Investigation of medicines consumption and disposal in Brazil: A study case in a developing country

Physiological responses on the reproductive, metabolism and stress endpoints of Astyanax lacustris females (Teleostei: Characiformes) after diclofenac and ibuprofen exposure

Diclofenac (DCF) and ibuprofen (IBU) are pharmaceutical compounds frequently detected in aquatic compartments worldwide. Several hazard effects including developmental abnormalities and redox balance impairment have been elucidated in aquatic species, but multiple endocrine evaluations are scarce. Therefore, the present study aimed to assess the disruptive physiological effects and toxicity of DCF and IBU isolated and combined, using females of the native freshwater teleost Astyanax lacustris. In regards to NSAIDs bioavailability, the results showed absence of degradation of IBU and DCF after 7 days of exposure. IBU LC50 for A. lacustris was 137 mgL-1 and females exposed to IBU isolated increased thyroxine (T4) concentration at 24 h and decreased after 96 h; DCF exposure decreased triiodothyronine (T3) concentration at 96 h. Circulating levels of 17β-estradiol (E2), cortisol (F) and testosterone (T) were not affected by any treatment. HPG and HPI axis genes fshβ, pomc and vtg were upregulated after 24 h of IBU exposure, and dio2 was downregulated in DCF fish exposed group after 96 h compared to the mixture. Protein concentration was reduced in muscle and increased in the liver by DCF and mixtures exposures at 24 h; while liver lipids were increased in the mixture groups after 96 h. The study point out the capacity of NSAIDs to affect endocrine endpoints in A. lacustris females and induce changes in energetic substrate content after acute exposure to isolated and mixed NSAIDs treatments. Lastly, the present investigation brings new insights into the toxicity and endocrine disruptive activity of NSAIDs in Latin America teleost species and the aquatic environment.

Modified polymer membranes for the removal of pharmaceutical active compounds in wastewater and its mechanism-A review

Membrane technology can play a suitable role in removing pharmaceutical active compounds since it requires low energy and simple operation. Even though membrane technology has progressed for wastewater applications nowadays, modifying membranes to achieve the strong desired membrane performance is still needed. Thus, this study overviews a comprehensive insight into the application of modified polymer membranes to remove pharmaceutical active compounds from wastewater. Biotoxicity of pharmaceutical active compounds is first prescribed to gain deep insight into how membranes can remove pharmaceutical active compounds from wastewater. Then, the behavior of the diffusion mechanism can be concisely determined using mass transfer factor model that represented by β and B with value up to 2.004 g h mg-1 and 1.833 mg g-1 for organic compounds including pharmaceutical active compounds. The model refers to the adsorption of solute to attach onto acceptor sites of the membrane surface, external mass transport of solute materials from the bulk liquid to the membrane surface, and internal mass transfer to diffuse a solute toward acceptor sites of the membrane surface with evidenced up to 0.999. Different pharmaceutical compounds have different solubility and relates to the membrane hydrophilicity properties and mechanisms. Ultimately, challenges and future recommendations have been presented to view the future need to enhance membrane performance regarding fouling mitigation and recovering compounds. Afterwards, the discussion of this study is projected to play a critical role in advance of better-quality membrane technologies for removing pharmaceutical active compounds from wastewater in an eco-friendly strategy and without damaging the ecosystem.

Option or necessity: Role of environmental education as transformative change agent

There is a consensus around the importance of environmental education in mitigating the ill effects of environmental problems and preserving the natural environment and promoting green behaviours. The present paper studies the role of environmental education based on transformative learning theory. It intends to present and test a model proposal using sequential mediation analysis of several constructs as the Environmental Education Support (EES) and Volunteer Attitude (VA). A quantitative study was carried out by using data obtained through online questionnaires from several Indian and Brazilian Higher Education Institutions. A multivariate statistical method was employed to analyse the data by using partial least squares structural equation modelling. The results demonstrated that environmental education positively influences students' environmental concern, willingness to be environmentally friendly, and volunteer attitude. As a novelty, it reports that environmental education beliefs, concern for the environment and willingness to be environmentally friendly sequentially mediate the relationship between environmental education support and volunteering attitude.

