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El-Ramady H, Brevik EC, Elbasiouny H, Elbehiry F, Amer M, Elsakhawy T, Omara AED, Mosa AA, El-Ghamry AM, Abdalla N, Rezes S, Elboraey M, Ezzat A, Eid Y. Planning for disposal of COVID-19 pandemic wastes in developing countries: a review of current challenges. ENVIRONMENTAL MONITORING AND ASSESSMENT 2021; 193:592. [PMID: 34424421 PMCID: PMC8380865 DOI: 10.1007/s10661-021-09350-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/30/2021] [Indexed: 05/18/2023]
Abstract
The health sector is critical to the well-being of any country, but developing countries have several obstacles that prevent them from providing adequate health care. This became an even larger concern after the COVID-19 outbreak left millions of people dead worldwide and generated huge amounts of infected or potentially infected wastes. The management and disposal of medical wastes during and post-COVID-19 represent a major challenge in all countries, but this challenge is particularly great for developing countries that do not have robust waste disposal infrastructure. The main problems in developing countries include inefficient treatment procedures, limited capacity of healthcare facilities, and improper waste disposal procedures. The management of medical wastes in most developing countries was primitive prior to the pandemic. The improper treatment and disposal of these wastes in our current situation may further speed COVID-19 spread, creating a serious risk for workers in the medical and sanitation fields, patients, and all of society. Therefore, there is a critical need to discuss emerging challenges in handling, treating, and disposing of medical wastes in developing countries during and after the COVID-19 outbreak. There is a need to determine best disposal techniques given the conditions and limitations under which developing countries operate. Several open questions need to be investigated concerning this global issue, such as to what extent developing countries can control the expected environmental impacts of COVID-19, particularly those related to medical wastes? What are the projected management scenarios for medical wastes under the COVID-19 outbreak? And what are the major environmental risks posed by contaminated wastes related to COVID-19 treatment? Studies directed at the questions above, careful planning, the use of large capacity mobile recycling facilities, and following established guidelines for disposal of medical wastes should reduce risk of COVID-19 spread in developing countries.
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Affiliation(s)
- Hassan El-Ramady
- Soil and Water Dept, Faculty of Agriculture, Kafrelsheikh University, Kafr El-Sheikh, 33516 Egypt
| | - Eric C. Brevik
- College of Agricultural, Life, and Physical Sciences, Southern Illinois University, Carbondale, IL USA
| | - Heba Elbasiouny
- Department of Environmental and Biological Sciences, Home Economy Faculty, Al-Azhar University, Tanta, 31732 Egypt
| | - Fathy Elbehiry
- Central Laboratory of Environmental Studies, Kafrelsheikh University, Kafr El-Sheikh, 33516 Egypt
| | - Megahed Amer
- Soils Improvement Dept., Soils, Water and Environment Research Institute, Sakha Station, Agricultural Research Center, Kafr El-Sheikh, 33717 Egypt
| | - Tamer Elsakhawy
- Agriculture Microbiology Department, Soil, Water and Environment Research Institute (SWERI), Agriculture Research Center, Sakha Agricultural Research Station, Kafr El-Sheikh, 33717 Egypt
| | - Alaa El-Dein Omara
- Agriculture Microbiology Department, Soil, Water and Environment Research Institute (SWERI), Agriculture Research Center, Sakha Agricultural Research Station, Kafr El-Sheikh, 33717 Egypt
| | - Ahmed A. Mosa
- Soils Department, Faculty of Agriculture, Mansoura University, Mansoura, 35516 Egypt
| | - Ayman M. El-Ghamry
- Soils Department, Faculty of Agriculture, Mansoura University, Mansoura, 35516 Egypt
