Prevalence of Ever Self-Reported Asthma and Associated Factors among University Students in Iran: A Population-Based Study

Background:

Asthma is a chronic inflammatory airway disease with regressive episodic symptoms. This study aimed to assess the prevalence of asthma ever (lifetime prevalence of asthma) and the associated factors among newly entered students in public universities in Iran.

Methods:

This population-based cross-sectional study was part of the “Mental and Physical Health Assessment of University Students in Iran.” The target population included all newly admitted students (N = 151,671) in 74 public universities in 28 provinces (out of the 31 provinces) in Iran. STATA version 12 was used for calculating the descriptive statistics. Univariate and multivariate logistic regression models were employed to identify relationships between asthma and socioeconomic variables. The level of significance was set at 95% confidence interval.

Results:

Of a total of 79,277 participants, 55.23% (n = 43,785) and 44.77% (n = 35,492) were female and male, respectively. The prevalence of ever asthma among studied student was 1.89%. Of all the participants with asthma, 88.43% (85.49%–90.84%) were nonsmokers. More than 20% of the subjects were physically inactive. The respondents who revealed smoking >10 cigarettes/week were about 1.22 (1.036–1.437) times more likely to suffer from asthma disease (0.017), as compared with those who were not smoking.

Conclusions:

Our study provides valuable information about the prevalence of asthma ever symptoms among university students in Iran. In fact, the results of this study can fill information gaps concerning the affected groups in Iran, and even worldwide.

Breakfast consumption pattern and its association with overweight and obesity among university students: a population-based study

PURPOSE

To determine the association between breakfast consumption habit and overweight and obesity in a sample of Iranian university students.

METHODS

A sample of 78,905 university students, aged 18 years or older, was recruited from 28 provinces in Iran to assess breakfast consumption pattern. Breakfast consumption habit was evaluated using a pre-tested questionnaire. Weight and height were measured using standard protocol and then body mass index (BMI) was calculated. Overweight (obesity included) and obesity were defined as BMI ≥ 25 and BMI ≥ 30 kg/m², respectively.

RESULTS

Mean age of participants was 21.50 ± 4.01. After controlling for potential confounders, participants who ate breakfast > 4 days/week had 15% lower risk of overweight compared with those who ate < 1 day/week (OR: 0.85, 95% CI 0.78-0.92). Such significant association was also seen in female students (OR: 0.82, 95% CI 0.72-0.93); however, it was marginally significant in male ones (OR: 0.89, 95% CI 0.79-1.00). In addition, a significant inverse association was found between breakfast consumption and obesity (OR: 0.74, 95% CI 0.64-0.85) such that after adjusting for potential confounders, students who consumed breakfast > 4 days/week were 33% less likely to be obese compared with those who consumed it < 1 day/week (OR: 0.67, 95% CI 0.57-0.78). Such significant inverse association was also seen in either gender.

CONCLUSIONS

Breakfast consumption was inversely associated with odds of overweight and obesity in university students.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive studies.

Dairy Consumption in Relation to Hypertension Among a Large Population of University Students: The MEPHASOUS Study

BACKGROUND

Hypertension is a chronic condition that its prevalence is increasing at an alarming rate. Findings on the association between dairy consumption and hypertension are conflicting and few data are available in the Middle East.

AIM

To assess the association between dairy consumption and hypertension among a large population of university students.

MATERIALS AND METHODS

The current study was performed in the framework of the Mental and Physical Health Assessment of University Student (MEPHASOUS) project. Overall, 67,011 university students with complete information were included in the statistical analysis. To assess dairy consumption, a self-administered dietary habits questionnaire was employed. Blood pressure was measured using a standard protocol. The systolic/diastolic blood pressure of ≥140/90 mmHg was considered hypertension.

RESULTS

Hypertension was prevalent among 6.9% of students. A significant inverse association was found between dairy consumption and the odds of hypertension; such that after taking potential confounders into account, individuals in the highest levels of dairy consumption had 85% lower odds for having hypertension compared with those in the lowest levels (odds ratio (OR): 0.15, 95% confidence interval (CI): 0.13-0.18). Such an inverse association was also seen among males (OR: 0.14, 95% CI: 0.11-0.18) and females (OR: 0.16, 95% CI: 0.12-0.21), normal-weight students (OR: 0.15, 95% CI: 0.12-0.18) and those with overweight or obesity (OR: 0.15, 95% CI: 0.11-0.21), and individuals with (OR: 0.13, 95% CI: 0.11-0.16) and without (OR: 0.24, 95% CI: 0.17-0.35) family history of hypertension.

