Enhancement of nutrient removal performance of activated sludge with a novel hybrid biofilm process.

The aim of this study was to investigate the efficacy of a hybrid biofilm pilot-scale treatment plant, designed with a novel configuration by the integration of a fixed-film system, to improve nitrogen removal. The pilot-scale system was established at a wastewater treatment plant in Istanbul and operated based on stream separation following a process consisting of Bio-P and primary sedimentation units in which carbonaceous compounds were entrapped/incorporated in settled biomass. The ammonia-rich supernatant was directed to a moving bed biofilm (MBBR) nitrification tank to obtain an efficient nitrification with the reduced organic loading after the primary sedimentation. The conventional activated sludge process, for which the net specific growth rate ([Formula: see text]) was measured to be 0.26 day-1 at 15 °C, exhibited a low nitrification capacity. However, the pilot-scale hybrid biofilm system secured nitrification performance up to 1.8 gN/m2/day ammonia loading, providing a competitive advantage over the conventional single sludge systems. The proposed hybrid configuration enables removal efficiencies of 80% and 85% for total nitrogen and phosphorus. It was possible to entrap organic matter by mixing 30% of return activated sludge (RAS) with raw wastewater. Simulation-based design study showed that the use of the hybrid biofilm system reduces the environmental footprint and aeration requirement of the nutrient removal by about 50% and 19%, respectively. Economic analyses highlighting the benefit of hybrid biofilm over conventional BNR system are illustrated.

Identifying the determinants of microalbuminuria in obese patients in primary care units: the effects of blood pressure, random plasma glucose and other risk factors.

OBJECTIVE: The objective of this study is to evaluate the demographic characteristics, blood pressure and blood glucose and the other related factors that affect the microalbuminuria levels in the obese patients aged 40 and above who applied to the primary care for medical evaluation. MATERIALS AND METHODS: The population of the research, which was a cross-sectional type, comprised obese patients aged 40 and above who had applied to the community health centers in the center of Malatya. A total of 422 obese patients consisting of 116 males and 306 females were included in the research. The anthropometric measurements of the participants were determined, their blood pressures and their random blood glucoses were evaluated, as well. A microalbuminuria measurement was performed in the urine samples taken from the patients using "Nycocard Reader II" device. FINDINGS: The incidence of microalbuminuria in patients was found as 31.5%, whereas the incidence of macroalbuminuria was 6.6%. The incidence of microalbuminuria in female patients was 32.7%, while it was 28.4% in male patients; on the other hand, the incidence of macroalbuminuria in female patients was found as 6.8%, whereas this percentage was determined as 7.8 in male patients (p > 0.05). The probability of the incidence of microalbuminuria increased 2.8 times more in those with the diastolic blood pressure of 90 mmHg and above when compared to those without it (GA: 1.79-4.56), whereas the incidence increased 3.2 times more in those with the random blood glucose of 200 mg/l and above (GA: 1.32-7.84) (p < 0.001). In our study, among the variables predicting the microalbuminuria in obese patients; the cutoff values of the diastolic and systolic blood pressures, the waist circumference were found as >85 mmHg; >130 mmHg; >141 mg/dl, respectively, in male patients and found as >85 mmHg, >114 cm, and 109 cm, respectively, in female patients. The sensitivity and specificity of the tests indicating the cutoff values showed significance (p < 0.05). There was no statistically significant relevance between the microalbumin levels of the obese patients via the anthropometric criteria, except for their waist circumference (p > 0.05). RESULT: In this study, the blood pressure and blood glucose levels of the patients along with their waist circumference that indicated a central obesity were specified as the determinants of microalbuminuria. While the obese patients are being evaluated in terms of proteinuria, the cutoff values of these variables can be taken into consideration.

Evaluation of inferior turbinate hypertrophy in patients with congenital and traumatic nasal septum deviation.

OBJECTIVE: To compare mucosal and bony measurements in patients with congenital and traumatic nasal septum deviation and compensatory inferior turbinate hypertrophy. METHODS: The study examined 50 patients with nasal septum deviation (25 congenital and 25 traumatic) and compensatory inferior turbinate hypertrophy in the contralateral nasal cavity, confirmed by computed tomography. RESULTS: The study compared inferior turbinate measurements on the concave and convex sides of the septum, in the congenital and traumatic groups. MEASUREMENTS COMPRISED: the shortest distance from the median line to the medial border of the conchal bone; the distances from the most medial part of the conchal mucosa and the conchal bone to the lateral line; the projection angle of the inferior turbinate; and the widest parts of the whole inferior turbinate and the inferior turbinate conchal bone. The differences between the concave and convex side measurements were compared in the congenital group versus the traumatic group; for three measurements, the difference between these two groups was statistically significant (p < 0.05). CONCLUSION: The present study findings suggest that the conchal bone has a marked influence on nasal patency in patients with congenital septal deviation. These findings supported the decision to excise the inferior turbinate bone at the time of septoplasty, especially when treating congenital septal deviation.

