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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Historical wind speed dataset of meteorological mast station in KhartoumFigshare

The data demonstration article presented here showcases three months of wind speed field records for Khartoum city from June to August 2017. These records were obtained from the SOBA-D161094 meteorological mast station, located within the premises of the National Energy Research Center of Sudan. Using the two-parameter Weibull distribution, the scale and shape parameters estimated by the method of moments for this dataset were 4.175 m/s and 2.099, respectively, with a coefficient of determination of 0.975, as provided in the associated literature. The accuracy of the data was verified using spatial wind speed information from the MERRA-2 database, compiled by a NASA observation satellite, with a root mean square error between the ground and remote sensing datasets found to be 0.385. Additionally, the Kolmogorov-Smirnov test suggests that the two samples are drawn from the same population and statistical distribution. Based on the Weibull density function, the mean power transported by wind and the maximum mean power that can be extracted by the turbine were 103.45 W and 61.3 W, respectively. The primary objective of this work is to provide the data in a format that enables its use as a benchmark or for reuse in various research endeavors. Special emphasis is placed on facilitating studies related to the parameter estimation of wind speed statistical distribution models. This approach is akin to the utilization of the RTC France solar cell dataset, which is commonly employed for parameter extraction in equivalent circuit models. The added value of this data lies in its potential to provide information that could reveal unrecognized opportunities for the domestic generation of wind power

Bacillus cereus in Raw Milk and its Virulence Genes

A frequent source of milk contamination is Bacillus cereus. The microorganism can contaminate raw milk at the time of milking since it is ubiquitous in the environment. In the current study, one hundred raw milk samples were obtained from farmers, supermarkets, street vendors and dairy shops in Egypt, collected samples were examined biochemically and by vietk 2 compact system to isolate Bacillus cereus. Prevalence values of B. cereus were 0, 20,8 and 12% respectively.  The Mean ± SE of the pH values for milk samples were 6.54 ± 0.04, 6.48 ± 0.06, 6.44 ± 0.05 and 6.53 ± 0.06 respectively, on the other hand sorch’s test for milk samples was positive in a percentage of 12, 8, 40 and, 16, respectively. Molecular characterization of hlbA and ces showed positive reaction for 30 and 20% of samples. Growth, proteolytic and lipolytic activities of Bacillus cereus was 100, 100, 20 and 40, 40, 20 at 30◦C/48 h and 7°C/10 days, respectively. Outcomes of the in vitro testing for susceptibility indicated that the highest resistance to antibiotics was against macrolides and mono, B-lactamase, whereas moderate resistance was exhibited to gentamicin. The current study's findings exhibited evidence of B. cereus isolation from raw milk has a high potential for producing food poisoning, so it is necessary to employ the techniques to lessen bacterial contamination while processing dairy products

Wind Speed Forecast for Sudan Using the Two-Parameter Weibull Distribution: The Case of Khartoum City

In this quick study, we estimated the Weibull distribution’s parameters using wind data collected between March 2017 and January 2018 using a twelve-meter mast meteorological station on the grounds of the National Energy Research Center in Khartoum. In order to quantify these descriptors, we relied on analytical and stochastic methods, subsequently enabling specialists from researchers, engineers, decision-makers, and policymakers to apprehend the wind characteristics in the vicinity. Hence, the computed scale and shape parameters were provided, in which the Firefly algorithm (FA) resulted in the most accuracy in terms of the coefficient of determination, which equaled 0.999, which we considered logical due to the observed nonlinearity in the wind speed numbers. On the contrary, the energy pattern factor method had the worst prediction capability depending on several goodness-of-fit metrics. This concise work is unique because it is the first to use data from Sudan to forecast local wind speeds using artificial intelligence algorithms, particularly the FA technique, which is widely used in solar photovoltaic modeling. Additionally, since classic estimating approaches act differently spatially, evaluating their efficacy becomes innovative, which was accomplished here. On a similar note, a weighted-average wind speed was found to equal 4.98 m/s and the FA average wind speed was 3.73 m/s, while the rose diagram indicated that most winds with potential energy equivalent to 3 m/s or more blow from the north

Mesenchymal stem cell-based therapy for type 1 & 2 diabetes mellitus patients: a systematic review and meta-analysis of randomized controlled trials