CONCLUSION

Our results support the previous findings on the inverse association between dairy consumption and hypertension among university students.

FRAX-based intervention and assessment thresholds for osteoporosis in Iran

We compared the utility of the current Iranian guidelines that recommend treatment in women with a T-score ≤ - 2.5 SD with a FRAX-based intervention threshold equivalent to women of average BMI with a prior fragility fracture. Whereas the FRAX-based intervention threshold identified women at high fracture probability, the T-score threshold was less sensitive, and the associated fracture risk decreased markedly with age.

INTRODUCTION

The fracture risk assessment algorithm FRAX® has been recently calibrated for Iran, but guidance is needed on how to apply fracture probabilities to clinical practice.

METHODS

The age-specific ten-year probabilities of a major osteoporotic fracture were calculated in women with average BMI to determine fracture probabilities at two potential intervention thresholds. The first comprised the age-specific fracture probabilities associated with a femoral neck T-score of - 2.5 SD, in line with current guidelines in Iran. The second approach determined age-specific fracture probabilities that were equivalent to a woman with a prior fragility fracture, without BMD. The parsimonious use of BMD was additionally explored by the computation of upper and lower assessment thresholds for BMD testing.

RESULTS

When a BMD T-score ≤ - 2.5 SD was used as an intervention threshold, FRAX probabilities in women aged 50 years was approximately two-fold higher than in women of the same age but with an average BMD and no risk factors. The relative increase in risk associated with the BMD threshold decreased progressively with age such that, at the age of 80 years or more, a T-score of - 2.5 SD was actually protective. The 10-year probability of a major osteoporotic fracture by age, equivalent to women with a previous fracture rose with age from 4.9% at the age of 50 years to 17%, at the age of 80 years, and identified women at increased risk at all ages.

CONCLUSION

Intervention thresholds based on BMD alone do not effectively target women at high fracture risk, particularly in the elderly. In contrast, intervention thresholds based on fracture probabilities equivalent to a "fracture threshold" target women at high fracture risk.

Iranian university students lifestyle and health status survey: study profile

Background

The physical health assessment of university students in Iran is a national large scale assessment examining health behaviors among tertiary education students. Understanding risky health behaviors which are the major sources of global mortality and morbidity in adulthood is the key objective of this assessment.

Methods

In academic year of 2012–2013, newly admitted students (N = 151,671) at 74 governmental eligible universities that had health center from 28 provinces were invited to participate in the health assessment program. The physical health behaviors of the students were evaluated by using questionnaire. The test-retest reliability method was applied to estimate the reliability of physical health questionnaire. After filling out the questionnaires, students were led to the examination room for the measurement of height, weight and blood pressure.

Results

From the total study population, 84,298 student’s ages between 18 and 29 years old, were participated in the health assessment. The mean response proportion was 63%. The mean age of students was 21.5 ± 4.01, with 49.20% percent being <20 years old. 32.31% were between 20 and 24 years, 13.44% between 25 and 29 years, 69% of the participants were undergraduate 34.9% were master’s students, and 2.9% were Ph.D. students. The mean BMI for total students was 22.5 ± 4.0 and regarding to gender, the mean BMI for male and female were 23.0 ± 4.1 and 22.2 ± 3.8 respectively.

Conclusion

Analysis of student’s findings will generate multiple studies which report different aspects of physical health of Iranian university students who constitute a large proportion of young adult aged 18–29 years in the country. This assessment also provides opportunity to compare Iranian student’s behavioral patterns with the behavioral pattern of students worldwide.

Brain Volume Estimation Enhancement by Morphological Image Processing Tools

BACKGROUND

Volume estimation of brain is important for many neurological applications. It is necessary in measuring brain growth and changes in brain in normal/abnormal patients. Thus, accurate brain volume measurement is very important. Magnetic resonance imaging (MRI) is the method of choice for volume quantification due to excellent levels of image resolution and between-tissue contrast. Stereology method is a good method for estimating volume but it requires to segment enough MRI slices and have a good resolution. In this study, it is desired to enhance stereology method for volume estimation of brain using less MRI slices with less resolution.

