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Liu S, Athar A, Quach D, Patanwala AE, Naylor JM, Stevens JA, Levy N, Knaggs RD, Lobo DN, Penm J. Risks and benefits of oral modified-release compared with oral immediate-release opioid use after surgery: a systematic review and meta-analysis. Anaesthesia 2023; 78:1225-1236. [PMID: 37415284 PMCID: PMC10952256 DOI: 10.1111/anae.16085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
Prescription of modified-release opioids for acute postoperative pain is widespread despite evidence to show their use may be associated with an increased risk of adverse effects. This systematic review and meta-analysis aimed to examine the available evidence on the safety and efficacy of modified-release, compared with immediate-release, oral opioids for postoperative pain in adults. We searched five electronic databases from 1 January 2003 to 1 January 2023. Published randomised clinical trials and observational studies on adults who underwent surgery which compared those who received oral modified-release opioids postoperatively with those receiving oral immediate-release opioids were included. Two reviewers independently extracted data on the primary outcomes of safety (incidence of adverse events) and efficacy (pain intensity, analgesic and opioid use, and physical function) and secondary outcomes (length of hospital stay, hospital readmission, psychological function, costs, and quality of life) up to 12 months postoperatively. Of the eight articles included, five were randomised clinical trials and three were observational studies. The overall quality of evidence was low. Modified-release opioid use was associated with a higher incidence of adverse events (n = 645, odds ratio (95%CI) 2.76 (1.52-5.04)) and worse pain (n = 550, standardised mean difference (95%CI) 0.2 (0.04-0.37)) compared with immediate-release opioid use following surgery. Our narrative synthesis concluded that modified-release opioids showed no superiority over immediate-release opioids for analgesic consumption, length of hospital stay, hospital readmissions or physical function after surgery. One study showed that modified-release opioid use is associated with higher rates of persistent postoperative opioid use compared with immediate-release opioid use. None of the included studies reported on psychological function, costs or quality of life.
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Affiliation(s)
- S. Liu
- Faculty of Medicine and HealthSchool of Pharmacy, University of SydneySydneyNSWAustralia
- Department of PharmacyPrince of Wales Hospital, RandwickSydneyNSWAustralia
| | - A. Athar
- Faculty of Medicine and Health, School of MedicineUniversity of Notre DameSydneyNSWAustralia
| | - D. Quach
- Faculty of Medical and Health Sciences, School of PharmacyUniversity of AucklandAucklandNew Zealand
| | - A. E. Patanwala
- Faculty of Medicine and Health, School of PharmacyUniversity of SydneySydneyNSWAustralia
- Department of PharmacyRoyal Prince Alfred HospitalCamperdownNSWAustralia
| | - J. M. Naylor
- Whitlam Orthopaedic Research Centre, Orthopaedic Department, Liverpool HospitalLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - J. A. Stevens
- School of Clinical Medicine, St VincentTable s Clinical CampusUniversity of New South WalesSydneyNSWAustralia
- University of Notre DameSydneyNSWAustralia
| | - N. Levy
- Department of Anaesthesia and Perioperative MedicineWest Suffolk HospitalBury St. EdmundsUK
| | - R. D. Knaggs
- School of PharmacyUniversity of Nottingham, and Primary Integrated Community ServicesNottinghamUK
| | - D. N. Lobo
- Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research CentreNottingham University Hospitals and University of Nottingham, Queen's Medical CentreNottinghamUK
- David Greenfield Metabolic Physiology Unit, MRC Versus Arthritis Centre for Musculoskeletal Ageing ResearchSchool of Life SciencesUniversity of Nottingham, Queen's Medical CentreNottinghamUK
| | - J. Penm
- Department of PharmacyPrince of Wales Hospital, RandwickSydneyNSWAustralia
