Removal of pharmaceuticals by fouled forward osmosis membranes: Impact of DOM fractions, Ca2+ and real water

This study systematically investigated the impact of dissolved organic matters (DOM) fractions, Ca²⁺, membrane orientation and real water matrix on the membrane fouling and the subsequent pharmaceutical retention in forward osmosis (FO). Ca²⁺ increased the removal of carbamazepine (CBZ) through steric effect, while it reduced sulfamethoxazole (SMZ) removal due to reduced electrostatic repulsion and enhanced external concentration polarization for three organic foulants. The study of operating mode showed that the pharmaceutical removal in pressure retarded osmosis (PRO) mode were lower than those in FO mode for both the baseline and HA fouling, which was attributed to the concentrative internal concentration polarization caused by long-term accumulation of pharmaceuticals or HA in support layer. In terms of the real water tests, the secondary effluent used as feed solution caused higher hydrophilicity and negative charge of fouled FO membrane, leading to increased removal of pharmaceuticals. Seawater used as draw solution also caused severe fouling in the support layer of FO with humic acid-like material as major foulants, increasing the removal of SMZ because of enhanced steric hindrance and electrostatic repulsion. However, the combined effects of increased adsorption and steric effect resulted in little change for the CBZ removal. This study gave implications on the practical application of FO process for pharmaceutical removal.

Three dimensional bioprinting technology: Applications in pharmaceutical and biomedical area

3D bioprinting is a technology based on the principle of three-dimensional printing of designed biological materials, which has been widely used recently. The production of biological materials, such as tissues, organs, cells and blood vessels with this technology is alternative and promising approach for organ and tissue transplantation. Apart from tissue and organ printing, it has a wide range of usage, such as in vitro/in vivo modeling, production of drug delivery systems and, drug screening. However, there are various restrictions on the use of this technology. In this review, the process steps, classification, advantages, limitations, usage and application areas of 3D bioprinting technology, materials and auxiliary materials used in this technology are discussed.

Mechanism and stability of an Fe-based 2D MOF during the photoelectro-Fenton treatment of organic micropollutants under UVA and visible light irradiation

This work reports the novel application of an Fe-based 2D metal-organic framework (MOF), prepared with 2,2'-bipyridine-5,5'-dicarboxylate (bpydc) as organic linker, as highly active catalyst for heterogeneous photoelectro-Fenton (PEF) treatment of the lipid regulator bezafibrate in a model matrix and urban wastewater. Well-dispersed 2D structures were successfully synthesized and their morphological, physicochemical and photocatalytic properties were assessed. UV/Vis PEF using an IrO₂/air-diffusion cell with an extremely low catalyst concentration (0.05 g L^-1, tenfold lower than reported 3D MOFs) outperformed electro-oxidation with electrogenerated H₂O₂, electro-Fenton and visible-light PEF. Its excellent performance was explained by: (i) the enhanced mass transport of H₂O₂ (and organic molecules) at the 2D structure, providing active sites for heterogeneous Fenton's reaction and in-situ Fe(II) regeneration; (ii) the ability of photoinduced electrons to reduce H₂O₂ to ^•OH, and Fe(III) to Fe(II); and (iii) the enhanced charge transfer and excitation of Fe-O clusters, which increased the number of electron-hole pairs. LC-QToF-MS and GC-MS allowed the identification of 16 aromatic products of bezafibrate. The complete removal of four micropollutants mixed in urban wastewater at pH 7.4 revealed the great potential of (Fe-bpydc)-catalyzed PEF process.

Toxicity of NSAID drug (paracetamol) to nontarget organism-Nostoc muscorum

Due to many folds increase in application of human and veterinary medicines, pharmaceuticals, a new category of pollutants, have emerged in our environment. They exist as residues in rivers, sewage effluents, streams, surface, ground, and potable water. Paracetamol (acetaminophen) is one such drug that is used as an antipyretic and analgesic medicine. It is a non-steroidal antiinflammatory drug (NSAID) and is easily available in the market because no medical prescription is necessary for its purchase and use. Paracetamol remains physiologically active even after their expiry period. Their detection in the environment in bioactive form has resulted in adverse effects on nontarget species. To determine the effect of paracetamol on aquatic photosynthetic organic (Cyanobacteria-Nostoc muscorum), present study was performed. Paracetamol (25 mg/L, 50 mg/L, 75 mg/L, 100, 125, and 150 mg/L) exposure showed toxic responses on the test organism by generating oxidative stress (MDA, H₂O_2, O₂^.-). Paracetamol caused a significant decrease in growth of cyanobacteria and showed EC₅₀ 113.68 mg/L after the 6th day of treatment. Photosynthetic pigments (chlorophyll, carotenoid, and phycobiliprotein) decreased with paracetamol increase. Antioxidant enzymatic (SOD, CAT, APX, GST, and GR) and osmolyte (Proline) also increased with increase in paracetamol to counteract the oxidative stress.

Insitu kinetics of human pharmaceutical conjugates and the impact of transformation, deconjugation, and sorption on persistence in wastewater batch bioreactors

The fate of selected common pharmaceuticals and four of their major conjugates in wastewater batch bioreactors was evaluated to determine how treatment plant parameters such as addition of air, and the presence of waste activated sludge (WAS) could influence the removal of parent compounds and conjugates. Under a realistic hydraulic residence time (HRT) for each treatment sub-process of approximately 2 h, acetaminophen and its sulfate metabolite were both rapidly degraded (>99%). Propranolol was sulfated and concurrently removed. Deconjugation of N-acetylsulfamethoxazole and sulfamethoxazole-glucuronide contributed to increases of the parent sulfamethoxazole. Thyroxine was resistant to degradation, while thyroxine-glucuronide was rapidly deconjugated (>90% in <2 h). In the absence of WAS, sorption to suspended solids was another major removal mechanism for acetaminophen, propranolol, sulfamethoxazole, and thyroxine. However, with WAS, concentrations associated with suspended solids decreased for all analytes within 24 h. These results indicate that both conjugation and back-transformation are compound-specific and dependent on parameters such as HRT, addition of microbial content, and suspended solids levels. Therefore, conjugation-deconjugation processes may strongly influence the speciation of pharmaceuticals and their fate in wastewater treatment plant effluents.

Combined effects of environmentally relevant concentrations of diclofenac and cadmium on Chironomus riparius larvae

The nonsteroidal anti-inflammatory drug diclofenac (DCF) is considered a contaminant of emerging concern. DCF can co-exist with heavy metals in aquatic environments, causing unexpected risks to aquatic organisms. This study aimed to assess the combined effects of DCF and cadmium (Cd) at environmentally relevant concentrations on the bioconcentration and status of oxidative stress and detoxification in Chironomus riparius larvae. The larvae were exposed to DCF (2 and 20 μg L^-1) and Cd (5 and 50 μg L^-1) alone or in mixtures for 48 h. The combined exposure to DCF and Cd was found to reciprocally facilitate the accumulation of each compound in larvae compared with single exposures. As indicated by the antioxidant enzyme activities, reduced glutathione levels, and malondialdehyde contents, the low concentration of the mixture (2 μg L^-1 DCF + 5 μg L^-1 Cd) did not alter the oxidative stress status in larvae, while the high concentration of the mixture (20 μg L^-1 DCF + 50 μg L^-1 Cd) induced stronger oxidative damage to larvae compared with single exposures. The expression levels of eight genes (CuZnSOD, MnSOD, CAT, GSTd3, GSTe1, GSTs4, CYP4G, and CYP9AT2) significantly decreased due to the high concentration of the mixture compared with single exposures in most cases. Overall, the results suggest that the mixture of DCF and Cd might exert greater ecological risks to aquatic insects compared with their individual compounds.

A Glassy Carbon Electrode for the Determination of Linagliptin, an Antidiabetic Drug in Pure Form, Tablets and Some Biological Fluids by Adsorptive Stripping Voltammetry

AIM

The present work provides a fast, simple, accurate, and inexpensive analytical method for the determination of Linagliptin (anti-diabetic drug).

METHODS

The analysis was performed using a square wave adsorptive anodic stripping voltammetric technique (SWAASV) and glassy carbon electrode (GCE) as a working electrode. The experimental and instrumental parameters were studied and discussed to ensure the validity of the method.

RESULTS

The method has a very good linearity (R² = 0.9984), wide concentration range (0.189 - 2.268 μg mL^-1), low detection limit of 0.052 μg mL^-1 and low quantitation limit of 0.172 μg mL^-1.

CONCLUSION

Linagliptin was identified successfully using the proposed method in pharmaceutical formulations, spiked human urine and plasma with 99.67, 91.96, and 92.78% recovery, respectively, and the results obtained were compared with other reported methods.