METHODS

In this study, a program for calculating volume using stereology method has been introduced. After morphologic method, dilation was applied and the stereology method enhanced. For the evaluation of this method, we used T1-wighted MR images from digital phantom in BrainWeb which had ground truth.

RESULTS

The volume of 20 normal brain extracted from BrainWeb, was calculated. The volumes of white matter, gray matter and cerebrospinal fluid with given dimension were estimated correctly. Volume calculation from Stereology method in different cases was made. In three cases, Root Mean Square Error (RMSE) was measured. Case I with T=5, d=5, Case II with T=10, D=10 and Case III with T=20, d=20 (T=slice thickness, d=resolution as stereology parameters). By comparing these results of two methods, it is obvious that RMSE values for our proposed method are smaller than Stereology method.

CONCLUSION

Using morphological operation, dilation allows to enhance the estimation volume method, Stereology. In the case with less MRI slices and less test points, this method works much better compared to Stereology method.

Protocol for a Systematic Review and Meta-Analysis of Lithium, Anticonvulsive or atypical antipsychotic Drugs for Treatment of Refractory Obsessive-Compulsive Disorder

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that causes significant distress to the afflicted individual. About half of OCD patients treated with an adequate trial of serotonin reuptake inhibitors fail to fully respond to treatment and continue to exhibit significant symptoms. Therefore, there is a need for other agents to alleviate the symptoms of these disorders. In spite of considerable research including numerous randomized controlled trials and systematic reviews, there exists uncertainty regarding what treatments are effective. In this systematic review, we evaluated the efficacy of mood stabilizers in treatment-refractory OCD.

MATERIALS AND METHODS

We conducted a meta-analysis of all randomized clinical trials evaluating lithium, anticonvulsive agents or atypical antipsychotic drugs for OCD to determine which therapies show more effective than a placebo, in reducing obsessive-compulsive symptoms. We acquired eligible studies through a systematic search of Cochrane Central Registry of Controlled Trials, MEDLINE, EMBASE, PsycINFO, Scopus, ProQuest and Google scholar. We conducted meta-analyses to establish the effect of lithium, anticonvulsive agents, or atypical antipsychotic drugs on patient-important outcomes when possible. To assess relative effects of treatments, we constructed a random effect model.

DISCUSSIONS

Our review was the first to evaluate all treatments for OCD, to provide the relative effectiveness of lithium, anticonvulsive agents, or atypical antipsychotic drugs, and prioritize patient-important outcomes with a focus on functional gains. Our review facilitated the evidence-based management of patients with resistant OCD, and identified the key areas for future research.

Defining polypharmacy in the elderly: a systematic review protocol

INTRODUCTION

Ageing--along with its associated physiological and pathological changes--places individuals at a higher risk of multimorbidity and treatment-related complications. Today, polypharmacy, a common and important problem related to drug use, occurs subsequent to this multimorbidity in the elderly in all populations. In recent decades, several scientific investigations have studied polypharmacy and its correlates, using different approaches and definitions, and their results have been inconclusive. Differences in definitions and approaches in these studies form a barrier against reaching a conclusion regarding the risk factors and consequences of polypharmacy. It is therefore imperative to establish an appropriate definition of polypharmacy.

METHODS AND ANALYSIS

A systematic review will be conducted using PubMed, Scopus, Web of Science, EMBASE, PsycINFO and AgeLine bibliographic databases, as well as the grey literature on polypharmacy in older adults to answer these two questions: What definitions in the literature are being used for polypharmacy in older people?, and Which definitions are more comprehensive and applicable? 2 independent reviewers will conduct the primary screening of the articles and data extraction, and eligible sources will be selected after discussing non-conformities. All extracted data from selected articles will be categorised based on the type of study participants, study design and setting, the methodological quality of primary studies and any other potential source of heterogeneity, and results will be summarised in a table, which will contain the levels of evidence and methodological quality of the included studies. The most comprehensive definition of polypharmacy will be selected from the final list of definitions through an international expert webinar.

ETHICS AND DISSEMINATION

This research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal.

