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

Effect of Vitex agnus castus L. Extract in Carp Fish Infected with Vibrio anguillarum

This work studied in vitro; the antibacterial activity of Vitex agnus-castus (VAC) extract against V. anguillarum, its minimal inhibitory and bactericidal concentrations (MIC and MBC) and detected its bioconstituents using gas chromatography-mass spectrometry (GC-MS) analysis besides evaluated its effect in vivo in carp either alone or combined with antibiotic to prevent or treat V. anguillarum infection. A total of 180 fish were divided into 6 groups; G1: negative-control, G2: V. anguillarum infected-control, G3: infected-(marbofloxacin (MAR) 10 mg/kg body weight), G4: infected-(VAC 1gm/kg ration), G5: infected-(VAC 1 gm/kg + MAR 10 mg/kg) all treatments lasted 7 days and G6: prophylactic treated-(VAC 1 gm/kg/30 day) then challenged. Results of scanning electron microscope revealed changes in bacterial morphology and loss of flagella by VAC where its MIC and MBC were 1.95 and 15.63 mg/ml respectively. Growth performance and survival rate improved in all treated groups in this descending order (G6, G4 then G5). All treatments significantly increased total protein, albumin, globulin, superoxide dismutase and decreased aspartate and alanine aminotransferases activities, malondialdehyde, urea and creatinine than G2 and mostly near to G1 in this ascending order (G3, G4 then G5). In G6, VAC protected carp from the infection and improved growth, survivability and most of blood parameters. MAR residue in fish musculature needed 4 days as a withdrawal period to be less than the maximum residue limits (MRL), while combination of VAC with MAR decreased it less than the MRL from the 1st day post treatment. Finally, VAC had a considerable antibacterial activity against V. anguillarum in both prevention and treatment assays. It can be used either alone or adding with MAR

Prevalence and Antibiogram of Pseudomonas aeruginosa Among Nile Tilapia and Smoked Herring, with an Emphasis on their Antibiotic Resistance Genes (blaTEM, blaSHV, blaOXA-1 and ampC) and Virulence Determinant (oprL and toxA)

Bacterial diseases are one of the most challenging issues facing aquaculture sector. Pseudomonas aeruginosa (P. aeruginosa) has been regarded as one of the most significant threats to the fishing industry, which also affects public health. We aimed to elucidate the occurrence and antibiogram profile of P. aeruginosa recovered from Nile tilapia (Oreochromis niloticus) and smoked herring (Clupea harengus) with emphasis on their antibiotic resistance genes (blaTEM, blaSHV, blaOXA-1 and ampC) and virulence determinant genes (oprL and toxA). A total of 150 fish samples (110 diseased Nile tilapia, and 40 smoked herring) were collected randomly from retails of Gharbia Governorate, Egypt. The retrieved isolates were phenotypically characterized using standard methods of culturing and biochemical tests. Then, verified using molecular assay, 16S rRNA gene was detected in 100% of the tested isolates. The overall incidence of P. aeruginosa was 33.3%, out of which 45% from smoked herring and 29% from Nile Tilapia. The occurrence of P. aeruginosa in various infected organs of O. niloticus showed that the gills were the most obviously infected organ followed by kidney, liver, and spleen, respectively. A significant difference (P< 0.05) was noticed in the distribution of P. aeruginosa among O. niloticus internal organs. The phenotypic susceptibility to nine commonly used antimicrobial agents was detected using disc diffusion assay. The tested strains were extremely susceptible to ciprofloxacin, amikacin, and imipenem, whereas exhibited remarkable resistance to oxacillin, cefpodoxime, amoxicillin with clavulanic acid, ceftriaxone, and nalidixic acid. Interestingly, 100% of P. aeruginosa isolates were multiple antimicrobial resistant (MAR). Three resistance phenotypes profiles were identified with MAR index ranged from 0.4-0.5. Screening for antibiotic resistance genes revealed a diversity of β-lactamases in P. aeruginosa isolates, with blaTEM being the most dominant gene (100%), followed by blaSHV, blaOXA-1 and ampC with a total prevalence of 66.6% to all of them. The identified antimicrobial resistance phenotypes and genotypes were found to be significantly correlated. Subsequently, the distribution of virulence determinants in these strains was identified. These isolates had 100% prevalence of oprL and toxA virulence genes. In conclusion, the emergence of MDR P. aeruginosa in fish particularly ESBL and AmpC beta-lactamases producers could pose a potential health hazard to consumers. Thus, antimicrobial susceptibility must be continuously monitored to assess potential risks to human health. Ciprofloxacin, amikacin, and imipenem were the most efficient antibiotics for treatment of the identified P. aeruginosa, ESBL and AmpC beta-lactamases producers

Antigenic evaluation of extracted fimbrial protein obtained from pathogenic Escherichia coli isolated from diarrheic camel neonates

Enteropathogenic Escherichia coli (EPEC) were considered prime reason of diarrhea among neonatal livestock animals in developing countries and could be of public health importance via contaminated milk and meat.  Continual attempts were conducted to combat this illness using various antigenic determinants. This study was performed on four E. coli serotypes O26, O45, O103 and O111, which were previously recovered from diarrheic camel calves in Giza, Egypt. Extraction of fimbrial proteins was carried out through dialysis then evaluation of their immunogenic activity was preceded. SDS-PAGE electrophoresis was performed on crude extracted fimbrial proteins and revealed single band for each isolate ranged from 22 to 33kDa. Immunobloting was implemented on the extracted crude fimbrial proteins against E.coli O26 antisera formerly prepared in rabbit.These findings suggested that the fimbrial proteins are of immunogenicity importance and can serve as a protective passive vaccine antigen in prevention of diarrhea caused by EPEC and ETEC infection in camel calves