Quantification of swelling characteristics of pharmaceutical particles

Particle swelling is a crucial component in the disintegration of a pharmaceutical tablet. The swelling of particles in a tablet creates stress inside the tablet and thereby pushes apart adjoining particles, eventually causing the tablet to break-up. This work focused on quantifying the swelling of single particles to identify the swelling-limited mechanisms in a particle, i.e. diffusion- or absorption capacity-limited. This was studied for three different disintegrants (sodium starch glycolate/SSG, croscarmellose sodium/CCS, and low-substituted hydroxypropyl cellulose/L-HPC) and five grades of microcrystalline cellulose (MCC) using an optical microscope coupled with a bespoke flow cell and utilising a single particle swelling model. Fundamental swelling characteristics, such as diffusion coefficient, maximum liquid absorption ratio and swelling capacity (maximum swelling of a particle) were determined for each material. The results clearly highlighted the different swelling behaviour for the various materials, where CCS has the highest diffusion coefficient with 739.70 μm²/s and SSG has the highest maximum absorption ratio of 10.04 g/g. For the disintegrants, the swelling performance of SSG is diffusion-limited, whereas it is absorption capacity-limited for CCS. L-HPC is both diffusion- and absorption capacity-limited. This work also reveals an anisotropic, particle facet dependant, swelling behaviour, which is particularly strong for the liquid uptake ability of two MCC grades (PH101 and PH102) and for the absorption capacity of CCS. Having a better understanding of swelling characteristics of single particles will contribute to improving the rational design of a formulation for oral solid dosage forms.

Pharmaceutical opioids utilisation by dose, formulation, and socioeconomic status in Queensland, Australia: a population study over 22 years

Background Prescription opioids are a central aspect of pain management and as the prevalence of pain is increasing so is the rate of use of prescription opioids. Increased opioid prescriptions increases the risk of deaths and morbidity. Objective To (a) describe the 22-year trend of prescription opioid dispensing in Queensland, (b) examine the effect of opioid dose, formulation and socioeconomic status on the number of prescriptions dispensed. Design/setting Retrospective analysis of data from the Monitoring of Drugs of Dependence system of the Monitored Medicines Unit of Queensland Health, Australia. Participants Queensland residents (3.3 million) from 18 years old dispensed 18.8 million opioid prescriptions from January 1997 to December 2018. Results Opioid prescriptions dispensed annually increased to over two million in 2018 from about 150,000 prescriptions in 1997. The number of prescriptions for modified-release formulations dispensed annually was three times higher compared to the immediate-release formulations. Oxycodone accounted for over 60% of prescriptions for pharmaceutical opioids since 2013. There was an increase in the number of prescriptions dispensed as socioeconomic status decreased and modified-release opioid formulations positively affects the pattern of dispensing. The highest increase in number of prescriptions dispensed (for all opioids) was observed among the high socioeconomic status (IRR = 1.25, 95% CI 1.25, 1.26). The disparities in the annual number of prescriptions across dose categories are wider in the modified-release than the immediate-release formulations. Conclusion The dispensing of opioids increased significantly in Queensland. There was a positive relationship between the increased dispensing of opioids and locations of lower socioeconomic status.

Removal of micropollutants by an electrochemically driven UV/chlorine process for decentralized water treatment

The ultraviolet/chlorine (UV/Cl₂) process is an emerging advanced oxidation technology for micropollutant abatement in water and wastewater treatment. However, the application of the conventional UV/Cl₂ process in decentralized systems is limited by the transport and management of liquid chlorine. To overcome this limitation, this study evaluated an electrochemically driven UV/Cl₂ (E-UV/Cl₂) process for micropollutant abatement under conditions simulating decentralized water treatment. The E-UV/Cl₂ process combines UV irradiation with in situ electrochemical Cl₂ production from anodic oxidation of chloride (Cl^-) in source waters. The results show that with typical Cl^- concentrations present in water sources for decentralized systems (30-300 mg/L Cl^-), sufficient amounts of chlorine could be quickly electrochemically produced at the anode to enable E-UV/Cl₂ process for water treatment. Due to its multiple mechanisms for micropollutant abatement (direct photolysis, direct electrolysis, Cl₂-mediated oxidation, as well as hydroxyl radical and reactive chlorine species oxidation), the E-UV/Cl₂ process effectively eliminated all micropollutants (trimethoprim, ciprofloxacin, metoprolol, and carbamazepine) spiked in a surface water in 5 min. In contrast, at least one micropollutant with ∼20-80% residual concentrations could still be detected in the water treated by 10 min of UV irradiation, chlorination, electrolysis, and the conventional UV/Cl₂ process under similar experimental conditions. The electrical energy per order (E_EO) for micropollutant abatement ranged from 0.15 to 1.8 kWh/m³ for the E-UV/Cl₂ process, which is generally comparable to that for the conventional UV/Cl₂ process (0.14-2.7 kWh/m³). These results suggest that by in-situ generating Cl₂ from anodic oxidation of Cl^-, the E-UV/Cl₂ process can overcome the barrier of the conventional UV/Cl₂ process and thus provide a promising technology for micropollutant abatement in decentralized water treatment systems.

A Multifaceted Perspective of Pharmaceutical Innovation: A Consideration of the Regulatory Role

BACKGROUND

The pace of innovation, the creative engine of the pharmaceutical industry, has been variably described as stagnant, stable, or accelerating depending on the metric used for assessment or the quality of evidence. If the predominant perception holds that the speed of innovation is sluggish, pressure for changes in the regulatory environment intensifies.

METHODS

A systematic evaluation of the course of innovation in this industry was performed by applying a formula derived from economic market share theory to estimate the innovative contribution of each new molecular entity approved since 1938. The total and average innovation scores per year are described based on the therapeutic class, mechanism, and drug target. These data are compared to the number and percent of first-in-class drugs per year.

RESULTS

The average annual score based on therapeutic class novelty has been declining; however, the therapeutic class total innovation score has been stable since the mid-1970s with occasional significant peaks of activity. While the average score based on mechanism or target experienced a decline beginning in the 1950s and 1960s, it has begun to rise since the early 1990s. Notably, the total innovation score has steadily increased since the 1970s. These variations closely parallel the number of first-in-class drugs approved on an annual basis.

CONCLUSIONS

While the reasons underlying these activities are likely complex, there is a temporal association between regulatory efforts to expedite drug development and approval. These findings should be considered when considering future incentivizing regulations and policies.

Raman imaging of amorphous-amorphous phase separation in small molecule co-amorphous systems

Many new active pharmaceutical ingredients (API) undergoing development have low permeabilities or low aqueous solubilities. However, the amorphous state is usually more soluble than its crystalline counterpart. The amorphous state has a higher Gibb's free energy, which can improve the apparent solubility but decrease the stability since the amorphous state tends to transform to the more stable crystalline form. Before recrystallization, a co-amorphous binary mixture's ingredients have to undergo a phase separation. The aim of this study was to obtain a better understanding of the amorphous-amorphous phase separation in co-amorphous binary mixtures and test the suitability of imaging Raman spectroscopy for detecting this phenomenon. To study the phase separation, we prepared three different 50:50 mass ratio binary mixtures of APIs: paracetamol-terfenadine, (PAR-TRF), paracetamol-indomethacin (PAR-IMC) and terfenadine-indomethacin (TRF-IMC). The binary mixtures were amorphized with melt-quenching and stored above their glass transition temperature (T_g) to monitor their phase separation. Thermal degradation was determined with a high performance liquid chromatography (HPLC) method to ensure that melt-quenching did not cause any thermal degradation of the molecules. Thermodynamic attributes (crystallization tendency, melting point (T_m) and T_g) were measured with differential scanning calorimetry (DSC) to ensure that the co-amorphous systems transformed to the amorphous state and remained amorphous after cooling and reheating. Phase separation was studied from the surface and cross-section (CS) with Raman imaging to examine if it occurred more on the surface than in the bulk. The Raman spectra were analyzed with principal component analysis (PCA) and Contour plots were produced from the PCA-score values to visualize concentration differences in the mixtures. The results showed that API vs API concentrations increased as a function of time in both surface and CS images before crystallization. This suggests that Raman imaging is a suitable technique to detect the phase separation phenomena in small molecule co-amorphous binary mixtures.

