Pharmaceuticals residues in selected tropical surface water bodies from Selangor (Malaysia): Occurrence and potential risk assessments

This study investigated the occurrence of nine pharmaceuticals (amoxicillin, caffeine, chloramphenicol, ciprofloxacin, dexamethasone, diclofenac, nitrofurazone, sulfamethoxazole, and triclosan) and to evaluate potential risks (human health and ecotoxicological) in Lui, Gombak and Selangor (Malaysia) rivers using commercial competitive Enzyme-Linked Immunosorbent Assay (ELISA) kit assays. Physicochemical properties of these rivers showed the surface samples belong to Class II of Malaysian National Water Quality Standards which requires conventional treatment before consumption. All the pharmaceuticals were detected in all three rivers except for triclosan, dexamethasone and diclofenac which were not detected in few of sampling locations in these three rivers. Highest pharmaceutical concentrations were detected in Gombak river in line of being as one of the most polluted rivers in Malaysia. Ciprofloxacin concentrations were detected in all the sampling locations with the highest at 299.88 ng/L. While triclosan, dexamethasone and diclofenac concentrations were not detected in a few of sampling locations in these three rivers. All these nine pharmaceuticals were within the levels reported previously in literature. Pharmaceutical production, wastewater treatment technologies and treated sewage effluent were found as the potential sources which can be related with pharmaceuticals occurrence in surface water samples. Potential human risk assessment showed low health risk except for ciprofloxacin and dexamethasone. Instead, ecotoxicological risk assessment indicated moderate risks were present for these rivers. Nevertheless, results confirmation using instrumental techniques is needed for higher degree of specificity. It is crucial to continuously monitor the surface water bodies for pharmaceuticals using a cost-effective prioritisation approach to assess sensitive sub-populations risk.

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.

A systematic review and Bayesian network meta-analysis of risk of intracranial hemorrhage with direct oral anticoagulants

Essentials Risk of intracranial hemorrhage (ICH) may differ between direct oral anticoagulants (DOACs). We compared the risk of ICH between DOACs using network meta-analysis. Dabigatran 110 mg and 150 mg were safer than rivaroxaban on Bayesian analysis. Dabigatran 110 mg ranked as the safest DOAC while rivaroxaban ranked last.

SUMMARY

Background The comparative risk of intracranial hemorrhage (ICH) among direct oral anticoagulants (DOACs) (dabigatran, rivaroxaban, apixaban and edoxaban) remains unclear. Objective To determine the difference in risk of ICH between DOACs Methods Seventeen randomized controlled trials (RCTs) were selected using PubMed/MEDLINE, EMBASE and CENTRAL (Inception, 31 December 2017). Estimates were reported as odds ratio (OR) with 95% credible interval (CR.I) in Bayesian network meta-analysis (NMA), and OR with 95% confidence interval (CI) in traditional meta-analyses. Relative ranking probability of each group was generated based on surface under the cumulative ranking curve (SUCRA). Results In NMA of 116 618 patients from 17 RCTs (apixaban = 19 495 patients, rivaroxaban = 14 157 patients, dabigatran = 16 074 patients, edoxaban = 11 652 patients, and comparator = 55 315 patients), all DOACs were safer than warfarin for risk of ICH. Dabigatran 110 mg ranked as the safest drug (SUCRA, 0.85) and reduced the risk of ICH by 56% compared to rivaroxaban (OR, 0.44; 95% Cr.I, 0.22-0.82). Pairwise meta-analysis validated these findings, showing that DOACs were safer than warfarin (OR, 0.46; 95% CI, 0.35-0.59). Subgroup analysis showed that the benefit was present when DOACs were used in non-valvular atrial fibrillation (NVAF) (OR, 0.51; 95% CI, 0.38-0.68) or venous thromboembolism (VTE) (OR, 0.32; 95% CI, 0.18-0.58). Conclusion Dabigatran 110 mg may be the safest choice among any anticoagulant regarding risk of ICH. Both dabigatran 110 mg and 150 mg were safer than rivaroxaban.

