Association of peri-operative prescription of non-steroidal anti-inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims-based cohort study

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the mainstays of multimodal pain management. While effective for acute pain control, recent pre-clinical evidence has raised concerns regarding an association between NSAIDs and chronic pain and potential opioid use. Our objective was to explore the association between peri-operative use of prescription NSAIDs and the need for continued opioid prescriptions lasting 90-180 days in previously opioid-naïve patients undergoing total knee arthroplasty. A database of health claims in the USA was used to identify all opioid-naïve adult patients who underwent primary knee arthroplasty between January 2010 and October 2021. We evaluated the magnitude of association between peri-operative prescription NSAID claims and claims for opioids at 90 days postoperatively using multivariable logistic regression models. Secondary outcomes included: the magnitude of association between peri-operative NSAID prescription and claims for opioids at 180 days postoperatively; and identifying other potential factors associated with opioid claims at 90 days postoperatively. After risk adjustment using multivariable logistic regression models in the 789,736-patient cohort, the adjusted odds ratio (95%CI) for a continuous claim of opioids at 90 and 180 days postoperatively among patients with a peri-operative NSAID prescription within 30 days was 1.32 (1.30-1.35), p < 0.001; and 1.12 (1.10-1.15), p < 0.001, respectively. This estimate of effect remained robust at 90 days after accounting for known potential confounders, including pre-existing knee pain and acute postoperative pain severity. Similar analysis of other pain medications (e.g. paracetamol) did not detect such an association. This population-based cohort study suggests that peri-operative prescription NSAID use may be associated with continued opioid prescription claims at 90 and 180 days after knee arthroplasty, even after adjusting for other observed covariates for continuous opioid claims. These novel findings can inform clinical decision-making for post-surgical pain management, risk-benefit discussions with patients and future research.

Response of Rhizobacterial strains and organic amendments on chickpea growth

Plant Growth Promoting Rhizobacteria (PGPR) are beneficial bacteria that colonize plant roots and promote plant growth through a variety of mechanisms such as phosphate solubilization, phytohormones production, antifungal activity and also improve plant growth and yield. Field experiment was carried out to investigate the residual effect of organic amendments plus soil microbes along with integrated nutrient management. (PGPR) are important soil organism that promotes plant growth and yield root colonization is an example of a direct and indirect mechanism. The treatments included control, (inorganic fertilizer and no organic fertilization).Five bacterial strains were identified morphologically and biochemically screened from the rhizospheres of chickpea, lentil, barseem, mungbean, and sesame. The experiment was conducted at the Arid Zone Research Center in D.I.Khan (Pakistan). The majority of isolates resulted in significant increase in shoot length, root length, and dry matter production of Cicer arietinum seedlings' shoot and root. The experiment represented that isolates treated plots with rhizobium strain inoculation resulted in greater plant height (35.000 cm) and nodule count (38.00) No of pods per plant-1 (44.66) when compared to the control treatment, While (Mesorhizobium cicero) along with organic amendments showed significant response the greater root length (50 cm) was observed in T4 treatment. The Performance of rhizobial strains on chickpea germination in an arid environment was found to significantly increase crop germination percentage. This combination thus increases nitrogen and phosphorus uptake in inoculation treated plots. The study found that plots with inoculation treatments yielded significantly higher than non-treated plots Treatment with Mesorhizobium Cicero and compost resulted in a higher grain yield (8%) as compared to the control. The greater grain yield was observed in Treatment T4 (183.67).The result showed that use of PGPR have the potential to increase nutrient absorption from soil while improved growth of chickpea.

Stormwater runoff reduction benefits of distributed curbside infiltration devices in an urban catchment

Distributed infiltration systems can benefit downstream water bodies by reducing the runoff flowrate and volume discharges from the catchment. Investigating their runoff flowrate and volume reduction potential at the catchment scale will inform decision makers regarding their efficacy for managing catchment outflows. To this end, we conducted field investigations at the residential catchment scale for three years. The study monitored the catchment for one year before the installation of leaky well systems (preinstallation) and two years after installation (postinstallation). The hydrological model, calibrated to preinstallation catchment outflows, acted as a virtual control tool. Runoff flow outputs from the control model and two years of monitored runoff flow data from the postinstallation period were analysed using statistical methods. The statistical tests showed a significant 13% reduction in average flowrates in storms with a corresponding runoff flowrate of up to 50 L/s. The study further reported the ability of infiltration systems to reduce runoff volume in the catchment by 9%. This reduction was not significant, however, as per the results of the statistical analysis. We then fitted the generalized linear model (GLM) to the monitored and simulated runoff volume data. This enabled us to break down the effect of curbside infiltration systems on runoff volume according to corresponding peak flowrates during the storm. The results of the two-way ANOVA performed to detect significant differences in the regression slopes of the GLM indicated that curbside infiltration systems significantly reduced runoff volume for storms when the runoff flowrates remained below 100 L/s.