Understanding the behavioural intention to dispose of unused medicines: an extension of the theory of planned behaviour

This study examined behavioural intention to dispose of unused medicines using a comprehensive model integrating the theory of planned behaviour (TPB), with knowledge as a driver of personal norms; attitudes, personal norms, and perceived busyness as additional drivers of behavioural intention; and perceived convenience as a moderator. The model was tested with data collected from 204 respondents using the partial least squares technique. Knowledge about the proper disposal of unused medicines was recognized as a strong predictor of personal norms and attitudes towards proper disposal of waste medications. The results showed that attitudes, personal norms, perceived busyness, and perceived behavioural control have significant effects on intention to dispose of unused medicines. Furthermore, perceived convenience moderates the impacts of attitude, personal norms, and perceived behavioural control on intention to dispose of unused medicines. The extended TPB explained 55.7% of the variance of intention to dispose of unused medicines properly. Our results indicate the importance of integrating additional variables into the TPB to enhance its explanatory power in predicting behavioural intention. The results suggest to governments that in order to implement planned programs for proper collection and destruction of waste medication, a plan is needed to enhance public knowledge on the impacts of improper medication waste disposal on the environment, and also that collection points should become accessible for anyone.

Phytoremediation of pharmaceutical-contaminated wastewater: Insights into rhizobacterial dynamics related to pollutant degradation mechanisms during plant life cycle

Rhizobacterial dynamics, relating to pollutant degradation mechanisms, over the course of plant lifespan have rarely been reported when using phytoremediation technologies for pharmaceutical-contaminated wastewater treatment. This study investigated the rhizobacterial dynamics of Typha angustifolia in constructed wetlands to treat ibuprofen (IBP)-polluted wastewater throughout plant development from seedling, vegetative, bolting, mature, to senescent stages. It was found that conventional pollutant and IBP removals increased with plant development, reaching to the best performance at bolting or mature stage (removal efficiencies: 92% organics, 52% ammonia, 60% phosphorus and 76% IBP). In the IBP-stressed wetlands, the rhizobacterial diversity during plant development was adversely affected by IBP accompanied with a reduced evenness. The bacterial communities changed dynamically at different developmental stages and showed significant differences compared to the control wetlands (free of IBP). The dominant bacteria colonized in the rhizosphere was the phylum Actinobacteria, having a final relative abundance of 0.79 and containing a large amount of genus norank_o__PeM15. Positive interactions were evident among the rhizobacteria in IBP-stressed wetlands and the predicted functions of 16S rRNA genes revealed the potential co-metabolism and metabolism of IBP. The co-metabolism of IBP might be related to root exudates such as amino acid, lipid, fatty acid and organic acid. In addition, positive correlations between the organic compounds of interstitial water (bulk environment) and the rhizobacterial communities were observed in IBP-stressed wetlands, which suggests that the influence of IBP on bulk microbiome might be able to modulate rhizosphere microbiome to achieve the degradation of IBP via co-metabolism or metabolism.

Adsorptive removal of cationic tricyclic antidepressants using cation-exchange resin

This study aimed to select a high-performance cation-exchange resin (CER) and estimate its uptake of positively ionized tricyclic antidepressants (TCAs), i.e., amitriptyline (AMI), imipramine (IMI), clomipramine (CLO), and desipramine (DES), which are frequently used, and detected in wastewater treatment systems. For the selection of the resin, the one-point check test of AMI in distilled water was examined using several CERs. As a result, the strong-acid polystyrene CER, Dowex 50WX4-200, was selected on the basis of its outstanding uptake of AMI. The maximum adsorption capacities of Dowex 50WX4-200 for removal of the TCAs ranged from 2.53 ± 0.20 mmol/g to 3.76 ± 0.12 mmol/g, which are significantly higher when compared with those of previously reported adsorbents. This is likely because the combination of electrostatic and π-π interactions between the TCAs and Dowex 50WX4-200 may lead to high uptakes of the TCAs. Additionally, the removal efficiency of DES as a representative of the TCAs was tested in actual wastewater system containing activated sludge and miscellaneous cations. Consequently, the removal efficiencies of the DES in distilled water, aerobic wastewater, and filtered wastewater were 95.68%, 77.99%, and 56.66%, respectively. It is interesting to note that the activated sludge could also contribute to adsorption of the DES, leading to increased removability, while the cations present in the wastewater acted as competing ions, decreasing the removal efficiency.

Enantiospecific behaviour of chiral drugs in soil

The importance of stereochemistry on the behaviour and effects of chiral pharmaceutical and illicit drugs in amended agricultural soils has been over looked to date. Therefore, this study was aimed at investigating the enantiospecific behaviour of a chemically diverse range of chiral drugs including naproxen, ibuprofen, salbutamol, bisoprolol, metoprolol, propranolol, acebutolol, atenolol, chlorpheniramine, amphetamine, fluoxetine and citalopram in soil microcosms. Considerable changes of the enantiomeric composition of ibuprofen, naproxen, atenolol, acebutolol and amphetamine were observed within 56 d. This is significant as enantiomer enrichment can favour the pharmacologically active (e.g., S(-)-atenolol) or less/non-active forms of the drug (e.g., R(-)-amphetamine). Single enantiomer microcosms showed enantiospecific degradation was responsible for enantiomer enrichment of atenolol and amphetamine. However, naproxen and ibuprofen enantiomers were subject to chiral inversion whereby one enantiomer converts to its antipode. Interestingly, chiral inversion was bidirectional and this is the first time it is reported in soil. Therefore, introduction of the less active enantiomer to soil through irrigation with reclaimed wastewater or biosolids as fertiliser can result in the formation of its active enantiomer, or vice versa. This phenomenon needs considered in risk assessment frameworks to avoid underestimating the risk posed by chiral drugs in amended soils.

First record of emerging contaminants in sponges of an inhabited island in the Maldives

In the Maldivian islands, the lack of sewage wastewater treatment and an improper landfill enhance the potential hazard of emerging contaminants, including pharmaceuticals and personal care products. In order to analyze the occurrence of emerging contaminants in the marine biota, sponges were collected in two coral reef areas of Magoodhoo island (Faafu), one near the landfill and the other furthest from the island. Caffeine, fluoxetine and norfluoxetine were detected only in the proximity of the landfill, with caffeine showing the highest concentration (28.4 ng/g d.w.), followed by fluoxetine (6.00 ng/g d.w.). Norfluoxetine was below the limit of quantification of 10 ng/g d.w. Nitro xylene, N,N-Diethyl-meta-toluamide and galaxolide were found in both areas, with concentrations of 3.51/6.11/8.54 and <LOQ/1.14/0.62 ng/g d.w., respectively. Due to the vital role of the coral reef for the livelihood and economy of the Maldivian people, attention should be paid to this class of contaminant.

In-line temperature measurement to improve the understanding of the wetting phase in twin-screw wet granulation and its use in process development

Wetting is the initial stage of wet granulation processes during which the first contact between the powder and the liquid occurs. Wetting is a critical step to allow granule growth and consolidation, but also to ensure uniform active pharmaceutical ingredient (API) distribution over all granule size fractions. A physical understanding of the wetting stage is therefore crucial to design a robust granulation process. In twin-screw granulation, wetting is physically separated from granule consolidation, growth, breakage and attrition. The present study used this particularity to investigate the wetting step in such a way that the fundamental mechanisms governing the wetting can be linked and understood. A modified granulator barrel was used allowing the collection of granules immediately after the wetting. A low drug-loaded pharmaceutical formulation containing a poorly soluble and poorly wettable API was used for this investigation. Granules obtained after the wetting zone were analysed for granule size distribution, API distribution over the different size fractions and granule temperature. It was found that "wetting efficiency" (i.e., fraction of powder being nucleated during the wetting stage) could be predicted using an energy balance based on in-line measurement of the granule temperature. Wetting efficiency could moreover be linked to final granule quality attributes (i.e., granule size distribution) at the outlet of the granulator. It was further demonstrated that granule growth and consolidation could only be achieved when complete wetting was achieved in the wetting zone of the granulator. This study suggested a methodology based on in-line temperature measurements to quickly determine wetting efficiency. The described methodology could therefore be used as a tool to gain more fundamental understanding of the wetting stage during twin-screw granulation as well as to define suitable formulation and process ranges for further granulation process development.

Medication-Related Quality of Life in Thai Epilepsy Patients

Background and Purpose

This study aimed to assess medication-related quality of life in Thai patients with epilepsy. The second objective was to evaluate the associations between the medication therapy-related quality of life and patient characteristics.

Methods

This was a cross-sectional study. A convenience sample of 173 outpatients with epilepsy was recruited from a university hospital in Bangkok, Thailand. Inclusion criteria were aged 18 or over who were continuously taking an epileptic drug for at least 3 months, understanding Thai language, and willing to participate in the study. The Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) was utilized to measure the medication therapy-related quality of life. Pearson’s correlation coefficients and stepwise multiple linear regressions were employed to assess the relationships between eight PROMPT-QoL domain scores and patient demographic and clinical characteristics.