| | - Neama Abdalla
- Plant Biotechnology Dept, , Genetic Engineering & Biotechnology Research Div, National Research Centre, Cairo, 12622 Egypt
| | - Szilárd Rezes
- Division of Oto-Rhyno-Laryngology, Medical and Health Science Center, Debrecen University, 4032 Debrecen, Hungary
| | - Mai Elboraey
- Division of Oto-Rhyno-Laryngology, Medical and Health Science Center, Debrecen University, 4032 Debrecen, Hungary
| | - Ahmed Ezzat
- Horticulture Dept, Faculty of Agriculture, Kafrelsheikh University, Kafr El-Sheikh, 33516 Egypt
| | - Yahya Eid
- Poultry Dept, Faculty of Agriculture, Kafrelsheikh University, Kafr El-Sheikh, 33516 Egypt
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10
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Kokturk N, Babayigit C, Kul S, Duru Cetinkaya P, Atis Nayci S, Argun Baris S, Karcioglu O, Aysert P, Irmak I, Akbas Yuksel A, Sekibag Y, Baydar Toprak O, Azak E, Mulamahmutoglu S, Cuhadaroglu C, Demirel A, Kerget B, Baran Ketencioglu B, Ozger HS, Ozkan G, Ture Z, Ergan B, Avkan Oguz V, Kilinc O, Ercelik M, Ulukavak Ciftci T, Alici O, Nurlu Temel E, Ataoglu O, Aydin A, Cetiner Bahcetepe D, Gullu YT, Fakili F, Deveci F, Kose N, Tor MM, Gunluoglu G, Altin S, Turgut T, Tuna T, Ozturk O, Dikensoy O, Yildiz Gulhan P, Basyigit I, Boyaci H, Oguzulgen IK, Borekci S, Gemicioglu B, Bayraktar F, Elbek O, Hanta I, Kuzu Okur H, Sagcan G, Uzun O, Akgun M, Altinisik G, Dursun B, Cakir Edis E, Gulhan E, Oner Eyuboglu F, Gultekin O, Havlucu Y, Ozkan M, Sakar Coskun A, Sayiner A, Kalyoncu AF, Itil O, Bayram H. The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients. Respir Med 2021; 183:106433. [PMID: 33957434 PMCID: PMC8079263 DOI: 10.1016/j.rmed.2021.106433] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 01/08/2023]
Abstract
The COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored.
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Affiliation(s)
- Nurdan Kokturk
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Cenk Babayigit
- Department of Pulmonary Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
| | - Seval Kul
- Department of Biostatistics, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Pelin Duru Cetinkaya
- Department of Pulmonary Medicine, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey.
| | - Sibel Atis Nayci
- Department of Pulmonary Medicine, Faculty of Medicine, Mersin University, Mersin, Turkey.
| | - Serap Argun Baris
- Department of Pulmonary Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Oguz Karcioglu
- Department of Pulmonary Medicine, Halil Sıvgın Cubuk State Hospital, Ankara, Turkey.
| | - Pinar Aysert
- Department of Infectious Disease, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Ilim Irmak
- Department of Pulmonary Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Aycan Akbas Yuksel
- Department of Pulmonary Medicine, Faculty of Medicine, Ufuk University, Ankara, Turkey.
| | - Yonca Sekibag
- Department of Pulmonary Disease, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Oya Baydar Toprak
- Department of Pulmonary Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - Emel Azak
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli Turkey.
| | - Sait Mulamahmutoglu
- Department of Pulmonary Disease, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Caglar Cuhadaroglu
- Department of Pulmonary Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey.
| | - Aslihan Demirel
- Department of Infectious Disease, Kadikoy Florence Nightingale Hospital, Istanbul, Turkey.
| | - Bugra Kerget
- Department of Pulmonary Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | | | - Hasan Selcuk Ozger
- Department of Infectious Disease, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Gulcihan Ozkan
- Department of Pulmonary Medicine, Maslak Acibadem Hospital, Istanbul, Turkey; Operating Room Services Department, Nisantasi University, Vocational School, Istanbul, Turkey.
