Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey

OBJECTIVE

To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic.

METHODOLOGY

The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019.

RESULTS

A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life.

CONCLUSIONS

Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.

Optimization of phosphorus precipitation from swine manure slurries to enhance recovery

Laboratory experiments were conducted using magnesium chloride (MgCl2 x 6H2O, 64% solution) to force the precipitation of phosphorus and reduce the concentration of soluble phosphorus (PO4(3-)) in two swine wastes. One of the swine wastes tested contained a high concentration of PO4(3-) (initially approximately 1,000 mg/L), and the other swine waste tested contained a low concentration of PO4(3-) (initially approximately 230 mg/L). The precipitation reactions were performed to determine the required reaction time, pH, magnesium addition rate and seed material for future precipitate recovery work. For the high and low concentration waste, a 10-minute reaction time at a pH of 8.6 was sufficient to remove 98 and 96% of the PO4(3-) from solution. A molar ratio of Mg2+:PO4(3-) of 1.6:1 was determined to be effective for PO4(3-) removal from both the low and high strength wastes. At a molar ratio of 1.6:1, the PO3- in the high concentration waste was reduced from 590 to 12 mg/L. In the low concentration waste, the PO4(3-) concentration was reduced from 157 to 15 mg/L. Seeding the reaction did not significantly enhance the recovery process.

Recovery of ammonia as struvite from anaerobic digester effluents

The effects of environmental conditions on ammonia removal as struvite (Magnesium ammonium phosphate, MAP) were studied in a laboratory scale batch reactor. MAP precipitation was carried out by adding phosphoric acid and magnesium source either as MgCl, or MgO. The effect of temperature, pH, MgN:P ratios were studied. Temperature did not significantly affect ammonia removal between 25-40 degrees C and over 90% removal was obtained. The effect of pH, however,was significant and highest removal was reached at pH 8.5-9.0. The various stoichiometric ratios of ammonium to Mg and P have been tested and slight excess of Mg and P found to be beneficial for higher recovery of ammonia as struvite. However further increase in Mg and P ratios did not result in further ammonia removal which is also costly for the practical application of the process. When MgO was used as M source,the ammonia recovery was 60-70% whereas the useMgCl2 has increased this figure up to 95%. In addition a two step purification process was developed to recover MAP crystals from impurities of the anaerobic digester. Firstly, precipitates were dissolved in acid and impurities were removed by centrifugation. The clarified supernatant was re-precipitated by adjusting its pH with caustic. It was shown that in the two steps process white MAP crystals could be obtained with over 85% recovery to be used for another applications. The economical analysis of the process has shown that ammonia in the digester effluents can be recovered at the cost of $7.5-8.0 kg(-1) NH4+-N. The rate of reaction is very fast and is completed almost in minutes. This simplifies the process design resulting in a smaller reaction vessel.