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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Comparison between combined regional nasal block and general anesthesia versus general anesthesia with dexmedetomidine during endoscopic sinus surgery

ABSTRACTBackground Research findings are inconsistent regarding the efficiency of regional nasal blocks over hypotensive techniques. The current study aimed to compare regional nasal block to dexmedetomidine (DEX) for surgical field optimization.Methods A total of 70 patients (ASA I or II) aged 18 to 65 years were divided into two groups (35 patients each). The DEX group received 1 µg/kg of DEX in 10 minutes after induction of anesthesia, followed by 0.7 µg/kg/hour during maintenance of anesthesia. The other group [Sphenopalatine ganglion block (SPGB) group] was subjected to regional nasal block by SPGB immediately after induction of general anesthesia. This was done via a transoral approach using 2 ml of a mixture of lidocaine (2%) and bupivacaine (0.5%) for each side.Results Surgical conditions were satisfactory in all patients of both groups, but significantly better with bilateral SPGB. In addition, the block group had also improved extubation characteristics and postoperative analgesia. Patients who received bilateral SPGB complained significantly of dental numbness.Conclusions Both DEX and regional nasal block provided excellent functional endoscopic sinus surgery (FESS) with a high score of surgeons’ satisfaction. The SPGB can provide better surgical field optimization with less blood loss, less intraoperative analgesic consumption, and early extubation with minor complications, and better immediate postoperative pain profile. So, SPGB can be used efficiently and safely in combination with general anesthesia in patients undergoing FESS

Echocardiographic findings in systemic lupus erythematosus and its relation to disease activity and damage index

Aim of the work: To assess the echocardiographic changes using Trans Thoracic Echocardiograghy in systemic lupus erythematosus (SLE) patients with and without antiphospholipid syndrome (APS) and to study the relation of the changes to the disease activity and damage. Patients and methods: This study was conducted on 50 SLE patients (25 with and 25 without APS) and 50 controls. The SLE disease activity index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage index (SLICC/DI) were assessed. Laboratory investigations were performed and transthoracic echocardiography (TTE) was done. Results: The mean age of the patients was 27.7 ± 8.5 years and disease duration 4.1 ± 3.7 years; 44 females and 6 males; 7.3:1. There was a high frequency of mitral (64%), aortic (22%) and tricuspid (24%) valve regurges as well as pericardial effusion (22%). Left ventricular hypertrophy and atrial dilation was present in 10% of the patients. The frequency of mitral, aortic and tricuspid regurge in SLE patients with APS tended to be higher (84%, 32% and 36%) than in those without (44%, 12% and 12%, respectively). There was a significant correlation between SLEDAI and pericardial effusion (p = 0.001), between the SLICC/DI with the left ventricular diastolic dysfunction (LVDD) (p = 0.001), the presence of lupus nephritis with the ejection fraction (p = 0.02) and between hypertension with the LVDD (p = 0.001). Conclusion: All SLE patients especially those with APS should be screened for the presence of structural cardiac abnormalities. TTE can be helpful as a noninvasive diagnostic tool for early detection of the abnormalities, resulting in earlier treatment and reduction in mortality and morbidity. Keywords: Systemic lupus erythematosus, SLEDAI, SLICC DI, Antiphospholipid syndrome, Echocardiograph

Synthesis, anticancer activity and molecular docking study of Schiff base complexes containing thiazole moiety

AbstractA Schiff base ligand 1 was prepared from condensation of salicyaldehyde with 2-amino-4-phenyl-5-methyl thiazole. The ligand forms complexes with CoII, NiII, CuII, and ZnII in good yield. The synthesized compounds were characterized by elemental analysis, magnetic susceptibility, molar conductance, infrared spectra, 1H and 13C NMR, mass, electronic absorption and ESR spectroscopy. The anticancer activity of the synthesized compounds was studied against different human tumor cell lines: breast cancer MCF-7, liver cancer HepG2, lung carcinoma A549 and colorectal cancer HCT116 in comparison with the activity of doxorubicin as a reference drug. The study showed that ZnII complex showed potent inhibition against human TRK in the four cell lines (HepG2, MCF7, A549, HCT116) by the ratio 80, 70, 61 and 64% respectively as compared to the inhibition in the untreated cells. Moreover, the molecular docking into TRK (PDB: 1t46) was done for the optimization of the aforementioned compounds as potential TRK inhibitors