Effect of endurance training on retinol-binding protein 4 gene expression and its protein level in adipose tissue and the liver in diabetic rats induced by a high-fat diet and streptozotocin

AIMS/INTRODUCTION

The present study was designed to investigate from which tissues the decrease in retinol-binding protein 4 (RBP4) expression could contribute to the improvement of serum RBP4 and insulin resistance (IR) after endurance training.

MATERIALS AND METHODS

Male 7-week-old Wistar rats were randomly assigned into four groups including control (C), trained (T), diabetic control (DC) and trained diabetic (TD). At 8 weeks-of-age, diabetes was induced by a high-fat diet and intraperitoneal injection of low-dose streptozotocin (STZ; 35 mg/kg). Rats in the T and TD groups carried out a 7-week exercise program on a motorized treadmill (15-20 m/min for 20 min/day for 5 weeks), whereas the C and DC remained sedentary in their cages. Tissues gene expression and protein levels of RBP4 were assessed by using real-time polymerase chain reaction and western blot, respectively, while serum RBP4 was measured using an enzyme-linked immunosorbent assay kit.

RESULTS

Exercise significantly improved IR and reduced serum concentration of RBP4 in the TD group. This reduction of serum RBP4 was accompanied by decreased RBP4 protein expression in visceral fat tissue. In contrast, exercise had no significant effect on RBP4 expression in liver and subcutaneous fat tissue in the TD group. Exercise also significantly decreased RBP4 gene expression in visceral fat tissue and muscle, whereas the effect of exercise on liver RBP4 messenger ribonucleic acid expression was not significant.

CONCLUSIONS

The present study showed that the mechanism for RBP4 reducing the effect of endurance training could involve decreased RBP4 messenger ribonucleic acid expression and its protein level in adipose tissue in STZ-induced diabetic rats.

The effect of 12 weeks Anethum graveolens (dill) on metabolic markers in patients with metabolic syndrome; a randomized double blind controlled trial

BACKGROUND

The clustering of metabolic abnormalities defined as metabolic syndrome is now both a public health and a clinical problem .While interest in herbal medicine has greatly increased, lack of human evidence to support efficacies shown in animals does exist. This clinical trial study designed to investigate whether herbal medicine, Anethum graveolens (dill) extract, could improve metabolic components in patients with metabolic syndrome.

METHODS

A double-blind, randomized, placebo-controlled trial using a parallel design was conducted. 24 subjects who had metabolic syndrome diagnostic criteria (update of ATP III) were randomly assigned to either dill extract (n = 12) or placebo (n = 12) for 3 months.

RESULTS

Across lipid component of metabolic syndrome, no significant differences in triglyceride (TG) concentration and high density lipoprotein cholesterol were seen between the two groups. However TG improved significantly from baseline (257.0 vs. 201.5p = 0.01) with dill treatment but such a significant effect was not observed in placebo group. Moreover, no significant differences in waist circumference, blood pressure and fasting blood sugar were seen between two groups after 3 months follow up period.

CONCLUSION

In this small clinical trial in patients with metabolic syndrome, 12 weeks of dill extract treatment had a beneficial effect in terms of reducing TG from baseline. However dill treatment was not associated with a significant improvement in metabolic syndrome related markers compared to control group. Larger studies might be required to prove the efficacy and safety of long-term administration of dill to resolve metabolic syndrome components.

Relationship between consultation length and rational prescribing of drugs in Gorgan City, Islamic Republic of Iran

Doctors with longer consultation times tend to diagnose illnesses more precisely, prescribe fewer drugs and present better health advice to their patients. The aim of this study was to measure the average consultation time of general practitioners in Gorgan, Islamic Republic of Iran and to investigate the factors affecting consultation length, especially in relation to rational prescribing of drugs. Data were collected on 620 patient consultations with 62 randomly selected general practitioners. Mean consultation length was 6.9 (SD 2.6) minutes. Patient factors that were significantly associated with a longer mean duration of consultation time were: higher number of health problems, older age and fewer items of previously used drugs. Physician factors that were significantly associated with a longer mean consultation time were: younger age, higher numbers of items prescribed and injectable drugs prescribed, frequency of interruptions and higher workload.

