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Journal ArticleDOI

Optimization of electrocoagulation process for efficient removal of ciprofloxacin antibiotic using iron electrode; kinetic and isotherm studies of adsorption

01 Jan 2017-Journal of Molecular Liquids (Elsevier)-Vol. 225, pp 544-553

AbstractThe present study focused on the removal of ciprofloxacin from hospital wastewater using electrocoagulation (EC) process by iron electrode and the kinetic and isotherms of adsorption were investigated. Response surface methodology (RSM) was used to evaluate the main effects of parameters, their simultaneous interactions and quadratic effect to achieve the optimum condition for EC process. The maximum removal rate was achieved at the current density of 15 mA·cm− 2, initial CIP concentration of 60 mg·L− 1, pH 7.5, inter-electrode distance 1.58 cm and electrolyte dose of 0.07 M NaCl within the equilibrium time of 20 min. The obtained experimental results are in good accordance with the Langmuir isotherm model for CIP adsorption on iron hydroxide by predicting the maximum adsorption capacity of 476.19 mg·g− 1. The predicted model for treatment of synthetic wastewater is in satisfactory agreement with real hospital wastewater treatment. First and second order kinetic models were studied to figure out the exact mechanism of the CIP removal using EC process. The obtained results revealed that the second order kinetic model best fitted the experimental results and suggested that the chemisorption mechanism controlled the adsorption of CIP. Under the optimal conditions of EC process, electrode consumption (ELC) and electrical energy consumption (EEC) were found to be 0.0625 g during a single run and 0.522 kWh·m− 3, respectively.

Topics: Adsorption (54%), Langmuir adsorption model (52%)

Summary (2 min read)

Introduction

  • The diabetes pandemic will increase from 175 million patients with diabetes in 2000 to 353 million in 2030.
  • According to the national coronary artery disease (CAD) risk factors surveillance report, the overall prevalence of diabetes in Iran is estimated to be 8.7% in adults aged 15-64 years, of whom half (4.1%) were the newly diagnosed cases.
  • It is not clear how many are at pre-diabetes stage and are prone to suffer from diabetes, or vice versa, with timely interventions, the disease can be prevented.
  • 5 Using fasting plasma glucose (FPG) ≥7.2 mmol/L the criteria for poor management of diabetes, about 57% of individuals with diagnosed diabetes had high level of plasma glucose.
  • The authors reported the age-sex standardized prevalence of diabetes at all stages including pre-diabetes (pre DM) and diabetes (DM).

Methods

  • The Kerman Coronary Artery Disease Risk Factors.
  • Study is a population based cohort study with repeated surveys.
  • The methodology of KERCADR study has been explained in detail elsewhere.
  • Only those who were able and provided written informed consent were recruited into the study.
  • The study protocol was approved by the Ethical committee of Kerman University of Medical Sciences, Iran (Permission No. 88/110KA).

Interview and measurements

  • All details of the measurement are presented elsewhere.
  • Part of the questionnaire that the authors used in this study included demographic information, cigarette smoking (yes/no), opium addiction (no/occasional/ dependent), the level of physical activity (low/moderate/ high), and the level of depression and anxiety (related BECK questionnaires).
  • Subjects who had no previous history of diabetes or anti-diabetic medication, but turned out to have FPG ≥7 mmol/L at the recruitment were considered as undiagnosed diabetic cases.
  • In the old definition, uncontrolled diabetes was specified as HbA1c >53 mmol/mol (>7%) for all individuals.
  • The authors found that diabetes and susceptibility in to diabetes was very common in Kerman.

Laboratory measurements

  • All participants were asked not to eat for 12-14 h before coming to the clinic.
  • Subjects who had FPG more than 5.6 mmol/L were recalled for another FPG test and HbA1c test (NYCOCARD Kit, Code 1042184, Austria).
  • To measure serum lipid profiles, total cholesterol (KIMIA Kit, Code 890303, Iran) and triglycerides (KIMIA Kit, Code 890201, Iran) were also measured for all individuals.

Statistical analysis

  • All statistical analyses were conducted under survey data analysis using STATAv.12 (StataCorp, 2011 College Station, TX, USA).
  • For age-sex direct standardizations, the authors used Kerman population reported in census 2006.
  • All prevalence rates were weighted according to the sampling weight (reciprocal of the probability of selection) and individual response rate.
  • The data were presented as absolute and relative frequencies as well as 95% confidence intervals (95% CI).
  • Univariate and multivariate logistic regression models were applied to determine the predictors of diabetes (both diagnosed and undiagnosed DM).

Undiagnosed and diagnosed diabetes

  • There was nearly an equal prevalence of undiagnosed-DM in subpopulations regarding depression and physical activity.
  • The prevalence of DM was diagnosed in 7.0% of occasional opium users, while it was 4.0% among dependent users.
  • Seven percent of overweight and 7.6% of obese people had diagnosed-DM.

Diabetes mismanagement: old definition

  • The uncontrolled-DM increased from 60% in young adults to 77.8% in elderly people.
  • The frequency of uncontrolled-DM among people without and with (both insulin and non-insulin) treatment was 57.9% and 92.9%, respectively.
  • The frequency of uncontrolled-DM varied from 76.1% among non opium users to 81.3% in dependent opium users.
  • People with low physical activity had a higher frequency of uncontrolled-DM (79.4%), which decreased to 66.7% in people with high level of physical activity.

