Retrospective Analysis of Characteristics, Indications and Outcomes of Endoscopic Retrograde Cholangiopancreatography (ERCP) in a Tertiary Referral Center in Saudi Arabia.

BACKGROUND:  Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure that is an essential tool in the management of pancreaticobiliary diseases. There is limited data available on the indications and outcomes of ERCP from this region. Therefore, we aim to report the characteristics of patients, indications and outcomes of ERCP in Saudi Arabia.  Methods: We retrospectively looked at ERCP procedures done at a tertiary referral center covering the western region of Saudi Arabia from August 2018 until July 2020. Data were collected from the hospital's electronic patient record and endoscopy database. RESULTS:  Of 1001 ERCPs performed, full data was available on 712 procedures on 581 patients that were included in the final analysis. Mean age was 53.1 years. Four hundred four (56.7%) were female. Board-certified consultants performed all ERCPs. The most common intervention was sphincterotomy, which was performed in 563 (96.9%) patients who underwent first-ever ERCP, followed by dilatation and stenting. The commonest indication of ERCP was confirmed or suspected choledocholithiasis (52.6%), followed by replacement or removal of a biliary stent (15.7%), 55 (7.7%) for suspected ascending cholangitis, 54 (7.5%) for acute biliary pancreatitis and 15 (2%) for suspected sphincter of Oddi dysfunction. The commonest finding among all patients was choledocholithiasis in 57.9%, debris in 15.2% and biliary stricture in 14.8%. The commonest complication was pancreatitis in 22 (3.1%) followed by post-sphincterotomy bleeding in 16 (2.2%) and perforation in nine (1.2%). Bleeding was controlled by endoscopic intervention in four (25%) and one (6.2%) patient underwent surgery. One (0.14%) patient had procedure-related mortality secondary to post-procedure pulmonary embolism and one had significant morbidity and prolonged hospitalization because of complicated perforation. The deeper common bile duct (CBD) cannulation rate was 97.3%. CONCLUSION: Our study results revealed that ERCP performed in the western region of Saudi Arabia has similar indications and findings as reported in the international literature. ERCP is successful in achieving the therapeutic objectives with complication rates consistent with published data.

Zn alleviated salt toxicity in Solanum lycopersicum L. seedlings by reducing Na+ transfer, improving gas exchange, defense system and Zn contents.

Soil secondary salinization is a serious menace that has significant influence on the sustainability of agriculture and threatens food security around the world. Zinc (Zn) as an essential plant nutrient associated with many physio-biochemical processes in plants and improve resistance against various abiotic stresses. The role of Zn in acclimation of Solanum lycopersicum L. challenged with salt stress is miserly understood. A hydroponic study was performed with two tomato varieties (Riogrande and Sungold) exposed to the salinity stress (0 mM and 160 mM NaCl) under two Zn concentrations (15 µM and 30 µM ZnSO4). The results revealed that salt stress exerted strongly negative impacts on root and shoot length, fresh and dry biomass, plant water relations, membrane stability, chlorophyll contents, Na+/K+ ratio along with inferior gas exchange attributes and activities of antioxidant enzymes. Moreover, Riogrande was found to be more resistant to salinity stress than Sungold. However, Zn supply significantly alleviated the hazardous effects of salinity by altering compatible solutes accumulation, photosynthetic activity, water relation, soluble sugar contents and providing antioxidant defense against salt stress. The salinity + Zn2 treatment more obviously enhanced RWC (19.0%), MSI (30.8%), SPAD value (17.8%), and activities of SOD (31.7%), POD (28.5%), APX (64.5%) and CAT (23.3%) in Riogrande than Sungold, compared with the corresponding salinity treatment alone. In addition, salinity + Zn2 treatment significantly (P > 0.05) ameliorated salinity stress due to the depreciation in Na+/K+ ratio by 63.3% and 40.8%, Na+ ion relocation from root to shoot by 10.4% and 6.4%, and thereby significantly reduced Na+ ion accumulation by 47.4% and 16.3% in the leaves of Riogrande and Sungold respectively, compared to the salinity treatment alone. Therefore, it was obvious that 30 µM Zn concentration was more effective to induce resistance against salinity stress than 15 µM Zn concentration. Conclusively, it can be reported that exogenous Zn application helps tomato plant to combat adverse saline conditions by modulating photosynthetic and antioxidant capacity along with reduced Na+ uptake at the root surface of tomato plant.