Nanohybrid catalysts with porous structures for environmental remediation through photocatalytic degradation of emerging pollutants

Water supplies have been seriously challenged by new emerging pollutants, which are difficult to remove by traditional wastewater treatment. Thus, new technologies such as catalytic advanced oxidation processes have merged as suitable solutions; however, the drawbacks of typical catalysts limit their application. To overcome this issue, new materials with enhanced textural properties have been developed, showing that their porosity and chemical nature influence their potential as a catalyst. Herein, the recent progress in highly porous catalysts and their suitable deployment to effectively nano-remediate the polluted environmental matrices are reviewed in detail. First, following a brief introduction, several environmental pollutants of emerging concerns from different sectors, including pharmaceutical residues, endocrine-disrupting chemicals (EDCs), pesticides, and hazardous dyes are also introduced with relevant examples. To effectively tackle the sustainable remediation of emerging pollutants, this work also focuses on the multifunctional features of nanohybrid porous materials that act as catalysts constructs to degrade emerging pollutants. The influence of surface reactive centers, stability, bandgap energies, light absorption capacities, and pollutants adsorption capacities are also discussed. Successful examples of the employment of nanohybrid porous catalysts for the degradation of pharmaceutical pollutants, EDCs, pesticides, and hazardous dyes are summarized. Finally, some challenges faced by nanohybrid porous materials to achieve their potential application as advanced catalysts for environmental remediation have been identified and presented herein.

Decontamination of emerging pharmaceutical pollutants using carbon-dots as robust materials

Environmental pollution is a critical issue that requires proper measures to maintain environmental health in a sustainable and effective manner. The growing persistence of several active pharmaceutical residues, such as antibiotics like tetracycline, and anti-inflammatory drugs like diclofenac in water matrices is considered an issue of global concern. Numerous sewage/drain waste lines from the domestic and pharmaceutical sector contain an array of toxic compounds, so-called "emerging pollutants" and possess adverse effects on entire living ecosystem and damage its biodiversity. Therefore, effective solution and preventive measures are urgently required to sustainably mitigate and/or remediate pharmaceutically active emerging pollutants from environmental matrices. In this context, herein, the entry pathways of the pharmaceutical waste into the environment are presented, through the entire lifecycle of a pharmaceutical product. There is no detailed review available on carbon-dots (CDs) as robust materials with multifunctional features that support sustainable mitigation of emerging pollutants from water matrices. Thus, CDs-based photocatalysts are emerging as an efficient alternative for decontamination by pharmaceutical pollutants. The addition of CDs on photocatalytic systems has an important role in their performance, mainly because of their up-conversion property, transfer photoinduced electron capacities, and efficient separation of electrons and holes. In this review, we analyze the strategies followed by different researchers to optimize the photodegradation of various pharmaceutical pollutants. In this manner, the effect of different parameters such as pH, the dosage of photocatalyst, amount of carbon dots, and initial pollutant concentration, among others are discussed. Finally, current challenges are presented from a pollution prevention perspective and from CDs-based photocatalytic remediation perspective, with the aim to suggest possible research directions.

Post-synthetic modification of aluminum trimesate and copper trimesate with TiO2 nanoparticles for photocatalytic applications

Organic pollutants have been a significant source of concern in recent years due to their facile dissemination and harmful effects. In this work, two different metal-organic frameworks (MOFs) were initially prepared by hydrothermal treatment, namely aluminum trimesate (MIL-100(Al)) and copper trimesate (HKUST-1). These materials were subsequently submitted to a post-synthetic modification step to grow titania nanoparticles on their surface. Anatase nanoparticles with sizes around 5 nm were successfully anchored on MIL-100(Al), and the concentration of TiO₂ in this sample was about 68 wt.%. This is the first time that this composite (TiO₂@MIL-100(Al)) is reported in the literature. It showed an improved photocatalytic activity, removing 90% of methylene blue (k _app = 1.29 h^-1), 55% of sodium diclofenac (k _app = 0.21 h^-1), and 62% of ibuprofen (k _app = 0.37 h^-1) after four hours of illumination with UV-A light. A significant concentration (14 µM) of reactive oxygen species (ROS) was detected for this composite. HKUST-1 showed a structural collapse during its post-synthetic modification, leading to a non-porous material and providing fewer sites for the heterogeneous nucleation of titania. This behavior led to a low concentration of rutile nanoparticles on HKUST-1 (9 wt.%). However, the obtained composite (TiO₂@HKUST) also showed an improved photoactivity compared to HKUST-1, increasing the photodegradation rates evaluated for methylene blue (0.05 h^-1 vs. 0.29 h^-1), sodium diclofenac (negligible vs. 0.03 h^-1), and ibuprofen (0.01 h^-1 vs. 0.02 h^-1). This work brings new insights concerning the preparation of photocatalysts by growing semiconductor nanoparticles on trimesate-based MOFs.

