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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Estimation of Genetic Diversity among Thirty Bread Wheat Varieties by RAPD Analysis

Abstract: RAPD markers were used to fingerprint thirty hexaploid wheat varieties (Triticum aestivum L.) from different genetic background. A total of 76 DNA fragments were amplified, using five primers, ranging in size from 1884 to 200 base pairs. Out of the 76 amplified products, 19.7% were monomorphic and 80.3% were polymorphic, averaging 12.2 polymorphisms per primer. The number of DNA fragments for each primer varied from 9 (OP-B14) to 20 (OP-C15) with an average of 15.2 fragments per primer. One specific marker out of 11 amplified fragments was detected for primer OP-B11 and two specific markers out of 9 amplified fargments were detected for primer OP-B14. The genetic similarity between varieties ranged from 32 to 97%, with an average of 64.5%. The large genetic diversity may be due to the different areas from which the genotypes were collected. Some distinctive varieties showed high genetic similarity with other varieties, such as Sids1 and Sids 8 (97%), Sids 7 and Icarda 46 (96%), Icarda1 and Gimeza 9 (95% ). On the contrary, some varieties displayed low genetic similarity such as Giza164 and Sakha 60 (32%). The similarity values showed clearly substantial differences among the wheat varieties. The dendrogram resulting from the UPGMA cluster analysis showed that the studied varieties could be divided into two main clusters from the same node. The first cluster contained ten varieties four of them are Egyptian, while the second cluster contained 19 varieties including 13 Egyptian. The dendrogram clustered the genotypes into ten groups and showed efficiency in identifying genetic variability. The results indicated that RAPD analysis is useful as molecular genetic marker for estimating the genetic diversity between wheat varieties

Effects of Orlistat and herbal mixture extract on brain, testes functions and oxidative stress biomarkers in a rat model of high fat diet

This study was designed to assess the effectiveness of herbal mixture extracts of pumpkin seed oil, peanuts shell and Orlistat on brain, testes functions, oxidative stress biomarkers and histopathological changes in male albino rats administered high fat diet. Fifty male rats were divided into four groups: 1st administered normal diet, 2nd administered high fat diet, 3rd administered high fat diet with Orlistat and 4th administered high fat diet with herbal mix. A group of rats were fed with a standard control diet (1st control group was 12 rats for 22 weeks) and another group of rats were fed a diet containing 35% fat (2nd high fat diet) for 16 weeks. Then, this group of high fat diet was divided into 3 groups for the following 6 weeks: 1st group administered high fat diet only (13 rats), 2nd group administered high fat diet plus 2 mg/kg bw/day Orlistat (12 rats) and 3rd group administered high fat diet plus 5 mg/kg bw/day pumpkins and 2 mg/kg bw/day peanut shell extract (13 rats). Blood samples, brain and testes tissues were collected for biochemical assays and histopathological studies. High fat diet group showed a high significant increase (P < .001) in feed intake, body weight and body mass index. HFD showed a significant increasing in Nor Epinephrine, Dopamine, BCHE, Homocysteine and malondialdehyde contents in brain. In testes high fat diet increased malonaldehyde contents of testes. An improvement by the treatments with Orlistat and herbal mixture was observed. Histopathological examination of brain and testes sections of high fat diet rats supported the previous biochemical results. We concluded that the treatment with Orlistat and herbal mixture ameliorated the harmful effects of the high fat diet and reduce feed intake

© 2007, INSInet Publication Identification and Prediction of the Flour Quality of Bread Wheat by Gliadin Electrophoresis

