, science teachers should implement instruction to help the development of their students’ conceptions regarding NOS

Geological, petrological, and geodynamical characteristics of the Karacaali Magmatic Complex (Kirikkale) in the Central Anatolian Crystalline Complex, Turkey

WOS: 000344525100005Mafic and felsic igneous rocks in the Karacaali Magmatic Complex (KMC) in the northwestern margin of the Central Anatolian Crystalline Complex (CACC) are classified into 4 groups: i) granitoid pluton including granite, granodiorite, and monzonite; ii) a few meter-scale porphyritic microgranite enclaves within the hybrid rocks; iii) hybrid rocks formed by mixing/mingling of mafic lavas (basaltic/diabasic/lamprophyric), anorthositic, and/or rhyolitic lavas; iv) diabasic dykes/veins within the granitoid pluton. Major element composition of the granitoid pluton and porphyritic microgranite enclaves within the hybrid rocks indicate subalkaline, calc-alkaline, and mostly I-type characteristics. These rocks are mainly peraluminous with aluminum saturation index > 1, but mainly between 1 and 1.1, indicating transitional peraluminous. On the tectonomagmatic discrimination diagrams (Y vs. Nb and (Y+Nb) vs. Rb diagrams), all the granitic and monzonitic rock suites from the complex fall mostly in the VAG+Syn-COLG and VAG fields respectively, suggesting arc-related origin. On the R1 vs. R2 tectonic diagram, the granitic rocks display distribution from preplate collision to syncollision field, but quartz-monzonitic samples plot within the postcollision uplift field. Based on limited geological, petrographic, and geochemical results, the tectonomagmatic evolution of the KMC can be summarized as follow: i) initiation of subduction of the Inner Tauride oceanic lithosphere beneath the CACC during the Late Cretaceous time; ii) underplating of partial melts derived from subducted slab and/or mantle wedge, which provided enough heat for partial melting of the mafic lower crust and generation of granitic magma; iii) slab detachment following the continent-continent collision that resulted in tensional forces within the overlying continental crust, which allowed the intrusion of the granitic magma to the upper crust, also cutting the central Anatolian ophiolites, from the Late Cretaceous to most likely the Paleocene time. The hybrid rocks formed by mixing/mingling of the mafic, anorthositic, and/or rhyolitic magmas most likely indicate their injection into a partly crystalline granitic magmatic system just after crystallization of granitic magma in the upper crust. However, this model is open to discussion and needs to be investigated using isotope data in future studies

Clinical and imaging clues of arteriopathy-Related pediatric arterial ischemic stroke: A single center experience

Background and Purpose: Arteriopathy is a common etiology for childhood arterial ischemic stroke (AIS). In this study, we aimed to address clinical, demographic, and neuroimaging characteristics and the reversibility of vasculopathy in patients with childhood stroke due to arteriopathy by classifying them according to Childhood AIS Standardized Classification and Diagnostic Evaluation (CASCADE) criteria. Methods: We included 15 patients with AIS due to arteriopathy presented between 2013 and 2018. All patients were diagnosed and followed up using magnetic resonance imaging (MRI) studies. All acute AIS patients were classified by acute CASCADE criteria (1–4). Moreover, each group was categorized according to the chronic CASCADE criteria, including progressive, stable, reversible, and indeterminate courses. Results: In the study population, CASCADE 2 patients were the most common group, and basal ganglia involvement was the most common involvement in CASCADE 2 patients. Of CASCADE 2 patients, 71.4% received steroids, which was compatible with a favorable outcome. In the study, trauma was present in 33.3% of patients, 60% of which was related to CASCADE 4. In the control visit on month 24, there were neuromotor sequelae of 60%, including hemiparesis, facial paralysis, and decreased fine motor skills; furthermore, the recurrence rate was 20%. Conclusion: We strongly emphasize that arteriopathy should be kept in mind in school-age children presenting with hemiparesis and headache. Moyamoya disease must be considered in the differential diagnosis with anterior circulation involvement, while focal cerebral arteriopathy (FCA) in patients with basal ganglia involvement was detected on MRI and dissection in the patients with a history of head-neck injury. We think that steroids have positive influences on neurologic prognosis in patients with FCA

Is the MDR1 C3435T polymorphism responsible for oral mucositis in children with acute lymphoblastic leukemia?