Results

Mean age was 36.4±9.5 years and approximately 57% were female. Among eight domains of the PROMPT-QoL, the therapeutic relationships with health care providers and psychological impacts of medication use domains yielded the highest (77.9) and lowest (61.9) mean scores, respectively. Seven out of eight PROMPT-QoL domain scores were considered as moderate-to-good. Age, gender, duration of epilepsy, seizure frequency, and treatment preference were significantly associated with PROMPT-QoL domain scores in multivariate linear regression analyses.

Conclusions

This study showed that Thai patients with epilepsy had moderate-to-good medication therapy-related quality of life. Healthcare providers should pay more attention to patients’ psychological impacts of antiepileptic drugs and those with characteristics related to lower medication therapy-related quality of life.

Accumulation of sulfonamide resistance genes and bacterial community function prediction in microbial fuel cell-constructed wetland treating pharmaceutical wastewater

Microbial fuel cell constructed wetlands (CW-MFCs) with different circuit operation conditions and hydraulic retention time (HRT) were constructed to evaluate their ability to remove and accumulate pharmaceutical and personal care products (PPCPs) (sulfadiazine (SDZ), carbamazepine (CBZ), naproxen (NPX) and ibuprofen (IBP)) during four months running process. The abundance level of corresponding sulfonamide antibiotic resistance genes (ARGs) was also investigated. The results showed that closed circuit operation of CW-MFC contributed to the decrease in mass loading of COD, NH₄⁺-N, PPCPs, and wastewater toxicity in the effluent. Additionally, closed circuit operation with low HRT contributed to enhancing selected PPCP mass accumulation on electrodes by electro-adsorption, and thus the higher sulfonamide ARG abundance was detected in the electrodes and effluent. Moreover, the composition of bacteria was greatly influenced by the mass accumulation of PPCPs revealed by redundancy analysis results. Procrustes analysis results further demonstrated that bacterial community contributed greatly to the ARGs profiles. Therefore, ARGs with their host bacteria revealed by network analysis were partially deposited on electrode substrates, and thus ARGs were effectively accumulated on electrodes. Function analysis of the bacterial community from PICRUSt predicted metagenomes revealed that closed circuit mode enhanced the abundances of the function genes of metabolic and the multiple ARGs, suggesting that closed circuit operation exhibited positive effects on metabolic process and ARG accumulation in CW-MFC system.

Morphological deformation of Daphnia magna embryos caused by prolonged exposure to ibuprofen

The effect of chronic exposure of freshwater cladoceran Daphnia magna to low, environmentally relevant concentrations i.e 4 μgL^-1of ibuprofen (a nonsteroidal anti-inflammatory drug) in a laboratory experiment was studied. We observed the key life history traits of first and fifth generation individuals: age and size at first reproduction, number of first clutch eggs and individual growth rate. Moreover, chosen molecular/subcellular markers of experimental animals stress response such as triglyceride content, heat shock proteins (HSP) expression and DNA:RNA ratio were collected. Overall, chronic exposure to ibuprofen had no significant effect on the molecular markers nor on the life history parameters of the Daphnia. It did, however, caused lethal morphological deformities in embryos and juvenile daphnids. Depending on the clonal affiliation, exposure to a low dosage of ibuprofen over five generations resulted in the deformation of ∼3%-∼10% of the first clutch of offspring. Also, up to 90% of females carried at least one deformed embryo. This is the first time that research has revealed such an effect of ibuprofen on D. magna.

In-column dilution: Improving volume loadability in reverse phase gradient chromatography through the use of a silica pre-column

Volume overload is a critical limitation in Reversed Phase (RP)-HPLC purification of pharmaceutical compounds. Limited solubility of these materials in most injection solvents leads to large injection volumes in order to maximize throughput. However, peak distortion due to volume overload limits injection amounts, and results in suboptimal use of chromatographic instruments. Volume loading for RP gradient separations was significantly increased by inserting a silica column ahead of the RP separation column. The sole purpose of this column is to dilute the plug of strong injection solvent so that the actual sample constituents are retained when the diluted injection plug arrives at the RP column. This is similar to the concept of a "retention gap" in GC, yet this has never been applied to liquid chromatographic separations. Injection volumes were increased by almost a factor of 3 when using appropriately sized silica columns. A discussion of critical parameters that determine the effectiveness of this approach is provided. The concept is easily applied and does not require any system modifications. It is therefore well suited for open access applications where more instrument intensive approaches, such as "At-Column Dilution", would be less desirable. We will also show that the generic concept which we have titled "In-Column Dilution" can easily be applied to increase the detection sensitivity for analytical application as well by allowing injection of larger sample volumes without peak deterioration for purifications.

Low dissolved oxygen increases uptake of a model calcium channel blocker and alters its effects on adult Pimephales promelas

Human population growth accompanied with urbanization is urbanizing the water cycle in many regions. Urban watersheds, particularly with limited upstream dilution of effluent discharges, represent worst case scenarios for exposure to multiple environmental stressors, including down the drain chemicals (e.g., pharmaceuticals) and other stressors (e.g., dissolved oxygen (DO)). We recently identified the calcium channel blocker diltiazem (DZM) to accumulate in fish plasma exceeding human therapeutic doses (e.g., C_min) in coastal estuaries impaired due to nonattainment of DO water quality standards. Thus, we examined whether DO influences DZM uptake by fish, and if changes in DO-dependent upatke alter fish physiological and biochemical responses. Low DO (3.0 mg DO/L) approximately doubled diltiazem uptake in adult fathead minnows relative to normoxic (8.2 mg DO/L) conditions and were associated with significant (p < 0.05) increases in fish ventilation rate at low DO levels. Decreased burst swim performance (U_burst) of adult fathead minnows were significantly (p < 0.05) altered by low versus normal DO levels. DO × DZM studies reduced U_burst by 13-31% from controls, though not significantly (p = 0.06). Physiological responses in fish exposed to DZM alone were minimal; however, in co-exposure with low DO, decreasing trends in U_burst appeared inversely related to plasma lactate levels. Such physiological responses to multiple stressors, when paired with internal tissue concentrations, identify the utility of employing biological read across approaches to identify adverse outcomes of heart medications and potentially other cardiotoxicants impacting fish cardiovascular function across DO gradients.

Widespread monitoring of chiral pharmaceuticals in urban rivers reveals stereospecific occurrence and transformation

The present work aimed to discuss the enantiomeric occurrence of chiral pharmaceuticals including 5 parent compounds (PCs) metoprolol, propranolol, atenolol, venlafaxine and fluoxetine as well as 6 of their transformation products (TPs) in surface water in Beijing. Among which, 9 out of 11 were detected during the two sampling campaigns with N-O-Didesmethylvenlafaxine (NODDV) and α-hydroxymetoprolol confirmed in the catchment for the first time. Metoprolol acid (MTPA) was the most abundant up to 1508 ng L^-1, followed by metoprolol and O-desmethylvenlafaxine (ODV). Most compounds showed 100% detection frequency or nearly, while norfluoxetine (the main metabolite of fluoxetine) and 4-hydroxypropranololone (one TP of propranolol) were not detected. Metoprolol (MTP) and venlafaxine (VFX) did not vary significantly between two sampling periods with mean concentrations of 280.7 and 22.9 ng L^-1, respectively. Enantiomeric enrichment was observed for venlafaxine, metoprolol and NODDV, where R-venlafaxine was preferentially biotransformed than the S-form through O-desmethylation. Risk assessment indicated that fluoxetine and atenolol could pose harmful effects to aquatic organisms. This work provides enantiospecific profiles of pharmaceutically active compounds (PhACs), and extended the concept of applying the ratio of TPs vs. parent compound plus their enantiomeric traits for quantitative assessment of in situ biodegradation. Due to the considerable contribution by TPs (64% in present study) as well as the unexpected impacts from enantiomeric existence, the stereoselectivity of chiral pollutants during environmental process should be taken into account in future study. To the best of the authors' knowledge, it is the first comprehensive evaluation of chiral pharmaceuticals and transformation products at enantiomeric level in aquatic environment in China, which would facilitate better understanding of their environmental fate.

