3 research outputs found
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
Ameliorative Effects of Selenium and Chlorella vulgaris Against Polystyrene Nanoplastics-induced Hepatotoxicity in African Catfish (Clarias gariepinus)
Polystyrene nanoplastics pollution is a global issue that has grabbed the attention of scientists and drew widespread attention owing to the possible health risks it poses. The objective of this research was to investigate the hepatotoxic effects of polystyrene nanoplastics (PS NPs) in catfish (Clarias gariepinus) from the histopathological, biochemical, and ultrastructural profiles. Six groups of fish were used (n= 24/group): the first group kept as control, the second group exposed to 5mg/L NPs, the third group exposed to NPs+selenium (1mg/kg diet), the fourth group exposed to NPs+Chlorella (25g/kg diet), the fifth group received only Chlorella and the sixth group received only selenium. The exposure was for 30 days. The biochemical tests showed a rise in ALT and AST activities after exposure to NPs compared to control group. Groups exposed to NPs and supplemented with chlorella and selenium showed a significant decrease in the serum activities of these enzymes compared to NPs-intoxicated group. Results of histopathological examination demonstrated the hepatotoxic effects of NPs in NPs-intoxicated group that consisted of micro and macrovesciular steatosis, coagulative necrosis, pericentral fibrosis, periportal fibrosis, glycogen depletion and toxic changes in cellular ultrastructure. Chlorella and selenium supplementation alleviated the hepatotoxic effects of NPs and restored the histological and ultrastructural appearances of the liver tissue. Therefore, nanoplastics toxicity has well-defined hepatotoxic effects and these cytotoxic changes were mitigated by dietary supplementation of Chlorella and selenium
Impact of <i>Chlorella vulgaris</i> Bioremediation and Selenium on Genotoxicity, Nephrotoxicity and Oxidative/Antioxidant Imbalance Induced by Polystyrene Nanoplastics in African Catfish (<i>Clarias gariepinus</i>)
Contamination of the environment with nano- and microplastic particles exerts a threatening impact on the aquatic ecosystems and sustainable catfish aquaculture. The presence of nanoplastics has been found to have a detrimental impact on both aquatic and terrestrial ecosystems. The present study examines the effect of polystyrene nanoplastics (PS NPs) on the DNA, erythrocytes, oxidative status and renal histology of catfish, in addition to the potential protective effects of Chlorella vulgaris bioremediation and selenium to hinder this effect. Six equal groups of fish were used as follows: Group 1 served as a control group and received water free from PS NPs; Group 2 was exposed to PS NPs at a concentration of 5 mg/L; Group 3 was exposed to PS NPs (5 mg/L) + selenium (1 mg/kg diet); Group 4 was exposed to PS NPs (5 mg/L) + C. vulgaris (25 g/kg diet); Group 5 was supplemented with C. vulgaris (25 g/kg diet); and Group 6 was supplemented with selenium (1 mg/kg diet). The exposure period was 30 days. The results indicated that PS NPs induced oxidative stress by significantly elevating malondialdehyde activities and slightly reducing antioxidant biomarkers, resulting in DNA damage, increased frequency of micronuclei, erythrocyte alterations, and numerous histopathological alterations in kidney tissue. Selenium and C. vulgaris significantly ameliorated the oxidative/antioxidant status, reducing DNA damage, micronucleus frequency, erythrocyte alterations, and improving the morphology of kidney tissue. Nevertheless, further research is needed for a profound understanding of the mechanism behind the toxicity of nano-microplatics in aquatic systems