- Faculty of Medicine and Health, School of PharmacyUniversity of SydneySydneyNSWAustralia
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Roobab U, Abida A, Chacha JS, Athar A, Madni GM, Ranjha MMAN, Rusu AV, Zeng XA, Aadil RM, Trif M. Applications of Innovative Non-Thermal Pulsed Electric Field Technology in Developing Safer and Healthier Fruit Juices. Molecules 2022; 27:molecules27134031. [PMID: 35807277 PMCID: PMC9268149 DOI: 10.3390/molecules27134031] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023] Open
Abstract
The deactivation of degrading and pectinolytic enzymes is crucial in the fruit juice industry. In commercial fruit juice production, a variety of approaches are applied to inactivate degradative enzymes. One of the most extensively utilized traditional procedures for improving the general acceptability of juice is thermal heat treatment. The utilization of a non-thermal pulsed electric field (PEF) as a promising technology for retaining the fresh-like qualities of juice by efficiently inactivating enzymes and bacteria will be discussed in this review. Induced structural alteration provides for energy savings, reduced raw material waste, and the development of new products. PEF alters the α-helix conformation and changes the active site of enzymes. Furthermore, PEF-treated juices restore enzymatic activity during storage due to either partial enzyme inactivation or the presence of PEF-resistant isozymes. The increase in activity sites caused by structural changes causes the enzymes to be hyperactivated. PEF pretreatments or their combination with other nonthermal techniques improve enzyme activation. For endogenous enzyme inactivation, a clean-label hurdle technology based on PEF and mild temperature could be utilized instead of harsh heat treatments. Furthermore, by substituting or combining conventional pasteurization with PEF technology for improved preservation of both fruit and vegetable juices, PEF technology has enormous economic potential. PEF treatment has advantages not only in terms of product quality but also in terms of manufacturing. Extending the shelf life simplifies production planning and broadens the product range significantly. Supermarkets can be served from the warehouse by increasing storage stability. As storage stability improves, set-up and cleaning durations decrease, and flexibility increases, with only minor product adjustments required throughout the manufacturing process.
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Affiliation(s)
- Ume Roobab
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510641, China; (U.R.); (J.S.C.)
- Overseas Expertise Introduction Center for Discipline Innovation of Food Nutrition and Human Health (111 Center), Guangzhou 510640, China
| | - Afeera Abida
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad 38000, Pakistan; (A.A.); (A.A.); (G.M.M.)
| | - James S. Chacha
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510641, China; (U.R.); (J.S.C.)
- Department of Food Science and Agroprocessing, School of Engineering and Technology, Sokoine University of Agriculture, Chuo Kikuu, Morogogoro P.O. Box 3006, Tanzania
| | - Aiman Athar
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad 38000, Pakistan; (A.A.); (A.A.); (G.M.M.)
| | - Ghulam Muhammad Madni
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad 38000, Pakistan; (A.A.); (A.A.); (G.M.M.)
| | | | - Alexandru Vasile Rusu
- Life Science Institute, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
- Faculty of Animal Science and Biotechnology, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania
- Correspondence: (A.V.R.); (X.-A.Z.); (R.M.A.)
| | - Xin-An Zeng
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510641, China; (U.R.); (J.S.C.)
- Overseas Expertise Introduction Center for Discipline Innovation of Food Nutrition and Human Health (111 Center), Guangzhou 510640, China
- Correspondence: (A.V.R.); (X.-A.Z.); (R.M.A.)
| | - Rana Muhammad Aadil
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad 38000, Pakistan; (A.A.); (A.A.); (G.M.M.)
- Correspondence: (A.V.R.); (X.-A.Z.); (R.M.A.)
