Hemodialysis water reuse within a circular economy approach. What can we add to current knowledge? A point of view.

The ongoing climate change and the ecological challenges call for sustainable medicine and, in our field, sustainable kidney care. Dialysis is life-saving and resource-consuming, and high water consumption is one of the main concerns. Circular water economy, meaning reuse and recycling of water, and recovering resources can help reducing emissions and enhancing resilience to climate change. Several actions are possible including reusing reverse osmosis reject water, employable for gardening, aquaponics or even simply for toilet flushing, or in sterilization settings, reusing spent dialysate, at least for toilet flushing, but with wider use if microbiologically purified, recovering thermal energy from spent dialysate, that can probably be done with simple devices, or using phosphate-rich spent dialysate for producing fertilizers, namely struvite. All these options may be economically sound, and all help reducing the final dialysis carbon footprint. There is room for open-minded innovative approaches to improve water-related sustainability in hemodialysis, ultimately reducing ecological impact and increasing availability.

Chemical composition, antioxidant properties, and antifungal activity of wild Origanum elongatum extracts against Phytophthora infestans.

Introduction: Phytophthora infestans, the causative agent of late blight disease, has gained notoriety for its destructive potential, leading to substantial losses in potato yields. Although conventional systemic fungicides have been shown to be effective in controlling plant pathogens, growing environmental concerns have prompted the need for more integrated disease management approaches. Hence, in this study, the effectiveness of wild Origanum elongatum extracts as biopesticides was explored in controlling P. infestans and potentially mitigating its devastating impact in planta. Methods: The aerial parts of O. elongatum were subjected to sequential extraction using water, hexane, chloroform, and methanol. The obtained extracts were tested in vitro through the poisoned food procedure for their capacity to obstruct P. infestans growth and to defeat potato blight severity in vivo. The phyto-contents (total phenolic content (TPC) and total flavonoid content (TFC)), as well as the antioxidant activities, were spectrophotometrically determined in all extracts, and the phytoconstituents of the most active extract (methanolic extract) were profiled via high-performance liquid chromatography-photodiode array-tandem mass spectrometry (HPLC-PDA-MS/MS). Results: In vitro, the complete inhibition rate of the P. infestans was obtained using the methanolic extract at 5 mg/mL, followed by the hexane and chloroform extracts at 10 mg/mL. Interestingly, complete inhibition of the pathogen was achieved upon the application of the aqueous extract at 10 mg/mL. In vivo, the aqueous extract at 25 mg/mL reduced the P. infestans severity rate to 27.25%, while the methanolic extract at 20 mg/mL led to the lowest severity rate. Moreover, the hexane and chloroform extracts impaired the pathogen severity rate to 50% and 41% using 20 mg/mL, respectively. The TPC and TFC in the extracts were variable with high concentrations detected in the methanolic extract with 485.42 mg GAE/g and 58.24 mg QE/g, respectively. In addition, the methanolic extract showed the highest antioxidant activities, while the chloroform extract exhibited the lowest activity. Liquid chromatography (LC)-MS/MS analysis of the methanol extract revealed 56 components from diverse classes. These included organic acids, phenolic acids, flavonoids, tannins, and coumarins. Conclusion: These findings suggest that O. elongatum could be investigated as a potential source of antifungal compounds targeting different phytopathogens.

Nitrogen and phosphorus recovery from hemodialysis wastewater to use as an agricultural fertilizer.

INTRODUCTION: Hemodialysis wastewater contains high concentrations of ammonia nitrogen and phosphorus. Recovery of these nutrients as soil fertilizers represents an interesting opportunity to ensure a sustainable fertilizer supply. METHODS: In this paper, a simple method for recovering phosphorous and nitrogen as crystalline struvite [MgNH4PO4·6H2O] is presented. An integrated cost model is also presented in order to create a positive business case. RESULTS: Recovery rates in form of struvite of 95% of PO43--P and 23% of NH4+-N were achieved with a profit. CONCLUSION: To the best of our knowledge, this paper is the first to study the recovery of these naturally occurring minerals from hemodialysis wastewater. This offers great potential for the valorization of this type of wastewater.

Towards zero liquid discharge in hemodialysis. Possible issues / Hacia el vertido cero de líquidos en hemodiálisis. Posibles problemas

Scarcity of water and energy, and legal requirements for discharge of waste and wastewater are forcing hemodialysis facilities to change their approach to a more integrated concept of connecting the residual output (in terms of waste, wastewater and energy loss) to the input (in terms of water and energy). Zero liquid discharge is an expanding water treatment philosophy in which hemodialysis wastewater is purified and recycled, leaving little to no effluent remaining when the process is complete, thereby saving money and being beneficial to the environment. This article explores the possible ways to treat hemodialysis wastewater, thus achieving ZLD conditions. (AU)

La escasez de agua y energía, y los requisitos legales para la descarga de desechos y aguas residuales están obligando a las instalaciones de hemodiálisis a cambiar su enfoque hacia un concepto más integrado de conectar la salida residual (en términos de desechos, aguas residuales y pérdida de energía) con la entrada (en términos de agua y energía). La descarga de líquido cero es una filosofía de tratamiento de agua en expansión en la que las aguas residuales de hemodiálisis se purifican y se reciclan, dejando poco o ningún efluente cuando se completa el proceso, lo que ahorra dinero y es beneficioso para el medio ambiente. Este artículo explora las posibles formas de tratar las aguas residuales de hemodiálisis, logrando así las condiciones de descarga de líquidos cero. (AU)

Towards zero liquid discharge in hemodialysis. Possible issues.