Multifunctional magnetic MgMn-oxide composite for efficient purification of Cd2+ and paracetamol pollution: Synergetic effect and stability

A multifunctional magnetic composite (0.3Ma-MgMnLDO-a) with the function of Cd²⁺ adsorption and paracetamol (PAM) degradation was successfully fabricated. Surface morphology showed that Fe₃O₄ agglomeration was overcome on composite. The composite had high specific surface area of 105.32 m² g^-1 and saturation magnetization of 40 emu∙g^-1. 0.3Ma-MgMnLDO-a could reach Cd²⁺ adsorption equilibrium within 5 min with 99 % removal rate. The maximum adsorption capacity was 3.76 mmol·g^-1 (422.62 mg g^-1), which apparently higher than that of Fe₃O₄-a and MgMnLDO-a, indicating that the Fe/Mn synergism results in excellent ability for Cd²⁺ adsorption. Moreover, the composite could efficiently activate peroxymonosulfate (PMS) to rapid degrade PAM with the highest first-order rate constants (k_obs = 0.116 min^-1) and total organic carbon (TOC) removal rate (67.7 %), which also due to the contribution of Fe/Mn synergism in PMS activation. The cycling of Mn^III/Mn^IV and Fe^II/Fe^III played an important role in activating PMS to generateO₂^-•, ¹O₂ and OH for degradation. The composite exhibited both stable adsorption and catalytic performance on wide pH (3-9) and five reuse cycles. Notably, there was mutual promotion between Cd²⁺ and PAM adsorption, while the coexistence of Cd²⁺ had slight inhibition on PAM degradation. Overall, the magnetic composite had promising application for purifying heavy metals and pharmaceuticals.

It Only Affects Me: Pharmaceutical Regulation and Harm to Others

In her Pharmaceutical Freedom, Jessica Flanigan argues that antibiotics can be regulated consistent with her otherwise largely deregulatory view with respect to pharmaceuticals and recreational drugs. I contend in this essay that the reasons for justifying antibiotic regulation are reasons that can be offered to justify the regulation of many other drugs, both pharmaceutical and recreational. After laying out the specifics of Flanigan's view, I suggest that it is amenable to the regulation of drugs like varenicline. Though such drugs can legitimately improve the quality of a patient's life by helping them quit smoking, they could be permissibly regulated if they expose others to impermissible risks. I then argue that recreational drugs like alcohol could be regulated using the same reasoning. In the penultimate section of this essay, I anticipate objections that one might have to my extension of arguments favoring antibiotic regulation to drugs correlated with aggression. Flanigan might find my extrapolation of her view as entirely plausible and accept that her view is relatively friendly to these regulations, or she might reconsider her antibiotic caveat if these regulations are overly paternalistic on her understanding. I conclude by briefly considering the benefits and drawbacks of adopting each view.

Near infrared analysis of pharmaceutical powders with empirical target distribution optimization (ETDO)

Near infrared (NIR) spectroscopy is a well-established method for analysis of pharmaceutical products, and especially useful for process monitoring and control of continuous production due to high sample throughput. In this work, a previously established method called empirical target distribution optimization (ETDO) wherein reference sample values using information from model prediction of the calibration data was used as a tool to improve the performance of NIR partial least squares (PLS) models. Model performance was assessed using root mean square error (R²), bias and accuracy in prediction of test samples. A target value selection threshold was tested to assess the ETDO procedure for NIR analysis of powder samples. The amount of specific variation captured by the model was examined and compared for models calibrated with and without ETDO. The results reported in this work suggests that PLS models optimized with ETDO of reference values can provide more specific PLS models for NIR analysis for complex powder mixtures. In addition, the model optimization method could also be applied as a tool to verify the necessary amount of PLS components to produce robust models. The ETDO method presented in this work is an approach that could be applied in the development of continuous blending or tableting processes where robust in-line quantitative analysis of powder samples is needed.

Impact of the antidepressant citalopram on the behaviour of two different life stages of brown trout

BACKGROUND

Over the last two decades, there has been a constant increase in prescription rates of antidepressants. In parallel, neuroactive pharmaceuticals are making their way into aquatic environments at increasing concentrations. Among the antidepressants detected in the environment citalopram, a selective serotonin reuptake inhibitor, is one of the most commonly found. Given citalopram is specifically designed to alter mood and behaviour in humans, there is growing concern it can adversely affect the behaviour on non-target wildlife.

METHODS

In our study, brown trout were exposed to citalopram (nominal concentrations: 1, 10, 100, 1000 µg/L) in two different life stages. Larvae were exposed at 7 and 11 °C from the eyed ova stage until 8 weeks post yolk sac consumption, and juvenile brown trout were exposed for 4 weeks at 7 °C. At both stages we measured mortality, weight, length, tissue citalopram concentration, behaviour during exposure and behaviour in a stressfull environment. For brown trout larvae additionally hatching rate and heart rate, and for juvenile brown trout the tissue cortisol concentration were assessed.

RESULTS

During the exposure, both larvae and juvenile fish exposed to the highest test concentration of citalopram (1 mg/L) had higher swimming activity and spent longer in the upper part of the aquaria compared to control fish, which is an indicator for decreased anxiety. Most probably due to the higher swimming activity during the exposure, the juveniles and larvae exposed to 1 mg/L citalopram showed decreased weight and length. Additionally, in a stressful artificial swimming measurement device, brown trout larvae displayed the anxiolytic effect of the antidepressant by reduced swimming activity during this stress situation, already at concentrations of 100 µg/L citalopram. Chemical analysis of the tissue revealed rising citalopram tissue concentrations with rising exposure concentrations. Tissue concentrations were 10 times higher in juvenile fish compared to brown trout larvae. Fish plasma concentrations were calculated, which exceeded human therapeutic levels for the highest exposure concentration, matching the behavioural results. Developmental parameters like hatching rate and heart rate, as well as mortality and tissue cortisol content were unaffected by the antidepressant. Overall, we could trace the pharmacological mode of action of the antidepressant citalopram in the non-target organism brown trout in two different life stages.

Environmental risk assessment of diclofenac residues in surface waters and wastewater: a hidden global threat to aquatic ecosystem

Pharmaceuticals are chemical compounds employed as medicinal drugs. They have severe physic-chemical properties which make them destructive for non-target species. Consequently, their continuous addition in the environment may pose hazardous effects. Among these, diclofenac (DCF), a non-steroidal anti-inflammatory drug (NSAID), is extensively used in Pakistan which may lead to its accumulation in both terrestrial and aquatic environment. Present study aims to assess the presence and concentration of pharmaceutically active drug (DCF) in surface water and wastewater of twin cities of Pakistan (Rawalpindi and Islamabad). For this purpose, a validated high-performance liquid chromatography (HPLC) method was adopted involving solid-phase extraction procedure. Wastewater samples were collected from various sites of Rawalpindi and Islamabad. Results of HPLC analysis revealed that DCF was extant with considerably high concentration, not only in wastewater but also in surface water samples. Concentrations as high as 216 μg L^-1 was detected in Rawat industrial area and low as 8 μg L^-1 was detected in dairy farm wastewater samples collected from Taramri. However, maximum DCF levels in residential wastewater and hospital wastewater were detected to be 105 μg L^-1 and 34 μg L^-1, respectively. Moreover, the highest detected level (116 μg L^-1) was found in surface water of Sawan River. Further, results of ecological risk assessment revealed its possible toxic effects of DCF on various aquatic organisms.

Interactive effects of diclofenac and copper on bioconcentration and multiple biomarkers in crucian carp (Carassius auratus)

Diclofenac (DCF), a non-steroidal anti-inflammatory drug, is widespread in aquatic environments and coexists with heavy metals to form combined pollution. However, the interactive effects of DCF and heavy metals on aquatic organisms remain unknown. This study aimed to investigate the interactive effects of DCF and copper (Cu) on the bioconcentration, oxidative stress status and detoxification-related gene expression in crucian carp (Carassius auratus). Fish were exposed to Cu (100 μg L^-1) and DCF (1, 10, 100 and 1000 μg L^-1) alone or in combination for 7 days. Results obtained showed that the treatment of Cu combined with high levels of DCF (100 and 1000 μg L^-1) significantly decreased tissue concentrations of DCF and Cu compared to the correspondingly individual exposure. Concerning oxidative stress status, as reflected by the activities of antioxidant enzymes and malondialdehyde content, low exposure concentrations of DCF (1 and 10 μg L^-1) seemed to mitigate the oxidative stress induced by Cu, whereas the co-exposure of Cu with the highest level of DCF (1000 μg L^-1) led to stronger oxidative damage in fish liver than Cu exposure alone. With regarding to detoxification-related genes, in most cases, the expressions of cyp 1a, cyp 3a, gstα, gstπ, pxr and P-gp in crucian carp were significantly altered upon exposure to the compounds in combination compared to exposure to the compounds individually. Collectively, these findings indicate the capacity of each of these pollutants to alter bioconcentration potential, pro-oxidative effects and detoxification-related gene responses of the other when both co-occur at specific concentrations.