Delving into the properties of nanostructured Mg ferrite and PEG composites: A comparative study on structure, electrical conductivity, and dielectric relaxation

Magnesium ferrite (MgFe2O4) and polyethylene glycol (PEG) are materials known for their versatility in various applications. This study presents a comprehensive comparative analysis of the electrical conductivity and dielectric relaxation of nanostructured MgFe2O4 and its composites with PEG. Through experimentation, it was observed that incorporating PEG into MgFe2O4 did not lead to a high relative observed decrease or increase in electrical conductivity at room temperature. The study revealed that the composites maintained stable electrical behavior at room temperature, with a dielectric constant value of around 9 and a loss tangent value of around 0.1 at high frequency (around 7 MHz). The electron-hole hopping mechanism was identified as the underlying cause for the strong dielectric dispersion with frequency. The low dielectric loss and conductivity of the MgFe2O4 and PEG/ferrite composites make them promising candidates for high-frequency switching applications and microelectronic devices, particularly in scenarios where negligible eddy currents are essential. Additionally, complex impedance data analysis demonstrated that the capacitive and resistive properties of the composites are primarily attributed to grain boundary processes. This study provides a comprehensive analysis of the electrical and dielectric properties of MgFe2O4 and PEG composites and highlights their potential for many applications in materials science, particularly in electrical and electronic devices

Structural, Magnetic, and AC Measurements of Nanoferrites/Graphene Composites

As a contribution to the graphene-based nanoferrite composites, this article is intended to present Mn, Co, and Co-Mn nanoferrites for the preparation and investigation of such samples. Nanoparticles of Co ferrite, Mn ferrite, and Co-Mn ferrite were chemically synthesized by the coprecipitation method. The composites of ferrite/graphene were made by incorporating weight ratios of 25% graphene to 75% ferrite. Various structural and characterizing investigations of ferrite samples and ferrite/graphene composites were performed, including XRD, EDX, SEM, VSM hysteresis loops, AC conductivity, and dielectric behavior. The investigations ensured the formation of the intended nanoferrite powders, each having a single-phase crystal structure with no undesired phases or elements. All samples exhibit a soft magnetic behavior. They show a semiconducting behavior of AC electrical conductivity as well. This was proved by the temperature dependence of the AC&rsquo;s electrical conductivity. Whereas the dielectric function and loss tangent show an expected, well-explained behavior, the ferrite/graphene composite samples have lower saturation magnetization values, lower AC conductivity, and dielectric constant values than the pure ferrites but still have the same behavior trends as those of the pure ferrites. The values obtained may represent steps on developing new materials for expected applications, such as manufacturing supercapacitors and/or improved battery electrodes

Investigation of AC-Measurements of Epoxy/Ferrite Composites

A pure ferrite and epoxy samples as well as the epoxy/ferrite composites with different 20 wt.%, 30 wt.%, 40 wt.%, and 50 wt.% weight ferrite contents have been prepared by the chemical co-precipitation method. AC-conductivity and dielectric properties such as the dielectric constant and dielectric loss of the prepared samples have been studied. The obtained results showed that the samples had a semiconductor behavior. The dielectric constant of the composites has been calculated theoretically using several models. For the composite sample that contains 20 wt.% of ferrites, these models give satisfactory compliance, while for the composite samples with a higher percentage of nanofillers, more than 30 wt.% theoretical results do not coincide with experimental data. The investigated polymer has very low conductivity, so this type of polymer can be useful for high-frequency applications, which can reduce the losses caused by eddy current. Thus, the prepared samples are promising materials for practical use as elements of microwave devices