Scarcity of water and energy, and legal requirements for discharge of waste and wastewater are forcing hemodialysis facilities to change their approach to a more integrated concept of connecting the residual output (in terms of waste, wastewater and energy loss) to the input (in terms of water and energy). Zero liquid discharge is an expanding water treatment philosophy in which hemodialysis wastewater is purified and recycled, leaving little to no effluent remaining when the process is complete, thereby saving money and being beneficial to the environment. This article explores the possible ways to treat hemodialysis wastewater, thus achieving ZLD conditions.

Towards zero liquid discharge in hemodialysis. Possible issues.

Scarcity of water and energy, and legal requirements for discharge of waste and wastewater are forcing hemodialysis facilities to change their approach to a more integrated concept of connecting the residual output (in terms of waste, wastewater and energy loss) to the input (in terms of water and energy). Zero liquid discharge is an expanding water treatment philosophy in which hemodialysis wastewater is purified and recycled, leaving little to no effluent remaining when the process is complete, thereby saving money and being beneficial to the environment. This article explores the possible ways to treat hemodialysis wastewater, thus achieving ZLD conditions.

Sleep quality and mental health in the context of COVID-19 pandemic and lockdown in Morocco.

BACKGROUND: The lockdown of COVID-19 (Coronavirus Disease 2019) is associated with several stressful factors that can negatively affect peoples' sleep quality and mental health. OBJECTIVES: We conducted this study to evaluate sleep disorders and psychological impact associated with the spread of the COVID-19 and the lockdown on the Moroccan population. We also aimed to study the effects of respondents' beliefs and attitudes about sleep on sleep disorders, anxiety-related symptoms, and depressive symptoms. MATERIAL AND METHODS: We used a questionnaire enclosing respondents' sociodemographic information, five psychological and behavioral tests including Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16), Athens Insomnia Scale (AIS), Epworth Sleepiness Scale (ESS), Hamilton Anxiety Rating Scale (HARS) and Beck Depression Inventory (BDI) test. RESULTS: Our results highlighted widespread false beliefs about sleep and the prevalence of sleep disorders, anxiety, and depression-related symptoms within the Moroccan population. Nearly 82.3% of respondents revealed false beliefs about sleep. Furthermore, we confirmed a strong positive correlation between knowledge and attitudes about sleep and the prevalence of sleep disorders, anxiety, and depression-related symptoms. However, we found no significant difference in the prevalence of sleep and psychological disorders, between healthcare workers and other professions workers. CONCLUSION: Our study revealed a high prevalence of sleep disorders, anxiety, and depressive symptoms in the Moroccan population during the COVID-19 lockdown period. Moreover, false beliefs on sleep understanding were prevalent and were presenting a risk factor leading to sleep disorders, anxiety, and depressive symptoms.

Study of Nutritional and Organoleptic Quality of Formulated Juices from Jujube (Ziziphus lotus L.) and Dates (Phoenix dactylifera L.) Fruits.

The present work aims to elaborate many juice formulas (F1 to F8) from two dried fruits (jujubes: Ziziphus lotus L. and dates: Phoenix dactylifera L.). Physicochemical and biochemical characterization of the formula juices shows that juices rich in dates fruits (F1, F3, F5, and F7) are loaded, on average, in total sugars (129.5 g/l), proteins (3.02 g/l), lipids (1.08 g/l), and carotenoid (0.02 mg/l), while juices rich in jujube fruits (F2, F4, F6, and F8) are overloaded, on average, in phenolic compounds (697 mg/l), flavonoids (6.32 mg/l), condensed tannins (2.1 mg/l), hydrolysable tannins (359.5 mg/l), and viscosity (1.062 mm 10-3 s). All formulations developed have a pH that rotates between 5.12 and 5.20. Total antioxidant capacity (CAT) reveals that formulations F1, F3, F5, and F7 show a strong activity compared to the other formulas. The DPPH test shows that all formulated juices have the same antioxidant profile with IC50 values lower than the template (BHT and Vit C). The FRAP test reveals that F2, F4, F6, and F8 formulas have a strong reducing power. Organoleptic evaluation by a jury shows that F4 formula is the best in terms of odor, aroma, and aftertaste agreeability.

Morphological, Biochemical, and Climatological Analysis of Three Moroccan Henna Verities.

