Factors associated with therapeutic non-adherence in renal transplant patients: a bicentric study in Algeria / Facteurs associés à la non-observance thérapeutique chez les patients greffés rénaux : une étude bicentrique en Algérie.

Introduction: Medication non-adherence is a global concern, particularly in the context of renal transplantation, where it leads to graft failures, increased hospitalizations, diminished quality of life for patients, and higher healthcare costs. The aim of this study was to assess the level of therapeutic adherence among Algerian kidney transplant recipients and identify potential influencing factors. Methods: A descriptive, cross-sectional bicenter study was conducted among kidney transplant patients receiving outpatient care at two specialized medical centers in Algeria: the Urology Department of the Hospital Establishment for Urology, Nephrology, and Renal Transplantation in Constantine, and the Nephrology and Renal Transplantation Department of the University Hospital Center (CHU) in Blida, spanning from January to December 2022. Therapeutic adherence was assessed using the 8-item Morisky questionnaire, while the level of knowledge was analyzed through a 12-item questionnaire. Logistic regression was used to identify factors associated with non-adherence to therapy. Results: This study included 130 patients with an average age of 47 years and a sex ratio of 1.7. The results revealed therapeutic non-adherence in 40.8% of the patients. Multivariate analysis identified several potentially associated factors, including residence, unemployment status, lack of affiliation with a health insurance fund, the use of a therapeutic regimen involving triple therapy, the occurrence of adverse effects, limited education level, and insufficient disease knowledge. Furthermore, non-adherence was associated with an increased risk of graft rejection. Conclusion: The findings of this study highlight concerning therapeutic adherence among kidney transplant recipients, emphasizing the crucial importance of therapeutic education to improve treatment adherence and underscoring the need to integrate these factors into clinical patient management.

Introduction: La non-observance thérapeutique est un problème mondial préoccupant, notamment dans le contexte de la transplantation rénale où elle entraîne des échecs de greffe, une augmentation des hospitalisations, une détérioration de la qualité de vie des patients et des coûts de santé accrus. Cette étude avait pour objectif d'évaluer le niveau d'observance thérapeutique chez les transplantés rénaux algériens et d'identifier les facteurs qui pourraient l'influencer. Méthodes: Une étude descriptive transversale bicentrique a été menée auprès de patients transplantés rénaux suivis en ambulatoire dans deux centres médicaux spécialisés en Algérie : le service d'urologie de l'Établissement hospitalier spécialisé (EHS) en urologie, néphrologie et transplantation rénale de Constantine ainsi que le service de néphrologie et transplantation rénale du Centre hospitalier universitaire (CHU) de Blida, sur une période allant de janvier à décembre 2022. L'observance thérapeutique a été évaluée à l'aide du questionnaire à 8 items de Morisky, tandis que le niveau de connaissance a été analysé à travers un questionnaire de 12 items. La régression logistique a été utilisée pour identifier les facteurs associés à la non-observance thérapeutique. Résultats: Cette étude a inclus 130 patients présentant un âge moyen de 47 ans et un sex ratio de 1,7. Les résultats ont révélé une non-observance thérapeutique chez 40,8 % des patients. L'analyse multivariée a permis d'identifier plusieurs facteurs potentiellement associés à cette non-observance, notamment le lieu d'habitation, le statut de chômage, l'absence d'affiliation à une caisse d'assurance maladie, l'utilisation d'un schéma thérapeutique incluant une trithérapie, la survenue d'effets indésirables, le niveau d'éducation limité et une connaissance insuffisante de la maladie. En outre, la non-observance a été associée à un risque accru de rejet de greffe. Conclusion: Les résultats de cette étude révèlent une observance thérapeutique préoccupante chez les transplantés rénaux, soulignant l'importance cruciale de l'éducation thérapeutique afin de l'améliorer et mettant en évidence la nécessité d'intégrer ces facteurs dans la gestion clinique des patients.