GPU based parallel framework for receiver coil sensitivity estimation in SENSE reconstruction

Magnetic Resonance Imaging (MRI) uses non-ionizing radiations and is safer as compared to CT and X-ray imaging. MRI is broadly used around the globe for medical diagnostics. One main limitation of MRI is its long data acquisition time. Parallel MRI (pMRI) was introduced in late 1990's to reduce the MRI data acquisition time. In pMRI, data is acquired by under-sampling the Phase Encoding (PE) steps which introduces aliasing artefacts in the MR images. SENSitivity Encoding (SENSE) is a pMRI based method that reconstructs fully sampled MR image from the acquired under-sampled data using the sensitivity information of receiver coils. In SENSE, precise estimation of the receiver coil sensitivity maps is vital to obtain good quality images. Eigen-value method (a recently proposed method in literature for the estimation of receiver coil sensitivity information) does not require a pre-scan image unlike other conventional methods of sensitivity estimation. However, Eigen-value method is computationally intensive and takes a significant amount of time to estimate the receiver coil sensitivity maps. This work proposes a parallel framework for Eigen-value method of receiver coil sensitivity estimation that exploits its inherent parallelism using Graphics Processing Units (GPUs). We evaluated the performance of the proposed algorithm on in-vivo and simulated MRI datasets (i.e. human head and simulated phantom datasets) with Peak Signal-to-Noise Ratio (PSNR) and Artefact Power (AP) as evaluation metrics. The results show that the proposed GPU implementation reduces the execution time of Eigen-value method of receiver coil sensitivity estimation (providing up to 30 times speed up in our experiments) without degrading the quality of the reconstructed image.

Reasons for failure to quit: a cross-sectional survey of tobacco use in major cities in Pakistan

BACKGROUND

Tobacco dependence has been defined as a chronic relapsing disease. Around 5 million annual tobacco-related deaths have been reported worldwide. The majority of smokers want to quit but are not successful.

OBJECTIVES

To screen our population for tobacco use, gauge the baseline demographics of tobacco users and assess factors associated with failed attempts to quit.

METHODS

Free health camps supervised by a physician were held across two major cities of Pakistan. All consenting participants were administered a questionnaire and had their exhaled carbon monoxide (CO) levels measured.

RESULTS

Of 12 969 participants successfully enrolled, the mean age was 31.4 ± 10.0 years. More than three quarters were aged 20-40 years (n = 10 168, 78.4%). The overall average CO level was 12.0 ± 8.0 ppm. The majority of the participants wanted to quit, and nearly everyone had received advice about quitting. The majority had tried smoking cessation pharmacotherapy. Friends/peer pressure (n = 1554, 12%), anxiety (n = 681, 5.3%), tobacco dependence (n = 1965, 15.2%) and stress/mood changes (n = 390, 3.0%) were the most widely observed reasons for failure to quit in study participants.

CONCLUSION

The information provided by this study can guide the development of more targeted intervention programmes for smokers who wish to quit.

Percutaneous Coronary Intervention Under Cover of Left Ventricular Assist Device (Impella 2.5)

Impella 2.5 is a temporary left ventricular assist device that is being increasingly used in high risk Percutaneous Coronary intervention (PCI). It reduces the cardiac workload and provides assistance to myocardium and vital organs in states of severe left ventricular dysfunction and cardiogenic shock. We report the first case of successful percutaneous coronary stenting performed in a high risk patient using impella 2.5. A 65-year old diabetic and hypertensive male with a known double vessel coronary artery disease and a reduced left ventricular function (ejection fraction, 20%) was admitted with intractable angina. He was on optimal medical treatment for 2 months. His coronary angiogram done 2 months back had revealed double vessel coronary artery disease (subtotally occluded co-dominant left circumflex and moderate 60% stenosis in left anterior descending artery and a normal co-dominant right coronary artery). He was considered a high risk both for Coronary Artery Bypass Graft (CABG) surgery and PCI due to co-morbidities and reduced left ventricular function. As he had failed a trial of optimal medical therapy and the cardiac surgeon's reluctance for surgery, the patient and his family was counseled for high risk PCI with left ventricular assist device using the impella 2.5.