Abstract Objective To systematically and statistically evaluate evidence from randomized controlled trials (RCTs) investigating the efficacy and safety of somatic stem cells in achieving glycemic control in type 1 and 2 diabetic patients. Methods Bibliographic databases including PubMed, Scopus, Web of Science, and Cochrane Library were searched from the time of their establishment till January 2024. Obtained records were meticulously screened by title, abstract, and full text to include only RCTs seeking mesenchymal stem cells (MSCs) treatment for type 1 diabetes mellitus (T1DM) and 2 diabetes mellitus (T2DM). Included studies underwent quality assessment using the Cochrane risk of bias 2 tool (ROB2). Results Thirteen studies were deemed eligible for meta-analysis, encompassing 507 patients (T1DM = 199, T2DM = 308). To measure treatment efficacy, the present meta-analysis was conducted on outcomes reported after 12 months following treatment. MSCs therapy group was associated with a significantly reduced glycosylated hemoglobin (HbA1c) compared to the control group, MD = -0.72; 95% CI: [-1.11 to -0.33], P = 0.0003, I2 = 56%. Daily insulin requirement was lower in the MSCs group versus placebo, MD = -14.50; 95% CI: [-19.45 to -9.55], P < 0.00001, I2 = 0%. Pooled fasting C-peptide levels were significantly higher in the MSCs group compared to placebo, MD = 0.24; 95% CI: [0.05 to 0.43], P = 0.01, I2 = 93%. Postprandial blood glucose (PPBG) was observed to be significantly lower in the MSCs arm in contrast to placebo, MD = -11.32; 95% CI: [-16.46 to -6.17], P < 0.0001, I2 = 17%. However, pooled analysis of fasting blood glucose (FBG) was not significantly different between both groups, MD = -6.22; 95% CI: [-24.23 to 11.79], P = 0.50, I2 = 81% at the end of the 12-month follow-up. Conclusion Mesenchymal stem cell-derived therapy is an efficacious glycemia-lowering modality agent compared to conventional therapy in T1DM and T2DM patients. Albeit more sizeable and longer RCTs are warranted to further support and standardize their clinical use

Structural Changes in Primary Teeth of Diabetic Children: Composition and Ultrastructure Analysis

Diabetes affects the developing enamel by altering the mineralization process, which can have a detrimental effect on oral health. The objectives of this study were to examine the ultrastructure and composition of surface enamel in primary teeth of diabetic children and its clinical implications. Hundred extracted primary teeth from diabetic children (Test group: n = 50) and healthy children (Control group: n = 50), between 6 and 12 years of age, were subjected to scanning electron microscopy to qualitatively examine the enamel surface. Energy dispersive X-ray (EDX) analysis was performed to investigate the mass percentage of calcium (Ca) and phosphorous (P) in the surface enamel. Ultrastructural aberrations of surface enamel were observed in the test group teeth. Additionally, prism perforations were seen at the junction of rod and inter-rod enamel and the prisms were loosely packed. An even aprismatic layer of surface enamel was evident in the control group teeth. There was a statistically significant difference (p < 0.05) of Ca and P mass percentage between the test and control group teeth. The mean mass percentage rates of Ca and P were 33.75% and 16.76%, respectively. A poor surface characteristic and elemental composition of the enamel surface of primary teeth is observed in diabetic children. Therefore, appropriate caries preventive measures are mandatory to maintain the structural integrity of the tooth in these patients

Structural Changes in Primary Teeth of Diabetic Children: Composition and Ultrastructure Analysis

Diabetes affects the developing enamel by altering the mineralization process, which can have a detrimental effect on oral health. The objectives of this study were to examine the ultrastructure and composition of surface enamel in primary teeth of diabetic children and its clinical implications. Hundred extracted primary teeth from diabetic children (Test group: n = 50) and healthy children (Control group: n = 50), between 6 and 12 years of age, were subjected to scanning electron microscopy to qualitatively examine the enamel surface. Energy dispersive X-ray (EDX) analysis was performed to investigate the mass percentage of calcium (Ca) and phosphorous (P) in the surface enamel. Ultrastructural aberrations of surface enamel were observed in the test group teeth. Additionally, prism perforations were seen at the junction of rod and inter-rod enamel and the prisms were loosely packed. An even aprismatic layer of surface enamel was evident in the control group teeth. There was a statistically significant difference (p &lt; 0.05) of Ca and P mass percentage between the test and control group teeth. The mean mass percentage rates of Ca and P were 33.75% and 16.76%, respectively. A poor surface characteristic and elemental composition of the enamel surface of primary teeth is observed in diabetic children. Therefore, appropriate caries preventive measures are mandatory to maintain the structural integrity of the tooth in these patients.</jats:p