Factors associated with therapeutic non-adherence in renal transplant patients: a bicentric study in Algeria / Facteurs associés à la non-observance thérapeutique chez les patients greffés rénaux : une étude bicentrique en Algérie

Introduction: Medication non-adherence is a global concern, particularly in the context of renal transplantation, where it leads to graft failures, increased hospitalizations, diminished quality of life for patients, and higher healthcare costs. The aim of this study was to assess the level of therapeutic adherence among Algerian kidney transplant recipients and identify potential influencing factors. Methods: A descriptive, cross-sectional bicenter study was conducted among kidney transplant patients receiving outpatient care at two specialized medical centers in Algeria: the Urology Department of the Hospital Establishment for Urology, Nephrology, and Renal Transplantation in Constantine, and the Nephrology and Renal Transplantation Department of the University Hospital Center (CHU) in Blida, spanning from January to December 2022. Therapeutic adherence was assessed using the 8-item Morisky questionnaire, while the level of knowledge was analyzed through a 12-item questionnaire. Logistic regression was used to identify factors associated with non-adherence to therapy. Results: This study included 130 patients with an average age of 47 years and a sex ratio of 1.7. The results revealed therapeutic non-adherence in 40.8% of the patients. Multivariate analysis identified several potentially associated factors, including residence, unemployment status, lack of affiliation with a health insurance fund, the use of a therapeutic regimen involving triple therapy, the occurrence of adverse effects, limited education level, and insufficient disease knowledge. Furthermore, non-adherence was associated with an increased risk of graft rejection. Conclusion: The findings of this study highlight concerning therapeutic adherence among kidney transplant recipients, emphasizing the crucial importance of therapeutic education to improve treatment adherence and underscoring the need to integrate these factors into clinical patient management.

Introduction: La non-observance thérapeutique est un problème mondial préoccupant, notamment dans le contexte de la transplantation rénale où elle entraîne des échecs de greffe, une augmentation des hospitalisations, une détérioration de la qualité de vie des patients et des coûts de santé accrus. Cette étude avait pour objectif d'évaluer le niveau d'observance thérapeutique chez les transplantés rénaux algériens et d'identifier les facteurs qui pourraient l'influencer. Méthodes: Une étude descriptive transversale bicentrique a été menée auprès de patients transplantés rénaux suivis en ambulatoire dans deux centres médicaux spécialisés en Algérie : le service d'urologie de l'Établissement hospitalier spécialisé (EHS) en urologie, néphrologie et transplantation rénale de Constantine ainsi que le service de néphrologie et transplantation rénale du Centre hospitalier universitaire (CHU) de Blida, sur une période allant de janvier à décembre 2022. L'observance thérapeutique a été évaluée à l'aide du questionnaire à 8 items de Morisky, tandis que le niveau de connaissance a été analysé à travers un questionnaire de 12 items. La régression logistique a été utilisée pour identifier les facteurs associés à la non-observance thérapeutique. Résultats: Cette étude a inclus 130 patients présentant un âge moyen de 47 ans et un sex ratio de 1,7. Les résultats ont révélé une non-observance thérapeutique chez 40,8 % des patients. L'analyse multivariée a permis d'identifier plusieurs facteurs potentiellement associés à cette non-observance, notamment le lieu d'habitation, le statut de chômage, l'absence d'affiliation à une caisse d'assurance maladie, l'utilisation d'un schéma thérapeutique incluant une trithérapie, la survenue d'effets indésirables, le niveau d'éducation limité et une connaissance insuffisante de la maladie. En outre, la non-observance a été associée à un risque accru de rejet de greffe. Conclusion: Les résultats de cette étude révèlent une observance thérapeutique préoccupante chez les transplantés rénaux, soulignant l'importance cruciale de l'éducation thérapeutique afin de l'améliorer et mettant en évidence la nécessité d'intégrer ces facteurs dans la gestion clinique des patients.

Multiscale investigation of pore structure heterogeneity in carbonate rocks using digital imaging and SCAL measurements: A case study from Upper Jurassic limestones, Abu Dhabi, UAE.