Endophytic Penicillium species and their agricultural, biotechnological, and pharmaceutical applications

Penicillium genus constituted by over 200 species is one of the largest and fascinating groups of fungi, particularly well established as a source of antibiotics. Endophytic Penicillium has been reported to colonize their ecological niches and protect their host plant against multiples stresses by exhibiting diverse biological functions that can be exploited for countless applications including agricultural, biotechnological, and pharmaceutical. Over the past 2 decades, endophytic Penicillium species have been investigated beyond their antibiotic potential and numerous applications have been reported. We comprehensively summarized in this review available data (2000-2019) regarding bioactive compounds isolated from endophytic Penicillium species as well as the application of these fungi in multiple agricultural and biotechnological processes. This review has shown that a very large number (131) of endophytes from this genus have been investigated so far and more than 280 compounds exhibiting antimicrobial, anticancer, antiviral, antioxidants, anti-inflammatory, antiparasitics, immunosuppressants, antidiabetic, anti-obesity, antifibrotic, neuroprotective effects, and insecticidal and biocontrol activities have been reported. Moreover, several endophytic Penicillium spp. have been characterized as biocatalysts, plant growth promoters, phytoremediators, and enzyme producers. We hope that this review summarizes the status of research on this genus and will stimulate further investigations.

Solubility of solid intermediate of pharmaceutical compounds in pure organic solvents using semi-empirical models

A new semi-theoretical equation is suggested for correlation of solid-liquid solubility data with temperature. The (solid + liquid) equilibrium for Terephthaldialdehyde, 4-Nitro-o-phennylenediamine, 2,4-dihydro- 5-methyl-2-(4-methylphenyl)-3H-pyrazol-3-one (also named 1-(p-tolyl)-3-methyl-5pyrazolone (PTMP)), 2-Amino-5-methylthiazole and 5-chloro-1-methyl-4-nitroimidazole in 18 solvents is correlated with semi-empirical models at temperatures T = 273.15-318.15 K under a pressure of 101.2 kPa. Moreover, a modified Apelblat model, λh model, Wilson model, NRTL model, new flexible equation as Akbari, Dideban and Farhang model (ADF) and for first time the modified Scatchard-Hildebrand equation were utilized to calculate the experiment values. The performance of both ADF and modified Scatchard-Hildebrand equation have been checked by calculating the solubility data with the AARD% of 1.3808% (for 775 data points) and 0.65% (for 100 data points), respectively. The Wilson model is applied to estimate the mixing Gibbs energy, mixing enthalpy, mixing entropy, activity coefficient (ln γ₁^∞) and reduced excess enthalpy (H₁^{E, ∞}) at infinitesimal concentration were calculated.

Para-sulfonatocalix[n]arene-based biomaterials: Recent progress in pharmaceutical and biological applications

The history, properties, and characteristics of para-sulfonato-calixarenes are described. On the one hand, the inherent antibacterial and antifungal properties against microorganisms, and on the other hand non-toxicity of these supramolecules toward human organs are analyzed. The resulting biocompatibility of para-sulfonato-calixarenes makes them potential candidates for diverse life sciences and pharmaceutical applications without significant side effects. The interactions with different drugs, the capability of drug encapsulation, delivery, and release, the formation of host-quest assemblies and inclusion complexation between para-sulfonato-calixarenes and drugs were also investigated in detail. Besides, their function in cancer treatment and their toxicity against different cancer cell lines were fully reviewed and summarized. Afterward, the capability of these macrocyclic compounds for biosensing of organic compounds, peptides and enzymes activity was highlighted. In this review, we also take a brief look at recent reports on the applications of para-sulfonato-calixarenes in fluorescence imaging and their usage as highly stable and bright probes for in vivo and in vitro imaging and sensing.

ICH Q3D based elemental impurities study in liquid pharmaceutical dosage form with high daily intake - comparative analysis by ICP-OES and ICP-MS

Guideline for Elemental Impurities-Q3D of the International Conference on Harmonisation represents a new paradigm in the control of elemental impurities (EIs) in pharmaceuticals. It changes the approach toward control of EIs from the historical 'heavy metals test', to a scientific-based risk assessment and testing by modern analytical instrumentation such as inductively coupled plasma-optical emission spectroscopy (ICP-OES) and inductively coupled plasma-mass spectrometry (ICP-MS). Management of EIs related to all finished drug products must be implemented in strict compliance with the regulatory requirements of pharmaceutical industry due to their quality and safety concerns. Testing for presence of EIs from Class 1 and Class 2a in methadone hydrochloride 1 mg/ml oral solution with recommended daily intake of 150 mg methadone hydrochloride was initially performed on ICP-OES using in-house validated method according to the requirements of pharmacopoeias, in line with Q3D. During the procedure, it became apparent that ICP-OES has its own limitations, especially when it comes to testing arsenic and lead in low concentrations. ICP-MS in-house validated method was developed and employed for determination of trace concentrations of arsenic and lead, providing resourceful information that were compared and correlated to the data obtained by ICP-OES analysis. Sample preparation using microwave digestion technique was applied for the analyses by both techniques. Although the applied ICP-OES in-house method is suitable for determination of Hg, Cd, Co, V, and Ni, more sensitive technique such as ICP-MS is required for accurate determination of As and Pb concerning pharmaceuticals with high daily intakes.

Twenty years of transcriptomics, 17alpha-ethinylestradiol, and fish

In aquatic toxicology, perhaps no pharmaceutical has been investigated more intensely than 17alpha-ethinylestradiol (EE2), the active ingredient of the birth control pill. At the turn of the century, the fields of comparative endocrinology and endocrine disruption research witnessed the emergence of omics technologies, which were rapidly adapted to characterize potential hazards associated with exposures to environmental estrogens, such as EE2. Since then, significant advances have been made by the scientific community, and as a result, much has been learned about estrogen receptor signaling in fish from environmental xenoestrogens. Vitellogenin, the egg yolk precursor protein, was identified as a major estrogen-responsive gene, establishing itself as the premier biomarker for estrogenic exposures. Omics studies have identified a plethora of estrogen responsive genes, contributing to a wealth of knowledge on estrogen-mediated regulatory networks in teleosts. There have been ~40 studies that report on transcriptome responses to EE2 in a variety of fish species (e.g., zebrafish, fathead minnows, rainbow trout, pipefish, mummichog, stickleback, cod, and others). Data on the liver and testis transcriptomes dominate in the literature and have been the subject of many EE2 studies, yet there remain knowledge gaps for other tissues, such as the spleen, kidney, and pituitary. Inter-laboratory genomics studies have revealed transcriptional networks altered by EE2 treatment in the liver; networks related to amino acid activation and protein folding are increased by EE2 while those related to xenobiotic metabolism, immune system, circulation, and triglyceride storage are suppressed. EE2-responsive networks in other tissues are not as comprehensively defined which is a knowledge gap as regulated networks are expected to be tissue-specific. On the horizon, omics studies for estrogen-mediated effects in fish include: (1) Establishing conceptual frameworks for incorporating estrogen-responsive networks into environmental monitoring programs; (2) Leveraging in vitro and computational toxicology approaches to identify chemicals associated with estrogen receptor-mediated effects in fish (e.g., male vitellogenin production); (3) Discovering new tissue-specific estrogen receptor signaling pathways in fish; and (4) Developing quantitative adverse outcome pathway predictive models for estrogen signaling. As we look ahead, research into EE2 over the past several decades can serve as a template for the array of hormones and endocrine active substances yet to be fully characterized or discovered.

Impact of US industry payment disclosure laws on payments to surgeons: a natural experiment

OBJECTIVES

To compare changes in the number and amount of payments received by orthopedic and non-orthopedic surgeons from industry between 2014 and 2017.

METHODS

Using the Centers for Medicare and Medicaid Services (CMS) Open Payment database from 2014 to 2017, we conducted a retrospective cohort study of industry payments to surgeons, including general payments and research payments.

RESULTS

Among orthopedic surgeons, the total number of general payments decreased from 248,698 in 2014 to 241,966 in 2017, but their total value increased from $97.1 million in 2014 to $110.2 million in 2017. Among non-orthopedic surgeons, the total number decreased from 604,884 in 2014 to 582,490 in 2017, while the total value remained stable at approximately $159 million. Between 2014 and 2017, there was a differential increase in the median number of general payments received by non-orthopedic when compared to orthopedic surgeons (incidence rate ratio, 1.09; 95% CI, 1.08-1.09; p < 0.001), but a differential decline in the median value of general payments (- 8.9%; 95% CI, - 9.5%, - 8.4%; p < 0.001). Findings were consistent when stratified by nature of payment. In contrast, between 2014 and 2017, there was neither a differential change in the median number nor median value of research payments received by non-orthopedics.