Predictors of diabetes

  • In crude analysis, sex (male vs female), age, education, opium addiction, depression, increased BMI category, lower physical activity, and DM familial history turned to be potential significant predictors for DM (Table 3 ).
  • While in the multivariate model, after removing confounding effects, it was shown that the odds diabetes increased significantly only by age group (AOR 5.0 to 18.2), depression (AOR 1.2), overweight and obesity (AOR 1.6, and 1.5), moderate and low physical activity, (AOR 1.5, and 1.4) and the positive familial history of DM (AOR 2.2).
  • The other variables did not have a statistically significant association with diabetes.

Diabetes-related co-morbidities

  • The maximum prevalence of co-morbidities among patients with diagnosed DM were anxiety (87.5%), depression (57.9%) and overweight/obesity (47.1%); among people with undiagnosed DM, most frequent co-morbidities were again anxiety (73.2%) and overweight/obesity (55.6%) while hypercholesterolemia (54.3%) also become very common, too (Table 4 ).
  • Among individuals with pre-diabetes, again anxiety (76.2%), overweight/obesity (50.5%) and hypercholesterolemia (35.4%) were the most frequent co-morbidities.

Discussion

  • In their analysis, the authors found one out of four individuals living in an urban area in Iran either had impaired glucose level (pre-diabetes) or diabetes.
  • In several studies, it has been reported that the prevalence of diabetes (diagnosed and undiagnosed), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) increased by age [13] [14] [15] is not similar between men and women.
  • Regarding the effect of cigarette smoking and opium consumption, the results of this study showed almost no statistically significant effects on control of diabetes or odds ratio of predictors of diabetes (Tables 2,3 ).
  • In rural areas, Iran has a well-developed primary health-care system, having Behvarz workers responsible for population-based prevention and control services.

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ORIGINAL ARTICLE
Epidemiology of diabetes mellitus, pre-diabetes,
undiagnosed and uncontrolled diabetes and its
predictors in general population aged 15 to 75 years:
A community-based study (KERCADRS) in
southeastern Iran
Hamid NAJAFIPOUR,
1
Mojgan SANJARI,
1,2
Mostafa SHOKOOHI,
3
Ali-Akbar HAGHDOOST,
3
Mehdi AFSHARI,
3
Mitra SHADKAM,
1
Koorosh ETEMAD
4
and Ali MIRZAZADE
1,5
1
Physiology Research Center, Institute of Neuropharmacology,
2
Department of Endocrinology, Afzalipour Hospital,
3
Research Center for
Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman,
4
Center for Non-Communicable
Diseases, Ministry of Health and Medical Education, Tehran, Iran, and
5
Institute for Health Policy Studies, University of California, San
Francisco, CA, USA
Correspondence
Mojgan Sanjari, Physiology Research
Center and Department of Endocrinology,
Kerman University of Medical Sciences,
Tahmasbab adjunction, Ebn-e-Sina Ave.
Kerman 7619813159, Iran.
Tel: +98 341 2264071
Fax: +98 341 2264097
Email: mjnsanjari@yahoo.com;
msanjari@kmu.ac.ir
Received 27 February 2014; revised 31
May 2014; accepted 02 July 2014.
doi: 10.1111/1753-0407.12195
Abstract
Background: The goal of this research was to measure the age-sex standard-
ized prevalence of pre-diabetes (pre-DM) and diabetes (DM), and the effec-
tiveness of diabetes management (using HbA1C as the indicator) in an urban
area in Iran.
Methods: Using a randomized cluster household survey, we recruited 5900
individuals whose age ranged from 15 to 75 from Kerman for assessing
coronary artery disease risk factors (KERCADRS) including diabetes. In
2010 and 2011, all of the participants were interviewed by trained staff for
medical history and physical activities, and were then examined for blood
pressure and anthropometric measures. Venus blood sample was also col-
lected for fasting plasma glucose and HbA1c.
Results: The age-sex standardized prevalence of pre-diabetes, diagnosed and
undiagnosed was 18.7%, 6.3% and 2.7%, respectively. Diabetes increased by
age (from 14.7% in the 15–24 years old group to 28.4% in the 65–75 years old
group), particularly after 40 years. Occasional opium users had the highest
prevalence of Pre-DM (34.6%). Seventy-nine percent of the depressed and
75.5% of the anxious participants with diagnosed-DM were identified as
uncontrolled-DM. More than 60% of diagnosed diabetic cases had impaired
HbA1c. Overweight and obesity (adjusted odds ratio (AOR) 1.6) and low
physical activity (AOR 1.5) were the most preventable risk factors associated
with diabetes.
Conclusion: Considerable prevalence of diabetes, susceptibility in progress-
ing to diabetes and uncontrolled diabetes among individuals living in
Kerman, suggested ineffective prevention and treatment of diabetes in urban
areas in Iran. Successful experience regarding primary health-care in rural
areas should be expanded to urban settings.
Keywords: diabetes mellitus, diabetes treatment, HbA1c, Iran, pre-diabetes,
uncontrolled diabetes, undiagnosed diabetes.
bs_bs_banner
Journal of Diabetes •• (2014) ••–••
1© 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd

Introduction
The diabetes pandemic will increase from 175 million
patients with diabetes in 2000 to 353 million in 2030.
1
It
is an important contributor to the burden of diseases,
particularly in developing countries.
2
According to the national coronary artery disease
(CAD) risk factors surveillance report, the overall preva-
lence of diabetes in Iran is estimated to be 8.7% in adults
aged 15–64 years, of whom half (4.1%) were the newly
diagnosed cases.
3
Based on a systematic review, the
prevalence of type 2 diabetes in Iran was estimated as
one out of four among adults aged 40.
4
However, it is
not clear how many are at pre-diabetes stage and are
prone to suffer from diabetes, or vice versa, with timely
interventions, the disease can be prevented.
In addition to late diagnosis, diabetes management is
another big challenge in Iran since only 39.2% of indi-
viduals with diagnosed diabetes in Iran receive treat-
ment.
5
Using fasting plasma glucose (FPG) 7.2 mmol/L
the criteria for poor management of diabetes, about 57%
of individuals with diagnosed diabetes had high level of
plasma glucose.
6
In this paper, we reported the age-sex standardized
prevalence of diabetes at all stages including pre-diabetes
(pre DM) and diabetes (DM). The research participants
were between 15 to 75 years of age, and they lived in an
urban setting in southeastern Iran, in Kerman. We also
assessed the effectiveness of diabetes management (using
HbA1C as the indicator) in people with diagnosed
diabetes. The prevalence of main related CAD
co-morbidities was also observed in pre-diabetic, diag-
nosed, undiagnosed and normal subpopulation.
Methods
The Kerman Coronary Artery Disease Risk Factors
(KERCADR) Study is a population based cohort study
with repeated surveys. In 2010–2011, 5900 individuals
aged between 15 and 75 years recruited into the first
round of the study. The subjects were recruited through
a non-proportional to size one-stage cluster sampling
household survey. The methodology of KERCADR
study has been explained in detail elsewhere.
7
Only those
who were able and provided written informed consent
were recruited into the study. The study protocol was
approved by the Ethical committee of Kerman Univer-
sity of Medical Sciences, Iran (Permission No.
88/110KA).
Interview and measurements
All details of the measurement are presented elsewhere.
7
In brief, the trained interviewers assessed the study sub-
jects for different CAD risk factors using a structural
questionnaire. Part of the questionnaire that we used in
this study included demographic information, cigarette
smoking (yes/no), opium addiction (no/occasional/
dependent), the level of physical activity (low/moderate/
high), and the level of depression and anxiety (related
BECK questionnaires). The subjects were asked about
their past medical history and familial history of DM,
and whether they were under insulin or non-insulin
treatment.
Physical activity was determined by the Global Physi-
cal Activity Questionnaire, and Metabolic Equivalents
were used to express the intensity of physical activities.
Hypertension was defined as systolic blood pressure
140 mmHg and/or diastolic blood pressure 90 mmHg,
and/or taking any antihypertensive drugs. Overweight
was defined as body mass index (BMI) between 25 to
29.9 kg/m
2
and obesity as BMI 30 kg/m
2
.
Every individual with previously diagnosed diabetes
(by a physician) and/or taking insulin or non-insulin
drugs and/or FPG 7 mmol/L at the time of recruitment
was considered a diabetic case. Others with FPG
between 5.6–6.9 mmol/L were considered as pre-diabetes
(pre-DM) cases. Subjects who had no previous history of
diabetes or anti-diabetic medication, but turned out to
have FPG 7 mmol/L at the recruitment were considered
as undiagnosed diabetic cases.
To determine the glycemic control status of diagnosed
diabetic patients, we tested every diabetic case for hemo-
globin A1c (HbA1c). Here we reported the uncontrolled
diabetes in both old and new definitions. In the old defi-
nition, uncontrolled diabetes was specified as HbA1c
>53 mmol/mol (>7%) for all individuals. However, based
Significant findings of the study: We found that diabetes and susceptibility in to diabetes was very common in
Kerman. The prevalence increased by age, particularly after 40 years. Depression and anxiety are very common in
uncontrolled diabetic patients in Iran.
What this study adds: A considerable number of people had their diabetes undiagnosed, while in those who have
been diagnosed for diabetes, the treatment was not effective and more than 60% presented with impaired HbA1c
test results.
Diabetes mellitus and management in an urban area in Iran H. NAJAFIPOUR et al.
2 © 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd

on the new definition, the cut-off is adjusted according to
the patients’ condition (American Diabetes Association,
2013).
8
Therefore, in those with onset or progression of
early stage microvascular and chronic complications,
and those aged more than 70 years HbA1c >64 mmol/
mol (>8%) was considered as the cut-off for poor glyce-
mic control (uncontrolled DM).
Laboratory measurements
All participants were asked not to eat for 12–14 h before
coming to the clinic. The blood samples were obtained
between 07.00 and 09.00 h, and FPG was measured
(KIMIA Kit, Code 890410, Iran). Subjects who had
FPG more than 5.6 mmol/L were recalled for another
FPG test and HbA1c test (NYCOCARD Kit, Code
1042184, Austria). To measure serum lipid profiles, total
cholesterol (KIMIA Kit, Code 890303, Iran) and triglyc-
erides (KIMIA Kit, Code 890201, Iran) were also mea-
sured for all individuals.
Statistical analysis
All statistical analyses were conducted under survey data
analysis using STATAv.12 (StataCorp, 2011 College
Station, TX, USA). For age-sex direct standardizations,
we used Kerman population reported in census 2006. All
prevalence rates were weighted according to the sam-
pling weight (reciprocal of the probability of selection)
and individual response rate. The data were presented as
absolute and relative frequencies as well as 95% confi-
dence intervals (95% CI). Univariate and multivariate
logistic regression models were applied to determine the
predictors of diabetes (both diagnosed and undiagnosed
DM). Crude and adjusted odds ratios (AOR) were also
reported.
Results
Demographic characteristics
The 5895 people recruited in this study were on average
45.4 (SD 16.4) years old and 54.9% were female. Accord-
ing to a self-report, 14.0% had never been to school and
a majority had not completed secondary education
(67.1%).
Pre-DM prevalence
Overall, the age- and sex-standardized prevalence of pre-
diabetes (Pre-DM) was 18.7% (men 23.4% vs women
13.7%) (Table 1). The Pre-DM prevalence constantly
increased from 14.7% in young adults (age group 15–24
years) to 28.4% in elderly people (age group 65–75 years).
One-quarter (25.9%) of the illiterate people had Pre-DM
status, which decreased to 18.0% in people with primary
to high school education. Pre-DM was more common
among non-smokers (11.5% vs 18.8%). Regarding opium
addiction, those who were reported to have occasional
use of opium had the highest prevalence of Pre-DM
(34.6%). Pre-DM prevalence was identified in 15.2% of
the depressed people and 18.4% in those with anxiety
symptoms. 16.1% of people with normal BMI had Pre-
DM, which increased to 22.1% in overweight and 20.1%
in obese people. The Pre-DM prevalence constantly
decreased from 20.5% in less physically active to 15.2%
in highly physically active people. Having familial
history of DM increased the prevalence of Pre-DM to
19.6%.
Undiagnosed and diagnosed diabetes
In general, the standardized prevalence of diabetes was
9% (men 7.7% and women 10.3%), of which 2.7% were
undiagnosed diabetes (men 2.8% vs women 2.6%) and
6.3% diagnosed (men 4.9% vs women 7.7%).
Undiagnosed DM was more prevalent in elderly indi-
viduals (6.8% among people aged 65–75 years), people
with primary-to-high school education (2.8%), non-
smokers (2.8%), opium dependent users (2.7%), people
without anxiety symptoms (3.2%), obese people (4%),
and those with positive familial history of DM (3.7%).
There was nearly an equal prevalence of undiagnosed-
DM in subpopulations regarding depression and physi-
cal activity.
The diagnosed-DM increased steadily from 1% in
young adult (age group 15–24) to 26.3% in elderly people
(aged 55–64 years). DM was diagnosed in 6.7% of (high
school and more) educated people. Compared to non-
cigarette smokers, prevalence of diagnosed-DM was
more in smokers (6.3% vs 9.1%). The prevalence of DM
was diagnosed in 7.0% of occasional opium users, while
it was 4.0% among dependent users. The diagnosed-DM
prevalence among individuals with depression and
anxiety symptoms was 7.3% and 6.6%, respectively.
Seven percent of overweight and 7.6% of obese people
had diagnosed-DM. In people with high physical activ-
ity, diagnosed-DM prevalence was at a minimum of
3.7%. Compared to subjects with negative familial
history of DM, people with positive history had higher
prevalence of diagnosed-DM (4.3% vs 10.0%).
Diabetes mismanagement: old definition
Overall, in people with diagnosed-DM, the prevalence of
uncontrolled DM was 76.5% (men 75.1% vs women
77.3%) (Table 2). The uncontrolled-DM increased from
H. NAJAFIPOUR et al. Diabetes mellitus and management in an urban area in Iran
3© 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd

60% in young adults to 77.8% in elderly people. The
frequency of uncontrolled-DM among people without
and with (both insulin and non-insulin) treatment was
57.9% and 92.9%, respectively. Less educated people had
worse uncontrolled DM in comparison with highly edu-
cated individuals (78.1% vs 68.3%). Uncontrolled-DM
among non-smokers was higher than smokers (77.3% vs
70.5%). The frequency of uncontrolled-DM varied from
76.1% among non opium users to 81.3% in dependent
opium users. Among the diagnosed-DM people, 79.5%
of depressed and 75.5% of anxious people were identified
as uncontrolled-DM. Regarding obesity, uncontrolled-
DM ranged from 79.9% (normal BMI) to 72.7% (obese
subgroup). People with low physical activity had a higher
frequency of uncontrolled-DM (79.4%), which decreased
to 66.7% in people with high level of physical activity.
More than 74% of the diabetic patients who had positive
history of familial DM were uncontrolled.
Table 1 Standardized prevalence of pre-diabetes, undiagnosed and diagnosed diabetes, Community-Based Study (KERCADR 1st Round:
n = 5895), Kerman, Iran, 2010–2011
Subgroups Normal Pre-diabetes
Diabetes
Undiagnosed Diagnosed
Overall 72.3 (70.8, 73.9) 18.7 (17.3, 20.1) 2.7 (2.3, 3.3) 6.3 (5.7, 6.9)
Sex
Men 68.8 (66.3, 71.2) 23.4 (21.2, 25.9) 2.8 (2.2, 3.6) 4.9 (4.2, 5.7)
Women 76.0 (74.2, 77.8) 13.7 (12.2, 15.3) 2.6 (2.1, 3.4) 7.7 (6.8, 8.7)
Age groups
15–24 83.7 (80.4, 86.5) 14.7 (12.0, 17.9) 0.7 (0.3, 1.6) 1.0 (0.4, 2.3)
25–34 81.2 (78.3, 83.9) 15.1 (12.7, 17.9) 1.8 (1.1, 3.0) 1.9 (1.1, 3.2)
35–44 68.3 (64.9, 71.5) 20.9 (18.2, 23.8) 4.9 (3.4, 6.9) 6.0 (4.5, 7.9)
45–54 53.2 (50.0, 56.5) 24.6 (21.8, 27.5) 4.8 (3.5, 6.4) 17.4 (15.1, 20.0)
55–64 42.0 (38.5, 45.5) 25.1 (22.2, 28.2) 6.7 (5.1, 8.7) 26.3 (23.3, 29.5)
65–75 40.9 (36.2, 45.7) 28.4 (24.2, 33.0) 6.8 (4.7, 9.8) 23.9 (20.0, 28.3)
Education
Illiterate 66.5 (50.9, 79.1) 25.9 (14.2, 42.5) 1.7 (1.1, 2.6) 6.0 (4.3, 8.2)
Primary to high school 72.9 (71.1, 74.7) 18.0 (16.4, 19.7) 2.8 (2.3, 3.5) 6.2 (5.5, 7.0)
Above high school 71.9 (68.7, 74.9) 19.5 (16.7, 22.6) 1.9 (1.2, 3.0) 6.7 (5.4, 8.2)
Current cigarette smoker
No 72.1 (70.4, 73.7) 18.8 (17.3, 20.4) 2.8 (2.3, 3.4) 6.3 (5.7, 7.0)
Yes 77.8 (71.4, 83.1) 11.5 (9.3, 14.0) 1.6 (1.0, 2.7) 9.1 (4.9, 16.3)
Opium addiction
No 72.4 (70.7, 74.0) 18.6 (17.1, 20.1) 2.6 (2.1, 3.2) 6.4 (5.8, 7.1)
Occasional user 56.8 (49.6, 63.7) 34.6 (28.1, 41.8) 1.5 (0.8, 2.7) 7.0 (5.1, 9.6)
Dependent user 60.0 (53.9, 65.8) 15.4 (10.4, 22.2) 2.7 (1.5, 5.0) 4.0 (2.9, 5.4)
Depression
No 71.9 (70.0, 73.7) 19.6 (17.9, 21.4) 2.8 (2.2, 3.4) 5.7 (5.0, 6.4)
Yes 74.8 (72.2, 77.2) 15.2 (13.1, 17.6) 2.7 (1.9, 3.6) 7.3 (6.1, 8.7)
Anxiety
No 72.8 (69.5, 75.9) 19.1 (16.3, 22.2) 3.2 (2.3, 4.4) 5.5 (4.1, 6.1)
Yes 72.5 (70.7, 74.2) 18.4 (16.8, 20.1) 2.5 (2.0, 3.2) 6.6 (5.9, 7.3)
Obesity
Normal 76.9 (74.9, 78.8) 16.1 (14.4, 17.9) 1.8 (1.3, 2.5) 5.2 (4.4, 6.2)
Overweight 67.6 (63.9, 71.1) 22.1 (18.9, 25.8) 3.2 (2.5, 4.2) 7.0 (6.0, 8.2)
Obese 68.3 (63.2, 73.0) 20.1 (16.0, 25.1) 4.0 (2.4, 6.4) 7.6 (6.2, 9.2)
Physical activity
Low 70.4 (67.7, 72.9) 20.5 (18.2, 23.0) 2.6 (2.0, 3.4) 6.5 (5.6, 7.5)
Moderate 72.7 (70.4, 74.9) 18.1 (16.1, 20.3) 2.8 (2.2, 3.7) 6.4 (5.6, 7.2)
High 77.8 (73.2, 81.9) 15.2 (11.7, 19.5) 3.2 (1.9, 5.4) 3.7 (2.3, 5.8)
Family History of DM
No 75.3 (73.5, 77.1) 18.0 (16.4, 19.8) 2.3 (1.8, 2.9) 4.3 (3.8, 5.0)
Yes 66.7 (63.6, 69.7) 19.6 (17.0, 22.5) 3.7 (2.8, 4.9) 10.0 (8.6, 11.6)
DM, diabetes mellitus; numbers are reported as % and (95% confidence interval).
Diabetes mellitus and management in an urban area in Iran H. NAJAFIPOUR et al.
4 © 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd

New definition
With the new definition (details are mentioned above in
the method), the overall uncontrolled-DM was observed
in 60.8% of the diagnosed DM cases (men 59.7% vs
women 61.5%). Using the new definition, the prevalence
of uncontrolled-DM decreased by 7% to 30% in different
subpopulations. The biggest difference was observed in
the elderly group (47.5%), those receiving insulin therapy
(69.6%), illiterate (48.2%), Opium dependent users
(62.5%), people with depression symptoms (60.4%) and
those with no familial history of DM (60.3%).
Predictors of diabetes
In crude analysis, sex (male vs female), age, education,
opium addiction, depression, increased BMI category,
lower physical activity, and DM familial history turned
to be potential significant predictors for DM (Table 3).
While in the multivariate model, after removing con-
founding effects, it was shown that the odds of diabetes
increased significantly only by age group (AOR 5.0 to
18.2), depression (AOR 1.2), overweight and obesity
(AOR 1.6, and 1.5), moderate and low physical activity,
(AOR 1.5, and 1.4) and the positive familial history of
DM (AOR 2.2). The other variables did not have a sta-
tistically significant association with diabetes.
19
Diabetes-related co-morbidities
The maximum prevalence of co-morbidities among
patients with diagnosed DM were anxiety (87.5%),
depression (57.9%) and overweight/obesity (47.1%);
among people with undiagnosed DM, most frequent
co-morbidities were again anxiety (73.2%) and
overweight/obesity (55.6%) while hypercholesterolemia
(54.3%) also become very common, too (Table 4).
Among individuals with pre-diabetes, again anxiety
(76.2%), overweight/obesity (50.5%) and hypercholester-
olemia (35.4%) were the most frequent co-morbidities.
The least frequent co-morbidity was hypertension (9.4%
to 17.1%).
Sex and age interacted on diabetes
The standardized prevalence of diabetes was almost
comparable in men and women by age of 45 years
(Fig. 1). In comparison to the trend observed for
younger people, the DM prevalence significantly
increased at about 40 years in both sexes, while later,
women disproportionately turned out to be diabetic in
comparison to men. DM prevalence peaked in men
(33.8%) at age of 60–64 years and in women (38.9%) at
age of 65–69 years and then started to decrease.
Discussion
In our analysis, we found one out of four individuals
living in an urban area in Iran either had impaired
glucose level (pre-diabetes) or diabetes. Near to 3% of
individuals had their diabetes undiagnosed and in more
Table 2 Prevalence of control and un-controlled diabetes among
diagnosed diabetic patients (n = 536), Community-Based Study
(KERCADR 1st Round: n = 5895), Kerman, Iran, 2010–2011
Subgroups
Uncontrolled diabetes
Old definition New definition
Overall 76.5 (72.7, 79.9) 60.8 (56.6, 64.9)
Sex
Men 75.1 (68.7, 80.6) 59.7 (52.8, 66.2)
Women 77.3 (72.5, 81.5) 61.5 (56.2, 66.6)
Age groups
15–34 60.0 (34.8, 80.8) 60.0 (34.8, 80.8)
35–44 59.5 (43.2, 73.9) 59.5 (43.2, 73.9)
45–54 77.7 (70.6, 83.5) 70.1 (62.6, 76.6)
55–64 77.8 (71.4, 83.1) 60.8 (53.7, 67.5)
65–75 77.8 (68.5, 85.0) 47.5 (37.9, 57.2)
DM Treatment
None 57.9 (48.7, 66.6) 44.7 (35.9, 53.9)
Non-insulin 80.1 (75.7, 83.9) 63.8 (58.8, 68.6)
Insulin 89.1 (76.4, 95.4) 69.6 (54.9, 81.1)
Insulin and non-insulin 92.9 (62.7, 99.0) 85.7 (56.9, 96.5)
Education
Illiterate 78.1 (70.4, 84.3) 48.2 (39.9, 56.6)
Primary to high school 77.3 (72.6, 81.4) 65.8 (60.6, 70.7)
Above high school 68.3 (55.6, 78.8) 61.7 (48.9, 73.0)
Current cigarette smoker
No 77.3 (73.3, 80.8) 61.1 (56.5, 65.4)
Yes 70.5 (58.2, 80.4) 59.0 (46.6, 70.4)
Opium addiction
No 76.1 (72.0, 79.9) 60.1 (55.3, 64.7)
Occasional user 74.5 (60.9, 84.6) 64.7 (50.8, 76.5)
Dependent user 81.3 (67.7, 89.9) 62.5 (48.2, 74.9)
Depression
No 72.9 (67.1, 78.0) 61.8 (55.6, 67.5)
Yes 79.5 (74.4, 83.8) 60.4 (54.5, 66.0)
Anxiety
No 78.3 (69.5, 85.1) 63.2 (53.8, 71.7)
Yes 75.9 (71.7, 79.7) 60.5 (55.8, 65.1)
Obesity
Normal 79.9 (72.7, 85.5) 66.4 (58.6, 73.5)
Overweight 77.2 (71.5, 82.0) 59.8 (53.5, 65.7)
Obese 72.7 (64.7, 79.4) 59.0 (50.4, 67.0)
Physical activity
High 66.7 (44.7, 83.2) 57.1 (36.0, 76.0)
Moderate 74.4 (68.7, 79.4) 59.7 (53.6, 65.5)
Low 79.4 (74.0, 83.9) 62.3 (56.1, 68.0)
Family History DM
No 78.6 (72.8, 83.4) 60.3 (53.8, 66.4)
Yes 74.4 (69.0, 79.1) 59.9 (54.1, 65.4)
H. NAJAFIPOUR et al. Diabetes mellitus and management in an urban area in Iran
5© 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd

Citations
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Journal ArticleDOI
Abstract: The hollow nanostructures receive increasing attention in recent years. In particular, the confined cavity in the hollow nanostructures can function as a carrier for loading target molecules, whereas the porous walls are beneficial for shortening the transport distance of target molecules from solution to surface of adsorbent, making it possible to achieve high adsorption capacity with short adsorption time. Here, the hollow Co3S4 was synthesized by using ZIF-67 as template and thioacetamide as sulfide reagent through a simple solvothermal method, and characterized by SEM, TEM, HRTEM, XRD, FT-IR, zeta potential measurement, TG, N2 adsorption-desorption and XPS analysis. The adsorption performance of hollow Co3S4 for ciprofloxacin (CIP) antibiotics was evaluated in neutral aqueous solution. The equilibrium adsorption data were well fitted by Langmuir model, and a high maximum CIP adsorption capacity of 471.7 mg g−1 was obtained. The relatively high correlation coefficient of Tempkin model (r2 = 0.960) indicated a stronger electrostatic interaction between CIP and hollow Co3S4, which was consistent with the observation from the effects of pH and ionic strength. Result of adsorption kinetic investigation indicated fast CIP adsorption by hollow Co3S4. The adsorption kinetics follows the pseudo-second-order kinetic model and liquid-film diffusion model. CIP adsorption by hollow Co3S4 was hardly affected by humic acid. Further, the hollow Co3S4 exhibited no obvious loss in CIP removal after recycling for five times. The result displays an important environmental significance of hollow Co3S4 for CIP sequestration, in particular in wastewater, where CIP antibiotics are only slightly transformed or even unchanged.

