A Novel Ensemble Framework for Multi-Classification of Brain Tumors Using Magnetic Resonance Imaging.

Brain tumors can have fatal consequences, affecting many body functions. For this reason, it is essential to detect brain tumor types accurately and at an early stage to start the appropriate treatment process. Although convolutional neural networks (CNNs) are widely used in disease detection from medical images, they face the problem of overfitting in the training phase on limited labeled and insufficiently diverse datasets. The existing studies use transfer learning and ensemble models to overcome these problems. When the existing studies are examined, it is evident that there is a lack of models and weight ratios that will be used with the ensemble technique. With the framework proposed in this study, several CNN models with different architectures are trained with transfer learning and fine-tuning on three brain tumor datasets. A particle swarm optimization-based algorithm determined the optimum weights for combining the five most successful CNN models with the ensemble technique. The results across three datasets are as follows: Dataset 1, 99.35% accuracy and 99.20 F1-score; Dataset 2, 98.77% accuracy and 98.92 F1-score; and Dataset 3, 99.92% accuracy and 99.92 F1-score. We achieved successful performances on three brain tumor datasets, showing that the proposed framework is reliable in classification. As a result, the proposed framework outperforms existing studies, offering clinicians enhanced decision-making support through its high-accuracy classification performance.

An Association Between the Intestinal Permeability Biomarker Zonulin and the Development of Diabetic Retinopathy in Type II Diabetes Mellitus.

Objectives: Increased intestinal permeability (IP) and gut microbiota dysbiosis have been implicated in low-grade chronic inflammation, which is an important factor in the pathogenesis of diabetic retinopathy (DR). This study aims to demonstrate the relationship between the IP biomarker zonulin and DR in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: This study was conducted with a total of 89 T2DM patients, including 33 non-DR, 28 with non-proliferative DR (NPDR), and 28 with proliferative DR (PDR), and 32 healthy controls. Zonulin levels were determined from blood samples using an enzyme-linked immunosorbent assay kit. Results: There was no difference between the four groups in terms of age (p=0.236), gender (p=0.952), and body mass index (p=0.134) of the participants. Zonulin levels were significantly higher in the PDR group compared to the other three groups, as well as in the non-DR and NPDR groups compared to the control group. In multivariate logistic regression analysis, zonulin was found to be an independent predictor of DR (odds ratio: 1,781, 95% confidence interval: 1,122-2,829, p=0.014). Conclusion: Our study showed that elevated zonulin levels may play a significant role in the development of DR, particularly during the transition to the proliferative stage. This suggests that regulation of IP could be one of the targets of DR treatment. More studies are needed to determine whether a eubiotic gut microbiota and IP have a direct relationship with DR.

Isolation and characterization of yogurt starter cultures from traditional yogurts and growth kinetics of selected cultures under lab-scale fermentation.

The development of new starter cultures is a crucial task for the food industry to meet technological requirements and traditional products are important reservoirs for new starter cultures. In this respect, this study aimed to isolate, identify, and determine the technological characteristics of Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus strains originated from traditional yogurt samples. Genotypic discrimination of 200 isolates revealed the presence of distinct 19 S. thermophilus and 11 Lb. delbrueckii subsp. bulgaricus strains as potential starter cultures. Strain-specific properties determined the acidification capacity of the yogurt starter cultures and a higher acidification capacity was observed for S. thermophilus strains compared to Lb. delbrueckii subsp. bulgaricus strains. Proteolytic activity was found between 0.012-0.172 and 0.078-0.406 for S. thermophilus and Lb. delbrueckii subsp. bulgaricus strains, respectively. 4 of S. thermophilus and 3 of Lb. delbrueckii subsp. bulgaricus strains were found resistant to all tested bacteriophages. The antibiotic susceptibility tests of the isolates revealed that a very low antibiotic resistance was observed for the yogurt starter cultures. Finally, the growth kinetics of selected strains were determined and the maximum specific growth rate of selected S. thermophilus and Lb. delbrueckii subsp. bulgaricus was calculated as 0.527 h-1 and 0.589 h-1, respectively.

A significant predictor of in-hospital and long-term mortality and progression in COVID-19 patients: The end-stage liver disease (MELD) score model.

