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

Using Rheumatoid Arthritis Disease Activity Index-5 questionnaire in the assessment of disease activity in patients with rheumatoid arthritis: correlation with quality of life, pain, and functional status

Objective The aim of our study was to assess the disease activity in patients with rheumatoid arthritis (RA) using Rheumatoid Arthritis Disease Activity Index-5 (RADAI‑5) questionnaire and to find its correlation with Disease Activity Score-28 (DAS28), quality of life, pain, and functional status. Patients and methods A total of 40 patients with RA were included. Quality of life was evaluated by Quality of Life–Rheumatoid Arthritis scale. The severity of pain was measured by 100-mm visual analog scale-pain. Health Assessment Questionnaire Disability Index was used to evaluate functional status. Disease activity was measured by using the DAS28 and RADAI-5. Results Mean RADAI-5 score was 4.2±1.7 (moderate disease activity). A total of seven (17.5%) patients were in remission, four (10%) patients had mild disease activity, 19 (47.5%) patients had moderate disease activity, and 10 (25%) patients had high disease activity. RADAI-5 was significantly correlated with DAS28, quality of life scale, pain scale, and functional status (r=0.9, P<0.001; r=0.9, P<0.001; r=0.4, P=0.02; and r=0.6, P<0.001, respectively). Moreover, RADAI-5 was found to be significantly correlated with morning stiffness duration, Ritchie articular index, tender 28-joint count, swollen 28-joint count, erythrocyte sedimentation rate, anticyclic citrullinated peptide, and rheumatoid factor positivity (r=0.3, P=0.03; r=0.8, P<0.001; r=0.9, P<0.001; r=0.7, P<0.001; r=0.6, P<0.001; r=0.6, P<0.001; and r=0.4, P=0.008, respectively). Conclusion RADAI-5 is a simple and low-cost self-report questionnaire that reflects patients’ perception of signs and symptoms. The correlations of RADAI-5 with DAS28, quality of life, pain, and functional status reflect its value in the assessment of disease activity in patients with RA

Usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome

Objective The aim of the study was to assess the usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome (CTS) and to determine the relationships of ultrasonographic measurements with the clinical severity and the electrophysiological grading scale. Patients and methods One hundred CTS diseased hands and 100 nondiseased hands were assessed clinically and by nerve conduction studies. We measured ultrasonographic cross-sectional area (CSA) of the median nerve at various levels of the carpal canal (inlet and outlet), flattening ratio (FR), palmar bowing of the flexor retinaculum, wrist/forearm ratio, as well as median nerve mobility and power doppler signals. Data from patients and controls were compared to determine the diagnostic relations and the grade of severity. Results Measures of CSA of the median nerve at the inlet and at the outlet, palmer bowing and inlet/forearm ratio in the CTS group were significantly higher than the control group (P<0.05); 50% of diseased hands showed restriction of mobility of the median nerve, while 31% had doppler signals. Positive correlations of ultrasonographic measurements with patient-oriented measures, clinical severity scale and electrophysiological grade were observed. Conclusion Ultrasonographic measurements of CSA at the inlet and flexor retinaculum have a relatively higher diagnostic accuracy than FR for CTS. The correlation between clinical scores, historical-objective-distribution scale, electrophysiological grade and ultrasonographic measurements reflects the usefulness of neuromuscular ultrasound in the diagnosis of idiopathic CTS

Role of ultrasound disease activity score in assessing inflammatory disease activity in rheumatoid arthritis patients

Aim of the work: To evaluate role of ultrasound disease activity score (DAS) in assessing joint inflammation in rheumatoid arthritis (RA), and its correlation with disease parameters. Patients and methods: Fifty RA were included. All patients were assessed for DAS-28, health assessment questionnaire disability index (HAQ-DI) and X-ray simple erosion narrowing score (SENS). Power Doppler (PD) and grey-scale (GS) US examination were done for all patients. PDUS score for synovitis in 22 joints and GS score for effusion/hypertrophy in 28 joints were included in US DAS calculation. Results: The mean age of the patients was 43.9 ± 10.8 years; 46 females and 4 males and the mean disease duration was 8.7 ± 6.1 years. The mean DAS28 was 5.04 ± 1.2 and HAQ-DI was 1.2 ± 0.7. The mean US DAS was 5.2 ± 1.3 (2.11–7.21). According to the US DAS, patients with high activity had significantly prolonged morning stiffness, higher swollen and tender joint counts, patient and physician global assessment, DAS-28, HAQ-DI, and SENS compared to those with moderate activity or low activity/remission. The mean US erosion count (USEC) was 8.9 ± 6.6 (0–18) and it was higher in patients with high disease activity (p = 0.04). A significant correlation was found between USDAS with DAS28 and HAQ-DI. US DAS showed moderate correlation (r = 0.5, p = 0.001), while USEC showed a strong correlation (r = 0.8, p < 0.001) with SENS. Conclusion: US DAS is a feasible scoring system for use in daily rheumatologic practice. US DAS may reflect disease activity and disability. The association between US DAS and USEC with radiologic scoring reflects their ability to detect structural joint damage

Use of the SS Scale, FIQR, and FIQ VASs for assessment of symptom severity in Egyptian fibromyalgia patients