103 citations


Journal ArticleDOI
Abstract: Pharmaceuticals as severe contaminants of surface and ground water around the manufacturing communities and residential zones received growing attention recently. Since, there is no report on ciprofloxacin (CIP) removal using electrocoagulation (EC) process by aluminum electrodes, the present work deals with efficient removal of CIP from hospital wastewater using mentioned method. Response surface methodology (RSM) was used to evaluate the main effects of parameters, their simultaneous interactions and quadratic effect to achieve the optimum condition for EC process. According to the obtained results from regression analysis, it was found that the experimental data are best fitted to the second-order polynomial model with coefficient of determination (R 2 ) value of 0.9086, adjust correlation coefficient (Adj. R 2 ) value of 0.8796 and predicted correlation coefficient (pred. R 2 ) value of 0.7834. EC process was applied successfully with removal efficiency of 88.57% under optimal operating condition of pH 7.78, inter-electrode distance 1 cm, reaction time 20 min, current density 12.5 mA cm −2 and electrolyte dose of 0.07 M NaCl with the initial CIP concentration of 32.5 mg L −1 . The experimental efficiency was in satisfactory agreement with the predicted efficiency of 90.34%. The obtained results revealed that, sweep flocculation as a determinant mechanism controlled the adsorption of CIP molecules on aluminum hydroxide precipitates. Electrode consumption and electrical energy consumption were found to be 66.80 g m −3 and 0.613 kWh m −3 , respectively. The obtained results from real sample analysis revealed that the initial CIP concentration of 154 ± 6 μg L −1 of hospital wastewater were found to reached to zero after applying optimal condition of EC process.

92 citations


Journal ArticleDOI
Abstract: This research investigated the photocatalytic degradation of ciprofloxacin by titanium dioxide nanoparticles immobilized on a glass plate in an aqueous solution. The important point about t...

78 citations


Cites background from "Optimization of electrocoagulation ..."

  • ...One of the major human antibiotics of the fluoroquinolone family which is prescribed extensively is ciprofloxacin (Paul et al., 2010; Bajpai et al., 2014; Fries et al., 2016; Yoosefian et al., 2017; Hassani et al., 2017b)....

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Journal ArticleDOI
TL;DR: The review places particular emphasis on the application of EC process to remove pharmaceutical contaminants, and the operational parameters influencing EC efficiency with the electroanalysis techniques are described.
Abstract: The pharmaceuticals are emergent contaminants, which can create potential threats for human health and the environment. All the pharmaceutical contaminants are becoming enormous in the environment as conventional wastewater treatment cannot be effectively implemented due to toxic and intractable action of pharmaceuticals. For this reason, the existence of pharmaceutical contaminants has brought great awareness, causing significant concern on their transformation, occurrence, risk, and fate in the environments. Electrocoagulation (EC) treatment process is effectively applied for the removal of contaminants, radionuclides, pesticides, and also harmful microorganisms. During the EC process, an electric current is employed directly, and both electrodes are dissoluted partially in the reactor under the special conditions. This electrode dissolution produces the increased concentration of cation, which is finally precipitated as hydroxides and oxides. Different anode materials usage like aluminum, stainless steel, iron, etc. are found more effective in EC operation for efficient removal of pharmaceutical contaminants. Due to the simple procedure and less costly material, EC method is extensively recognized for pharmaceutical wastewater treatment over further conventional treatment methods. The EC process has more usefulness to destabilize the pharmaceutical contaminants with the neutralization of charge and after that coagulating those contaminants to produce flocs. Thus, the review places particular emphasis on the application of EC process to remove pharmaceutical contaminants. First, the operational parameters influencing EC efficiency with the electroanalysis techniques are described. Second, in this review emerging challenges, current developments and techno-economic concerns of EC are highlighted. Finally, future recommendations and prospective on EC are envisioned.

55 citations


Journal ArticleDOI
Abstract: The current work deals with efficient removal of acetaminophen (AC) from hospital wastewater using electro-Fenton (EF) process. The degradation yield of 99.5% was obtained under optimal experimental conditions, namely 5.75 mg L−1 initial AC concentration, 2.75 pH solution, 3-cm inter-electrode distance, 100 mg L−1 KCl electrolyte, 122.5 µL L−1 H2O2, 8 mA cm−2 current density at equilibrium time of 8 min. Analysis of variance (ANOVA) suggested that the effect of mentioned operating parameters was statistically significant on the AC removal. The low probability amount of P value (P < 0.0001), the Fisher’s F-value of 65.91, and correlation coefficient of the model (R2 = 0.9545) revealed a satisfactory correlation between the experimental and the predicted values of AC removal. The predicted removal efficiency of 99.4% was in satisfactory agreement with the obtained experimental removal efficiency of 98.7%. The AC degradation during the EF followed a first-order kinetic model with rate constants (Kapp) of 0.6718 min−1. Using the ordinary radical scavengers revealed that main mechanism of AC degradation controlled by the hydroxyl free radicals produced throughout the EF process. The excess amount of iron (II) scavenged the active radicals and diminished the concentration of ·OH available to react with AC. The optimum molar ratio of H2O2 to Fe2+ was found to be 2.5. The developed EF process as a promising technique applied for treatment of real samples.

53 citations


Cites background or methods from "Optimization of electrocoagulation ..."