The aim of this study is to investigate the relationship between the model for end-stage liver disease (MELD) score and disease progression and mortality in COVID-19 patients. The files of 4213 patients over the age of 18 who were hospitalized with the diagnosis of COVID-19 between March 20, 2020 and May 1, 2021 were retrospectively scanned. Sociodemographic characteristics, chronic diseases, hemogram and biochemical parameters at the time they were diagnosed with COVID-19 of the patients, duration of hospitalization, duration of intensive care unit (ICU), duration of intubation, in-hospital mortality from COVID-19 and outside-hospital mortality for another reason (within the last 1 year) and recurrent hospitalization (within the last 1 year) were recorded. The MELD scores of the patients were calculated. Two groups were formed as MELD score < 10 and MELD score ≥ 10. The rate of ICU, in-hospital mortality from COVID-19 and outside-hospital mortality from other causes, intubation rate, and recurrent hospitalization were significantly higher in the MELD ≥ 10 group. The duration of ICU, hospitalization, intubation were significantly higher in the MELD ≥ 10 group (p < 0.001). As a result of Univariate and Multivariate analysis, MELD score was found to be the independent predictors of ICU, in-hospital mortality, intubation, and recurrent hospitalization (p < 0.001). MELD score 18.5 predicted ICU with 99% sensitivity and 100% specificity (area under curve [AUC]: 0.740, 95% confidence interval [CI]: 0.717-0.763, p < 0.001) also MELD score 18.5 predicted in-hospital mortality with 99% sensitivity and 100% specificity (AUC: 0.797, 95% CI: 0.775-0.818, p < 0.001). The MELD score was found to be the independent predictors of in-hospital mortality, ICU admission, and intubation in COVID-19 patients.

The Effects of Demographic, Training, and Specialization Differences of Physicians in COVID-19 Treatment in Turkey.

INTRODUCTION: The study aimed to determine how physicians' professional and institutional characteristics affect their treatment approaches for COVID-19 antiviral and supportive treatment, as well as their demographic characteristics and participation in COVID-19 trainings that may influence these orientations. METHODS: After researching the literature and conducting interviews with the experts, a questionnaire was prepared. The convenience sampling method was used to distribute the questionnaire online to 408 physicians across the nation in January 2021. Exploratory factor analysis was used to verify the research scale, and the Cronbach's Alpha test was used to confirm its reliability. During the data analysis, descriptive and inferential statistical tests were used. RESULTS: It was observed that the physicians were willing to give COVID-19 patients the antivirals but hesitant to provide and suggest supportive care. The training status for COVID-19 treatment was varied. Female physicians prescribed more antiviral drugs than male physicians, received more training, and scored higher across the scale than male physicians ( p = 0.001). The treatment approaches of physicians varied according to their specializations ( p = 0.002) all over the scale. CONCLUSION: The publication of current Ministry of Health guidelines on a variety of themes related to COVID-19 treatment, as seen in Turkey, is both beneficial and important. However, because all physicians, regardless of specialty, are affected by current and will be in the future pandemics, it is necessary to design and maintain a continuous training program on pandemics and their management for all physicians.

Effect of COVID-19 pandemic on anxiety depression and intention to go to hospital in chronic patients.

OBJECTIVE: The aim of this study was to investigate the effects of the COVID-19 pandemic on anxiety depression and intention to go to the hospital in chronic patients. METHODS: The Bostan Intention to Go to Hospital Scale developed by one researcher (SB) as the data collection tool and the Beck Anxiety-Depression Inventories were used. RESULTS: Of all patients, 56.8% stated that they would go to the hospital in case of emergency and 28.3% expressed that they did not want to go to the hospital even in this case. 50% of the participants said that they did not want to go to the hospital under any circumstances during the pandemic process. As a result of the correlation analysis, there was an inverse correlation between the anxiety-depression levels and encountering COVID-19 patients and having a relative with COVID-19 (P = .001). Inverse correlation was found between intention to go to hospital and encountering COVID-19 patients (P = .001). CONCLUSION: It was revealed that chronic patients did not have any intentions to go to hospital during the COVID-19 pandemic and only half of the people were willing to go to the hospital in case of emergency. Anxiety and depression levels were found to increase when COVID-19 patients were encountered or a relative had COVID-19.

Detailed characterization, antibiotic resistance and seasonal variation of hospital wastewater.

