Ferrate as a coagulant prior to sand filters treating secondary wastewater effluent for reuse.

Wastewater reuse is one of the crucial water resources in Egypt due to the ongoing need to increase water resources and close the supply-demand gap. In this study, a new coagulant has been investigated before sand filters as an advanced wastewater treatment method. The sand filter pilot was run at a hydraulic loading rate of 0.75 m/h and two different dosages of three coagulants (Alum, FeCl3, and Ferrate VI) were selected using the jar tests. The sand filter without coagulant removed 12% of BOD5 and 70% of turbidity. Applying in-line coagulation before the sand filter provided effluents with better quality, especially for turbidity, organics, and microorganisms. Ferrate provided the highest removal of turbidity (90%) and BOD5 (93%) at very low dosages and lower costs compared with other coagulants, however, it adversely impacted both conductivity and dissolved solids. A significant effect on reducing bacteria was obtained with 40.0 mg/L of alum. According to the study's findings, the ferrate coagulant enhanced the sand filter's performance producing effluents with high quality, enabling it to meet strict water reuse regulations as well as aquatic environmental and health preservations.

In-line coagulation assessment for ultrafiltration fouling reduction to treat secondary effluent for water reuse.

Low pressure membranes are attracting attention for their potential to improve secondary effluent quality, but membrane fouling can limit their widespread applicability. In this study, in-line coagulation as pre-treatment to ultrafiltration (UF) was investigated using a bench-scale hollow fiber membrane at a constant flux of 33 L/m2 h. Membrane fouling was monitored by observing change in trans-membrane pressure when the membrane was fed with secondary effluent and in-line coagulated secondary effluent over a 24-h period. The impact of four coagulants at different dosages on reversible and irreversible membrane fouling and permeate quality was studied. It was found that in-line coagulation improved UF performance to varying degrees depending on coagulant type and dosage. Generally, higher reduction of fouling was achieved by increasing coagulant dosage within the 0.5-5.0 mg/L range investigated. Ferric-based coagulants were better than aluminum-based coagulants with respect to improving membrane performance for the secondary effluent investigated, even at low dosages (0.5 mg/L). Further investigations are required to determine how in-line coagulation affects removal of organic compounds through UF membranes.

Patient-Reported Outcome in Two Chronic Diseases: A Comparison of Quality of Life and Response Profiles in Severe Migraine and Severe Asthma.

INTRODUCTION: Migraine and asthma are two frequent, disabling, chronic disorders with a major impact on patient well-being. The objectives of this study were to compare subjective well-being between patients with severe forms of migraine or asthma using a panel of PROs. METHODS: Adult patients were recruited during routine consultations with chest physicians or neurologists. Patients with severe migraine (reporting headaches on ≥8 days/month and having failed ≥2 prophylactic treatments) and patients with severe asthma (according to the 2017 GINA definition: requiring Step 4 or 5 treatment or presenting uncontrolled symptoms) were eligible. Each patient completed the EuroQol Questionnaire (EQ-5D-5L), the Work Productivity and Activity Impairment Questionnaire (WPAI) and the Hospital Anxiety and Depression scale (HAD). Patients with severe migraine the 6-item Headache Impact Test (HIT-6) and those with severe asthma completed the Asthma Control Test (ACT). RESULTS: 249 patients with severe migraine and 96 with severe asthma were enrolled. Mean EQ-5D-5L utility scores were significantly higher in the severe migraine group than in the severe asthma group (0.75±0.25 vs 0.68±0.26; p<0.01). Low EQ-5D-5L utility scores were associated with frequent (≥15 headache days/month) or disabling (HIT-6 score ≥60) headaches and with poor asthma control. Patients with severe migraine more frequently presented a HAD depression score ≥11 (23.0% in severe migraine; 7.5% in severe asthma; p<0.01), whereas those with severe asthma more frequently reported problems with mobility, self-care and usual activities. Absenteeism (percent worktime missed) was similar in both groups (severe migraine: 9.0%±19.1%; severe asthma: 13.8%±22.9%) but work impairment was higher in the severe migraine group (44.3% vs 28.4%; p<0.01). CONCLUSION: Quality of life, work activity and psychological distress are all deteriorated in both severe migraine and severe asthma. Different aspects are affected in the two diseases: a greater impact on psychological aspects in severe migraine and a greater impact on physical aspects in severe asthma.

