Valorization of Rice Husk and Straw Agriculture Wastes of Eastern Saudi Arabia: Production of Bio-Based Silica,Lignocellulose, and Activated Carbon

Bio-based silica, lignocellulose, and activated carbon were simply produced via the recycling of Hassawi rice biomass waste of Al-Ahsa governorate in the eastern Saudi Arabia region using a fast chemical treatment procedure. Rice husk and rice straw wastes were collected, ground, and chemically treated with sodium hydroxide to extract silica/silicate from the dried plant tissues. The liquid extract is then treated with acid solutions in order to precipitate silica/silicate at neutral medium. Lowering the pH of the supernatant to 2 resulted in the precipitation of lignocellulose. Thermal treatment of the biomass residue under N₂ gas stream resulted in activated carbon production. Separated products were dried/treated and characterized using several physical examination techniques, such as FT-IR, SEM/EDX, XRD, and Raman spectroscopy in order to study their structure and morphology. Silica and lignocelluloses products were then preliminarily used in the treatment of wastewaters and water-desalination processes.     

Evaluation of Liver and Renal Toxicity in Peptide Receptor Radionuclide Therapy for Somatostatin Receptor Expressing Tumors: A 2-Year Follow-Up

BackgroundPeptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin receptor (SSR) analogs is now an established systemic treatment for neuroendocrine tumors (NET). However, more short- and long-term data about renal and hepatotoxicity is needed. Here we present our experience in this clinical scenario.MethodsEighty-six patients with progressive SSR-expressing malignancies underwent PRRT with Lu-177 Dotatate and were followed up for up to 2 years. Laboratory tests were done 1 week before each cycle and every 2 months at follow-up. Hepatic and renal toxicity was determined based on NCI CTCAE V5.0.Results55/86 (64%) patients completed all 4 cycles of PRRT; 18/86 (20.9%) are currently being treated; 13/86 (15.1%) had to discontinue PRRT: 4/13 (31%) due to hematologic toxicity, 9/13 (69%) due to non-PRRT-related comorbidities. Out of the patients who finished treatment, only transient grade 2 toxicities were observed during PRRT: hypoalbuminemia in 5.5% (3/55), and renal toxicity (serum creatinine and estimated glomerular filtration rate) in 1.8% (1/55). No grade 3 or 4 liver and renal toxicity occurred. Patients presenting with impaired liver or renal function prior to PRRT, either improved or had stable findings. No deterioration was observed.ConclusionPeptide receptor radionuclide therapy does not have a negative impact on liver and renal function, even in patients with pre-existing impaired parameters. No grade 3 or 4 hepatic or renal toxicity was identified. Only transient grade 2 hypoalbuminemia in 5.5% and nephrotoxicity in 1.8% of patients were seen during PRRT.     

The Duboisia Genus,Australian Aborigines and Suggestibility

Abstract

Plant hallucinogens, such as those of the Duboisia genus called pituri, have been used by tribal elders in Australian aboriginal populations to create managed states of consciousness, to provide their youth with a fast-paced educational experience, and to inculcate values, beliefs and religious tenets. Use of the suggestible states created by such substances (particularly in pubertal initiatory rituals marking the transition to manhood) are part of this process, which contributes to cultural cohesiveness and survival; their effectiveness is due to the unique ability of the biochemical properties of the plant to evoke suggestibility in those who ingest them. This article draws on research about suggestibility as a psychological characteristic of altered states of consciousness as well as a normal human psychological phenomenon, and examines in great detail the use of the pituri plant, deriving data from a 100-item bibliography generated by the Australian Institute of Aboriginal and Torres Strait Islander Studies in Canberra. Botanical/chemical data on use of the Duboisia genus up to the end of the nineteenth century is examined, as well as the way in which this hallucinogen was utilized as a “psychotechnology.”     

Axillary Recurrence in Breast Cancer Patients with Isolated Tumor Cells in the Sentinel Lymph Node [AJCC N0(i+)]

Background  

Completion axillary lymph node dissection (CALND) is controversial in patients with sentinel lymph node (SLN) metastases ≤ 0.2 mm [N0 (i+)]. Our goal was to characterize patients with SLN isolated tumor cells regarding surgical management and axillary recurrence.     