Public awareness level and occurrence of pharmaceutical residues in drinking water with potential health risk: A study from Kajang (Malaysia)

Studies on the occurrence of pharmaceutical residues in drinking water were conducted especially in developed countries. However, limited studies reported the occurrence of pharmaceutical residues in developing countries. Thus, this study is conducted to fill the knowledge gap of pharmaceutical residue occurrences in developing countries, particularly in Malaysia, along with public awareness level and its potential human health risk. This study investigates public awareness level of drinking water quality and pharmaceutical handling, the occurrence of nine pharmaceutical residues (amoxicillin, caffeine, chloramphenicol, ciprofloxacin, dexamethasone, diclofenac, nitrofurazone, sulfamethoxazole, and triclosan) and potential human health risks in drinking water from Kajang (Malaysia) using commercially competitive enzyme-linked immunosorbent assay kits. In general, the public awareness level of Kajang population showed poor knowledge (82.02%), and less positive attitude (98.88%) with a good practice score (57.3%). Ciprofloxacin was detected at the highest concentration (0.667 ng/L) while amoxicillin was at the lowest concentration (0.001 ng/L) in drinking water from Kajang (Malaysia). Nevertheless, all the reported occurrences were lower than previous studies conducted elsewhere. There was no appreciable potential human health risk for all the pharmaceutical residues as the risk quotient (RQ) values were less than 1 (RQ < 1). The results of this study will provide authorities with quantitative knowledge and resources to improve drinking water risk management and regulation in Malaysia.

Bezold's abscess: A rare complication of acute otitis media

Otitis media is a common disease encountered in the primary practice. Most cases are successfully treated with antibiotics without any sequelae. Because of these, potential serious complications of otitis media may be overlooked. We report a rare case of Bezold's abscess, as a complication of otitis media and discuss its pathophysiology and management.

Oral health knowledge, attitudes and behaviour among nursing staff in Lesotho

The decreasing prevalence of oral diseases in industrialised countries is attributed to a paradigm shift of oral health services from being mainly curative to preventative care. In under-resourced countries, the use of non-oral health care workers in the promotion of oral health, can contribute substantially to improving oral health and the adoption of a multidisciplinary team approach in oral health is highly recommended. Owing to the inadequate number of oral health personnel in Lesotho, the use of health care workers other than oral health care workers has been investigated. Nurses are one of the most suitable cadres of health care workers to take on this role. The aim of this study was to determine oral health knowledge, attitudes and behaviour among nurses in Lesotho. A descriptive cross-sectional study, using a random sampling method was used. A self-administered questionnaire with open and closed-ended questions was used to collect the data. The response rate was 87%. Knowledge of aetiology and prevention of dental caries, periodontal disease and the oral manifestations of HIV-infection was found to be adequate, while knowledge of oral cancer was found to be satisfactory. Nurses in Lesotho reported positive attitudes towards the provision of oral health education and oral hygiene practices. Most nurses themselves were found to be symptom-orientated in their utilisation of the oral health services. It is recommended that oral health be given greater attention in the nursing curriculum, with more clinical hands-on training in oral examination and diagnosis of oral diseases.

Exploring the Traditional Chinese Medicine (TCM) database chemical space to target I7L protease from monkeypox virus using molecular screening and simulation approaches

In the current study, we used molecular screening and simulation approaches to target I7L protease from monkeypox virus (mpox) from the Traditional Chinese Medicines (TCM) database. Using molecular screening, only four hits TCM27763, TCM33057, TCM34450 and TCM31564 demonstrated better pharmacological potential than TTP6171 (control). Binding of these molecules targeted Trp168, Asn171, Arg196, Cys237, Ser240, Trp242, Glu325, Ser326, and Cys328 residues and may affect the function of I7L protease in in vitro assay. Moreover, molecular simulation revealed stable dynamics, tighter structural packing and less flexible behaviour for all the complexes. We further reported that the average hydrogen bonds in TCM27763, TCM33057, TCM34450 and TCM31564I7L complexes remained higher than the control drug. Finally, the BF energy results revealed -62.60 ± 0.65 for the controlI7L complex, for the TCM27763I7L complex -71.92 ± 0.70 kcal/mol, for the TCM33057I7L complex the BF energy was -70.94 ± 0.70 kcal/mol, for the TCM34450I7L the BF energy was -69.94 ± 0.85 kcal/mol while for the TCM31564I7L complex the BF energy was calculated to be -69.16 ± 0.80 kcal/mol. Although, we used stateoftheart computational methods, these are theoretical insights that need further experimental validation.