Enhanced nutrient recovery from anaerobically digested poultry wastewater through struvite precipitation by organic acid pre-treatment and seeding in a bubble column electrolytic reactor.

Limited mineralization of organic phosphorus to phosphate during the anaerobic digestion process poses a significant challenge in the development of cost-effective nutrient recovery strategies from anaerobically digested poultry wastewater (ADPW). This study investigated the influence of organic acids on phosphorus solubilization from ADPW, followed by its recycling in the form of struvite using a bubble column electrolytic reactor (BCER) without adding chemicals. The impact of seeding on the efficiency of PO43- and NH3-N recovery as well as the size distribution of recovered precipitates from the acid pre-treated ADPW was also evaluated. Pre-treatment of the ADPW with oxalic acid achieved complete solubilization of phosphorus, reaching ∼100% extraction efficiency at pH 2.5. The maximum removal efficiency of phosphate and ammonia-nitrogen from the ADPW were 88.9% and 90.1%, respectively, while the addition of 5 and 10 g/L struvite seed to the BCER increased PO43- removal efficiency by 9.6% and 11.5%, respectively. The value of the kinetic rate constant, k, increased from 0.0176 min-1 (unseeded) to 0.0198 min-1, 0.0307 min-1, and 0.0375 min-1 with the seed loading rate of 2, 5, and 10 g/L, respectively. Concurrently, the average particle size rose from 75.3 µm (unseeded) to 82.1 µm, 125.7 µm, and 148.9 µm, respectively. Results from XRD, FTIR, EDS, and dissolved chemical analysis revealed that the solid product obtained from the recovery process was a multi-nutrient fertilizer consisting of 94.7% struvite with negligible levels of heavy metals.

Experiences of nurses regarding challenges faced while dealing with psychiatric patients in both public and private tertiary care hospitals of Karachi, Pakistan.

OBJECTIVE: To explore the challenges of mental health nurses in dealing with psychiatric patients. METHODS: The qualitative, descriptive, phenomenological study was conducted at three public and private psychiatric setups in Karachi from August 13 to October 30, 2018, and comprised mental health nurses having a minimum 6-month experience of working in a psychiatric ward. Data was collected using focus group discussion using a semi-structured interview guide. The proceedings were transcribed, translated and analysed using thematic analysis, leading to the formation of themes, categories and sub-categories. RESULTS: Of the 15 nurses with mean age 25±1.95 years, 5(33.3%) were from the public sector and 10(66.6%) were associated with private-sector institutions. Besides, 7(46.6%) nurses had work experience up to 5 years. There were three sessions of focus group discussion; 1(33.3%) of public-sector nurses and 2(66.6%) of priver-sector nurses. Each session had 5(33.3%) participants. Post-transcription feedback was provided by 8(53%) nurses. There were 4 themes; lack of resources, safety-related challenges, lack of staff capacity building, and lack of support. The themes overall had 14 categories and 7 sub-categories. CONCLUSIONS: The nurses exposed to patient aggression should be provided debriefing sessions to deal with possible burnout.

Evaluation of a liquid-phase plasma discharge process for ammonia oxidation in wastewater: Process optimization and kinetic modeling.

Removing ammonia-nitrogen (NH3N) from wastewater is of paramount importance for wastewater treatment. In this study, a novel continuous liquid plasma process (CLPD) was evaluated to remove NH3N from synthetic wastewater. The Box-Behnken experimental design was used to optimize the main process parameters, including the initial NH3N concentration (50-200 mg/L), power input (150-300 W), and gas-flow rate (1.5-2.5 L/min), for efficient NH3N removal from wastewater. The gas-flow rate and power input were found to be significant factors affecting the removal efficiency of NH3N, whereas the initial concentration of NH3N played a vital role in determining the energy efficiency of the process. Under the optimal conditions of an initial NH3N concentration of 200 mg/L, applied power of 223 W, and gas-flow rate of 2.4 L/min, 98.91% of NH3N could be removed with a N2 selectivity of 92.91%, and the corresponding energy efficiency was 0.527 g/kWh after 2 hrs of treatment. A small fraction of undesirable NO3--N (7.05 mg/L) and NO2--N (2.83 mg/L) were also produced. Kinetic modeling revealed that NH3N degradation by the CLPD followed a pseudo-first-order reaction model, with a rate constant (k) of 0.03522 min-1. Optical emission spectroscopy (OES) was used to gather information about the active chemical species produced during the plasma discharge. The obtained spectra revealed the presence of several highly oxidative radicals, including ‧OH, ‧O, and ‧O2+. These results demonstrate the potential of liquid phase plasma discharge as a highly efficient technology for removing ammonia from aqueous solutions.

Synchronous Microscopic Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma of the Adrenal and Lymphoplasmacytic Lymphoma: De Novo Disease or Transformation?

Lymphomas arising in the adrenal are rare, and to our knowledge, 2 cases of Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphomas (DLBCL) in an adrenal pseudocyst have been reported. We report an incidental EBV-positive DLBCL arising in an adrenal pseudocyst in a 58-year-old man with a 7-year history of lymphoplasmacytic lymphoma (LPL). The DLBCL was present in the fibrinous exudate, while the LPL resided in the cyst wall. The patient underwent de-roofing of the same cyst 3 years previously; review of histology revealed foci of LPL in the cyst wall, but not of DLBCL. There have been reports of similar microscopic EBV-positive DLBCLs within enclosed cystic spaces. However, all these cases were incidental extranodal primary DLBCLs. Since residual LPL was present alongside DLBCL, with similar light chain restriction, we propose that this may represent transformation, rather than a de novo primary EBV-driven lymphoma.