This study investigates the presence of the different classes of micro-pollutants such as pharmaceutical active compounds (PhACs) (20 antibiotics, 8 analgesics and anti-inflammatories, 5 cytostatic agents, 7 ß-blockers, 4 lipid regulators, 13 psychiatrics, 1 antidiabetic, 1 receptor antagonist, 1 local anaesthetic, 1 antihypertensive and their 5 metabolites), hormones (8 compounds), X-ray contrast agents (6 compounds), benzotriazoles (3 compounds) and pesticides (6 compounds), and antibiotic resistance in hospital wastewater (HWW) of a medical faculty in Istanbul, Turkey. In addition, the seasonal variations of the selected PhACs and X-ray contrast agents and antibiotic resistance were evaluated for 2 years in a total of eight samples. In the PhACs, sulfamethoxazole and its metabolite (4 N-acethyl-sulfamethoxazole) in the antibiotic group and paracetamol in the analgesic and anti-inflammatory group were found at 100% of frequency and the highest concentrations as 35, 43 and 210 µg/L, respectively. The mean concentrations of psychiatric compounds were found less than 0.25 µg/L except carbamazepine (1.36 µg/L). Bisphenol A in hormone group had the highest concentration up to 14 µg/L. In the hormone group compounds, 17-α-Ethinylestradiol and 17-ß-Estradiol were detected at lower mean concentrations of 0.2 and 0.05 µg/L, respectively. 1H-benzotriazole had the highest concentration with the mean concentration of 24.8 µg/L in benzotriazole group compounds. The compounds in X-ray contrast agents group were noted as compounds detected at the highest concentration in HWW up to 3000 µg/L. Antibiotic resistance against azithromycin, clindamycin and trimethoprim-sulfamethoxazole antibiotics was observed around 50% in the winter period. The seasonal variation was detected for the most of the investigated PhACs, especially in antibiotic group which was in line with those significant differences in antibiotic resistance rates in the studied antibiotics between winter and summer seasons.

Application of nanofiltration and reverse osmosis for treatment and reuse of laundry wastewater.

The aim of this study was to investigate the treatment and reuse of laundry wastewater with couple of nanofiltration (NF) and reverse osmosis (RO). In the NF process, optimal values of pH, temperature, transmembrane pressure (TMP) and cross-flow rate were determined using the Taguchi L16 (44) experimental design method. The smaller-the-better signal-to-noise (S/N) ratio was used to analyze the results of experiments. Flux decline caused by fouling was selected as response parameter. A pH of 8.5, temperature of 30 °C, TMP of 12 bar and cross-flow rate of 2 L/min were determined as optimum operating conditions in the NF process. According to analysis of variance (ANOVA), pH was the most effective factor while TMP and cross-flow rate had low effects on the fouling. Membrane fouling was also evaluated with scanning electron microscope (SEM), energy dispersive X-ray spectroscopy (EDX), zeta potential and optical profilometer measurements. In the RO process, the quality of NF permeate obtained from optimum operating conditions was improved by an RO membrane. Although a NF membrane was not effective in reducing chemical oxygen demand (COD), Orto-P and NH4 +-N, these parameters were almost removed in the NF + RO system. These results showed that, the Taguchi method was successfully applied to determine the optimum operating conditions for the treatment of laundry wastewater with an NF process. Water treated with integrated membrane processes (NF + RO) is sufficient for use as laundry washing water.

The relationship between severe acute respiratory syndrome coronavirus 2 (SARS - COV - 2) pandemic and fragmented QRS.

OBJECTIVE: The aim of the study is to determine the frequency of fragmented QRS (FQRS) in patients with SARS - COV - 2. METHODS: A total of 125 consecutive patients over 20 years of age who were hospitalized for SARS - COV - 2 between 20th March 2020 and 18th May 2020 were included in the study. The data of the patients in the inpatient ward and in the intensive care unit were recorded separately. The duration of QRS and presence of FQRS were evaluated by two experienced cardiologists. The patients were divided into two groups as FQRS positive and FQRS negative considering presence of FQRS. Moreover, the frequency of FQRS in the patients in the inpatient ward and in the intensive care unit were compared with each other. RESULTS: FQRS was found in 24% of the patients who had SARS-COV-2. There was no difference between FQRS positive and negative groups in terms of age and gender. Heart rate was higher in FQRS positive group. C-reactive protein (7.25 ±â€¯6.65 mg/dl vs. 4.80 ±â€¯4.48 mg/dl; p = .02) levels were also significantly higher in the FQRS positive group. In patients with SARS-COV-2, intensive care unit requirement increased with increasing levels of troponin (p < .000). A positive correlation was detected between serum CRP levels and FQRS (r = 0.204, p = .024). CONCLUSIONS: The frequency of FQRS is high in patients with SARS - COV - 2. Serum CRP levels increase with increasing frequency of FQRS in patients with SARS - COV - 2 indicating that patients with FQRS are exposed to more inflammation. Presence of FQRS in SARS - COV - 2 patients may be useful in predicting cardiovascular outcomes.