Background and Aim: Although the functional consequences of MDR-1 polymorphisms have been the subject of numerous studies, to the best to our knowledge, associations with clinical side effects of anticancer drugs have yet to be assessed. Our aim was to clarify any role of the C3435T polymorphism of the MDR1 gene in oral mucositis and its relation with elevated reactive oxygen species (ROS) levels, in children with acute lymphoblastic leukemia (ALL). Materials and Methods: The distribution of the MDR-1 C3435T polymorphism in 47 patients with ALL was determined by RFLP and compared with that of 68 healthy controls. Results: There were no association in distribution of genotypes of MDR-1 C3435T polymorphism and the risk of ALL. Oral mucositis were detected in 78.7% (n=37) of the patients and significantly related to the MDR-1 CT genotype (p=0.042), as confirmed by logistic regression analysis. Conclusion: Our preliminary data suggest that children carrying the CT genotype are more prone to develop oral mucositis, which might mean that the heterozygous genotype leads to accumulation of more reactive oxygen species. Since a limited number of patients was investigated, further studies are needed to confirm these findings

True Functional Reconstruction of Total or Subtotal Glossectomy Defects Using a Chimeric Anterolateral Thigh Flap with Both Sensorial and Motor Innervation

Background The purpose of this study was to report the motor functional outcomes and sensory recovery of patients who had undergone total or subtotal glossectomy for oral squamous cell carcinomas reconstructed with chimeric anterolateral thigh (ALT) flaps. Methods Six patients, 4 men and 2 women, with a mean age of 49.5 years (range, 36-73 years) were included in the study. All patients were treated with chimeric ALT, including the vastus lateralis muscle with its motor nerve and skin paddle with its innervating nerve. All patients were administered functional tests involving sensory recovery, intelligibility, and swallowing. Flap sensibility was evaluated using light touch sensation with the Semmes-Weinstein monofilament test, 2-point discrimination according to the Weber sensitive test, warm and cold temperature sensations, and pain sensation. Intelligibility was scored by a speech therapist on a scale from 1 to 5. Swallowing was assessed by electromyography, deglutition scores (on a scale of 1 to 8), and modified barium swallow. Donor-site morbidities were recorded. Results Mean follow-up was 26.6 months (6 months-5 years). The flaps were successful in all 6 patients. The donor site was closed primarily and no complications were seen in the follow-up period. Normal extension of the knee joint and no evidence of lateral patella instability occurred. Speech intelligibility was good (4) in 3 patients and acceptable (3) in 3. Deglutition scores were 6 in 2 patients, 5 in 2, and 4 in 2. Modified barium swallow revealed that 4 patients experienced bolus transit, but 2 required a liquid swallow to promote bolus transit. Electromyographic recordings showed innervations of the vastus lateralis muscle with active generation of motor unit potentials in 4 patients when trying to elevate the tongue. This was not performed in 1 patient, and 1 other had macroscopic muscle contractions. All sensory tests were satisfactory in all parameters. Conclusions The results of this reconstructive option were satisfactory in terms of motor function and sensitive assessment of the neotongue. This technique is strongly recommended for patients with total or subtotal glossectomy

Cation exchange properties of low rank Turkish coals: removal of Hg, Cd and Pb from waste water

The removal of contaminant heavy-metal ions from spiked aqueous samples containing low-to-moderate levels of contamination using Turkish Beypazari low rank coal was investigated. Carboxylic acid and phenolic hydroxyl functional groups present on the coals surface were the adsorption site to remove cations from solution via ion exchange. The equilibrium pH of the coal/solution mixture has been shown to be the principal factor controlling the extent of removal of Hg(II), Cd(II), and Pb(II) ions from aqueous solutions. The optimum pH was measured to be 4.0 for Hg and Cd, and 5.0 for Pb and it was found that the system reached equilibrium in 20 min. The maximum adsorption capacities of the metal ions from their single solutions were 0.039 mmol for Hg(LI), 0.008 mmol for Cd(II) and 0.041 mmol for Pb(II) per gram of coal. The order of affinity on; a mole basis was as follows: Pb(II) > Hg(II) > Cd(II). The same behavior was observed during the competitive adsorption, that is in the case of adsorption from their ternary solutions. Waste water samples were obtained from a mining industry plant located within Aegean Region, Turkey. It was observed that the use of low rank coal was considerably effective in removing Hg, Cd and Pb cations from water