Some early results related to electrical impedance of normal and abnormal gastric tissue

Gastric cancer is the fourth most common cancer and most patients with gastric cancer are being diagnosed in advanced stages of the disease so they do not gain any survival chance from conventional surgical, chemotherapeutic or radiotherapeutic methods. These are relatively high cost procedures in terms of both time and money. This study considers the introduction of a novel minimally invasive diagnostic technique which shows the relationship between histopathology and the electrical impedance spectrum in the human stomach. In this study, 4 electrode technique was used to differentiate tissues from each other using Tabriz Mark 1 electrical impedance system (30 different frequencies in the range of 2 kHz to 1 MHz). A total of 97 points from 45 patients were studied in terms of their biopsy reports matching to the electrical impedance measurements (in vivo). After impedance measurements and applying calibration factors, a non-parametric statistical technique, the Kruskal-Wallis test was used to evaluate the difference among the groups. According to the calculation of respective data using this spectroscopy system, the resistivity of the normal group was higher than that of the benign group, and the resistivity of these groups were higher than that of the malignant group at frequencies between 470 kHz and 1 MHz (P < 0.05). In these frequencies, the impedivity of the dysplastic tissue was significantly lower than that of the other groups (P < 0.05). Also, Cole equation fitting procedure was used to generate a scatter plot of the malignant and benign points: it shows in general, benign points had higher values of R than the malignant points. Therefore, electrical impedance spectroscopy can be a useful technique to characterize the stomach tissue.

The impact of one session resistance exercise on plasma adiponectin and RBP4 concentration in trained and untrained healthy young men

We designed this study, to investigate the predicting effect of a single resistance exercise session on serum level of RBP4 and adiponectin in trained and untrained subjects and to evaluate whether regular training may affect the response of these adipokines to exercise. Thirty four healthy young male students including 19 trained and 15 untrained participated in this study; each group was then randomly assigned to intervention and control groups. The exercise session prolonged 120 minutes intensive resistance program at 70%-80% of 1RM. The blood samples were collected just before the start of training program and 4 hours post exercise to evaluate concentration of adiponectin, RBP4 and CRP as well as other metabolic markers. The serum level of adiponectin, RBP4 and CRP was not significantly different between trained and untrained groups at baseline. More over four hours post exercise adipokines concentration and CRP didn't differ between groups. Adjusted regression model showed, basal adiponectin (β=0.59, p=<0.001) and HDL cholesterol (β=0.28, p=0.09) were the main predictors of post exercise adiponectin concentration. In addition, the basic level of RBP4 appeared to be the only predictor of after exercise RBP4 concentration (β=0.46, p=0.02). Neither one session of high intensity resistance exercise nor long term training had predicting effect on post exercise adiponectin and RBP4 concentration in healthy young men. In the other hand, the beneficial effect of acute resistance exercise training may not be reflected by changes in adiponectin, RBP4 and CRP concentration in healthy young individual no matter they trained or untrained.

Evidence-based approach to HIV/AIDS policy and research prioritization in the Islamic Republic of Iran

In formulating the second national strategic plan for prevention of HIV/AIDS in the Islamic Republic of Iran a more evidence-based approach was needed. This paper reports on a systematic review of the local evidence about the determinants of HIV/AIDS transmission in 3 categories: poor knowledge and negative attitudes about HIV transmission; injection drug use; and sexual promiscuity. Of 93 reports reviewed, 53 met the inclusion criteria. Information about the prevalence and magnitude of effect for the 3 risk determinants at the national and regional level was scarce. Heterogeneity between studies, even in the same sub-population, was significant. An improved research base and better sharing of information are needed within countries of the Eastern Mediterranean Region.

Sentinel hospital-based surveillance of rotavirus diarrhea in iran

BACKGROUND

Rotavirus is the most common causes of severe, acute diarrhea during childhood and is an important cause of morbidity and mortality in developing countries. We established active hospital-based surveillance of childhood diarrhea to assess the scope of severe rotavirus disease in Iran.

METHODS

From May 2006 through April 2007, prospective surveillance of rotavirus diarrhea among children aged <5 years was conducted in 5 sentinel hospitals in Iran. Stool samples were tested for rotavirus using a commercially available enzyme immunoassay, and rotavirus-positive samples were genotyped using reverse-transcriptase polymerase chain reaction.

