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

Archaeological Exploration using Magnetic and GPR Methods at the First Court of Hatshepsut Temple in Luxor, Egypt

The Hatshepsut Temple at Luxor, southern Egypt was built as a garden for Amun, and the first court indeed had exotic trees and vegetations. The pathway to the temple was along a sphinx-lined causeway linking the valley to pylons, which are missing now. As an effort to outline remains of the vanished garden and missing pylons and any other possible archaeological structures at this first court site, an extensive integrated magnetic/ground-penetrating radar (GPR) geophysical survey was conducted. The magnetic survey covered the entire area of the first court (100 x 60 m), while the GPR survey covered only an area of 50 x 50 m. The acquired GPR data were processed and presented as 2-D depth sections providing a reasonable vertical/horizontal resolution for the upper 6 m of the investigated site. The acquired magnetic data was processed and presented as 2-D image. The integrated interpretation of the acquired GPR and magnetic data revealed some archaeological features including a rectangular depression which is presumably an ancient man-made pond in the garden of the temple, a rectangular feature that may be a foundation of the missing pylon of the temple, and a suite of aligned anomalies that could be the remnants of sphinx. Such findings reflect the archaeological potentiality of the surveyed site and outline the extension of the temple. Meanwhile, these results necessitate further geophysical investigation or archaeological excavation to be confirmed

Spectral, Molecular Modeling, and Biological Activity Studies on New Schiff’s Base of Acenaphthaquinone Transition Metal Complexes

The newly synthesized Schiff’s base derivative, N-allyl-2-(2-oxoacenaphthylen-1(2H)-ylidene)hydrazine-1-carbothioamide, has been characterized by different spectral techniques. Its reaction with Co(II), Ni(II), and Zn(II) acetate led to the formation of 1 : 1 (M:L) complexes. The IR and NMR spectral data revealed keto-thione form for the free ligand. On chelation with Co(II) and Ni(II), it behaved as mononegative and neutral tridentate via O, N1, and S donors, respectively, while it showed neutral bidentate mode via O and N1 atoms with Zn(II). The electronic spectra indicated that all the isolated complexes have an octahedral structure. The thermal gravimetric analyses confirmed the suggested formula and the presence of coordinated water molecules. The XRD pattern of the metal complexes showed that both Co(II) and Ni(II) have amorphous nature, while Zn(II) complex has monoclinic crystallinity with an average size of 9.10 nm. DFT modeling of the ligand and complexes supported the proposed structures. The calculated HOMO-LUMO energy gap, ΔEH-L, of the ligand complexes was 1.96–2.49 eV range where HAAT < Zn(II) < Ni(II) < Co(II). The antioxidant activity investigation showed that the ligand and Zn(II) complex have high activity than other complexes, 88.5 and 88.6%, respectively. Accordingly, the antitumor activity of isolated compounds was examined against the hepatocellular carcinoma cell line (HepG2), where both HAAT and Zn(II) complex exhibited very strong activity, IC50 6.45 ± 0.25 and 6.39 ± 0.18 μM, respectively

Synthesis, anticancer activity, and molecular docking of new pyrazolo[1,5-a]pyrimidine derivatives

The reaction of 3-aminopyrzoles with dimethylamino-acrylonitrile derivatives was utilized for the production of new functionalized pyrazolopyrimidine compounds 4a-c and 6a-c. The structures of the obtained pyrazolopyrimidines were characterized by the different spectroscopic measurements (IR, NMR, and mass analyses). The DFT quantum chemical calculations were applied to the determination of the HOMO-LUMO energies and Mulliken atomic charges. The investigated derivatives exhibited a low HOMO-LUMO energy gap, ranging from 2.70 to 2.34 eV, 4c and both 4b and 6b, respectively. Furthermore, the anticancer activities of the synthesized compounds have also been investigated against four cancer cells as well as normal cells (WI38). The investigated compounds demonstrated an impressive cytotoxic effect on MCF-7 and Hep-2 cells. On comparison with 5-fluorouracil, pyrazolopyrimidines 6a–c showed promising cytotoxic action against MCF-7 and Hep-2, with IC50 values of 18.31–26.51 and 24.15–27.16 μM, respectively. Molecular docking of the prepared pyrazolopyrimidines 4 and 6 with the crystal structure of the KDM5A protein, obtained from the PDB, revealed the types of the protein's binding sites

CSEM IMAGING OF THE NEAR SURFACE DYNAMICS AND ITS IMPACT FOR FOUNDATION STABILITY AT QUARTER 27, 15th OF MAY CITY, HELWAN, EGYPT

In the present work, we involve the Control Source Electromagnetic (CSEM) Technique to image the dynamic migration center of the near surface fractures, fissures, and cracks in a new dwelling area at 15th of May city close to Cairo. This area forms the center of the zonal weakness of the subsoil, which in turn, interact with the weight center of the construction leading to catastrophiccollapses.The control source electromagnetic technique has been developed recently to monitor the migration of the weakness center represented as the accumulative fissures and cracks in thenear surface. Three composite profiles of wide and planshet mesh data have been collected in 2008. This survey has been followed by performing two profiles in 2010; one of these profiles has been repeated to observe the situation changes, and the second profile has been measured between the other two profiles of2008. The last profile had been performed to study the mutual relation between the measurements of the two cycles. The objectives of the whole process are to validate the capability of the technique to pick the minor changes of the weakness center, consequently, study its relation to the weight center of the adjacent construction to produce a recommended procedure to minimizethe destruction resources at the site of investigation.The measured data has been interpreted and represented in graphs showing the distribution of the heterogeneity of the geoelectric parameters in the subsoil, furthermore, in a series of geoelectric cross section representing the applied frequencies used during the survey. The study concludes that (1) the center of the cracked zone is moving upward closer to the surface of the ground and heaver, (2) the water content is moving downward producing soil dryness at the shallow depths, and (3) the site became more stable in 2010 than 2008, however, the destruction resources remain warning with collapse events. Furthermore, the situation reflects the relation between the water content and the changes in the weakness center