Knowledge and practices concerning the storage and disposal of home medications among people in the eastern region of Saudi Arabia: A cross-sectional study

Background

Medications are widely used and stored in people’s homes throughout the year. Inappropriate storage of home medications is a worldwide problem and may affect the effectiveness and stability of medications, which impacts the activity and capability of these medications to treat diseases. This study aimed to assess the awareness of the public in the eastern region of Saudi Arabia concerning the appropriate storage of used medications and the proper disposal of unwanted medications.

Method

A cross-sectional survey was conducted in the eastern region of Saudi Arabia between February and June 2018. The study questionnaire tool was constructed based on several previous studies regarding medication storage, recycling, and the correct and safe disposal of expired, unwanted, or unused medication.

Results

A total of 820 responses was collected. The results showed that 91.0% of the respondents keep their medications in the original container, and only 4.5% of them write the expiry date on the new containers. While 47.1% of the respondents read the storage instructions written in the medication leaflet, only 16.2% of the respondents ask the pharmacist about the storage instructions. A majority of the respondents (84.4%) check the expiry date of medications before use, and 70.1% of them periodically check the expiry date of stored medications. Age, gender, and education level were important factors that affected medication storage practices.

Conclusion

This work underpinned the lack of awareness among the public regarding the appropriate way to store home medications and the proper way to dispose of unwanted and expired medications.

The link between pharmaceuticals and cyanobacteria: a review regarding ecotoxicological, ecological, and sanitary aspects

Cyanobacteria are important for ecosystem functioning, but eutrophication may affect the surrounding biome by losing ecosystem services and/or through affecting the cyanotoxins production that threatens ecological and human health. Pollution is an environmental issue that affects aquatic ecosystems worldwide, and the knowledge of the role of synthetic chemicals such as pharmaceuticals is still scarce. Therefore, studies coupling these two relevant issues are essential to better understand the ecological risks and the potential threats to public health. Thus, an overview of ecotoxicological tests performed in the literature exposing cyanobacteria to pharmaceuticals and the possible consequences regarding ecological and sanitary aspects was conducted. Moreover, a risk assessment was performed to enable a better understanding of pharmaceuticals affecting cyanobacteria ecology. Most of the studies found in the literature tested isolated pharmaceuticals in laboratory conditions, while others assessed mixture effects on in situ conditions. The endpoints most assessed were growth, photosynthesis, and antioxidant enzyme activity. The studies also point out that cyanobacteria may present resistance or sensitivity depending on the concentrations and the therapeutic class, which may cause a change in the ecosystem dynamics and/or sanitary implications due to cyanotoxin production. The risk assessment highlighted that antibiotics are among the most relevant substances due to the chemical diversity and higher levels found in the environment than other therapeutic classes. This review highlighted gaps regarding cyanotoxin release into aquatic environments due to the occurrence of pharmaceuticals and the need for more realistic experiments to better understand the potential consequences for human and environmental health.