RESULTS

Of 2198 children admitted to the hospital for acute gastroenteritis, 1298 (59.1%) had stool samples test positive for rotavirus by enzyme immunoassay. Of the rotavirus episodes, 85% occurred during the first 2 years of life, with the peak prevalence of severe rotavirus disease occurring from September through January. Among the 110 rotavirus-positive samples that were genotyped, G4P[8] was the most commonly detected rotavirus genotype (30.9% of strains). Other commonly detected genotypes included P[8] with G nontypeable (21.8%), G4 with P nontypeable (13.6%), G1[P8] (10.9%), and G2[P4] (5.5%).

CONCLUSIONS

Rotavirus is the most common cause of severe diarrhea in Iran, which indicates that safe and effective rotavirus vaccination in Iran is a public health priority.

Serum zinc levels in newborns with neural tube defects

Neural tube defects (NTD) comprise of a group of congenital malformations that include spina bifida, anencephaly and encephalocele. Reports have implicated zinc deficiency as one of the causative factors of NTDs. We compared the serum zinc level of 23 newborns having neural tube defects with 35 healthy controls by spectrophotometery during 2003-2004. Zinc deficiency was documented in 43.5% of the cases and 8.6% of the controls (P = 0.002). Multivariate logistic regression analysis revealed a significant association between the presence of NTDs and zinc deficiency (OR = 8.2, 95% Cl: 1.9-34.7).

Mathematical modeling of non-ideal mixing continuous flow reactors for anaerobic digestion of cattle manure

Most conventional digesters used for animal wastewater treatment include continuously stirred-tank reactors. While imperfect mixing patterns are more common than ideal ones in real reactors, anaerobic digestion models often assume complete mixing conditions. Therefore, their applicability appears to be limited. In this study, a mathematical model for anaerobic digestion of cattle manure was developed to describe the dynamic behavior of non-ideal mixing continuous flow reactors. The microbial kinetic model includes an enzymatic hydrolysis step and four microbial growth steps, together with the effects of substrate inhibition, pH and thermodynamic considerations. The biokinetic expressions were linked to a simple two-region liquid mixing model, which considered the reactor volume in two separate sections, the flow-through and the retention regions. Deviations from an ideal completely mixed regime were represented by changing the relative volume of the flow-through region (a) and the ratio of the internal exchange flow rate to the feed flow rate (b). The effects of the hydraulic retention time, the composition of feed, the initial conditions of the reactor and the degree of mixing on process performance can be evaluated by the dynamic model. The simulation results under different conditions showed that deviations from the ideal mixing regime decreased the methane yield and resulted in a reduced performance of the anaerobic reactors. The evaluation of the impact of the characteristic mixing parameters (a) and (b) on the anaerobic digestion of cattle manure showed that both liquid mixing parameters had significant effects on reactor performance.

Electrical impedance spectroscopy (EIS) in the urinary bladder: the effect of inflammation and edema on identification of malignancy

Previous studies have shown that tetrapolar electrical impedance spectroscopy measurements can identify cervical interstitial neoplasia with the same sensitivity and specificity as cervical smears. In the urinary bladder, the same technique yields significant differences (p < 0.05 at seven frequencies between 9.6 and 614 kHz) between normal and malignant urothelium, but is unable to classify individual measurements. Detailed histological examination demonstrates that inflammation and edema--both of which are common in abnormal urothelium--alter the impedance spectrum significantly in opposing directions. Consideration of morphological changes in abnormal urothelium suggests alternative measurement strategies.

Dynamic simulation of cyclic batch anaerobic digestion of cattle manure

Cyclic batch reactors with periodical feeds and extractions, are often used in cattle manure anaerobic digestion. The dynamic behavior of this type of reactor was simulated in this study. The kinetic model developed by I. Angelidaki et al. [Biotechnol. Bioeng. 42 (1993) 159], together with microbial growth kinetics, conventional material balances for an ideally cyclic batch reactor, liquid-gas interactions, and liquid phase equilibrium chemistry were used in this study. The model showed good agreement with the experimental data of R.I. Mackie and M.P. Bryant [Appl. Microbiol. Biotechnol. 43 (1995) 346], and R. Borja et al. [Chem. Eng. J. 54 (1994) B9]. The effects of hydraulic retention time (HRT), organic loading rate, reactant concentrations, feeding interval, and initial conditions such as pH and ammonia concentration on process performance can be evaluated by the dynamic model. Also simulation results show that the equilibrium conditions can be considered for CO2 distribution between liquid and gas phases, especially for processes with long retention times.