An integrated electrocoagulation-nanofiltration process for carwash wastewater reuse.

In the present work, advanced treatment of carwash wastewater with an integrated electrocoagulation-nanofiltration (EC-NF) process to reuse the treated wastewater as rinsing water was investigated. The wastewater was pretreated by EC process under various operating parameters such as temperature (25 °C, 35 °C, 45 °C), stirring speed (150 rpm, 250 rpm, 350 rpm), and electrode connection mode (MP-P, MP-S, BP-S) using Fe electrode. The best results were achieved at 25 °C, 250 rpm and MP-P connection mode for EC, considering both pollutant removals and energy consumptions. EC sludge was characterized scanning electron microscopy-energy dispersive index (ESEM-EDX) analysis. The pretreated carwash wastewater using EC process was further treated by NF process using NF 270 and Desal 5DL membranes. Desal 5 DL membrane provided the highest treatment performance for chloride (92%), conductivity (80%) and total hardness (90%) parameters for EC-NF process. Resistance in series model was used for a deeper discussion of the reasons for flux decline. In addition, Fourier transform infrared (FTIR) spectroscopy and contact angle measurements were conducted for membrane fouling characterization. The foulants mainly accumulated on the membrane surface forming a cake layer and lower extent of membrane fouling was occurred for both membranes. As a result, this study showed that the water quality for reuse in carwashing process could be achieved with an integrated EC-NF process.

Neutrophil-Lymphocyte Ratio Could Be a Marker for Erectile Dysfunction.

PURPOSE: The literature reveals lots of information about the relationship between inflammatory markers and many diseases. In this study, we aimed to determine the relationship between erectile dysfunction and the neutrophil-lymphocyte ratio (NLR), which is a simple and nonspecific inflammatory marker. MATERIALS AND METHODS: Ninety patients with erectile dysfunction (ED) and ninety-four healthy subjects were included in this study from our internal medicine and urology clinics. As diagnosis criteria, we used the first 5 questions of International Index for Erectile Function. The duration of erectile dysfunction was asked and recorded. Height, weight and waist circumference of patients were measured. We performed total blood count, sedimentation, C-reactive protein, and blood chemistry. RESULTS: There were statistically significant differences between the control [1,038 (0,507-1,92)] and ED [59,5 (52,0-68,0)] groups in terms of NLR (P < .001). According to the multivariate logistic regression analysis, Duration of ED (Cut off: 7,5 month) predicted ED with 78,8% sensitivity and 63,1% specificity (AUC: < ,001, 95% CI 1,030 (1,010-1,050), P = .003). Moreover, NLR (Cut off: 1,574) predicted ED with 81,8% sensitivity and 67,0% specificity (AUC: < 0,001, 95% CI 1,994 (1,139-3,490), P = .016) according to the multivariate logistic regression analysis. CONCLUSION: It was found that the neutrophil-lymphocyte ratio was higher in patient group than the control group. Also, the neutrophil-lymphocyte ratio (NLR) predicted ED and it might be helpful in diagnosing erectile dysfunction.

Adsorption kinetics and aggregation for three classes of carbonaceous adsorbents in the presence of natural organic matter.

In this study, adsorption kinetics of phenanthrene (PNT) and trichloroethylene (TCE) by a graphene nanosheet (GNS), a graphene oxide nanosheet (GO), a single-walled carbon nanotube (SWCNT), a multi-walled carbon nanotube (MWCNT), and two coal based activated carbons (ACs) (F400 and HD3000) were examined in distilled and deionized water (DDW) and under natural organic matter (NOM) preloading conditions. The results showed the times needed for the adsorption of PNT and TCE to reach apparent equilibrium (i.e., ≤3% change per day) followed the order of GO ≥ MWCNT > GNS > SWCNT ∼ HD3000∼F400 and SWCNT > GNS ∼ HD3000 > F400 ∼ MWCNT > GO, respectively. The pseudo second order model successfully represented kinetics data for three classes of carbonaceous adsorbents. The Weber-Morris intraparticle diffusion model indicated three steps adsorption process for PNT and two step adsorption for TCE. In addition, the times needed to reach apparent equilibrium for the adsorption of PNT and TCE in the presence of hydrophobic (HPO) and hydrophilic (HPI) NOM solutions increased for all adsorbents (except for GO). In general, both NOM showed similar impacts on the adsorption rates of PNT and TCE. Aggregation of both GNS and CNTs rapidly occurred during initial couple hours of contact time during preloading, and spiking both PNT and TCE further increased their aggregation.