Temporal and Spatial Variability of Micropollutants in a Brazilian Urban River

In Brazil, environmental occurrence of micropollutants, such as pharmaceuticals, is rarely studied, and these compounds are not part of national water quality guidelines. In this study, we evaluated the occurrence of micropollutants in the Paraibuna River, located in the southeast region of Brazil, which is the most populated region of the country. Surface water samples were taken every 3 months for 1.5 years at four different sites downstream the city of Juiz de Fora. A total of 28 compounds were analyzed on an UHPLC-Orbitrap-MS/MS using a direct injection method. Nine substances were found in at least one water sample, with concentrations ranging from 11 to 4471 ng L^-1. The micropollutants found in the river were not detected at the reference site upstream of the city, except for caffeine, which was present at low concentrations in the reference site. Additionally, a nontarget screening of the river samples was applied, which resulted in the identification of 116 chemicals, most of which were pharmaceuticals. Concentrations of most of the micropollutants varied with season and correlated significantly with rainfall events, which caused dilution in the river. The highest observed concentrations were for pharmaceuticals used for treating chronic diseases, such as metformin, which is used to treat diabetes, and were among the most consumed in Juiz de Fora during the study period. Moderate ecotoxicological risks were found for metformin, oxazepam, triclosan, and tramadol. Considering the complex mixture of micropollutants in the environment, more knowledge is needed to elucidate their ecological risk in aquatic ecosystems.

Medications disposal and medications storage in Jordan: A cross-sectional study

AIMS

Many concerns arise from the improper disposal of medications, which is associated with a negative impact on health and wildlife. The majority of the consumers of pharmaceutical products remain unaware of the procedures of disposal of unused or expired medicines. This study aimed to explore the practices of Jordanian individuals regarding the disposal and storage of unused or expired medications.

METHODS

A cross-sectional study was conducted in Jordan for the period between July and November 2019 of patients who reported having unused, leftover or expired medications in their homes. The questionnaire tool was constructed based on a number of studies concerning medication recycling and international guidelines about correct and safe disposal of expired, unwanted or unused medication.

RESULTS

A total of 1092 participants were included in the study. Their mean age was 32.4 (SD = 13.6) years and 56.8% (n = 620) were males. More than half of the participants (58.1%, n = 634) reported that they had unused, leftover or expired medications in their homes. The bedroom, kitchen and store room were the three most commonly reported places for the storage of unused, leftover or expired medications. The pharmacist was the main source for information regarding the storage of medications. The three most common reasons reported by the participants regarding having unused/leftover medications at home were change or discontinuation by the doctor (29.4%), self-discontinuation as the illness symptoms improved or resolved (28.2%) and forgetfulness (25.1%).

CONCLUSION

A high percentage of the Jordanian population improperly handles their unused, leftover or expired medications. More restrictions are needed on the prescribing and dispensing of medications by the authorities concerned and there is a need to establish public guidelines regarding the use and correct disposal of pharmaceuticals.

A multi-attribute decision-making-based site selection assessment algorithm for garbage disposal plant using interval q-rung orthopair fuzzy power Muirhead mean operator

With the increase of the global population and the improvement of people's living standards, the output of garbage generated by human activities is also increasing day by day. Choosing an appropriate garbage disposal site is one of the key links for the harmless disposal of garbage. However, due to the uncertainty and complexity of socio-economic development and the limited cognitive ability of decision-makers, how to rationally select the garbage disposal site has become a challenging task. This study drew a new multi-attribute decision-making method based on interval q-rung orthopair fuzzy weighted power Muirhead mean (Iq-ROFPWMM) operator to evaluate site selection scheme of garbage disposal plant, and support for garbage disposal site selection. In this method, firstly, power average and Muirhead mean operators are integrated and introduced into the interval q-rung orthopair fuzzy environment to construct an Iq-ROFPWMM operator. Meanwhile, some properties of idempotence, boundedness and monotonicity for the Iq-ROFPWMM operator are analyzed. Then, a multi-attribute decision-making method using Iq-ROFPWMM operator is established. After that, a practical case on the evaluation of garbage disposal site selection scheme is given to verify the effectiveness of the proposed method. Further, parameter analysis and comparative analysis are applied to demonstrate the superiority of our method. The results show that this method boasts wider space for evaluation information representation, more flexible adaptation to the environment evaluation, and stronger robustness of the evaluation results. Finally, some conclusions of this study are drawn and the development direction is revealed.

Evaluation of the potential environmental risk from the destination of medicines: an epidemiological and toxicological study

BACKGROUND

The high consumption of medicines by the population and their storage at home might cause an increase in the number of pharmaceutical substances that may be inappropriately discarded in the sanitary sewage, reaching an environmental aquatic. Thus, the effects of these emerging contaminants need more studies.