Background Fibromyalgia (FM) is a complex syndrome associated with significant impairment in the quality of life and function. The ability to evaluate and measure the severity of FM is likely to provide several benefits. Objective This study aimed to assess symptom severity in Egyptian FM patients using the Symptom Severity Scale (SS Scale), Revised Fibromyalgia Impact Questionnaire (FIQR), and Fibromyalgia Impact Questionnaire Visual Analog Scales (FIQ VASs). Patients and methods Twenty-four female patients who fulfilled the ACR-2010 criteria of FM were included in the present study. The SS Scale, FIQR, and FIQ VASs were used to assess symptom severity of FM. Results The respective mean of the SS Scale, FIQR, and FIQ VASs were 7.3 ± 2.4, 52.9 ± 22.1, and 39.3 ± 14.2, and they were positively correlated with measure of pain distribution [widespread pain index (WPI)] in our patients. The SS Scale, WPI, FIQR, and FIQ VASs scores were positively correlated with many regional pain distribution sites (upper arm pain and jaw pain at most) and somatic pain symptoms (central nervous system symptoms, musculoskeletal symptoms, otological and hypersensitivity symptoms). The high scores of the SS Scale, FIQR, and FIQ VASs and their positive correlations with most of the regional pain sites and distribution and somatic symptoms indicate the severity of symptoms in the studied population. The FIQ VAS was the only significant independent determinant of FM severity (P < 0.001) in backward/stepwise multiple linear regression models. Conclusion The SS Scale of the ACR-2010 criteria, FIQR, and FIQ VASs were excellent methods for assessment of symptom severity in our Egyptian FM patients

Clinical diagnosis of distal diabetic polyneuropathy using neurological examination scores: correlation with nerve conduction studies

Aim The aim of this study was to diagnose diabetic sensorimotor polyneuropathy using neurological examination scores and to correlate the findings with nerve conduction studies (NCS). Patients and methods Thirty patients with type 2 diabetes were included in the study. Detection and grading of neuropathy were carried out based on the Diabetic Neuropathy Symptom (DNS) Score, modified Neuropathy Symptom Score (NSS), Diabetic Neuropathy Examination (DNE), and modified Neuropathy Disability Score (NDS). For the NCS, amplitudes, velocities, and latencies of seven nerves - that is, four motor (median, ulnar, tibial, and common peroneal) and three sensory (median, ulnar, and sural) nerves - were recorded. If the patient had two or more abnormal findings in any of these nerves, the patient was diagnosed as having peripheral sensorimotor neuropathy. Thereafter, the sensitivity, specificity, and diagnostic efficacy of each neurological score were recorded taking NCS as the gold standard. Results Diabetic sensorimotor polyneuropathy was diagnosed clinically and electrophysiologically in 17 patients (56.7%). However, there were nine cases (30%) of subclinical neuropathy. Neurological examination scores were significantly correlated with each other and with individual variables of NCS and the nerve conduction sum score. Taking the NCS as gold standard, DNS, modified NSS, DNE, and modified NDS had 65.4, 61.5, 30.8, and 61.5% sensitivity and 100, 75, 100, and 100% specificity, respectively. Their diagnostic efficacies were 70, 63.3, 40, and 66.7%, respectively. Conclusion Neurological examination scores can detect and grade neuropathy in the majority of cases. However, NCS was accurate for detection of diabetic sensorimotor polyneuropathy, especially for the subclinical neuropathies

Down-regulation of MSH3 and MSH6 genes in female breast cancer patients receiving taxane-based therapy

Abstract Background The DNA in each cell in our body is constantly in danger of becoming damaged. Most DNA damage gets repaired straight away via many different proteins encoded by DNA—repair genes. MSH3 and MSH6 are pivotal DNA repair genes maintaining human genome integrity. Dysregulated expression of such genes has its implications resulting in developing of adverse reactions in cancer breast patients receiving taxanes. Cancer chemotherapy with some of taxane class of agents are associated with significant neurotoxicity, arthralgias and myalgias that may offset the therapeutic benefits of taxane use. Our aim is to identify gene expression pattern of MSH3 and MSH6 DNA mismatch repair genes in female breast cancer patients who develop adverse reactions to taxane-based therapy. One hundred and five patients with histologically proven breast cancer who received paclitaxel (PTX) as a single agent or combination therapy have been enrolled along with a group of 50 females with benign breast lesions serving as controls.Gene expression studies of mismatch repair genes (MMR) genes; MSH3 and MSH6; have been performed by real-time PCR. Patients were divided into groups according to the determined type/grade of PTX-based toxicity and fold changes of both genes were estimated. Results In the present work both MMR genes showed significantly lower expression in all the studied patients compared to benign cases as a control group. Toxicity findings were encountered in 75.2% of the studied patient cohort. The most common observed type of toxicity was peripheral neuropathy (PN), 58.1% of the studied patients. Both MSH3 and MSH6 genes were significantly down-regulated in the presence of high grade PN toxicity ≥ 2 (p = 0.034 and 0.01); diarrhea toxicity (p = 0.02 and 0.008); dyspnea (p = 0.01 and 0.016) respectively and bone pain (p = 0.024 for MSH6 only). Conclusion Dysregulated expression of MMR GENES [MSH3and MSH6] can be implicated in paclitaxel—induced toxicity experienced by some cancer breast patients