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

Natural Radioactivity Assessment and Radiation Hazards of Pegmatite as a Building Material, Hafafit Area, Southeastern Desert, Egypt

Sixty-seven sites of Hafafit pegmatite from the Southeastern Desert of Egypt were investigated radiometrically in the field using an in situ γ-ray spectrometer to determine eU, eTh, and K contents. The obtained results ranged from 0.4 to 6 ppm for eU with a mean value of 2.5 ppm, from 0.2 to 32 ppm for eTh with a mean value of 6.7 ppm, and from 0.7% to 5.4% for K with a mean value of 3.3%. Consequently, the radiological effects from these rocks were estimates by determination of the environmental parameters: gamma activity concentration index Iγ, external hazard index Hex, internal hazard index Hin, external absorbed dose rates in outdoor, and external absorbed dose rates in indoor air. The results obtained in this study showed that values U, Th, and K lie in the range of the acceptable world values. In addition, the calculated radiation hazard parameters (Iγ, Hex, and Hin) have values lower than the world values, while the calculated external absorbed dose rates (Dair) have values higher than the world and Egyptian permissible levels

Growth performance, liver and kidney functions, blood hormonal profile, and economic efficiency of broilers fed different levels of threonine supplementation during feed restriction

ABSTRACT: The objective of the existing investigation was to determine the effect of dietary inclusion of threonine amino acid at different levels during feed restriction on growth indices, liver and kidney function parameters, and some hormonal profiles along with economic indicators in broiler chickens. A total of 1,600 from 2 different breeds (800 Ross 308 and 800 Indian River) at 21-day-old age were incorporated. Chicks were randomly assigned into 2 main groups, control and feed-restricted (8 h/d), during the fourth week of age. Each main group was subdivided into 4 groups. The first group was fed a basal diet without adding extra threonine (100%), the second, third, and fourth groups were fed a basal diet with extra threonine levels of 110, 120, and 130%, respectively. Each subgroup consisted of 10 replicates of 10 birds. We noticed that the dietary inclusion of threonine at extra levels in the basal diets significantly enhanced final body weight, body weight gain, and better feed conversion ratio. This was mainly due to the enhanced levels of growth hormone (GH), insulin-like growth factor (IGF1), triiodothyronine (T3), and thyroxine (T4). Moreover, the lowest feed cost per kilogram body weight gain and improved return parameters were reported in control and feed-restricted birds fed higher levels of threonine than other groups. Also, a significant increase in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and urea levels was observed in feed-restricted birds supplemented with 120 and 130% levels of threonine. Hence, we recommend supplementing threonine at levels of 120 and 130% in the diet of broilers to promote growth and profitability

Clinical and Histochemical Response to Automated Microneedling Therapy in Treatment of Traumatic Scars

Background: Post traumatic skin injuries are challenging to manage. Patients may have erythematous, hypertrophic, or atrophic scars. Microneedling therapy is minimally invasive non-surgical and non-ablative procedure used for skin rejuvenation that relies on the principle of neocollagenesis. Aim: We aimed to assess the clinical and histochemical response to automated microneedling therapy in treatment of traumatic scars. Methods: This prospective study included twenty patients with traumatic scars. All patients received 4 monthly sessions of automated microneedling therapy. Outcome assessment included modified Vancouver Scar Scale, digital photographic documentation and patient's satisfaction. Histochemical evaluation by quantitative morphometric assessment for collagen and elastic fibers using image analyzer performed before and 3 months after treatment for Masson's trichrome and Orcein stained sections respectively.  Results: There was statistically significant improvement in scar vascularity (p= 0.018), scar pigmentation (p= 0.008), and scar pliability (p= 0.002) and sum of mVSS (P=0.000002). Histochemically, there was significant increase in collagen content, (p= 0.023), and elastin content (p= 0.003) as quantified by image analyzer. There was no significant correlations (r: 0.158 and -0.259; p-values: 0.55 and 0.34) between micro-needling therapy and scar type (atrophic versus hypertrophic)

Utilization of Jamun Fruit (Syzygium cumini L.) for Value Added Food Products

The goal of this study is to draw attention to the vital nutrients, health advantages, and potential for encouraging the consumption of jamun fruits (Syzygium cumini L.) and making the most of their useful features to create valuable goods. In the current study, efforts have been made to evaluate the jamun fruit’s physicochemical characteristics and bioactive components. Moreover, ready-to-serve beverages, squash, syrup, and jam, have been prepared, and their quality has been monitored throughout the storage. Jamun fruit had an ovoid or spherical form and was a dark purple tint. The initial analysis of fruits showed 83.59% moisture, 17.56 °Brix, 3.63 pH, 328.50 mg cyd-3-Glu/100 g anthocyanin, 219.21 mg GAE/100 g total phenolics, 91.33 mg QE/100 g total flavonoids, and 91.33% antioxidant activity. High-performance liquid chromatography examination, revealed the existence of three main anthocyanin pigments, delphinidin 3, 5-diglucoside, petunidin 3, 5-diglucoside, and malvidin 3, 5-diglucoside, which were measured at 175.80, 156.50, and 83.12 mg/100 g, respectively. While the main phenolic compounds present were chlorogenic, gallic, caffeic, vanillic, and catechin, with respective concentrations of 14.22, 12.18, 10.33, 6.44, and 4.13 mg/100 g. Total soluble solids, pH, and total sugars increased with the storage of jamun products, but acidity, total phenolic, and anthocyanin contents declined. In conclusion, jamun is a fruit that has promise for the future of producing useful goods. The various jamun fruit-based products met good standards and were sensory-acceptable