This study presents a comprehensive analysis of rock properties for a selected group of six carbonate reservoir rock samples revealing complex structures at various length scales. Experimental laboratory methods as well as image analysis techniques were conducted in this study to characterize the macro- and micro-pores in mud- and grain-dominated limestones samples from the Upper Jurassic Arab Formation (Arab D member). Mercury Injection Capillary Pressure (MICP), porosimeter, and permeameter lab measurements were employed to assess the pore network heterogeneity and complexity. In addition, a multiscale rock imaging approach was implemented to detect grain and pore phases at several length scales using Thin Sections (TS), Scanning Electron Microscopy (SEM), Focused Ion Beam Scanning Electron Microscopy (FIB-SEM), as well as 3D X-ray Computed Tomography (CT), and micro-computed tomography images (MCT). Furthermore, the multifractal analysis method was applied on the MICP and FIB-SEM to characterize quantitatively the heterogeneity of the pores in the studied samples. Heterogeneous samples 3R, 4M, 5W, and 6M display the highest non-uniformity degree Δα values, falling within the range of [1.21, 1.39] based on FIB-SEM images. Samples 1G, 2R, 3R, and 5W exhibit more heterogeneous pore structure, with Δα values ranging from 0.73 to 1.49 based on the MICP experiments. The results and findings confirm the effectiveness of multifractal parameters Δα and the asymmetry degree in the vertical axis Δf(α) in quantifying and characterizing rock heterogeneity.

A comprehensive review of viscoelastic polymer flooding in sandstone and carbonate rocks.

Polymer flooding is a proven chemical Enhanced Oil Recovery (cEOR) method that boosts oil production beyond waterflooding. Thorough theoretical and practical knowledge has been obtained for this technique through numerous experimental, simulation, and field works. According to the conventional belief, this technique improves macroscopic sweep efficiency due to high polymer viscosity by producing moveable oil that remains unswept after secondary recovery. However, recent studies show that in addition to viscosity, polymer viscoelasticity can be effectively utilized to increase oil recovery by mobilizing residual oil and improving microscopic displacement efficiency in addition to macroscopic sweep efficiency. The polymer flooding is frequently implemented in sandstones with limited application in carbonates. This limitation is associated with extreme reservoir conditions, such as high concentrations of monovalent and divalent ions in the formation brine and ultimate reservoir temperatures. Other complications include the high heterogeneity of tight carbonates and their mixed-to-oil wettability. To overcome the challenges related to severe reservoir conditions, novel polymers have been introduced. These new polymers have unique monomers protecting them from chemical and thermal degradations. Monomers, such as NVP (N-vinylpyrrolidone) and ATBS (2-acrylamido-2-methylpropane sulfonic acid), enhance the chemical resistance of polymers against hydrolysis, mitigating the risk of viscosity reduction or precipitation in challenging reservoir conditions. However, the viscoelasticity of these novel polymers and their corresponding impact on microscopic displacement efficiency are not well established and require further investigation in this area. In this study, we comprehensively review recent works on viscoelastic polymer flow under various reservoir conditions, including carbonates and sandstones. In addition, the paper defines various mechanisms underlying incremental oil recovery by viscoelastic polymers and extensively describes the means of controlling and improving their viscoelasticity. Furthermore, the polymer screening studies for harsh reservoir conditions are also included. Finally, the impact of viscoelastic synthetic polymers on oil mobilization, the difficulties faced during this cEOR process, and the list of field applications in carbonates and sandstones can also be found in our work. This paper may serve as a guide for commencing or performing laboratory- and field-scale projects related to viscoelastic polymer flooding.

Static and dynamic adsorption of a gemini surfactant on a carbonate rock in the presence of low salinity water.