Amebicidal effects of fenugreek (Trigonella foenum-graecum) against Acanthamoeba cysts.

Trigonella foenum-graecum L. (TF) is known to the public as a chest emollient, mucous expectorant, laxative and is used to prevent maturation of boils and diabetes since ancient times. In this study, we aimed to determine the amebicidal effects against Acanthamoeba cysts. Plant extracts were prepared at concentrations of 1, 2, 4, 8, 16, and 32 mg/ml and were placed in a hemocytometer with cell counts 22 × 106 cell/ml. The fatty acid profiles of TF seeds were determined. Standard Acanthamoeba cysts were added and incubated at 25°C. The viability of the parasite was checked and recorded at hours 3, 24, 48, 72, 96, and 102. The values of lethal concentration doses (LD50 and LD90) were calculated using probit analysis. This study revealed that T. foenum-graecum prevented proliferation of the parasite at certain times. However, further for in vivo and controlled experimental studies are needed in order to find out how to use this plant as medication.

Occurence and Prioritization of Pharmaceutical Active Compounds in Domestic/Municipal Wastewater Treatment Plants.

In this study, pharmaceutically active compounds (PhACs) were analyzed in the influent and effluent of a domestic wastewater treatment plant in Turkey and a municipal wastewater treatment plant in Germany and the toxicity of these wastewaters were estimated using a toxic unit (TU) approach. A total of 21 and 32 PhACs were detected in the domestic wastewater and the municipal wastewater, respectively. The TUs estimated for PhACs in municipal wastewater were higher than the TUs estimated for PhACs present in domestic wastewater. The levels of the anti-anxiety drug, oxazepam were estimated to be in the high risk category (HQ > 10) in both wastewaters. In bench-scale tests with ozonation, the removals of four PhACs in the municipal wastewater were investigated. At a dose of 2 mg/L ozone, 97%-98% of diclofenac and carbamazepine were removed. The lowest removal rate at 71% was observed for metoprolol.

Do AB0 blood groups affect lower urinary tract symptoms?

OBJECTIVE: The aim of this study is to investigate whether there is a correlation between AB0 blood group antigens and Rhesus factor and lower urinary tract symptoms (LUTS). MATERIAL AND METHODS: A total of 556 male patients applying to our clinic with LUTS complaints from April 2012-2015 and complying with the study criteria were included in the study. The patients were divided into two groups as those with (Group 1; n=283) and without LUTS (Group 2; n=273) complaints. The effect of blood groups on LUTS complaints was compared using univariate logistic regression analyzes. RESULTS: According to AB0 blood groups, blood groups A (56.7%) and AB (56.9%) were most common in the LUTS group. But 0 blood group (44.1%) was the least common. According to rhesus factor, the incidence of LUTS in Rh (+), and Rh (-) groups were 48.9%, and 66.7%, respectively. Compared to 0 blood group, the LUTS incidence was 1.65, and 1.66 times higher for individuals with blood groups A, and AB, respectively. The same risk increased 2.09 times for individuals with Rhesus factor negative. CONCLUSION: This study identified a correlation between AB0 blood group and Rhesus factor and LUTS. The risk of LUTS risk increased in individuals with blood group A Rh (). Additionally there was a clear risk increase observed for AB blood group, though this did not reach statistical significance.

A New and Simple Risk Predictor of Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention: TIMI Risk Index.