Abstract: Gliadin proteins were used to identify and characterize 30 wheat varieties. SDS-PAGE of gliadins revealed a total of 30 bands ranged from 74.5 to 6.5 kDa, where the number of total bands varied between varieties. The region of omega-gliadin had a wide range for a number of bands. Among gliadin protein bands, nine bands were monomorphic and 21 bands were polymorphic, which were used to characterize the wheat varieties. The similarity index and dendrogram demonstrated the genetic relationships among wheat varieties using the gliadin protein bands resulted from SDS-PAGE analysis. In the studied Egyptian wheat varieties, the gliadin band of ã-45 related to high gluten quality, while the ù-38 band related to moderate gluten quality. However, it was found that ã-42 band related to low gluten quality. The concentration of each gliadin protein subgroup was varied among the wheat varieties and some of gliadin subgroups were related partially to gluten quality in some varieties. The obtained results indicate that gliadin proteins analysis is useful as biochemical genetic markers for characterizing the wheat varieties and detecting flour quality

Ubiquinol attenuates γ-radiation induced coronary and aortic changes via PDGF/p38 MAPK/ICAM-1 related pathway

Abstract Endothelial vascular injury is one of the most pivotal disorders emerging during radiotherapy. It is crucial to rely on strong antioxidants to defend against vascular damage. The current study was carried out to investigate the ameliorative effect of ubiquinol (Ubq) against gamma (γ)-radiation induced aortic and coronary changes, with highlighting its role in suppression of p38 mitogen activated protein kinase (MAPK). Exposure to γ-radiation was adopted as a potent detrimental model that induces vascular tissue damage. Concisely, male albino rats were irradiated at a dose level of 7 Gy and treated daily with Ubq (10 mg/kg/day, p.o.) for 7 days pre-and post-irradiation. At the end of the experiment, lipid profile, 8-hydroxydeoxyguanosine (8-OHdG), gene expression of intercellular adhesion molecule (ICAM-1), platelet derived growth factor (PDGF), p38 MAPK and matrix metalloproteinase-9 (MMP-9) were estimated. Exposure to radiation significantly deteriorates aortic and coronary tissues. Conversely, administration of Ubq significantly reduced serum t-cholesterol, LDL and triglycerides (p = 0.001). In addition, Ubq prevented oxidative DNA damage (8-OHdG) (p = 0.1) and reduced serum MMP-9 (p = 0.001) which contributed to the endothelial cells damage. The positive impact of Ubq was more apparent in suppression of both PDGF (p = 0.001) and p38 MAPK (p = 0.1) protein concentrations, leading subsequently in reduction of ICAM-1 (p = 0.001) gene expression. As a conclusion, vascular endothelial damage brought on by γ-radiation is one of the leading causes of coronary and aortic deteriorations which could be successfully mitigated by Ubq

Exploring the antimicrobial, antiviral, antioxidant, and antitumor potentials of marine Streptomyces tunisiensis W4MT573222 pigment isolated from Abu-Qir sediments, Egypt

Abstract Due to the therapeutic importance of microbial pigments, these pigments are receiving the attention of researchers. In this present study 60 isolates were isolated from sediments of Abu-Qir coast of the Mediterranean sea, Alexandria, Egypt, out of which 12 were considered as pigmented actinomycetes. Streptomyces sp. W4 was characterized by small round green pigmented colonies when grown on starch-casein agar medium. The green pigment was extracted using a mixture of acetone-methanol (7:3 v/v). The antimicrobial, antioxidant, antiviral, and anticancer activities of the green pigment produced by Streptomyces sp.W4 were investigated. The pigment was characterized using FTIR, Raman spectroscopy, EDX and GC–MS. The results revealed that the pigment has antibacterial and antifungal activity and also showed inhibition of HAV 78% but its antiviral activity against the Adenovirus was weak. The results proved the safety of the pigment toward normal cells and anticancer activity against three different cancer cell lines HepG-2 (liver cancer cell line), A549 (lung cancer cell line), and PAN1 (pancreas cancer cell line). The pigment was combined with 9 antibiotics and then tested against the Gram-negative bacterium Enterococcus faecalis using disc diffusion bioassay. LEV showed an antagonistic effect, while CXM and CIP showed a synergistic effect