Mons Pubis Ptosis: Classification and Strategy for Treatment

Background  

Obesity and massive weight loss cause bulging and ptosis of the mons pubis. The pubic area can cause an embarrassment to patients. In some cases, the deformity can be seen even under clothing. Ptosis of the mons usually is addressed during abdominoplasty. The author presents a new clinical classification of mons deformity based on the amount of adipose tissue deposit and the degree of ptosis. A strategy of treatment to achieve a proper rejuvenation of mons deformities is provided.     

Functional outcomes of nonunion scaphoid fracture treated by pronator quadratus pedicled bone graft

Between 1998 and 2007, a pronator quadratus pedicled bone graft was performed for 45 patients of ununited scaphoid fracture. One of them had bilateral ununited scaphoid fracture. There were 29 men and 16 women with a median age at operation of 24 (16-32) years. The affected side was the right side (dominant hand) in 32 patients whereas 13 patients had fracture of the nondominant left side. There had been 32 proximal pseudoarthrosis (through or proximal to the junction of the proximal and middle thirds of the bone) and 14 of the middle third of the scaphoid. The original fractures were caused by motor cycle accidents in 23 patients, falling on outstretched hand in 15 patients, and sport injuries in the remaining 7 patients. Surgery was indicated from 5 months to 6 years after injury (average 43 months) because of complaints of pain on heavy work. The fracture has been missed at the initial examination in 23 patients whereas cast immobilization was done for 6 weeks and 3 months in 15 and 7 cases, respectively, that had failed to result in union. There were no preoperative osteoarthritic changes, but in 25 cases, there were avascular necrosis of the proximal fragment of the scaphoid. Forty-three patients showed radiographic union after an average of 14 weeks (12-16 weeks). One patient had dislodgement of the graft and refused to do it again. The average range of movement of wrist improved after operation. Taken as a percentage of the normal range, dorsiflexion increased from 69% to 80%, palmar flexion from 66% to 76%, radial deviation from 45% to 70%, and ulnar deviation from 67% to 84%. Grip strength improved from 82% to 92% of normal. All the patients have been able to return to their former activities with no pain.     

Outcome of 234 pregnancies in 140 renal transplant recipients from five middle eastern countries

OBJECTIVE: To study the pregnancy and offspring outcomes in postrenal transplant recipients. METHODS: This is a retrospective case-note review study investigating the outcome of 234 pregnancies in 140 renal transplant recipients from five different Middle Eastern countries. RESULTS: Of the overall pregnancies 74.4% were successful albeit with high prevalences of preterm and Caesarean deliveries (40.8% and 53%, respectively). The mean serum creatinine did not rise significantly during pregnancy in the group as a whole but did so in patients who had serum creatinine of or above 150 micromol/L at the beginning of their pregnancies. The mean birth weight was (2,458 g) with 41.3% of the newborns being of low birth weight (<2,500 g). The prevalences of stillbirths were 7.3% and of spontaneous abortion was 19.3%. Preeclampsia and gestational diabetes were observed in 26.1% and 2% of pregnancies, respectively. CONCLUSIONS: In the presence of good allograft function, the majority of pregnancies in renal transplant recipients have a good outcome but with increased incidence of preeclampsia, reduced gestational age, and low birth weights. Patients with baseline serum creatinine of above 150 micromol/L have an increased risk of allograft dysfunction resulting from the pregnancy.     

Six-month clinical outcome of cyclosporine microemulsion formulation (Sigmasporin Microral) in stable renal transplant patients previously maintained on sandimmun neoral

The trial objective was to investigate the feasibility and safety of conversion to a generic microemulsion cyclosporine in stable renal transplant patients premaintained on Neoral. We enrolled 75 patients from seven centers in five Middle Eastern countries monitored them for 6 months after conversion to Sigmasporin Microral. Readings at 0, 0.5, 1, 2, 3, 4.5, and 6 months included cyclosporine blood level, serum creatinine, liver enzymes, lipid profile, blood sugar, blood pressure and adverse events. Patients included 54 men and 21 women of mean age 38.9 +/- 10.7 years at 30.3 +/- 29.3 months post-transplantation maintained on Sigmasporin Microral dose of 2.8 +/- 1.0 mg/kg per day; they were observed to be stable throughout the study period as reflected by the therapeutic blood C(0) level of 181.6 +/- 102.1 and C(2) of 759.2 +/- 384.4. Their absorption profile as represented by C(2)/C(0) was 4.9 +/- 2.8, and C(2)/cyclosporine dose of 282.3 +/- 128.8. An average serum creatinine level of 116.1 +/- 29.5 mumol/L denoted stable graft function and their liver enzymes did not change during the study. No new-onset cases of hypertension, diabetes mellitus, or hyperlipidemia were reported among the patients. Graft function was stable for all patients, except for two incidences of mild acute rejection and two of mild cyclosporine nephrotoxicity; graft and patient survival rates were both 100%. Results of this 6-month study showed that Sigmasporin Microral was effective to maintain stable renal function in kidney transplant patients converted from Neoral with similar safety and tolerability profiles as those reported in the literature.     