BACKGROUND: The thrombolysis in myocardial infarction risk index (TRI) was developed to estimate prognosis at the initial contact of the healthcare provider in coronary artery disease patients without laboratory parameters. In this study, we aimed to investigate the relationship of the baseline TRI and contrast-induced nephropathy (CIN) in patients with ST-elevation myocardial infarction (STEMI). METHODS: A total of 963 consecutive STEMI diagnosed patients who underwent primary percutaneous intervention were included in the study. TRI was calculated using the formula "heart rate × (age/10) 2/SBP" on admission. CIN was defined as an increase in serum creatinine concentration ≥25%, 48 hours later over the baseline. RESULTS: Of the total of 963 patients, CIN was observed in 13% (n=128). TRI was significantly higher in the CIN (+) group compared with the CIN (-) group (32.9 ± 18.8 vs 19.9 ± 9.9, P < 0.001). There was a stronger correlation between CIN and age, diastolic blood pressure, heart rate, Killip class, left ventricular ejection fraction, amount of contrast media, and diabetes mellitus. The amount of contrast media (OR 1.010, 95% CI 1.007-1.012, P < 0.001) and TRI (OR 1.047, 95% CI 1.020-1.075, P=001) were independent predictors of CIN. The best threshold TRI for predicting CIN was ≥25.8, with a 67.1% sensitivity and 80.4% specificity (area under the curve (AUC): 0.740, 95% CI: 0.711-0.768, P < 0.001). CONCLUSION: TRI is an independent predictor of CIN, and it may be used as a simple and reliable risk assessment of CIN in STEMI patients without the need for laboratory parameters.

Acute renal involvement in organophosphate poisoning: histological and immunochemical investigations.

PURPOSE: Today, the long-term effects of partial exposure of cholinesterase on the kidney continue to be a research topic. In this study, we aimed to histopathologically investigate the possible effect of acute toxicity due to fenthion, an organophosphate (OP) compound, on the kidneys. METHODS: In all, 21 rats were randomly divided into three groups. Experimental group was each administered intraperitoneal 0.8 g/kg fenthion within physiologic serum. Sham group was only administered intraperitoneal physiologic serum. The control group continued normal nutrition with no procedure performed. After 24 h, all rats were sacrificed by cervical dislocation. Half of the recipient kidney tissues were examined histopathologically and the other half biochemically. RESULTS: No histopathological findings were found in the control group. Rats in the experimental group were observed to have epithelial cell disorganization in tubules, moderate epithelial cell loss, and degeneration. Again, expansion of tubules, vacuolization of tubular epithelial cells, and tubular structure approaching atrophy were observed, with cells approaching apoptosis and common hemorrhage noted although rats in the sham group were observed to have mild tubular degeneration. CONCLUSIONS: It should not be forgotten that one of the causes of systemic complaints linked to acute toxicity exposed to the OP compound of fenthion may be cellular injury to glomerular and tubular structures in the kidneys.

Monocyte to high-density lipoprotein cholesterol ratio in patients with diabetes mellitus and diabetic nephropathy.

AIM: We investigated the relationship of monocyte to high-density lipoprotein cholesterol ratio (MHR) with diabetes mellitus and diabetic nephropathy. METHODS & RESULTS: A total of 220 diabetes mellitus patients and 70 healthy controls were enrolled. There was no difference in an MHR between normoalbuminuric diabetic patients and the healthy controls. The MHR in patients with diabetic nephropathy was significantly higher than that of both the normoalbuminuric diabetic patients and the healthy controls. There was a significant positive correlation between urine albumin to creatinine ratio and the MHR. In multivariate linear regression analysis, the MHR was independently correlated with urine albumin to creatinine ratio.  Conclusion: An increased MHR may be a biomarker for diabetic nephropathy.

Performance and microbial shift during acidification of a real pharmaceutical wastewater by using an anaerobic sequencing batch reactor (AnSBR).

In this study, a lab-scale anaerobic sequencing batch reactor (AnSBR) was used for the acidification of a pharmaceutical wastewater sourced from etodolac chemical synthesis tanks. The effects of the organic loading rate (OLR), and etodolac and sulfate concentrations on the acidification rate and microbial community in AnSBR were investigated at 35 °C with a hydraulic retention time (HRT) of 37 h, a pH of 5, and OLRs up to 5.2 kgCOD/m3·day. The AnSBR accomplished a 60% acidification ratio and 50-60% etodolac removal at OLRs up to 2.6 kgCOD/m3·day. However, at OLR = 3.9 kgCOD/m3·day, acidification was not achieved due to sulfite inhibition; pre-ozonation was applied to overcome this sulfite inhibition. Although etodolac and COD removals were improved, the wastewater was not successfully acidified. Real-time polymerase chain reaction (Q-PCR) and fluorescent in situ hybridization (FISH) analyses revealed that acidification was inhibited by the dominance of sulfate reducing bacteria (SRB) over acidification bacteria in the AnSBR. However, increasing the OLR to 5.2 kgCOD/m3·day led to toxicity stress in the SRB due to increased sulfite concentrations. Sulfate load fundamentally affected acidification process and microbial community composition. The presence of etodolac with concentration up to 56 mg/L did not have a significant effect on VFA production and the microbial community.