| | - Monica Trif
- Department of Food Research, Centre for Innovative Process Engineering (Centiv) GmbH, 28857 Syke, Germany;
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Entis P, Athar A, Ballenger M, Bendeck MS, Birbari W, Brock G, Curiale MS, Estvander J, Fung DYC, Green K, Ingham SC, Jafary MM, Jagow JA, Kalinowski R, Kelley G, Lee YJ, Lerner I, Lin CCS, Mendenhall CK, Tomer J, Reyes D, Rivera G, Rudolph C, Ryu JH, Sado P, Snider J, Soto-Lopez L, Thakur RAH, Watson J, White SA, Wilkin E, Williams WD. Two-Day Hydrophobic Grid Membrane Filter Method for Yeast and Mold Enumeration in Foods Using YM-11 Agar: Collaborative Study. J AOAC Int 1996. [DOI: 10.1093/jaoac/79.5.1069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Twenty laboratories participated in a collaborative study to validate a 2-day hydrophobic grid membrane filter method using YM-11 agar for enumeration of yeast and mold in foods. Six naturally contaminated food products were included in the study: garlic powder, raw ground beef, walnuts, flour/meal, orange juice, and yogurt. The test method produced significantly higher results than the 5-day pour plate reference method for orange juice and significantly lower, though numerically similar, results for walnuts and yogurt. Differences between the test and reference methods were not significant for garlic powder, raw ground beef, or flour/meal. Repeatability and reproducibility were similar for both the test and reference methods in all cases. The hydrophobic grid membrane filter method for enumeration of yeast and mold in foods has been adopted by AOAC INTERNATIONAL.
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Affiliation(s)
- Phyllis Entis
- QA Life Sciences, Inc., 6645 Nancy Ridge Dr, San Diego, CA 92121
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Abstract
Three peaks of methyltransferase activity specific for MNNG alkylated DNA have been identified from extracts of chemically adapted M. luteus. They are designated as TI to TIII in order to their elution from a Sephadex G-75 column. The first one of these peaks has been purified to homogeneity. TI, is an inducible, unusually salt resistant, heat labile protein which corrects O6-methylguanine in alkylated DNA by the transfer of the O6-alkyl group to a cysteine amino acid in the TI protein. There is a stoichiometric relationship between the loss of O6-methylguanine from the DNA and the production of S-methylcysteine. Partially purified TII & TIII proteins show specificity for O4-alkylthymine and methyl phosphotriesters respectively. The mode of repair by the isolated methyltransferases is similar yet there is no competition for substrate specificity. The apparent molecular weights of TI, TII & TIII proteins are 31Kd, 22Kd, and 13Kd respectively.
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Affiliation(s)
- S Riazuddin
- Centre for Advanced Molecular Biology, University of the Punjab, Lahore, Pakistan
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Abstract
Five peaks of DNA glycosylase activity showing a preference for MNNG alkylated DNA have been identified from extracts of adapted M. luteus. They are numerically designated as GI to GV in order of their decreasing molecular weights. The first two of these peaks have been highly purified. GI, is a constitutive heat labile protein, 35% stimulated by the presence of 50 mM NaCl, acts exclusively on 3 MeA residues in alkylated DNA, 60-70% inhibited by the presence of 2 mM free 3MeA and has been designated as 3MeA DNA glycosylase enzyme. GII, which is an inducible protein, is heat stable, 28% inhibited by the presence of 50 mM NaCl, removes 3MeA, 3MeG, 7MeA & 7MeG with different efficiency, and has been designated as 3,7 methylpurine DNA glycosylase enzyme. The rate of release of 3 methylpurines is 30 times that of 7MeG. There is no activity of either enzyme on O2-MeC, O2-MeT, O4-MeT or O6-MeG. The apparent molecular weights of GI and GII proteins are 28 Kd and 22 Kd respectively.
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Riazuddin S, Athar A, Saffhill R. Chemical adaptation of M. luteus induces repair functions for O-alkylated DNA pyrimidines. Nucleic Acids Res 1985; 13:7153-66. [PMID: 4059055 PMCID: PMC322030 DOI: 10.1093/nar/13.19.7153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A partially purified extract prepared from adapted M. luteus cells contains repair functions for oxygen methylated pyrimidine residues present in alkylated DNA. The removal of O2-MeT is mediated by a DNA glycosylase enzyme whereas disappearance of O4-MeT is effected by a methyltransferase in a manner similar to the in situ repair of O6-MeG. O4-MeT methyltransferase enzyme is unusually heat resistant. Synthesis of these repair proteins, which are distinctly different from the previously known inducible 3-MeA DNA glycosylase and O6-MeG methyltransferase activities, forms a part of the adaptive response.
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