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

Radioprotective Effect of Selenium and Gamma Rays on Cyclosporine-Immunosuppressed Wistar Rats

Introduction: Cyclosporine is known as an immunosuppressive drug. Selenium has antioxidant characteristics. This study investigated the synergistic effects of radiation therapy emitted from Gamma rays with the protective effect of selenium after suppressing the immune system of rats with cyclosporine. Methods: 60 adult male mice, randomly divided into 6 groups (5 experimental groups, and one control group). Experimental group number 1: technetium + cyclosporine; group number 2: iodine 131 + cyclosporine; group number 3: selenium + cyclosporine; group number 4: cyclosporine + technetium + selenium; group number 5: cyclosporine + iodine131 + selenium. Experimental groups 1 and 4 treated with 75 mCi Technetium in a volume of 0.5 ml through intraperitoneal injection. Experimental groups 1 and 5 treated with 0.5 ml iodine 131 (30 mCi). Experimental groups 3, 4 and 5 received 0.1 mg of selenium per kg of their body weight through gavage method. Control group also treated with 0.5 ml normal saline containing 50 mg cyclosporine per kilograms of their body weight to minimize statistical errors. Six hours after treatment with cyclosporine, about 1 ml of heart blood for determining the content of lymphocytes taken and every 6 hours the population of rats has been counted. Results: Percentage of lymphocytes and survival rate was significantly decreased in the experimental group 2. Survival rate of rats in the experimental groups 3, 1, and 4, significantly increased compared to the control group. Conclusion: Treatment with cyclosporine and iodine-131 has a meaningful synergistic effect in the reduction of lymphocyte percentage and also survival time. Selenium and low doses of Technetium has the ability to neutralize the synergistic effect of cyclosporine and iodine-131

المشكلات الادارية والقانونية والمالية في النظام الضريبي العراقي

تهدف هذه الدراسة الى بيان الهيكل الضريبي في العراق وإيراد كل نوع من أنواع الضرائب وكذلك التعرف على المشكلات الإدارية والقانونية والمالية التي يعاني منها هذا النظام، ومحاولة إيجاد الحلول لها. واعتمد البحث على المنهج الاستقرائي باستخدام الأسلوب التحليلي. وتوصلت الدراسة الى جملة من الاستنتاجات منها: تبين من خلال البحث صحة الفرضية التي تم اعتمادها وهي أن معالجة المشكلات التي يعاني منها النظام الضريبي سوف يساهم في زيادة حصيلة الضرائب، وان المشاكل التي يعاني منها لإدارة الضريبية  هي ضعف الثقة بين الإدارة والمكلف، ويعتمد الهيكل الضريبي في العراق وبنسبة كبيرة على الضرائب غير المباشرة، والاعتماد على التشريعات القديمة وغير المتجددة لا توافي الزيادات الحاصلة في النفقات، وان التهرب الضريبي بأنواعه المختلفة يترتب عليه اثارا اقتصادية واجتماعية ونفسية سلبية في المجتمع، كما وإن مساهمة الضرائب في تمويل الموازنة منخفضة في العراق، وذلك لان الدولة تعتمد بشكل رئيسي في تمويل النفقات على النفط وإيراداته.