| | - Zeynep Ture
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Begum Ergan
- Department of Pulmonary Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Vildan Avkan Oguz
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Oguz Kilinc
- Department of Pulmonary Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Merve Ercelik
- Department of Pulmonary Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey.
| | - Tansu Ulukavak Ciftci
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Ozlem Alici
- Department of Infectious Disease, Faculty of Medicine, Turkiye Gazetesi Private Hospital, Istanbul, Turkey.
| | - Esra Nurlu Temel
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
| | - Ozlem Ataoglu
- Department of Pulmonary Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey.
| | - Asena Aydin
- Department of Pulmonary Medicine, Kestel State Hospital, Bursa, Turkey.
| | | | - Yusuf Taha Gullu
- Department of Pulmonary Medicine, Faculty of Medicine, On Dokuz Mayis University, Samsun, Turkey.
| | - Fusun Fakili
- Department of Pulmonary Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Figen Deveci
- Department of Pulmonary Medicine, Faculty of Medicine, Firat University, Elazig, Turkey.
| | - Neslihan Kose
- Department of Pulmonary Medicine, Bilecik Training and Research Hospital, Bilecik, Turkey.
| | - Muge Meltem Tor
- Department of Pulmonary Medicine, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
| | - Gulsah Gunluoglu
- Department of Pulmonary Medicine, University of Health Science, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Sedat Altin
- Department of Pulmonary Medicine, University of Health Science, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Teyfik Turgut
- Department of Pulmonary Medicine, Faculty of Medicine, Firat University, Elazig, Turkey.
| | - Tibel Tuna
- Department of Pulmonary Medicine, Faculty of Medicine, On Dokuz Mayis University, Samsun, Turkey.
| | - Onder Ozturk
- Department of Pulmonary Medicine, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
| | - Oner Dikensoy
- Department of Pulmonary Medicine, Faculty of Medicine, Taksim, Acibadem University, Istanbul, Turkey.
| | - Pinar Yildiz Gulhan
- Department of Pulmonary Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey.
| | - Ilknur Basyigit
- Department of Pulmonary Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Hasim Boyaci
- Department of Pulmonary Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - I Kivilcim Oguzulgen
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Sermin Borekci
- Department of Pulmonary Disease, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Bilun Gemicioglu
- Department of Pulmonary Disease, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Firat Bayraktar
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Osman Elbek
- Department of Pulmonary Medicine, Kadikoy Florence Nightingale Hospital, Istanbul, Turkey.
| | - Ismail Hanta
- Department of Pulmonary Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - Hacer Kuzu Okur
- Department of Pulmonary Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey.
| | - Gulseren Sagcan
- Department of Pulmonary Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey.
| | - Oguz Uzun
- Department of Pulmonary Medicine, Faculty of Medicine, On Dokuz Mayis University, Samsun, Turkey.
| | - Metin Akgun
- Department of Pulmonary Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | - Goksel Altinisik
- Department of Pulmonary Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | - Berna Dursun
- Department of Pulmonary Medicine, Ankara Memorial Hospital, Ankara, Turkey.
| | - Ebru Cakir Edis
- Department of Pulmonary Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey.
| | - Erkmen Gulhan
- Department of Thoracic Surgery, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
| | - Fusun Oner Eyuboglu
- Department of Pulmonary Medicine, Baskent University, School of Medicine, Ankara, Turkey.
| | - Okkes Gultekin
- Department of Pulmonary Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
| | - Yavuz Havlucu
- Department of Pulmonary Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
| | - Metin Ozkan
- Department of Pulmonary Medicine, Ankara Memorial Hospital, Ankara, Turkey.
| | - Aysin Sakar Coskun
- Department of Pulmonary Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
| | - Abdullah Sayiner
- Department of Pulmonary Medicine, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Ali Fuat Kalyoncu
- Department of Pulmonary Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Oya Itil
- Department of Pulmonary Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Hasan Bayram
- Department of Pulmonary Medicine, Koc University Research Center for Translational Medicine (KUTTAM), Koc University School of Medicine, Istanbul, Turkey.
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