OBJECTIVES

To identify the profile of most medicines that are discarded by users of community pharmacy and evaluate the toxicity of the most disposed drugs.

METHODS

This was a translational study. A descriptive observational study was carried out for convenience of community pharmacy users using a standardized questionnaire. Subsequently, the lethal concentration 50 (LC₅₀) for medicine that is most frequently discarded was determined. After LC_50, the embryos (n = 144) were exposed to sublethal concentrations for most discarded drug at 24, 48, and 72 h. Mortality, heartbeat, and embryo deformities were used as parameters of toxicity.

RESULTS

Most respondents (96%) had a "home pharmacy." The primary forms of disposal were in the common household waste, kitchen sink, and/or bathroom. The medicines that were most incorrectly discarded by the interviewees were nimesulide (17.1%), dipyrone (10.7%), and paracetamol (5.2%). LC₅₀ of nimesulide was calculated (0.92 μgmL^-1). The toxicological test revealed that embryos exposed to nimesulide showed several abnormalities, such as defects in the spinal cord, tail, yolk sac, as well as pericardial edema. Furthermore, the heartbeat decreased by 30% at a concentration of 0.4 μgmL^-1 as compared with control group. The yolk sac and pericardial areas increased to >100% in all treatment groups when compared with the control group.

CONCLUSION

Respondents disposed medicines in an inappropriate manner primarily in household waste and in the toilet. Nimesulide was the most discarded drug according to study population. Moreover, teratogenic effects such as spinal cord defects, decreasing heartbeats, and increasing pericardial and yolk sac area in embryos were observed after exposure to nimesulide. These results show that nimesulide may promote risk to aquatic organisms and to human health if it is discarded in an unsafe manner.

Antimicrobial Resistance Profile and Biofilm Production of Microorganisms Isolated from Oropharynx of Rupornis magnirostris (Gmelin, 1788) and Caracara plancus (Miller, 1777)

The aim of this preliminary study was to identify microorganisms with antimicrobial resistance profile and biofilm producers in oropharynx of Rupornis magnirostris and Caracara plancus. Six R. magnirostris and six C. plancus maintained in Triage Center for Wild Animals (CETAS) facilities were studied. Coagulase-positive staphylococci (CoPS), enterobacteria, and yeasts were identified by the biochemical analysis or MALDI-TOF mass spectrometry. The resistance profile of the microorganisms was analyzed according to CLSI. The biofilm production was evaluated by Congo red and violet crystal staining methods. Among the 12 birds, 10 presented strains of CoPS and/or enterobacteria with resistance profile, such as methicillin-resistant CoPS (MR-CoPS), vancomycin-resistant CoPS (VR-CoPS), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), and Klebsiella pneumoniae carbapenemase- (KPC-) producing bacteria. Regards the fungal analysis, Candida spp., Cryptococcus spp., Rhodotorula mucilaginosa, R. glutinis, and Trichosporon coremiiforme were identified. All the Trichosporon coremiiforme strains were resistant to amphotericin B, as well as all the Rhodotorula mucilaginosa exhibited resistance to fluconazole. Related to the biofilm production, among the 8 CoPS, 27 enterobacteria, and 10 yeasts isolates, 3, 16, and 7 strains were biofilm producers, respectively. Thus, the presence of these microorganisms in birds of prey is worrisome, highlighting its possible influence in the spread of infections in urban centers.

Can high rate algal ponds be used as post-treatment of UASB reactors to remove micropollutants?

The present study evaluated the removal capacity of a UASB-HRAP treatment system, combining anaerobic and microalgae-based, aerobic treatment, for eleven organic micropollutants present in raw sewage, including pharmaceuticals, estrogens and xenoestrogens. The UASB reactor and the HRAP were operated at a hydraulic retention time (HRT) of 7 h and 8 days, respectively. Influent and effluent samples from the UASB and HRAP were collected periodically. All the target compounds were detected in raw sewage, with an occurrence ranging from 70 to 100%. Removal rates in the UASB reactor were generally incomplete, ranging from no removal (-25.12% for the hormone EE2-ethinylestradiol) to 84.91% (E2 - estradiol). However, the overall performance of the UASB + HRAP system was highly efficient for the majority of the compounds, with removal rates ranging from 64.8% (ibuprofen) to 95% (estrone). Gemfibrozil and bisphenol A were the only exceptions, with overall removal rates of 39% and 43%, respectively. Hormones were the compounds with the highest removal rates in the system.

