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

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

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

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

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit