GENDER DIFFERENCES IN THE CLINICAL PROFILE AND SOCIODEMOGRAPHIC CHARACTERISTICS OF DILATED CARDIOMYOPATHY IN IBADAN, NIGERIA.

Background: Cardiomyopathies contribute about 18.2-40.2% (average- 21.4%) to the global burden of heart failure of which dilated cardiomyopathy (DCM) is a major cause. DCM is the second commonest cause of heart failure in Ibadan. The gender differences in the clinical profile has not been described in our setting. Objective: In this study, we set out to describe the gender differences in the pattern and presentation of DCM at the University College Hospital, Ibadan, Nigeria. Methods: This was an analysis of a prospectively collected data over a period of 5 years (August 1, 2016 to July 31, 2021). Results: A total of 117 subjects, 88 males (75.3%) and 29 females (24.8%) aged 50.30 ± 14.7 years (range, 17 to 86 years). Males had significantly achieved a higher educational level than females (p = 0.004). Males were more likely to be employed and had more monthly income compared to females. Males were significantly more likely to use alcohol and smoke cigarette (p = 0.0001 and 0.001 respectively). Females were more likely to be in NYHA class III/IV. There was no statistically significant difference in the relationship between any medication and gender of participants (p > 0.05). Conclusions: DCM is a disease of young and middle-aged adults in our population. The commonest age group was 20-39 years and there was male preponderance. There were some gender differences in the clinical profile of the disease in our environment.

Concurrent hydrogen production and phosphorus recovery in dual chamber microbial electrolysis cell.

Concurrent hydrogen (H2) production and phosphorus (P) recovery were investigated in dual chamber microbial electrolysis cells (MECs). The aim of the study was to explore and understand the influence of applied voltage and influent COD concentration on concurrent H2 production and P recovery in MEC. P was efficiently precipitated at the cathode chamber and the precipitated crystals were verified as struvite, using X-ray diffraction and scanning electron microscopy analysis. The maximum P precipitation efficiency achieved by the MEC was 95%, and the maximum H2 production rate was 0.28m3-H2/m3-d. Response surface methodology showed that applied voltage had a great influence on H2 production and P recovery, while influent COD concentration had a significant effect on P recovery only. The overall energy recovery in the MEC was low and ranged from 25±1 to 37±1.7%. These results confirmed MECs capability for concurrent H2 production and P recovery.

Performance assessment and microbial diversity of two pilot scale multi-stage sub-surface flow constructed wetland systems.

This study assessed the performance and diversity of microbial communities in multi-stage sub-surface flow constructed wetland systems (CWs). Our aim was to assess the impact of configuration on treatment performance and microbial diversity in the systems. Results indicate that at loading rates up to 100gBOD5/(m(2)·day), similar treatment performances can be achieved using either a 3 or 4 stage configuration. In the case of phosphorus (P), the impact of configuration was less obvious and a minimum of 80% P removal can be expected for loadings up to 10gP/(m(2)·day) based on the performance results obtained within the first 16months of operation. Microbial analysis showed an increased bacterial diversity in stage four compared to the first stage. These results indicate that the design and configuration of multi-stage constructed wetland systems may have an impact on the treatment performance and the composition of the microbial community in the systems, and such knowledge can be used to improve their design and performance.

Nitrogen dynamics model for a pilot field-scale novel dewatered alum sludge cake-based constructed wetland system.

A model simulating the effluent nitrogen (N) concentration of treated animal farm wastewater in a pilot on-site constructed wetland (CW) system, using dewatered alum sludge cake (DASC) as wetland substrate, is presented. The N-model was developed based on the Structural Thinking Experiential Learning Laboratory with Animation software and is considering organic nitrogen, ammonia nitrogen (NH3) and nitrate nitrogen (NO3-N) as the major forms of nitrogen involved in the transformation chains. Ammonification (AMM), ammonia volatilization, nitrification (NIT), denitrification, plant uptake, plant decaying and uptake of inorganic nitrogen by algae and bacteria were considered in this model. pH, dissolved oxygen, temperature, precipitation, solar radiation and nitrogen concentrations were considered as forcing functions in the model. The model was calibrated by observed data with a reasonable agreement prior to its applications. The simulated effluent detritus nitrogen, NH4-N, NO3-N and TN had a considerably good agreement with the observed results. The mass balance analysis shows that NIT accounts for 65.60%, adsorption (ad) (11.90%), AMM (8.90%) followed by NH4-N (Plants) (5.90%) and NO3-N (Plants) (4.40%). The TN removal was found 52% of the total influent TN in the CW. This study suggested an improved overall performance of a DASC-based CW and efficient N removal from wastewater.

Epidemiology and Risk Factors for Diabetes in Semi-Urban Communities in South West, Nigeria.

BACKGROUND: Diabetes mellitus (DM) is a growing public health problem both in developing and developed countries. The prevalence of diabetes has doubled in the last 20 years. This study aimed to assess the burden of type 2 diabetes in semi-urban communities in Ekiti, South-West Nigeria. STUDY DESIGN: This study was part of a larger study to assess the prevalence of cardiovascular risk factors among adults (>18 years) dwellers in 10 semi-urban communities. A total of 750 respondents took part in the study, using stratified sampling method to recruit participants within these communities. They had their clinical history assessed, fasting blood glucose (FBG) determined and body mass indices measured. RESULTS: Of the 750 participants recruited 529 (70.5%) were females, 51 (6.8%) had FBG >7.0mmol/L (126mg/dl), hence were diagnosed as having DM and 45 participants (6.0%) had Impaired fasting glucose (IFG). Both DM and IFG were higher in males than females but the differences not statistically significantly. All indices of anthropometry (BMI, WC and WHR) were significantly higher in females than males. Family history of diabetes, age, BMI, WC and systolic hypertension were significantly associated with DM. CONCLUSION: The prevalence and risk factors for the development of DM and IFG are high in these communities. This requires prompt and adequate health promotion so as to reduce the burden of these conditions in this environment.

Process-based modelling of phosphorus removal in a novel constructed wetland system using dewatered alum-sludge as substrate.

A process-based model that can evaluate the transport and the fate of phosphorus (P) in agricultural wastewater was developed for a novel 4-stage dewatered alum sludge cakes (DASC) based constructed wetlands (CWs) system using STELLA software (version 9.1.4). The model considered adsorption, plant and microbial uptakes as the major forms of P involved in the transformation chains. The results were obtained by experimental procedure through laboratory measurement, from literature and/or calibration. The observed effluent P concentration in the CWs ranged from 3.62 to 8.50 mg/L (stage 1), 2.00 to 4.45 mg/L (stage 2), 1.39 to 3.76 mg/L (stage 3) and 0.52 to 2.36 mg/L (stage 4), whereas the simulated values ranged from 2.12 to 10.99 mg/L (stage 1), 1.32 to 5.65 mg/L (stage 2), 0.84 to 3.64 mg/L (stage 3) and 0.53 to 2.25 mg/L (stage 4), respectively. The simulated and observed values of P removal in the CWs system were in good agreement. A mass balance analysis was performed for all the major processes which resulted in a major pathway of P removal through adsorption (64-75%, 58-66%, 57-63% and 49-58%) followed by plant uptake (7-11%, 8-14%, 14-17% and 9-19%) and microbial uptake (3-7%, 3-5%, 9-12% and 7-12%) for stage 1, stage 2, stage 3 and stage 4, respectively. Thus the mathematical model developed in this study could be used to explain the removal processes and simulate the fate of P in the DASC-based CWS system.

STELLA software as a tool for modelling phosphorus removal in a constructed wetland employing dewatered alum sludge as main substrate.

A dynamic simulation model was developed for the removal of soluble reactive phosphorus (SRP) from the vertical flow constructed wetlands (VFCW) using a dynamic software program called STELLA (structural thinking, experiential learning laboratory with animation) 9.1.3 to aid in simulating the environmental nature and succession of relationship between interdependent components and processes in the VFCW system. In particular, the VFCW employed dewatered alum sludge as its main substrate to enhance phosphorus (P) immobilization. Although computer modelling of P in treatment wetland has been well studied especially in recent years, there is still a need to develop simple and realistic models that can be used for investigating the dynamics of SRP in VFCWs. The state variables included in the model are dissolved phosphorus (DISP), plant phosphorus (PLAP), detritus phosphorus (DETP), plant biomass (PLBI) and adsorbed phosphorus (ADSP). The major P transformation processes considered in this study were adsorption, plant and microbial uptake and decomposition. The forcing functions which were considered in the model are temperature, radiation, volume of wastewater, P concentration, contact time, flow rate and the adsorbent (i.e., alum sludge). The model results revealed that up to 72% of the SRP can be removed through adsorption process whereas the uptake by plants is about 20% and the remaining processes such as microbial P utilization and decomposition, accounted for 7% SRP removal based on the mass balance calculations. The results obtained indicate that the model can be used to simulate outflow SRP concentration, and it can also be used to estimate the amount of P removed by individual processes in the VFCW using alum-sludge as a substrate.

On the fit of statistical and the k-C* models to projecting treatment performance in a constructed wetland system.

The objective of this study was to assess the suitability of statistical and the k-C* models to projecting treatment performance of constructed wetlands by applying the models to predict the final effluent concentrations of a pilot field-scale constructed wetlands system (CWs) treating animal farm wastewater. The CWs achieved removal rates (in g/m(2).d) ranging from 7.1-149.8 for BOD(5), 49.8-253.8 for COD and 7.1-47.0 for NH(4)-N. Generally, it was found that the statistical models developed from multiple regression analyses (MRA) were stronger in predicting final effluent concentrations than the k-C* model. However, both models were inadequate in predicting the final effluent concentrations of NO(3)-N. The first-order area-based removal rate constants (k, m/yr) determined from the experimental data were 200.5 for BOD(5), 80.1 for TP and 173.8 for NH(4)-N and these indicate a high rate of pollutant removal within the CWs.

Performance evaluation and prediction for a pilot two-stage on-site constructed wetland system employing dewatered alum sludge as main substrate.

Dewatered alum sludge, a widely generated by-product of drinking water treatment plants using aluminium salts as coagulants was used as main substrate in a pilot on-site constructed wetland system treating agricultural wastewater for 11 months. Treatment performance was evaluated and spreadsheet analysis was used to establish correlations between water quality variables. Results showed that removal rates (in g/m(2)d) of 4.6-249.2 for 5 day biochemical oxygen demand (BOD(5)), 35.6-502.0 for chemical oxygen demand (COD), 2.5-14.3 for total phosphorus (TP) and 2.7-14.6 for phosphate (PO(4)P) were achieved. Multiple regression analysis showed that effluent BOD(5) and COD can be predicted to a reasonable accuracy (R(2)=0.665 and 0.588, respectively) by using input variables which can be easily monitored in real time as sole predictor variables. This could provide a rapid and cheap alternative to such laborious and time consuming analyses and also serve as management tools for day-to-day process control.

Two strategies for improving animal farm wastewater treatment in reed beds.

In this study, dewatered alum sludge cakes were used as substrate in a laboratory scale tidal vertical flow reed bed system treating animal farm wastewater. Tidal flow operation was employed to enhance oxygen transfer into the system while dewatered alum sludge cake was used to enhance phosphorus (P) removal through ligand exchange. Except for the removal of P which was consistently high throughout the experiment, the removal of organics (BOD5, COD) exhibited a trend of gradual and increasing removal and this highlights the benefits of using dewatered alum sludge cake in the reed bed. For the removal of organics, a mean removal percentage of 82.3 +/- 3.5% was obtained for BOD5 at a mean loading rate of 84.6 g/m2.d. The first-order kinetics constant for BOD5 removal (K(BOD), m/d) obtained was about 9 times the rate constant commonly obtained in conventional horizontal flow systems. The mean level of dissolved aluminium (Al) monitored in the effluent was 0.04 +/- 0.01 mg/1 and this is well below the discharge limit of 0.2 mg/l for Al discharge into all waters.

Equilibrium and kinetic analysis of phosphorus adsorption from aqueous solution using waste alum sludge.

Excess phosphorus (P) in wastewaters promotes eutrophication in receiving waterways. A cost-effective method such as use of novel low-cost adsorbents for its adsorptive removal would significantly reduce such impacts. Using batch experiments, the intrinsic dynamics of P adsorption by waste alum sludge (an inevitable by-product of drinking water treatment plants) was examined. Different models of adsorption were used to describe equilibrium and kinetic data, calculate rate constants and determine the adsorption capacity. Results indicate that the intraparticle rate constant increased from 0.0075 mg g(-1)min(-1) at 5 mg L(-1) to 0.1795 mg g(-1)min(-1) at 60 mg L(-1) indicating that more phosphate is adsorbed per g min at higher P concentration. Further analyses indicate involvement of film and particle diffusion mechanisms as rate controlling steps at lower and higher concentrations, respectively. Mass transfer coefficient obtained ranged from 1.7 × 10(-6) to 1.8 × 10(-8) indicating a rapid transportation of phosphate molecules onto the alum sludge. These results further demonstrates that alum sludge-hitherto thought of as undesirable waste, can be used as novel adsorbent for P removal from wastewater through various applications, thus offsetting a portion of the disposal costs while at the same time improving water quality in sensitive watersheds.

Alum sludge-based constructed wetland system for enhanced removal of P and OM from wastewater: concept, design and performance analysis.

The concept, design and performance analysis of a four-stage novel constructed wetland system (CWs) capable of enhanced and simultaneous removal of phosphorus (P) and organic matter (OM) from wastewaters is described. Alum sludge, a largely available by-product of drinking water facilities using aluminium salts as coagulant was used as the media. Under a hydraulic loading rate of 1.27 m(3)/m(2) d and a range of organic loading rate of 279.4-774.7 g-BOD(5)/m(2)d and 361.1-1028.7 g-COD/m(2)d, average removal efficiencies (mean+/-SD) of 90.6+/-7.5% for BOD(5) and 71.8+/-10.2% for COD were achieved, respectively. P removal was exceptional with average removal efficiency of 97.6+/-1.9% achieved for soluble reactive P at a mean influent concentration of 21.0+/-2.9 mg/l. Overall, the system holds great promise as a novel CWs for simultaneous removal of P and OM, and at the same time, it transforms alum sludge from a waste into a useful material.

Leachability and leaching patterns from aluminium-based water treatment residual used as media in laboratory-scale engineered wetlands.

CONCEPT AND PURPOSE: Virtually all water treatment facilities worldwide generate an enormous amount of water treatment residual (WTR) solids for which environmentally friendly end-use options are continually being sought as opposed to their landfilling. Aluminium-based WTR (Al-WTR) can offer huge benefits particularly for phosphorus (P) removal and biofilm attachment when used as media in engineered wetlands. However, potential environmental risks that may arise from the leaching out of its constituents must be properly evaluated before such reuse can be assured. This paper presents results of an assessment carried out to monitor and examine the leachability and leaching patterns of the constituents of an Al-WTR used as media in laboratory-scale engineered wetland systems. MAIN FEATURES, MATERIALS AND METHODS: Al-WTR was used as media in four different configurations of laboratory-scale engineered wetland systems treating agricultural wastewater. Selected metal levels were determined in the Al-WTR prior to being used while levels of total and dissolved concentration for the metals were monitored in the influent and effluent samples. The increase or decrease of these metals in the used Al-WTR and their potential for leaching were determined. Leached metal levels in the effluents were compared with relevant environmental quality standards to ascertain if they pose considerable risks. RESULTS: Aluminium, arsenic, iron, lead and manganese were leached into the treated effluent, but aluminium exhibited the least leaching potential relative to its initial content in the fresh Al-WTR. Levels of P increased from 0.13 mg-P/g (fresh Al-WTR) to 33.9-40.6 mg-P/g (used Al-WTR). Dissolved levels of lead and arsenic (except on one instance) were below the prescribed limits for discharge. However, total and dissolved levels of aluminium were in most cases above the prescribed limits for discharge, especially at the beginning of the experiments. CONCLUSIONS, RECOMMENDATIONS AND PERSPECTIVES: Overall, the study indicates that leaching is observed when Al-WTR is beneficially reused for enhanced P removal in engineered wetlands. In particular, levels of aluminium in the treated effluent beyond the prescribed limits of 0.2 mg/l were observed. However, since the results obtained indicate that aluminium leached is mostly associated with solids, a post-treatment unit which can further reduce the level of aluminium in the treated effluent by filtering out the solids could serve to mitigate this. In addition, plants used in such wetland systems can uptake metals and this can also be a potential solution to ameliorating such metal releases. Periodic monitoring is thus advised. Notwithstanding, the use of Al-WTR as a media in engineered wetlands can serve to greatly enhance the removal of P from wastewaters and also serve as support material for biofilm attachment.

Two strategies for phosphorus removal from reject water of municipal wastewater treatment plant using alum sludge.

In view of the well recognized need of reject water treatment in MWWTP (municipal wastewater treatment plant), this paper outlines two strategies for P removal from reject water using alum sludge, which is produced as by-product in drinking water treatment plant when aluminium sulphate is used for flocculating raw waters. One strategy is the use of the alum sludge in liquid form for co-conditioning and dewatering with the anaerobically digested activated sludge in MWWTP. The other strategy involves the use of the dewatered alum sludge cakes in a fixed bed for P immobilization from the reject water that refers to the mixture of the supernatant of the sludge thickening process and the supernatant of the anaerobically digested sludge. Experimental trials have demonstrated that the alum sludge can efficiently reduce P level in reject water. The co-conditioning strategy could reduce P from 597-675 mg P/L to 0.14-3.20 mg P/L in the supernatant of the sewage sludge while the organic polymer dosage for the conditioning of the mixed sludges would also be significantly reduced. The second strategy of reject water filtration with alum sludge bed has shown a good performance of P reduction. The alum sludge has P-adsorption capacity of 31 mg-P/g-sludge, which was tested under filtration velocity of 1.0 m/h. The two strategies highlight the beneficial utilization of alum sludge in wastewater treatment process in MWWTP, thus converting the alum sludge as a useful material, rather than a waste for landfill.

Development of alum sludge-based constructed wetland: an innovative and cost effective system for wastewater treatment.

This article describes a research attempt to integrate the dewatered alum sludge, a residual by-product of drinking water treatment process, into a constructed wetland (CW) system for the purpose of enhancing the wastewater treatment performance, thus developing a so called alum sludge-based constructed wetland system. A multi-dimensional research project including the batch tests of phosphorus (P) adsorption onto alum sludge followed by the model CWs trials of single and multi-stage CWs, has been conducted since 2004. It has been successfully demonstrated that the alum sludge-based CW is capable of enhanced and simultaneous removal of P and organic matter (in terms of BOD5 and COD), particularly from medium and high strength wastewater. The sludge cakes act as the carrier for developing biofilm for organics removal and also serve as adsorbent to enhance P immobilization. Batch P-adsorption tests revealed that the alum sludge tested possesses excellent P-adsorption ability of 14.3 mg-P/g x sludge (in dry solids) at pH 7.0 with the adsorption favored at lower pH. The results obtained in a 4-stage treatment wetland system suggest that high removal efficiencies of 90.4% for COD, 88.0% for BOD5, 90.6% for SS, 76.5% for TN and 91.9% for PO4(3-)-P under hydraulic loading of 0.36 m3/m2 x d can be achieved. The field demonstration study of this pioneering development is now underway.

Phosphorus removal in laboratory-scale unvegetated vertical subsurface flow constructed wetland systems using alum sludge as main substrate.

This research has two eventual goals: (1) To optimize performance of subsurface constructed wetlands for removal of phosphorus (P) (2) To demonstrate that dewatered alum sludge (a by-product), can be reused as a constructed wetland substrate. To achieve these, alum sludge from a water treatment plant was characterized and used as main substrate in four experimental vertical sub-surface flow constructed wetland systems treating dairy farm wastewater. Results show that the alum sludge has suitable hydraulic characteristics (uniformity coefficient = 3.6) for use as a substrate, and in the batch studies, up to 48.6 mg-P was removed by 1 g of the alum sludge at a P concentration of 360 mg-P/l and a dosage of 5 g/l. Results from the experimental systems highlight the significant P removal ability of the alum sludge. However, the inclusion of pea gravel at the infiltrative surface of some of the systems had a negative effect on the P removal performance. Sequential P-fractionation results show that there was no significant increase in the easily extractable P, but for total P, there was significant increase, although this was found to decrease with depth. This study shows that the novel use of dewatered alum sludge can bring about high P removal in vertical subsurface flow constructed wetland systems.

Characterization of aluminium-based water treatment residual for potential phosphorus removal in engineered wetlands.

Aluminium-based water treatment residual (Al-WTR) is the most widely generated residual from water treatment facilities worldwide. It is regarded as a by-product of no reuse potential and landfilled. This study assessed Al-WTR as potential phosphate-removing substrate in engineered wetlands. Results indicate specific surface area ranged from 28.0 m(2) g(-1) to 41.4 m(2) g(-1). X-ray Diffraction, Fourier transform infrared and energy-dispersive X-ray spectroscopes all indicate Al-WTR is mainly composed of amorphous aluminium which influences its phosphorus (P) adsorption capacity. The pH and electrical conductivity ranged from 5.9 to 6.0 and 0.104 dS m(-1) to 0.140 dS m(-1) respectively, showing that it should support plant growth. Batch tests showed adsorption maxima of 31.9 mg P g(-1) and significant P removal was achieved in column tests. Overall, results showed that Al-WTR can be used for P removal in engineered wetlands and it carries the benefits of reuse of a by-product that promotes sustainability.

Use of dewatered alum sludge as main substrate in treatment reed bed receiving agricultural wastewater: long-term trial.

This study aims to explore a novel application of dewatered alum sludge cakes (DASC) as the main medium in a single model reed bed to treat phosphorus-rich animal farm wastewater under "tidal flow" operation on a long-term basis. It is expected that the cakes act as the carrier for developing biofilm and also serve as adsorbent to enhance phosphorus (P) immobilization. Results have demonstrated that average removal efficiencies of 73.3+/-15.9% for COD, 82.9+/-12.3% for BOD(5), 86.4+/-6.0% for RP (reactive P), 88.6+/-7.2% for soluble reactive P (SRP) and 77.6+/-17.5% for SS can be achieved during the two year's operation. More significantly, the "P-adsorption proportion" by DASC in the reed bed is 42% of the overall P removal. The remaining removal of P may be contributed by the trapping and filtration process of DASC. Therefore, the lifetime of the DASC in reed bed is reasonably longer than that determined from the batch isotherm test.

Use of dewatered alum sludge as a substrate in reed bed treatment systems for wastewater treatment.

In this paper, two laboratory-scale simulated reed beds were investigated for the purpose of assessing the feasibility and effectiveness of using dewatered alum sludge as a possible substrate for wastewater treatment reed bed systems. One horizontal subsurface flow setup and one vertical flow setup were used. The horizontal flow system was planted with Phragmites australis while the vertical flow system was left unplanted. Thus, the latter was more akin to a sand filter system, but was examined with the potential use as a planted vertical reed bed system. The influent source used was farmyard wastewater. It is expected that the present study will provide the basis for long-term and large-scale trials in realizing the concept of integrating "waste" into treatment processes. Results obtained so far have shown that the dewatered alum sludge holds great promise as a low-cost resource media for use in reed bed treatment systems. Appreciable and stable performance was obtained during the continuous operation at high hydraulic, organic and phosphorus loadings. In particular, both wetlands achieved over 90% phosphorus removal, reflecting the significant advantage of this novel approach over conventional reed bed treatment systems. However, extensive research into possible surface clogging and possible release of some substances from the sludge to the treated effluent is necessary to ensure reliability of the system. This will help to make the alum sludge-based reed bed environmentally and economically justifiable.