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

Antibiotic Resistance and Biofilm Formation in <i>Enterococcus</i> spp. Isolated from Urinary Tract Infections

Background: A urinary tract infection (UTI) resulting from multidrug-resistant (MDR) enterococci is a common disease with few therapeutic options. About 15% of urinary tract infections are caused by biofilm-producing Enterococcus spp. Therefore, the objective of this study was to identify the MDR enterococci associated with UTIs and assess their potential to produce biofilms. Methods: Thirty Enterococcus isolates were obtained from urine samples collected from UTI patients at King Abdulaziz Specialist Hospital in Taif, Saudi Arabia. The antimicrobial resistance profiles of the isolates were evaluated using disk diffusion techniques against 15 antimicrobial agents. Two techniques, Congo red agar (CRA) and a microtiter plate (MTP), were used to assess the potential of the isolates to produce biofilms. The enterococcal isolates were screened for biofilm-related genes, esp; ebpA; and ebpB, using the PCR method. Results: The molecular identification of the collected bacteria revealed the presence of 73.3% Enterococcus faecalis and 26.6% Enterococcus faecium. The antibiotic susceptibility test revealed that all the tested Enterococcus spp. were resistant to all antimicrobials except for linezolid and tigecycline. Additionally, by employing the CRA and MTP techniques, 76.6% and 100% of the Enterococcus isolates were able to generate biofilms, respectively. In terms of the association between the antibiotic resistance and biofilm’s formation, it was observed that isolates capable of creating strong biofilms were extremely resistant to most of the antibiotics tested. The obtained data showed that all the tested isolates had biofilm-encoding genes. Conclusions: Our research revealed that the biofilm-producing enterococci bacteria that causes urinary tract infections were resistant to antibiotics. Therefore, it is necessary to seek other pharmacological treatments if antibiotic medicine fails

APPLICATION OF THE OVERLAY WEIGHTED MODEL AND BOOLEAN LOGIC TO DETERMINE THE BEST LOCATIONS FOR ARTIFICIAL RECHARGE OF GROUNDWATER

With population increase, lack of conventional fresh water resources and uncertainties due to climate change, there is growing interest in the arid and semi-arid areas to increase groundwater recharge with recycled water. Finding the best locations for artificial recharge of groundwater in such areas is one of the most crucial design steps to guarantee the long life and the sustainability of these projects. This study presents two ways to go about performing analysis; creating a suitability map to find out the suitability of every location on the map and another way is querying the created data sets to obtain a Boolean result of true or false map. These techniques have been applied on Sadat Industrial City which is located in a semi arid area in the western desert fringes of The Nile delta in the north west of Egypt. Thematic layers for number of parameters were prepared from some maps and satellite images and they have been classified, weighted and integrated in ArcGIS environment. By the means of the overlay weighted model in ArcGIS a suitability map which is classified into number of priority zones was obtained and it could be compared with the obtained true-false map of Boolean logic. Both methods suggested mostly the northern parts of the city for groundwater recharge; however the weighted model could give more accurate suitability map while Boolean logic suggested wider ranges of areas. This study recommends Boolean logic as a first estimator for locating the best locations as it is easier and not time consuming, while the overlay weighted model for more accurate results

Staphylococcus aureus and Salted Fish: Prevalence, Antibiogram, and Detection of Enterotoxin-coding Genes

This study was taken to investigate the prevalence of Staphylococcus aureus (S. aureus) in four types of salted fish, namely salted sardine, fesiekh, sahlia, and salted herrings that retailed in Zagazig city, Egypt. The antimicrobial susceptibility testing of the recovered S. aureus isolates was examined. Moreover, PCR was used for the detection of the coding genes of S. aureus-enterotoxins (SE) including SEA, SEB, SEC, and SED. The obtained results of the current investigation revealed isolation of S. aureus from the examined salted sardine, fesiekh, sahlia, and salted herrings at 15%, 40%, 30%, and 15%, respectively. Fesiekh had significantly (p&lt; 0.05) the highest total S. aureus count (3.17 ± 0.13 log 10 cfu/g), followed by sahlia (3.08 ± 0.13 log 10 cfu/g), sardine (2.33 ± 0.07 log 10 cfu/mL), and salted herrings (2.30 ± 0.11 log 10 cfu/g), respectively. Besides, 10%, 35%, 20%, and 5% of the examined salted sardine, fesiekh, sahlia, and salted herrings, respectively exceeded Egyptian limits of S. aureus. The recovered S. aureus isolates showed clear multidrug resistance profiling. PCR testing of selected S. aureus isolates for harboring Staphylococcal enterotoxin-coding genes revealed SEA, and SEB were not detected in any examined isolate. However, SEC was detected in 3 S. aureus isolates recovered from fesiekh, and in 2 isolates that recovered from sahlia. SED was only detected in 2 isolates that recovered from fesiekh. Therefore, strict hygienic measures should be adopted during handling, and processing of salted fish

Protective role of humoral immune responses during an outbreak of hepatitis E in Egypt

Although the seroprevalence of hepatitis E virus (HEV) is approximately 80% in adult Egyp- tians living in rural areas, symptomatic HEV-caused acute viral hepatitis (AVH) is sporadic and relatively uncommon. To investigate the dichotomy between HEV infection and clini- cal AVH, HEV-specific immune responses in patients with symptomatic and asymptomatic HEV infection during a waterborne outbreak in Egypt were examined. Of 235 acute hepati- tis patients in Assiut hospitals screened for HEV infection, 42 (17.9%) were hepatitis acute hepatitis patients confirmed as HEV-caused AVH; 37 (88%) of the 42 patients were residents of rural areas, and 14 (33%) were from one village (Kom El-Mansoura). Another 200 AVH contacts of AVH cases in this village were screened for HEV and 14 (7.0%), all of whom were family members of AVH cases, were asymptomatic HEV IgM-positive. HEV infections in this village peaked during the summer. Asymptomatic HEV seroconverters had significantly higher levels of epitope-specific neutralising (p=0.006) and high avidity (p=0.04) anti-HEV antibodies than the corresponding AVH cases. In conclusion, naturally acquired humoral immune responses appear to protect HEV-exposed subjects from AVH during an HEV outbreak in Egypt

Strong Hepatitis C Virus (HCV)–specific Cell-mediated Immune Responses in the Absence of Viremia or Antibodies Among Uninfected Siblings of HCV Chronically Infected Children

Background. Cell-mediated immune (CMI) responses to hepatitis C virus (HCV) antigens in adults without seroconversion or viremia are biomarkers for prior transient infection. We investigated HCV-specific CMI responses in seronegative children living with HCV-infected siblings