  • ...To evaluate the percentage effect of each operating factor on removal efficiency of AC, Pareto analyses were conducted according to the following relation (Yoosefian et al. 2017): (3) Y = 0 + n...

    [...]

  • ...Since the presence of CO3 anions may result in the precipitation of Ca2+ cations that form an insulating layer on the surface of the cathode and lead to increase in the ohmic resistance of the EF reactor (Khandegar and Saroha 2013; Yoosefian et al. 2017)....

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  • ...05) implies the validity of the quadratic model (Doltabadi et al. 2016; Yoosefian et al. 2017)....

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  • ...To conduct a successful study, RSM is applied to find a suitable approximation for the relation between independent main variables and response as expressed below (Ahmadzadeh et al. 2017; Yoosefian et al. 2017):...

    [...]


References
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Journal ArticleDOI
TL;DR: The objective of the present manuscript is to review the potential of electrocoagulation for the treatment of industrial effluents, mainly removal of dyes from textile effluent.
Abstract: Various techniques such as physical, chemical, biological, advanced oxidation and electrochemical are used for the treatment of industrial effluent. The commonly used conventional biological treatment processes are time consuming, need large operational area and are not effective for effluent containing toxic elements. Advanced oxidation techniques result in high treatment cost and are generally used to obtain high purity grade water. The chemical coagulation technique is slow and generates large amount of sludge. Electrocoagulation has recently attracted attention as a potential technique for treating industrial effluent due to its versatility and environmental compatibility. This technique uses direct current source between metal electrodes immersed in the effluent, which causes the dissolution of electrode plates into the effluent. The metal ions, at an appropriate pH, can form wide range of coagulated species and metal hydroxides that destabilize and aggregate particles or precipitate and adsorb the dissolved contaminants. Therefore, the objective of the present manuscript is to review the potential of electrocoagulation for the treatment of industrial effluents, mainly removal of dyes from textile effluent.

488 citations


Journal ArticleDOI
Abstract: This article reviews both the pollution by the electrochemical industry and the use of electrochemistry to clean water. Main pollutants include Pd, Cd, Ni, Hg and other metals and cyanide as well as organic pollutants. The cause for water pollution by electrochemistry is due to the effluents from different electrochemical industries such as mercury from chlor-alkali industry; lead, cadmium and mercury from battery industry; heavy metals and organic contaminants from electroplating wastes; contaminants from corrosion processes; and persistent organic pollutants from the synthesis and use of pesticides, dyes and pharmaceuticals. Most pollutants can be successfully eliminated or converted to non-toxic materials by methods based on the electrochemical principles. Electrochemical depolluting methods are mainly electrodialysis, electrocoagulation, electroflotation, anodic processes, cathodic processes and electrochemical advanced oxidation processes.

255 citations


Journal ArticleDOI
TL;DR: Combined use of both electrode materials in the EC unit may yield high process performances with respect to both COD and oil-grease removals.
Abstract: Treatment of poultry slaughterhouse wastewater (PSW) by electrocoagulation (EC) has been investigated batchwise in this paper. Effects of the process variables such as medium pH, electrode material, current density, and operating time are investigated on chemical oxygen demand (COD) and oil-grease removal efficiencies, electrical energy consumption, and sacrificial electrode consumption. The highest COD removal efficiency is reached with aluminum as 93%, and maximum oil-grease removal is obtained with iron electrodes as 98%. Combined use of both electrode materials in the EC unit may yield high process performances with respect to both COD and oil-grease removals. Further work needs to be carried out at pilot scale to assess the technical end economic feasibility of the process.

211 citations


Journal ArticleDOI
TL;DR: Radical species other than hydroxyl radicals were suggested to occur at acidic pH which can explain fast ciprofloxacin ozonation at pH 3.5.
Abstract: A bubble reactor was used for ozonation of the antibiotic ciprofloxacin. Effects of process parameters ozone inlet concentration, ciprofloxacin concentration, temperature, pH and H 2 O 2 concentration were tested. Desethylene ciprofloxacin was identified, based on HPLC–MS analysis, as one of the degradation products. Formation of desethylene ciprofloxacin was highly dependent on pH, with the highest concentration measured at pH 10. Radical scavengers t -butanol and para chlorobenzoic acid were added in order to gain mechanistic understanding. Radical species other than hydroxyl radicals were suggested to occur at acidic pH which can explain fast ciprofloxacin ozonation at pH 3.

187 citations


Journal ArticleDOI
Abstract: We report the synthesis of nanostructure ZnO semiconductor with ∼2.1 nm diameter using a chemical precipitation method. The resulting nanoparticles were characterized by X-ray diffraction analysis (XRD), Fourier-transform infrared (FT-IR) spectroscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The optical properties were investigated by UV–vis and fluorescence techniques. The absorption spectra exhibit a sharp absorption edge at ∼334 nm corresponding to band gap of ∼3.7 eV. The fluorescence spectra displayed a near-band-edge ultraviolet excitonic emission at ∼410 nm and a green emission peak at ∼525 nm, due to a transition of a photo-generated electron from the conduction band to a deeply trapped hole. The photocatalytic activity of the prepared ZnO nanoparticles has been investigated for the degradation of ciprofloxacin drug under UV light irradiation in aqueous solutions of different pH values. The results showed that the photocatalytic degradation process is effective at pH 7 and 10, but it is rather slow at pH 4. Higher degradation efficiency (∼50%) of the drug was observed at pH 10 after 60 min. Photodegradation of the drug follows a pseudo-first-order kinetics.

157 citations