Endocrine disruptive action of diclofenac and caffeine on Astyanax altiparanae males (Teleostei: Characiformes: Characidae)

Diclofenac (DCF) and caffeine (CAF) are persistent pharmaceuticals that occur in mixtures in the aquatic ecosystems causing effects in the reproductive physiology of aquatic organisms. This study evaluated the physiological reproductive responses of Astyanax altiparanae males exposed to nominal concentrations of DCF (3.08 mg L^-1) and CAF (9.59 mg L^-1) separately and combined, for 96 h. The steroids profile, estrogenic biomarker vitellogenin (vtgA), testes and liver morphology, and also mortality of males were assessed. DCF and CAF degradation was 5% of the initial concentration for 24 h. The LC₅₀ of the DCF and CAF were 30.8 mg L^-1 and 95.9 mg L^-1, respectively. Males exposed to DCF and CAF exhibited a reduction of 17β-Estradiol (E₂) concentration compared to control (CTL). Similarly, testosterone (T) was also reduced in the DCF treatment, but this response was not observed in 11-Ketotestosterone (11-KT). Males exposed to DCF + CAF combined did not exhibit differences in T, E₂ and 11-KT steroids. The vtgA gene expression and the sperm concentration did not change among the treatments. Moreover, acute exposure revealed a hypertrophy of hepatocytes cells in the DCF and DCF + CAF treatments. In conclusion, DCF and CAF, isolated, exhibit an endocrine disruptive activity in A. altiparanae male, an opposite response observed with the mixture of both compounds that abolishes the endocrine disruptive effects. DCF seems to be more toxic for this species, altering also hepatocytes morphology.

Expired Medication: Societal, Regulatory and Ethical Aspects of a Wasted Opportunity

A massive volume of expired medications amasses annually around the world because of pharmaceutical overprescription, combined with overproduction. The accumulation of pharmaceutical waste imposes ecological, economic and social/ethical burdens. Managing this presumed “waste” has developed into a global challenge due to the absence of specific regulations, unreasonable behavior of the patients, and an improper understanding of the concept of “expired medications” in general. This paper summaries, first, the recent literature reporting practices related to the disposal of unused medications. In this context, 48 papers from 34 countries with a total of 33,832 participants point towards a significant lack of public awareness regarding the appropriate disposal of such biologically potent chemicals. These findings are corroborated by a local survey on the disposal practices of unused medicines among pharmacy students at Saarland University. The regulatory aspects surrounding this topic, often based on the official guidelines for the disposal of expired medications and local waste management strategies, are then discussed in light of these findings. Finally, a closer inspection of the epistemic values of expired medications and different strategies for managing expired medications have been reviewed.

A global trend of caffeine consumption over time and related-environmental impacts

Caffeine is one of the most consumed substances, and it has been largely detected in aquatic ecosystems. We investigated the trends in caffeine consumption over three decades and its relationships with gross domestic product (GDP) and human development index (HDI) to understand global patterns and to identify potential hotspots of contamination. The total caffeine consumption is increasing mainly due to population growth. Moreover, caffeine consumption per capita is also increasing in some countries, such as Brazil, Italy, and Ethiopia. A high positive correlation between caffeine consumption per capita with HDI and GDP was found for coffee-importing countries in Europe, while a high negative correlation was found for coffee-exporting countries in Africa. The literature review showed that the highest caffeine concentrations coincide with countries that present an increasing caffeine consumption per capita. Also, approximately 35% of the caffeine concentrations reported in the literature were above the predicted no-effect concentration in the environment and, again, overlaps with countries with increasing per capita consumption. Despite the high degradation rate, caffeine consumption tends to increase in a near future, which may also increase the overall amount of caffeine that comes into the environment, possibly exceeding the thresholds of several species described as tolerant to the current environmental concentrations. Therefore, it is essential to prevent caffeine from reaching aquatic ecosystems, implementing sewage treatment systems, and improving their efficiency.