The impact of COVID-19 pandemic in medical waste amounts: a case study from a high-populated city of Turkey.

In this study, the amount of medical waste generated in a high-populated city in Turkey between January 2018 and August 2021 was evaluated, and the effect of the COVID-19 pandemic on waste amounts and waste production rate was investigated. While a total of 79,027 kg/month of medical waste was produced in the city before COVID-19, this value reached 116,714 kg/month after COVID-19. The increase in the amount of medical waste due to the COVID-19 pandemic in the province was calculated as 48% on average. It was determined that 75% of this waste amount originates from public hospitals in the city. While the production of medical waste was 0.86 kg/bed day in the pre-COVID-19 period, this value increased to 0.96 kg/bed day in 2020 and to 1.34 kg/bed day in 2021 with the COVID-19 pandemic. According to the results obtained, the amount of medical waste reached in the province due to COVID-19 is the amount of medical waste expected to be generated in the 2040s under normal conditions. It is a very important issue in terms of public health that the capacity of waste disposal in medical waste management in cities is flexible to respond to severe epidemic conditions. Based on the information obtained within the scope of the study, changes in the amount of medical waste in a city with a dense population under pandemic conditions can be obtained based on real data and projections regarding disposal capacity can be made more realistically. Supplementary Information: The online version contains supplementary material available at 10.1007/s10163-022-01428-3.

The evaluation of the sensitivity and specificity of wrist examination findings for predicting fractures.

BACKGROUND: The aim of this study was to evaluate the sensitivity and specificity of physical examination findings and functional tests in adult acute wrist trauma patients who presented to the emergency department (ED) and to create a reliable and practical clinical decision rule for determining the necessity of radiography in wrist trauma. METHODS: This prospective observational study was conducted in a tertiary ED. Each patient was checked for 18 physical examination findings and functional tests. Patients with suspected fracture were enrolled consecutively. Antero-posterior and lateral wrist views were performed for each patient. All radiographical studies were interpreted by an orthopedic surgeon. The prevalence, sensitivity and specificity, negative and positive predictive values of each finding were calculated. A modeling for predicting fractures was created using computer. RESULTS: 207 patients were evaluated and 69 patients (33.3%) had fractures. The most common encounterd fracture site was distal radius (29.5%). The most sensitive examination finding was pain in dorsiflexion (95.7%) and the most specific finding was ecchymosis (97.8%). Wrist edema, deformity and pain aggravated by pronation were found to be strong predictors of fracture. The area under the receiver operating characteristic curve at internal validation for a prediction model based on these three predictors was 0.88 (95% CI: 0.83-0,93). The overall sensitivity and specificity of this model were 94% (95% CI: 85-98%) and 51% (95% CI 43-60%) respectively. According to the model created in this study, 34% of acute blunt wrist trauma patients do not require any X-ray imaging. CONCLUSIONS: This triple modeling may be used as an effective decision rule for predicting all wrist fractures in the ED and in the disaster setting.

Methylenetetrahydrofolate reductase C677T and A1298C gene polymorphisms and therapy-related toxicity in children treated for acute lymphoblastic leukemia and non-Hodgkin lymphoma.

This study aimed to investigate the association of the methylenetetrahydrofolate reductase (MTHFR) gene C677T and A1298C polymorphisms with serum drug levels and toxicities after high-dose methotrexate (MTX) infusion. The study included 37 children with acute lymphoblastic leukemia or non-Hodgkin lymphoma. Serum MTX levels and toxicities of bone marrow, liver and kidney were analysed. Genotype analysis of the C677T and A1298C gene polymorphisms from genomic DNA of the subjects was performed by real-time PCR. Subjects with MTHFR polymorphism for C677T (CT, TT) had significantly higher MTX levels at 24 h (p = 0.009), and these genotypes did not seem to cause toxicity. Subjects with MTHFR polymorphism for A1298C (AC, CC) had significantly higher MTX levels at 48 h (p = 0.02), and had more grade III/IV anemia (p = 0.02), thrombocytopenia (p = 0.0001), elevated AST levels (p = 0.04) and frequent febrile neutropenic episodes (p = 0.004). The present study suggests that A1298C gene, but not C677T polymorphism is associated with MTX-related toxicity.