Exercise hemodynamics of aortic prostheses: comparison between stentless bioprostheses and mechanical valves

BACKGROUND: Nonstented bioprostheses have been associated with lower resting gradients than stented bioprostheses or mechanical valves. We compared the hemodynamic performance of nonstented bioprostheses and mechanical valves with normal native aortic valves at rest and exercise. METHODS: Dobutamine echocardiography was used to assess gradients and effective orifice area index at rest and exercise in patients with the Toronto stentless porcine valve (TSPV; n = 13; mean implant size 25.7 mm), Medtronic Freestyle (FR; n = 11; mean implant size 23.9 mm), Sorin Bicarbon (SOR; n = 11; mean implant size 24.5 mm), St. Jude Medical (SJM; n = 10; mean implant size 21.3 mm), and normal native aortic valves (NOR; n = 10). RESULTS: All groups demonstrated a major rise in cardiac output at maximal dobutamine infusion. At rest and exercise, respectively, mean gradients were 5.48 +/- 1.1 mm Hg and 5.83 +/- 0.9 mm Hg for TSPV, 5.68 +/- 1.2 mm Hg and 7.50 +/- 1.7 mm Hg for FR, 10.29 +/- 1.4 mm Hg and 20.78 +/- 2.7 mm Hg for SJM, 5.26 +/- 0.8 mm Hg and 11.1 +/- 1.8 mm Hg for SOR, and 1.54 +/- 0.4 mm Hg and 2.18 +/- 0.7 mm Hg for NOR. In comparison with normal valves, both stentless groups showed no change in mean gradient at exercise, whereas both mechanical groups showed an increase in gradient at exercise (p < 0.04). CONCLUSIONS: Stentless valves behave similarly to normal aortic valves in that there is almost no increase in gradient at exercise. Both mechanical valve groups showed increased gradients at exercise, suggesting that these valves obstruct blood flow. Our data add further evidence that stentless valves are hemodynamically superior to mechanical valves in the aortic position.     

Current status of renal transplantation in the Kingdom of Saudi Arabia

The reported annual incidence of end-stage renal disease in Saudi Arabia is 100 to 120 patients per million population. The first dialysis unit in Saudi Arabia was established in 1971; thereafter, rapid advances have been made in the field of renal replacement therapy. At the end of 2002, there were 144 centers offering dialysis to about 7390 patients. A National Kidney Foundation was established in 1985 to implement the cadaveric organ transplant program and to coordinate the renal care facilities. This center was renamed Saudi Center for Organ Transplantation (SCOT) in 1993 to encompass transplantation of organs other than the kidney. An impetus was achieved in 1982 with the approval by Islamic scholars of the concept of brain-death and organ transplantation. From 1979, when the first renal transplant was performed, until the end of 2002, more than 3810 renal transplants have been performed in 13 transplant centers in Saudi Arabia, in addition to 260 liver, 95 heart, 280 heart valve, 510 cornea, 4 pancreas, 8 lung, and 1000 bone marrow transplants. The survival of patients and (grafts) in those who received living related renal transplants was 98.4(96.9), 96.7(96.7), and 96.7(92.2) at 1, 3, and 5 years, respectively. Moreover, the survival of patients and grafts among those who received cadaveric donor organs was 96.2(96.2), 93(92.1), and 93(87.2), at 1, 3, and 5 years, respectively. In conclusion, there has been increased renal transplantation in Saudi Arabia and there is even more room to increase the frequency of these transplants to decrease the expanding gap between supply and demand through increasing the efforts for organ donation from living and cadaveric donors.