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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

A Comparison of the Effects of Several Foliar Forms of Magnesium Fertilization on ‘Superior Seedless’ (Vitis vinifera L.) in Saline Soils

Magnesium (Mg) is the most essential element constituent in chlorophyll molecules that regulates photosynthesis processes. The physiological response of ‘Superior Seedless’ grapes was evaluated under different foliar magnesium fertilization such as sulfate magnesium (MgSO4·7 H2O), magnesium disodium EDTA (Mg-EDTA), and magnesium nanoparticles (Mg-NPs) during the berry development stages (flowering, fruit set, veraison, and harvest). In general, the ‘Superior Seedless’ vine had a higher performance in photosynthesis with Mg-NPs application than other forms. The Fy/Fm ratio declined rapidly after the fruit set stage; then, it decreased gradually up until the harvesting stage. However, both MgSO4 and Mg-EDTA forms showed slight differences in Fv/Fm ratio during the berry development stages. The outcomes of this research suggest that the Fv/Fm ratio during the growth season of the ‘Superior Seedless’ vine may be a good tool to assess magnesium fertilization effects before visible deficiency symptoms appear. Mg-NPs are more effective at improving ‘Superior Seedless’ berry development than the other magnesium forms. These findings suggest that applying foliar Mg-NPs to vines grown on salinity-sandy soil alleviates the potential Mg deficiency in ‘Superior Seedless’ vines and improves bunches quality

Effect of Titanium and Vanadium on Antioxidants Content and Productivity of Red Cabbage

The present work studied the effect of foliar spray of different concentrations of titanium (Ti, applied as titanium dioxide) and vanadium (V, applied as vanadium pentoxide) on growth, chemical composition, antioxidant contents, antioxidant enzymes, antioxidant capacity, yield and quality criteria of red cabbage plants. For this purpose, 2.0, 4.0 and 6.0 mg L−1 of Ti and V were used to treat red cabbage plants. The control plants were treated with tap water. Our results showed that plants treated with 4.0 mg L−1 of Ti recorded the highest values of plant growth and bioactive compounds, while antioxidant capacity was decreased compared to the other treatments. In addition, plants treated with Ti and V at 2.0 and 4.0 mg L−1, respectively, showed higher values of all of the growth, yield, non-enzymatic antioxidants and antioxidants enzymes’ parameters compared to the untreated plants. Based on the obtained results, it could be concluded that the low concentrations of both Ti and V (2.0 and 4.0 mg L−1) were able to enhance red cabbage growth and yield, as well as the antioxidant contents, enzymes and capacity

Effect of Titanium and Vanadium on Antioxidants Content and Productivity of Red Cabbage

The present work studied the effect of foliar spray of different concentrations of titanium (Ti, applied as titanium dioxide) and vanadium (V, applied as vanadium pentoxide) on growth, chemical composition, antioxidant contents, antioxidant enzymes, antioxidant capacity, yield and quality criteria of red cabbage plants. For this purpose, 2.0, 4.0 and 6.0 mg L−1 of Ti and V were used to treat red cabbage plants. The control plants were treated with tap water. Our results showed that plants treated with 4.0 mg L−1 of Ti recorded the highest values of plant growth and bioactive compounds, while antioxidant capacity was decreased compared to the other treatments. In addition, plants treated with Ti and V at 2.0 and 4.0 mg L−1, respectively, showed higher values of all of the growth, yield, non-enzymatic antioxidants and antioxidants enzymes’ parameters compared to the untreated plants. Based on the obtained results, it could be concluded that the low concentrations of both Ti and V (2.0 and 4.0 mg L−1) were able to enhance red cabbage growth and yield, as well as the antioxidant contents, enzymes and capacity