Migraine burden and costs in France: a nationwide claims database analysis of triptan users.

Objectives: To estimate the burden of migraine in the population of French patients identified as specific migraine acute treatment users compared to a control group. Methods: A cross-sectional retrospective analysis was performed on the Echantillon Généraliste des Bénéficiaires claims database, a 1/97 random sample of the French public insurance database. A representative sample of all adults with at least one delivery of triptans, ergot derivatives or acetylsalicylic acid/metoclopramide (all drugs with a specific label in migraine acute treatment - SMAT) in 2014 was selected with a control group matched on age, gender and geographic region. Among triptan users, a sub-group of over-users was defined according to their level of triptan uptake expressed in defined daily doses (DDD - a standard daily dose of treatment of acute migraine) per month over 3 months and more, was also compared with controls. The cost analysis was performed in a societal perspective for direct costs. Sick leave indirect costs were estimated using the human capital approach. Results: In total 8639 SMAT users (mean age: 44.6 years; 78.7% women) were selected representing a crude prevalence rate of 1.7%. The annual per capita total healthcare expenditures were higher by €280 in this group compared to controls (€2463 vs. €2183). Triptans contributed 47.8% to this extra cost. They used significantly (p < .0001) more frequently than controls antidepressants (20.8% vs. 11.0%), anxiolytics (29.4% vs. 18.8%) and analgesics (53.8% vs. 35.8%). The per capita annual productivity loss associated with sick leave was higher by €295 (€1712 vs. €1417). Among triptan users, there were 2.9% over-users. This last group was characterized by substantially higher per capita annual extra direct (+ €1805) and indirect costs (productivity loss +€706) compared to controls. Conclusions: Due to its high prevalence, migraine costs generate a significant societal burden. The group of over-users concentrates high per capita direct and indirect costs.

Characterization of thalamic neuronal responses to urinary bladder distention, including the effect of acute spinal lesions in the rat.

UNLABELLED: Chronic visceral pain has proved to be difficult to treat. This study characterized urinary bladder distention (UBD)-evoked responses of neurons located within the ventrobasal group of the thalamus. Units were also characterized for responses to cutaneous stimuli and colorectal distention (CRD). In addition, the effects of spinal lesions on UBD-evoked responses were examined in a subset of neurons. After a stable response to UBD was established, 3 sequential lesions of the spinal cord at the mid-cervical level were performed, and responses to UBD were determined 1 and 5 minutes later. A majority of the neurons in the ventrobasal group of the thalamus were excited by UBD, demonstrated graded responses to graded distention pressures, and responded to cutaneous stimulation. No correlation between the magnitude of the responses of thalamic neurons to UBD and CRD was found. UBD-evoked thalamic neuronal activity was significantly attenuated after dorsal midline lesions of the spinal cord. The present study is a quantitative description of ventrobasal thalamic neuronal responses to UBD in the rat and provides direct neurophysiologic evidence that nociceptive information from the urinary bladder to the ventrobasal group of the thalamus ascends via a dorsal midline pathway. PERSPECTIVE: The effect of dorsal midline lesions is of profound clinical interest because it points to a potential treatment for urinary bladder pain, such as that which is characteristic of interstitial cystitis. Further research might reveal pharmacologic approaches to modulate this pain pathway and result in novel treatments for interstitial cystitis.

Acute tuberculous abscess of the thyroid gland.

The authors are presenting our experience of managing an interesting case of a 28-year-old woman who presented to our clinic with a midline neck swelling of 1-month duration. There was a rapid increase in the degree of swelling associated with erythema, pain and fever 7 days before seeking medical help. Plain and contrast-enhanced CT scans of the neck were done. Diagnosis of acute suppurative abscess was made and the patient underwent emergency incision and drainage. Histopathological examination of the abscess wall showed epitheloid and Langhans' giant cells. The findings were suggestive of tuberculosis. Subsequently, a positive culture for Mycobacterium tuberculosis was obtained on Lowenstein-Jenson medium. The patient was started on antituberculous chemotherapy for 6 months. On a 6-month clinical follow-up, the patient was asymptomatic and euthyroid. We discuss the clinical presentation, diagnosis and treatment of this case as well as a review of the literature.