CONCLUSION

Examination of a natural experiment of prior public disclosure of payments to orthopedic surgeons suggests that the Physician Payment Sunshine Act was associated with an increase in the number, but a decline in the value, of general payments received by non-orthopedic surgeons, but not on research payments received.

The effect of the antidepressant venlafaxine on gene expression of biotransformation enzymes in zebrafish (Danio rerio) embryos

The effect of venlafaxine, a pharmaceutical commonly found in aquatic environment, was analyzed on non-target organism, Danio rerio (Hamilton, 1822). D. rerio embryos were treated by two different concentrations of venlafaxine: either concentration relevant in aquatic environment (0.3 μg/L) or concentration that was two orders of magnitude higher (30 μg/L) for the evaluation of dose-dependent effect. Time-dependent effect was rated at 24, 96, and 144 h post-fertilization (hpf). For gene expression, genes representing one of the phases of xenobiotic biotransformation (0 to III) were selected. The results of this study showed that the effect of venlafaxine on the zebrafish embryos is the most evident at hatching (96 hpf). At this time, the results showed a downregulation of gene expression in each phase of biotransformation and in both tested concentrations. In contrast, an upregulation of most of the genes was observed 144 hpf for both tested venlafaxine concentrations. The study shows that venlafaxine can affect the gene expression of biotransformation enzymes in D. rerio embryos even in the environmentally relevant concentration and thus disrupt the process of biotransformation. Moreover, the pxr regulation of genes seems to be disrupted after venlafaxine exposure in dose- and time-dependent manner.

Prioritization of pharmaceuticals in water environment in China based on environmental criteria and risk analysis of top-priority pharmaceuticals

Numerous studies have shown that a wide range of pharmaceuticals are present in the environment and many of their adverse biological effects on the aquatic ecosystem and human health are unknown. Due to the high population density and large number of pharmaceuticals produced and consumed in China, a systematic approach is needed to identify pharmaceuticals that require greater attention. The present study provides a ranking of pharmaceuticals in China in terms of their occurrence (O), persistence, bioaccumulation, and toxicity (PBT) based on the predicted environmental concentration (PEC). The total and partial ranking method implemented in the decision analysis by ranking techniques (DART) tool was used, which is an easy-to-use tool for the analysis of datasets. Using the DART approach, 10 pharmaceuticals were selected as priority compounds. These pharmaceuticals included antibiotics, anti-inflammatory and antilipidemic. In order to identify the characteristics of the priority pharmaceuticals, ecotoxicological endpoints were considered. The results of this study and the priority list facilitate the selection of candidate pollutants in future monitoring studies.

Overview of Immobilized Enzymes' Applications in Pharmaceutical, Chemical, and Food Industry

The use of immobilized enzymes in industry is becoming a routine process for the manufacture of many key compounds in the pharmaceutical, chemical, and food industry. Some enzymes like lipases are naturally robust and efficient, can be used for the production of many different molecules, and have found broad industrial applications. Some more specific enzymes, like transaminases, have required protein engineering to become suitable for applications in industrial manufacture. For all enzymes, the possibility to be immobilized and used in a heterogeneous form brings important industrial and environmental advantages such as simplified downstream processing or continuous process operations. Here, we present a series of large-scale applications of immobilized enzymes with benefits for the food, chemical, pharmaceutical, cosmetics, and medical device industries, some of them hardly reported before.

[Pharmaceutical copayment in Spain after the 2012 reform from the user's perspective. Evidence of inequity?]

OBJECTIVE

Identify what are the characteristics of the part of the population that says they cannot buy all the medicines prescribed by a public health doctor, relating them to the criteria that define the pharmaceutical co-payment system established by Royal Decree 16/2012, with the purpose of guiding changes that eliminate possible inequities.

METHOD

Association study and causal relationship between the difficulty to buy prescription drugs that users expressed through the survey called Health Barometer and a set of variables that reflect the degree of need for health services and the economic capacity, that is also part of the co-payment criteria, using multiple correspondence and regression analysis techniques.

RESULTS

After the analysis of the data corresponding to the years 2013-2017, evidence has been found in favour of the hypothesis that the poorest users, as well as the working ones and those with worst health show greater difficulties in accessing the medicines which have been prescribed by a public health doctor and, consequently, changes are proposed in the copayment system aimed at eliminating or, at least, reducing such differences.

CONCLUSIONS

The results obtained are compatible with the hypothesis that the current copayment is perceived as a barrier to access necessary medicines by some sectors of the population. Although certain actions aimed at reducing this barrier can be derived from the work, more research that considers the opinion of the users is needed.

Laboratory-to-field extrapolation: Increase in carbamazepine toxicity in a higher tier, multiple-stress experiment

The toxicity and environmental risk of chemicals, such as the antiepileptic drug carbamazepine (CBZ), is commonly assessed using standardized laboratory tests and laboratory-to-field extrapolation. To investigate the toxicity of CBZ to aquatic key organisms in a more complex and environmentally relevant scenario, we conducted a 32-day multiple-stress experiment in artificial indoor streams. We exposed the non-biting midge Chironomus riparius, the blackworm Lumbriculus variegatus, and the New Zealand mud snail Potamopyrgus antipodarum to 80 and 400 μg CBZ/L in six artificial indoor streams. In addition to hydraulic stress, species' interaction, and low organic content in the sediment, organisms were co-exposed to the herbicide terbutryn (TBY) as a second chemical stressor at a concentration of 6 μg/L. The exposure to CBZ under multiple stress conditions resulted in a 10- to more than 25-fold higher toxicity in C. riparius and P. antipodarum when compared to a previous, standardized laboratory experiment. The co-exposure to TBY enhanced the adverse effects of CBZ on snails (reduced production of embryos). This effect was additive as the single exposure to TBY also reduced the reproduction of snails, most likely through the reduction of biofilm biomass. The emergence of C. riparius declined at a CBZ concentration of 400 μg/L (without the co-exposure to TBY) and at 80 μg/L in combination with TBY. The difference in sensitivity between laboratory and indoor stream experiments is indicative of a potential underestimation of risk when toxicity data are extrapolated to field conditions. The present results suggest the inclusion of non-chemical and chemical stressors in environmental hazard and risk assessments.

Presence of pharmaceutical compounds, levels of biochemical biomarkers in seafood tissues and risk assessment for human health: Results from a case study in North-Western Spain

This study assessed the presence of 27 pharmaceutically active compounds belonging to common therapeutic groups (cardiovascular, antiashmatic, psychoactive, diuretic, analgesic/anti-inflammatory, and antibiotic drugs) in the tissues of representative seafood species of bivalves, cephalopods, arthropods, and fish of high economic importance and consumption rates in North-Western Spain. Four pharmaceutical compounds, out of the 27 analyzed, were detected in the collected samples. The benzodiazepine citalopram was detected in the tissues of common octopus (14.1 ng g^-1 dry weight) and pod razor (9.4 ng g^-1 dw). The anxiolytic venlafaxine was detected in the tissues of common cockle (2.9 ng g^-1 dw). The veterinary antiparasitic ronidazole was found in pod razor (2.3 ng g^-1 dw) and, finally, the psychoactive compound alprazolam was also measured in common octopus (0.3 ng g^-1 dw). Hazard quotients were calculated to assess the hazard posed by the consumption of the sampled seafoods. Octopus and pod razor tissues containing citalopram and alprazolam exceeded our chosen hazard limits (HQ > 0.1) for toddlers who are high consumers of seafood (HQ values between 0.18 and 0.27). A battery of biochemical biomarkers of effects (acetylcholinesterase, glutathione S-transferase; catalase, glutathione peroxidase and glutathione reductase enzymes activities and reduced/oxidized glutathione and malondialdehyde levels) was applied to samples of the study species with the aim of characterizing their basal levels and evaluating their suitability as a tool in the monitoring chronic exposure to environmental contaminants such as those analyzed in this study. According to the measured biomarkers, pod razor and cockles have the potential to be good bioindicator species, based on the observed among-site differences detected on acetylcholinesterase, glutathione S-transferase, catalase, glutathione peroxidase activities; reduced/oxidized glutathione and malondialdehyde levels.