Are standard wastewater treatment plant design methods suitable for any municipal wastewater?

The design and operational parameters of an activated sludge system were analyzed treating the municipal wastewaters in Istanbul. The design methods of ATV131, Metcalf & Eddy together with model simulations were compared with actual plant operational data. The activated sludge model parameters were determined using 3-month dynamic data for the biological nutrient removal plant. The ATV131 method yielded closer sludge production, total oxygen requirement and effluent nitrogen levels to the real plant after adopting correct influent chemical oxygen demand (COD) fractionation. The enhanced biological phosphorus removal (EBPR) could not easily be predicted with ATV131 method due to low volatile fatty acids (VFA) potential.

Multiple relapses in extramedullary localization of acute lymphoblastic leukemia.

Extramedullary relapses of acute lymphoblastic leukemia in children and young adults are rare and in most cases are usually related to the central nervous system or testes. We describe a case of a 25-year-old man with an acute lymphoblastic leukemia with multiple extramedullary relapses in the testes, gallbladder, breast, parotid gland and eye at various times (Fig. 5, Ref. 21).

Rubella seroprevalence in an unvaccinated pregnant population in Malatya, Turkey.

BACKGROUND: Controlling congenital rubella by 2010 is one of the targets of the World Health Organization. Most European countries currently include rubella vaccine in their national immunization programmes, but not yet in Turkey. OBJECTIVES: To define rubella seroprevalence in pregnancy in Malatya, Turkey. STUDY DESIGN: A cross-sectional interview survey was conducted among pregnant women living in Malatya province from November 2003 to May 2004, together with a follow-up component. METHODS: Stratified probability proportional to size sampling methodology. A total of 824 pregnant women from 60 clusters were enrolled. After obtaining informed consent, participants' socio-demographic and fertility characteristics were collected by interview questionnaire. Various blood samples were drawn. After storing serum samples at -20 degrees C for 6 months, anti-rubella IgM and IgG titres were studied by micro ELISA. Only 803 sera were eligible for serological study. RESULTS: Of the 803 samples tested for rubella antibodies, 753 cases (93.8%) had anti-rubella IgG positivity, indicating past infection. Five of the pregnant women (0.6%) had both anti-rubella IgM and IgG positive results, suggesting a recent infection. The remaining 45 women (5.6%) were seronegative for both antibodies. Seroprevalence was not associated with age or urban/rural residency. All the five anti-rubella IgM positive women were in the second trimester of pregnancy. CONCLUSIONS: As 5.6% of pregnant women were susceptible to rubella during pregnancy, and five of them had already had a recent infection, immunization efforts should be directed at babies and adolescents.

[Orbital manifestation of Wegener's granulomatosis]. / Manifestación orbitaria de la enfermedad de Wegener.

CASE REPORT: Patient who consults for a recidivant orbital mass. Preliminary clinical and image studies suggested an initial differential diagnosis between a lachrymal gland tumor or an orbital located pseudotumor. However, the clinical evolution of the case required a re-evaluation of the preliminary diagnosis. The clinical, histologic and serologic findings were key in the final diagnosis. DISCUSSION: Wegener's granulomatosis is a necrotizing vasculitis. Classically it affects the upper airways, lungs and kidneys. Between 30% and 70% of patients present ophthalmic symptoms during the course of the illness. Ophthalmic affectation prior to systemic manifestations is less frequent and could delay final diagnosis.

Evaluation of the immune response to hepatitis B vaccination in children aged 1-3 years in Malatya, Turkey.

By the end of 1998, Turkey had launched the routine vaccination of infants against hepatitis B. The purpose of the study is to evaluate the immune response in a sample of vaccinated children aged 1-3 years in the city of Malatya. A total of 210 vaccinated children 12 to 48 months old were selected for the study with 30 cluster sampling in the city of Malatya, Turkey. The children were visited at their homes during January-April 2002. The information on demographic characteristics, family's and child's medical history was gathered, childrens' weight and height were measured and blood samples were taken. Anti-HBs, HbsAg and anti-HBc titers were assayed by micro-ELIZA from the sera. The mean age of the children was 26.3 months, 100 (47.6%) were male and 110 (52.4%) were female. Overall, 203 (96.7%) children had protective anti-HBs levels (> or = 10 IU/l), 0.5% showed evidence of natural infection (with positive anti-HBc and anti-HBs titers), 0.5% had acute or chronic infection (with positive HbsAg and anti-HBc titers) and 2.3% were seronegative. Geometric mean titer of anti-HBs among vaccinated children except those who had positive anti-HBc titers was 138.7 mIU/ml (95% CI:124.7-154.2) and seroconversion rates did not differ by age, sex, anthropometric measurements, time after third dose and place of vaccine administered (P > 0.05). The high seroprotection rate over 95% showed that routine infant vaccination program for hepatitis B was successfully carried out in the city Malatya.