In this study, we aimed to evaluate planted Henna in three sites in Morocco, namely, Alnif, Tafraoute Sidi Ali, and Tazzarine. Morphometric study shows that Tafraoute Sidi Ali Henna variety has highest geometric and weight parameters (length of 27.48 mm, width of 10.92 mm, specific mass of 25.1 mg/leaf, leaf area of 51, 53 mm2, and rib's number of 9.41) when compared to Alnif and Tazzarine varieties. On the other hand, biochemical analysis shows that Tazzarine Henna variety, in the first rank, is characterized by high levels of total sugars (11.27 g/100 g), reducing sugars (5.59 g/100 g), proteins (4.4 g/100g), lipids (3.05 g/100g), phenolic compounds (31.9 g/100 g), flavonoids (5.68 g/100 g), and tannins (5.5 g/100 g). Chromatographic study shows that Tazzarine Henna variety is rich in monocyclic and polycyclic phenolic compounds. Climatic conditions analysis shows that the morphometric and biochemical diversity is related to hydrous and thermal profiles of studied sites. As a conclusion of this work, we can recommend the use of morphometric analysis and phytochemical and chromatographic analysis to determine the quality of Henna in Morocco and elsewhere.

Study of the Biochemical Biodiversity of Camel Milk.

Due to its balanced composition in basic nutrients, its richness in vitamins and in minerals, camel milk has a special place in the daily diet of southern populations. The present study aimed at examining some physicochemical and biochemical characteristics of camel milk (Camelus dromedarius) in Morocco. To achieve this aim, three batches of samples of camel milk were collected from various regions (Dakhla, Errachida, and Fès-Meknes) undergoing physicochemical and biochemical analyses. Results showed that Moroccan camel milk is characterized by slight hydronium potential (pH=6.5), low Dornic acidity (15°D), low density (1.029 kg/l), and high content of ashes (8.06 g/l). Likewise, samples had a high content of macronutrients (Fats: 34.09 g/l; Proteins: 32.4 g/l; Sugar: 49.8 g/l) and micronutrients (Vitamin C: 27.53 mg/l; Flavonoids: 29.05 mg EQ/l: total phenolic compounds: 35.45mg GAE/l). In this respect, working on multiple specimens from different Moroccan regions highlighted an analytical diversity from the south to the north. Comparative study of samples from numerous territories all over the world has confirmed this diversity. North African milk is characterized by high content of proteins, fats, and sugar. On the other hand, oriental milk is peculiarized by high vitamin C content.

The effects of water shortages on health and human development.

Shortages of water could become a major obstacle to public health and development. Currently, the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) estimate that 1.1 billion people lack access to a water supply and 2.6 billion people lack adequate sanitation. The global health burden associated with these conditions is staggering, with an estimated 1.6 million deaths every year from diseases associated with lack of access to safe drinking water, inadequate sanitation and poor hygiene. In this paper we review the impact of water shortages on health and human development.

Water conservation: an emerging but vital issue in hemodialysis therapy.

Water conservation refers to reducing the usage of water and recycling of wastewater for different purposes such as irrigation, laundry and sanitation. As water scarcity increases worldwide, dialysis facilities should be focused on salvaging water. However, most of them still ignorantly discard to the sewer huge volumes of this reusable resource. This article reviews the current water conservation techniques in hemodialysis and the potential benefits drawn when using this technology.

Current understanding of ozone use for disinfecting hemodialysis water treatment systems.

BACKGROUND: Water treatment systems are susceptible to microbial contaminations and periodical disinfection procedures are mandatory to obtain results requested from international standards. According to the Association for the Advancement of Medical Instrumentation, ozone is the most effective method to destroy microorganisms, and to prevent, reduce or remove the biofilm. This study aims to review the literature on the application of ozone in the disinfection of water treatment systems for hemodialysis. METHODS: Data were obtained from databases (Ovid MEDLINE, Cochrane, EMBASE, and others). RESULTS: Ozone is quite effective in killing bacteria and degrading endotoxins and biofilm, with efficacy being concentration- and time-dependent. However, being a strong oxidant, appropriately compatible materials should be used. Also ozone production should be monitored and its level in ambient air should also be checked periodically to maintain a contamination air standard of 0.1 ppm. CONCLUSION: Ozone appears to be promising in hemodialysis. However, further investigations are necessary to approve its wider use.

Severe jaw enlargement associated with uremic hyperparathyroidism.

Marked enlargement of the jaws is a rare complication of renal osteodystrophy. This report describes a localized enlargement of the mandible due to a brown tumor in a patient undergoing chronic hemodialysis. Literature on jaw involvement in secondary hyperparathyroidism is reviewed.

Recycling wastewater after hemodialysis: an environmental analysis for alternative water sources in arid regions.

Water is a vital aspect of hemodialysis. During the procedure, large volumes of water are used to prepare dialysate and clean and reprocess machines. This report evaluates the technical and economic feasibility of recycling hemodialysis wastewater for irrigation uses, such as watering gardens and landscape plantings. Water characteristics, possible recycling methods, and production costs of treated water are discussed in terms of the quality of the generated wastewater. A cost-benefit analysis is also performed through comparison of intended cost with that of seawater desalination, which is widely used in irrigation.