Gut Microbiome Dysbiosis in Antibiotic-Treated COVID-19 Patients is Associated with Microbial Translocation and Bacteremia

Although microbial populations in the gut microbiome are associated with COVID-19 severity, a causal impact on patient health has not been established. Here we provide evidence that gut microbiome dysbiosis is associated with translocation of bacteria into the blood during COVID-19, causing life-threatening secondary infections. We first demonstrate SARS-CoV-2 infection induces gut microbiome dysbiosis in mice, which correlated with alterations to Paneth cells and goblet cells, and markers of barrier permeability. Samples collected from 96 COVID-19 patients at two different clinical sites also revealed substantial gut microbiome dysbiosis, including blooms of opportunistic pathogenic bacterial genera known to include antimicrobial-resistant species. Analysis of blood culture results testing for secondary microbial bloodstream infections with paired microbiome data indicates that bacteria may translocate from the gut into the systemic circulation of COVID-19 patients. These results are consistent with a direct role for gut microbiome dysbiosis in enabling dangerous secondary infections during COVID-19

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

Predicament of a Woman in Manju Kapur’s Home

Manju Kapur is an Indian novelist. She was born on 25th October 1948. She is an archetypal representative of the postcolonial women novelists. She was a professor of English Literature at her alma mater at Miranda House College, Delhi. But she is retired from there. She joined the growing number of Indian women novelists, who have contributed to the progression of Indian fiction i.e. Shashi Deshpande, Arundhati Roy, Kamla Das, Geetha Hariharan, Anita Nair, Shobha De. Her novels reflect the position of women in the patriarchal society and the problems of women for their longing struggle in establishing their identity as an autonomous being. Her works not only gives voice to the society’s effort to improve its women population but it is for every woman’s self–consciousness in order to improve the society. She has written five novels, Difficult Daughters (1998), A Married Woman (2002), Home (2006), The Immigrant (2008), and Custody (2011). Kapur’s most memorable female characters are Virmati, Astha, Nisha, Nina, Shagun and so many others. All of them strive to assert themselves. These characters give us a rare glimpse of modernized Indian women who are in their aggression may enter into a scandalous relationship with her married neighbor, the professor or develop lesbian relationship as Virmati does in Difficult Daughters and Astha in A Married Woman. But Nisha in Home is different from her predecessors.</jats:p

EMERGENCE OF WORKPLACE SPIRITUALITY AS AN OUTCOME OF CALLING WITH A MODERATING ROLE OF CAREER COMMITMENT AMONG MEDICAL PROFESSIONALS IN PAKISTAN

The study focused on the emergence of workplace spirituality as an outcome of calling, among medical professionals in Pakistan. Some of the main determinants of calling identified in this research were passion, occupational self-efficacy and work meaningfulness. The data was collected from a sample of 200 participants by using questionnaires. Results showed that calling was positively related with workplace spirituality and passion. On the other hand, calling was not found to be associated with occupational self-efficacy and work meaningfulness. Calling was found to be mediating the relationship of passion, occupational self-efficacy and work meaningfulness with workplace spirituality. However, career commitment was not found to be moderating the relationship of calling with workplace spirituality.</jats:p