A Novel Method for the Synthesis of Furo-imidazo[3.3.3]propellanes from Thiocarbonohydrazides

Novel furo-imidazo[3.3.3]propellanes are synthesized via reactions of thiocarbonohydrazides with (1,3-dioxo-2,3-dihydro-1H-inden-2-ylidene)propanedinitrile in tetrahydrofuran. A rationale for these conversions involving nucleophilic addition on the dicyanomethylene carbon atom is presented. The structures of these unexpected products are confirmed by using IR, NMR, mass spectrometry and single-crystal X-ray diffraction

Tetracyanoethylene as a mediator and building block in synthesis of 5-substituted amino-1,3,4-thiadiazolyl-1H-pyrazole derivatives

The conversion of thiocarbonohydrazides to 5-substituted amino-1,3,4-thiadiazolyl-1H-pyrazoles in one-step was achieved via the reaction with tetracyanoethylene (TCNE). In this conversion, TCNE is used as a mediator and/or a building block. The product was conclusively confirmed by spectroscopic data and single crystal X-ray structural analysis. (C) 2015 Elsevier Ltd. All rights reserved

Csem imaging of the near surface dynamics and its impact for foundation stability at quarter 27, 15th of may city, helwan, egypt

In the present work, we involve the Control Source Electromagnetic (CSEM) Technique to image the dynamic migration center of the near surface fractures, fissures, and cracks in a new dwelling area at 15th of May city close to Cairo. This area forms the center of the zonal weakness of the subsoil, which in turn, interact with the weight center of the construction leading to catastrophiccollapses.The control source electromagnetic technique has been developed recently to monitor the migration of the weakness center represented as the accumulative fissures and cracks in thenear surface. Three composite profiles of wide and planshet mesh data have been collected in 2008. This survey has been followed by performing two profiles in 2010; one of these profiles has been repeated to observe the situation changes, and the second profile has been measured between the other two profiles of2008. The last profile had been performed to study the mutual relation between the measurements of the two cycles. The objectives of the whole process are to validate the capability of the technique to pick the minor changes of the weakness center, consequently, study its relation to the weight center of the adjacent construction to produce a recommended procedure to minimizethe destruction resources at the site of investigation.The measured data has been interpreted and represented in graphs showing the distribution of the heterogeneity of the geoelectric parameters in the subsoil, furthermore, in a series of geoelectric cross section representing the applied frequencies used during the survey. The study concludes that (1) the center of the cracked zone is moving upward closer to the surface of the ground and heaver, (2) the water content is moving downward producing soil dryness at the shallow depths, and (3) the site became more stable in 2010 than 2008, however, the destruction resources remain warning with collapse events. Furthermore, the situation reflects the relation between the water content and the changes in the weakness center

Synthesis, biological activity and assembly of pH-responsive alkyl-substituted naphthalene-type hydrazonotriazole organogelators

Hydrazones have been a significant group of materials with diverse pharmacological and industrial applications, such as treatment of cardiovascular diseases, parasitic infections, and viral disorders, as well as cosmetic and food additives. In this context, we present the synthesis and characterization of novel hydrazonotriazole analogues with different hydrophobic alkoxy units. The synthesized alkyl-substituted naphthalene-type hydrazonotriazoles were able to act as pH-sensitive and thermoreversible organogelators. They were prepared by a straightforward aldol condensation of 2-naphthalaldehyde with different adducts of 1-(5-methyl-1-(4-alkoxyphenyl)-1H-1,2,3-triazol-4-yl)ethan-1-one at room temperature in ethanolic solution and in the presence of sodium hydroxide as a catalytic agent. The provided compounds were exposed to condensation reaction with (2,4-dinitrophenyl)hydrazine in a refluxing acid ethanolic solution. Different spectroscopic methods were utilized to analyze and prove the chemical structures of the naphthalene-type hydrazonotriazoles, inclusing FT-IR, elemental analysis, and NMR spectra. The photophysical properties of the prepared hydrazonotriazoles were reported. The alkyl-substituted naphthalene-type hydrazonotriazole gelators were able to gelate a variety of solvents, displaying a sol–gel reversible response to pH changes together with colorimetric change from yellow to purple. The optimal gelation was monitored for nonyl-substituted hydrazone in a variety of solvents, demonstrating thermal stability up to 58 °C, and critical gelator concentration (CGC) of ∼ 1–11 mM. Several analytical methods were used to inspect the morphological properties of the hydrazonotriazole-based organogelators, displaying self-assembled nanofibers (7–15 nm). Both cytotoxic and antimicrobial activity of the alkyloxy-containing naphthalene-type hydrazonotriazole gelators was investigated