Chronic exposure to venlafaxine and increased water temperature reversibly alters microRNA in zebrafish gonads (Danio rerio)

MicroRNA (miRNA) are short, non-coding RNA that act by downregulating targeted mRNA transcripts. Only recently have they been used as endpoints in studies of aquatic toxicology. The purpose of this study was to determine the effect of an antidepressant contaminant, venlafaxine (VFX), and increased temperature on specific microRNA levels in zebrafish (Danio rerio) reproductive tissue. Adult zebrafish were exposed to one of four conditions; control, 1 μg/L VFX (VFX), 32 °C (Temp), or 1 μg/L VFX + 32 °C (VFX & Temp) for 21 days. Half of the fish were returned to control conditions for a 21-day recovery period. RT-qPCR was performed to measure relative abundances of several miRNAs known to respond to antidepressant exposure: dre-miR-22b-3p, dre-miR-301a, dre-miR-140-5p, dre-let-7d-5p, dre-miR-210-5p, and dre-miR-457b-5p. After the exposure period, dre-miR-22b-3p and dre-miR-301a showed a significant downregulation in response to all treatments. In contrast, after the recovery period, there were no significant differences in microRNA abundance. These altered microRNA are predicted to target several genes, including phosphofructokinase, and are associated with ovarian pathologies. Combined, we have shown that VFX and increased water temperature alter miRNA abundances in zebrafish reproductive tissue, an effect correlated with a functional stress response and cell cycle dysregulation.

Phenotypical and molecular changes induced by carbamazepine and propranolol on larval stages of Mytilus galloprovincialis

The possible impact of carbamazepine (CBZ) and propranolol (PROP), two widespread pharmaceuticals in the aquatic environment, were investigated on morphology and gene transcription of early larvae of Mytilus galloprovincialis. Pharmaceuticals were first tested in a wide concentration range (from 0.01 to 1000 μg/L) through the 48-hpf embryotoxicity assay. The results showed that both compounds significantly affected embryo development from environmental concentrations. Although similar EC₅₀ were obtained, (≅ 1 μg/L) CBZ induced a progressive increase in embryo malformations, whereas PROP apparently showed greater impacts in terms of arrested development and embryo mortality at higher concentrations (>10 μg/L). Transcriptional analyses of 17 genes involved in different physiological functions in mussels and/or in their response to environmental contaminants, were performed at 24 and 48 h pf at two selected concentrations of CBZ and PROP (0.01 and 1 μg/L). Both compounds induced down-regulation of shell-specific and neuroendocrine related transcripts, while distinct effects were observed on antioxidant, lysosomal, and immune-related transcripts, also depending on the larval stage investigated. The results demonstrate that CBZ and PROP can affect development and gene transcription in mussel early larvae at environmental concentrations.

Adsorption of ibuprofen using cysteine-modified silane-coated magnetic nanomaterial

Industrialization and growth of the pharmaceutical companies have been a boon to the mankind in our day to day life in myriad ways. However, due to the uninhibited release of these active pharmaceutical compounds into the water systems has caused detrimental effects to the genetic pool. In this study, L-cysteine-modified 3-glycidyloxypropyltrimethoxysilane-coated magnetic nanomaterial showed a maximum removal of the efficiency of 82.90% for the nanomaterial dosage of 30 mg at an initial concentration of 50 mg L^-1 at pH 6.0. Further, the nanomaterial showed reusability efficiency up to 80% for three cycles. The adsorption kinetics follow the pseudo-second-order reaction and the adsorption isotherm model best fits the Langmuir isotherm proving the adsorption process to be a monolayer sorption on a monolayer surface. This magnetic nanomaterial could serve as a promising tool for the removal of pharmaceutical compounds from aqueous solutions. Graphical abstract ᅟ.

Less anxious salmon smolt become easy prey during downstream migration

Hatchery-reared salmon smolt used for supplementary stocking often display poor migration behavior compared to wild smolt, which reduces the success of this management action. Oxazepam, an anxiolytic drug, has been shown to intensify salmon smolt migration in mesocosm experiments, and treatment with this drug has, therefore, been suggested as a management option to improve downstream smolt migration. In this study, we tested this by assessing migration performance of hatchery-reared Atlantic salmon (Salmo salar) smolt along a 21-km long natural river-to-sea migration route in a boreal river in Northern Sweden. Using acoustic telemetry, the migration rate and survival of smolt that had been exposed to oxazepam (200 μg L^-1, N = 20) was monitored and compared with a control group (N = 20) of unexposed smolt. Exposed smolt took significantly longer time to initiate migration after release compared to the control fish, but after that we observed no significant difference in downstream migration speed. However, exposed smolt had considerably higher probability of being predated on compared to control smolt. We attribute these results to increased risk-taking and higher activity in oxazepam-exposed smolt, which in turn increased initial non-directional exploratory behavior and decreased predator vigilance. These results are discussed based on current concerns for ecological implications of behavioral modifications induced by pharmaceutical pollution and climate change. We conclude that exposure to oxazepam is an unsuitable management option to prime migration of reared salmon in natural systems.

Distribution and ecological risk of pharmaceuticals in surface water of the Yeongsan river, Republic of Korea

This study examined the distribution of pharmaceuticals in Yeongsan River and at point sources (PSs) in the associated water system, and performed a risk assessment based on our findings. The samples included effluents collected from three sewage treatment plants (PS1, PS2, and PS3) and two industrial complexes (PS4 and PS5) as well as surface water collected from seven mainstreams and 11 tributaries of the river. The target pharmaceuticals were acetylsalicylic acid, carbamazepine, clarithromycin, naproxen, sulfamethazine, sulfamethoxazole, sulfathiazole, and trimethoprim, which were detected by liquid chromatography-tandem mass spectrometry. All pharmaceuticals except acetylsalicylic acid and sulfathiazole were found in PS1, PS2, and PS3 samples, whereas acetylsalicylic acid, carbamazepine, sulfamethazine, and sulfamethoxazole were found in PS4, most of the pharmaceuticals were not present in PS5. The rank order of pharmaceutical concentration in surface water was carbamazepine (97.2%, 0.2067 μg/L) > sulfamethoxazole (88.9%, 0.1132 μg/L) > naproxen (51.4%, 0.0516 μg/L) > clarithromycin (43.1%, 0.0427 μg/L). The distribution of pharmaceuticals in the Yeongsan River at PSs and non-PSs differed, and higher concentrations of human pharmaceuticals were detected in upstream and midstream areas whereas higher concentrations of animal pharmaceuticals were found downstream. Hazard quotients (HQs) evaluated at each sites based on mean concentration and 95% upper confidence limits (95% UCLs) were all less than one, indicating a low risk of toxicity. The findings of this study are expected to be useful for risk assessment of aquatic ecosystems.

The effects of diltiazem on growth, reproduction, energy reserves, and calcium-dependent physiology in Daphnia magna

With the growth of both the pharmaceutical industry and the human population and longevity, more drugs are used and processed each day. Inevitably, these pharmaceuticals enter wastewater through human excretion and improper disposal of leftovers. One such medication, diltiazem, a calcium channel blocker, is of importance due to its widespread consumption, and prevalence in aquatic environments. To study the sub-lethal effects of diltiazem on aquatic animals, we investigated its impacts no feeding behaviour, heart rate, respiration, growth, and reproduction of a bioindicator species, Daphnia magna. When exposed to environmentally relevant concentrations, D. magna increased their heart rate by 12% and oxygen consumption by 48%. However, exposure did not have any effects on thoracic limb movement frequency or peristalsis (i.e. feeding behaviour). Individuals exposed to diltiazem for a longer duration (16 days) showed a 44% decrease in lipid reserves and produced between 17 and 28% fewer neonates which were 10-12% larger. Our study demonstrated that exposure to diltiazem creates an energy imbalance in D. magna which could, in the long run, influence their populations.

Occurrence and potential human health risk of pharmaceutical residues in drinking water from Putrajaya (Malaysia)

Occurrence of pharmaceutical residues in drinking water has been widely reported in countries that have registered steady economic growth. This can exert concerns among the general consumers, prompting them to explore the potential human health risks associated with continuous exposure to pharmaceuticals. However, such an occurrence is rarely reported in developing or under-developed countries. To give more contexts, this study looked at the presence of nine pharmaceutical residues in drinking water (amoxicillin, caffeine, chloramphenicol, ciprofloxacin, dexamethasone, diclofenac, nitrofurazone, sulfamethoxazole, and triclosan) at Putrajaya residential area in Malaysia. Additionally, the potential health risks associated with contaminated drinking water were investigated. This study has found the presence of pharmaceutical residue concentrations up to 0.38 ng/L, with the highest concentration of caffeine (0.38 ng/L) and the lowest concentration of diclofenac (0.14 ng/L). In comparison, all the nine pharmaceutical residues were substantially lower than previously reported studies. In general, Hazard Quotient (HQ) values indicated that low potential health hazards were present for all age groups. Nevertheless, quantitative occurrences of pharmaceutical residues in drinking water will help guide future toxicological studies to examine other chronic effects, while canvassing for proper framework to look into the water risk management and regulation in Malaysia.