In chemical enhanced oil recovery (cEOR) techniques, surfactants are extensively used for enhancing oil recovery by reducing interfacial tension and/or modifying wettability. However, the effectiveness and economic feasibility of the cEOR process are compromised due to the adsorption of surfactants on rock surfaces. Therefore, surfactant adsorption must be reduced to make the cEOR process efficient and economical. Herein, the synergic application of low salinity water and a cationic gemini surfactant was investigated in a carbonate rock. Firstly, the interfacial tension (IFT) of the oil-brine interface with surfactant at various temperatures was measured. Subsequently, the rock wettability was determined under high-pressure and high-temperature conditions. Finally, the study examined the impact of low salinity water on the adsorption of the cationic gemini surfactant, both statically and dynamically. The results showed that the low salinity water condition does not cause a significant impact on the IFT reduction and wettability alteration as compared to the high salinity water conditions. However, the low salinity water condition reduced the surfactant's static adsorption on the carbonate core by four folds as compared to seawater. The core flood results showed a significantly lower amount of dynamic adsorption (0.11 mg/g-rock) using low salinity water conditions. Employing such a method aids industrialists and researchers in developing a cost-effective and efficient cEOR process.

Investigation of the Coupled Effect of IFT Reduction and Wettability Alteration for Oil Recovery: New Insights.

Interfacial tension (IFT) reduction and wettability alteration (WA) are both important enhanced oil recovery (EOR) mechanisms. In oil-wet formations, IFT reduction reduces the magnitude of negative capillary pressure, releasing trapped oil. WA changes the negative capillary pressure to positive conditions, helping the entrance of the aqueous phase, and the displacement of the oil phase. In most cases, IFT reduction and WA happen at the same time. However, studies regarding the coupled effect provided different, sometimes conflicting observations. It requires further study and better understanding. In our study, oil-aged Indiana limestone samples were chosen to represent oil-wet carbonate rocks. Static contact angle and spinning drop method were adopted for wettability assessment and IFT measurement, respectively. Spontaneous imbibition was adopted to reflect on the oil recovery mechanisms in different cases. The impact of IFT reduction, WA, and permeability on the coupled effect was discussed by choosing four pairs of comparison tests. Results showed that when the coupled effect took place, both a higher IFT value and a stronger WA performance resulted in faster and higher oil recoveries. The importance of IFT reduction was enhanced in the higher-permeability condition, while the importance of WA was enhanced in the lower-permeability condition.

Updated Perceptions on Polymer-Based Enhanced Oil Recovery toward High-Temperature High-Salinity Tolerance for Successful Field Applications in Carbonate Reservoirs.

The aging of the existing reservoirs makes the hydrocarbon extraction shift toward newer reserves, and harsh conditioned carbonates, which possess high temperature and high salinity (HTHS). Conventional polymer-flooding fails in these HTHS carbonates, due to precipitation, viscosity loss, and polymer adsorption. Therefore, to counteract these challenges, novel polymer-based cEOR alternatives employ optimized polymers, polymer-surfactant, and alkali-surfactant-polymer solutions along with hybrid methods, which have shown a potential to target the residual or remaining oils in carbonates. Consequently, we investigate novel polymers, viz., ATBS, Scleroglucan, NVP-based polymers, and hydrophobic associative polymers, along with bio-polymers. These selected polymers have shown low shear sensitivity, low adsorption, and robust thermal/salinity tolerance. Additionally, adding an alkali-surfactant to polymer solution produces a synergy effect of improved mobility control, wettability alteration, and interfacial-tension reduction. Thus, enhancing the displacement and sweep efficiencies. Moreover, low-salinity water can precondition high-salinity reservoirs before polymer flooding (hybrid method), to decrease polymer adsorption and viscosity loss. Thus, this paper is a reference for novel polymers, and their hybrid techniques, to improve polymer-based cEOR field applications under HTHS conditions in carbonates. Additionally, the recommendations can assist in project designs with reasonable costs and minimal environmental impact. The implication of this work will aid in supplementing the oil and gas energy sector growth, making a positive contribution to the Middle Eastern economy.