Adrenal lymphangioma presenting as a non-functional adrenal cyst.

Lymphangiomas are neoplastic lesions derived from lymphatic endothelium. They are largely encountered in the head and neck region. We describe a case of an adrenal lymphangioma, an extremely uncommon cystic lesion of the adrenal and discuss the differential diagnosis, clinical, imaging, histopathologic and immunophenotypic features of this lesion.

"Delayed Villous Maturation" in Placental Reporting: Concordance among Consultant Pediatric Pathologists at a Single Specialist Center.

Delayed villous maturation (DVM) has been associated with an increased risk of adverse pregnancy outcome, including stillbirth, in the late third trimester, but there are limited published data. Moreover, it is recognized that the assessment of villous maturation is subjective and hampered by both intraobserver and interobserver variability. This audit aims to assess concordance in the reporting of DVM among pediatric pathologists at a single specialist center to improve reproducibility of this potentially important diagnosis. This is a retrospective review of singleton placentas from pregnancies at 35 weeks gestation or greater submitted for histopathologic examination between June 2013 and December 2013. Placental slides were reviewed independently by 4 pediatric pathologists, blinded to the original report, apart from gestational age; villous maturation was assessed as appropriate, accelerated, or delayed for the stated gestational age. A total of 464 placental histopathology reports were reviewed, of which 164 were greater than 35 weeks gestation; of those, 42 (26%) were originally reported as DVM. Following the audit slide review, 38 cases (23%) were assessed to show DVM by at least 1 pathologist. Consensus, with at least 3 pathologists agreeing to a diagnosis of DVM, was achieved in only 14 cases (9% of all cases reviewed; 37% of all cases called DVM). However, the proportion of overall agreement between 2 of the pathologists was 0.92. Concordance for DVM is poor among pathologists and subject to much interobserver variability. Consistency may be improved by consensus histologic review of all the placentas in which the diagnosis of DVM is being considered and stringent application of the published diagnostic criteria.

Study Protocol: Validation and Adaptation of community-worker-administered stroke symptom questionnaire in a periurban Pakistani community to determine disease burden.

BACKGROUND: Stroke is the second leading cause of mortality and the leading cause of disability in the world today. The disease burden is on the rise in developing nations, but there is scarcity of data from these regions to inform policy decisions. Stroke burden can be determined by clinical diagnosis alone in the public health context and is a far more feasible way to assess disease status in low- to middle-income countries like Pakistan. We aim to translate and adapt a validated stroke symptom questionnaire, train community health workers in its administration, and verify it against assessment by two trained neurologists. METHODS/DESIGN: This is a prospective study, which we aim to carry out in Ibrahim Hyderi, a periurban slum of Karachi. We translated into Urdu the questionnaire for verifying stroke free status (QVSFS), which is an internationally validated tool to assess the same. Two community health workers (CHW) will be identified and will receive training by neurologists, which will include teaching regarding stroke pathophysiology, symptomatology, and detection. They will be familiarized with the QVSFS, and their questionnaire administration will be assessed through roleplay. We intend to recruit 322 subjects from the same community and the CHWs will gather data on them. The same subjects will later be assessed by two trained neurologists, and the findings collaborated to validate those obtained by the CHWs. Sensitivity, specificity, positive and negative predictive values, and Cohen's kappa will be determined for the CHW-administered questionnaire tested against assessment by two neurologists together and separately for the two CHWs. Data analysis will be done using SPSS version 19.0. DISCUSSION: The results of this study will determine if and how well CHW-administered questionnaires are at assessing stroke status in a community. This will facilitate use of the same as a practical alternative for stroke surveillance in the country. TRIAL REGISTRATION: NCT02073955.

Can trained field community workers identify stroke using a stroke symptom questionnaire as well as neurologists? Adaptation and validation of a community worker administered stroke symptom questionnaire in a peri-urban Pakistani community.

BACKGROUND: Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by community health workers (CHWs) are required to identify stroke in the community in a resource-strapped region such as this. METHODS: The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire to Verify Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community-dwelling subjects using purposive sampling. Each CHW collected data independently, which was validated by a vascular neurologist who directly examined each participant. To assess the effect of audit and feedback, data from the final 10% of the subjects were collected after a second training session for the CHWs. Sensitivity, specificity, and Cohen kappa were determined for the CHW-administered questionnaire against neurovascular assessment. RESULTS: Mean age of participants was 56.5 years with 71% of participants being women. The sensitivity and specificity of the questionnaire of detecting stroke was 77.1% (confidence interval [CI], 64.1-86.9) and 85.8% (CI, 83.5-87.5), respectively. The chance-corrected agreement using the Cohen kappa statistic was .51 (CI, .38-.60). Kappa ranged from .37 to .58 for each of the 7 stroke symptoms. Hemianesthesia (72.9%) and hemiplegia (64.6%) were the most sensitive symptoms. The performance and agreement improved from moderate to substantial after audit and feedback. CONCLUSIONS: We found a reasonable sensitivity and specificity and moderate agreement between CHW-administered QVSFS and assessment by a vascular neurologist.