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

Extraction en phase solide de certains herbicides présents dans l'eau

L'extraction en phase solide (SPE) est devenue une alternative très intéressante à l'extraction liquide - liquide dans l'analyse des pesticides dans l'eau. Le travail réalisé consiste à mettre au point une méthode SPE sur un nouveau type de cartouche (Oasis - HLB) pour certains herbicides de la famille des triazines et phénylurées substituées. Les cartouches sont conditionnées par le passage de petits volumes de méthanol et d'eau de qualité HPLC. L'analyse des extraits a été réalisée par chromatographie en phase gazeuse avec un détecteur à azote et phosphore (CPG / NPD). L'automatisation du procédé d'extraction en phase solide a permis l'obtention de résultats très reproductibles et un important gain de temps et de solvants. Les taux d'extraction obtenus ont été supérieurs à 80 % pour la majorité des molécules étudiées

Application de l'outil hydrochimique pour la détermination du biseau salé du système aquifère de Guerbès (Nord-Est Algérien)

La nappe côtière de Guerbès est contenue dans les sables dunaires. Ces formations très perméables facilitent les échanges entre la nappe et son environnement. Les nombreux marécages présents peuvent influencer le chimisme des eaux. L'examen des cartes hydrochimiques ainsi que les profils du rapport Br/CI, mettent en évidence une salinité des eaux. Cette dernière peut avoir plusieurs origines : apports latéraux par le massif de Filfila, apport par la partie amont par l'oued Kébir, recyclage des eaux d'irrigation. Les profils Br/CI montrent un accroissement du rapport du Sud vers le Nord pouvant atteindre voire dépasser 1,7%o. Cette valeur observée dans le secteur côtier indique une intrusion marine. Au Sud, la salinité des eaux aurait une origine anthropique

Chemical and spatial analysis of protein loaded PLGA microspheres for drug delivery applications

AbstractPolymer microspheres for controlled release of therapeutic protein from within an implantable scaffold were produced and analysed using complimentary techniques to probe the surface and bulk chemistry of the microspheres. Time of Flight – Secondary Ion Mass Spectrometry (ToF-SIMS) surface analysis revealed a thin discontinuous film of polyvinyl alcohol (PVA) surfactant (circa 4.5nm thick) at the surface which was readily removed under sputtering with C60. Atomic Force Microscopy (AFM) imaging of microspheres before and after sputtering confirmed that the PVA layer was removed after sputtering revealing poly(lactic-co-glycolic) acid(PLGA). Scanning electron microscopy showed the spheres to be smooth with some shallow and generally circular depressions, often with pores in their central region. The occurrence of the protein at the surface was limited to areas surrounding these surface pores. This surface protein distribution is believed to be related to a burst release of the protein on dissolution. Analysis of the bulk properties of the microspheres by confocal Raman mapping revealed the 3D distribution of the protein showing large voids within the pores. Protein was found to be adsorbed at the interface with the PLGA oil phase following deposition on evaporation of the solvent. Protein was also observed concentrated within pores measuring approximately 2μm across. The presence of protein in large voids and concentrated pores was further scrutinised by ToF-SIMS of sectioned microspheres. This paper demonstrates that important information for optimisation of such complex bioformulations, including an understanding of the release profile can be revealed by complementary surface and bulk analysis allowing optimisation of the therapeutic effect of such formulations

Flavonoid profile, antioxidant and antiglycation properties of <i>Retama sphaerocarpa</i> fruits extracts

<p><i>Retama sphaerocarpa</i> occurs in the Mediterranean area of North-east Africa and in the Iberian Peninsula, and grows on a variety of soil types and climatic conditions. Used in Algerian folk medicine, it is a valuable species for revegetation and soil restoration. The aim of this study is to evaluate flavonoid composition and antioxidant and antiglycation properties of methanolic and aqueous extracts from <i>R. sphaerocarpa</i> fruits. HPLC-PDA/ESI-MS was used to identify/quantify flavonoid content. Antioxidant activity was evaluated by Folin–Ciocalteu, ORAC, FRAP, TEAC, and DPPH assays, and antiglycation capability by glucose/fructose-BSA assay. Results showed that fruits contain isoflavones (daidzein and genistein derivatives) and flavonols (apigenin, isorhamnetin, kaempferol and quercetin derivatives), and extracts (especially the methanolic one, richer in flavonoids) possess good <i>in vitro</i> antioxidant and antiglycation properties. These findings evidence that <i>R. sphaerocarpa</i> fruits are a source of valuable phytochemicals, with potential applications in the field of phytopharmaceuticals and in food industry.</p