Crop straw-derived biochar alleviated cadmium and copper phytotoxicity by reducing bioavailability and accumulation in a field experiment of rice-rape-corn rotation system.

Biochar has the potential to control the bioavailability and transformation of heavy metals in soil, thereby ensuring the safe crop production. A three seasons field experiment was conducted to investigate the effect of crop straw-derived biochar on the bioavailability and crop accumulation of Cd and Cu in contaminated soil. Wheat straw biochar (WSB), corn stalk biochar (CSB), and rice husk biochar (RHB) were applied at the rate of 0, 1.125, and 2.25 × 104 kg ha-1, respectively. The results showed that all types of biochar significantly increased soil pH, organic carbon and cation exchangeable capacity (CEC), compared to the control. The reduction in DTPA extractable Cd and Cu contents was much greater under high dosage biochar application, with a prominence at RHB treatment throughout the three cropping seasons, compared to the control. Moreover, the biological accumulation of Cd and Cu in the grains of rapeseed and corn significantly decreased after biochar application. Linear regression also confirmed the effective role of biochar in controlling the translocation and accumulation of Cd and Cu due to their inactive bioavailability. In addition, the sequential extraction indicated that exchangeable fraction (EXF) of Cu and Cd had decreased, while residual fraction (RSF) had increased under all biochar amendments. Contrarily, the oxidizable fraction (OXF) of Cd decreased while OXF of Cu increased under biochar treatments. Biochar application, especially RHB, could be an effective measure to enhance Cd and Cu adsorption and immobilization in polluted soils and thereby reducing its uptake and translocation to crops.

Cadmium uptake and translocation: selenium and silicon roles in Cd detoxification for the production of low Cd crops: a critical review.

Cadmium (Cd) is a primary contaminant in agricultural soils of the world. The ability of Cd uptake, transport, detoxification, and accumulation varies among different plant species and genotypes. Cd is translocated from soil to root by different transporters which are used for essential plant nutrient uptake. A number of strategies have been suggested for decreasing Cd toxicity in Cd contaminated soils. Recently, a lot of research have been carried out on minimizing Cd uptake through selenium (Se) and silicon (Si) applications. Both Se and Si have been reported to mitigate Cd toxicity in different crops. Vacuolar sequestration, formation of phytochelatins, and cell wall adsorption have been reported as effective mechanisms for Cd detoxification. The present review discussed past and current knowledge of literature to better understand Cd toxicity and its mitigation by adopting different feasible and practical approaches.

Postoperative Analgesic Efficacy of Bilateral Transversus Abdominis Plane Block in Patients Undergoing Midline Colorectal Surgeries Using Ropivacaine: A Randomized, Double-blind, Placebo-controlled Trial.

BACKGROUND: Ultrasound-guided transversus abdominis plane (TAP) block is done as a part of multimodal analgesia for pain relief after abdominal surgeries. This prospective randomized, double-blind, placebo-controlled trial was conducted to evaluate the postoperative analgesic efficacy of bilateral TAP block in patients undergoing midline colorectal surgeries using ropivacaine. MATERIALS AND METHODS: Eighty patients scheduled for elective colorectal surgeries involving midline abdominal wall incision under general anesthesia were enrolled in this prospective randomized controlled trial. Group A received TAP block with 20 ml of 0.2% ropivacaine on either side of the abdominal wall, and Group B received 20 ml of normal saline. The time to request for rescue analgesia, total analgesic consumption in 24 h, and satisfaction with the anesthetic technique were assessed. RESULTS: The mean visual analog scale scores at rest and on coughing were higher in control group (P > 0.05). Time (min) to request for the first rescue analgesia was prolonged in study group compared to control group (P < 0.001). The total tramadol consumption in 24 h postoperatively was significantly high in control group (P < 0.001). Nausea/vomiting was more common in control group (P > 0.05). The level of satisfaction concerning postoperative pain control/anesthetic technique was higher in study group (P < 0.001). CONCLUSION: TAP block produces effective and prolonged postoperative analgesia in patients undergoing midline colorectal surgery. It is a technically simple block to perform with a high margin of safety. It produces a considerable reduction in mean intravenous postoperative tramadol requirements, reduction in postoperative pain scores, and increased time to first request for further analgesia, both at rest and on movement.