Detection of pharmaceuticals and phytochemicals together with their metabolites in hospital effluents in Japan, and their contribution to sewage treatment plant influents

Chitosan-based adsorbents for wastewater treatment: A comprehensive review

Chitosan has emerged as a promising biopolymer for developing eco-friendly adsorbents for wastewater treatment contaminated by different compounds, such as heavy metals, pharmaceutical compounds, pesticides, and synthetic dyes. Despite its biocompatibility and biodegradability, the application of pristine chitosan in adsorption systems is limited by its low surface area, poor thermal and mechanical stability, and high solubility under acidic conditions. This comprehensive review analyzes recent advances in chitosan's chemical and physical modification to enhance its physicochemical, morphological, and adsorption performance. The role of crosslinking agents, nanocomposite synthesis, and the incorporation of magnetic particles in improving the material's textural characteristics, selectivity, and regeneration potential was highlighted. The novelty of this work lies in its evaluation of how these structural modifications can influence the adsorption mechanisms and performance in different classes of contaminants under varying experimental conditions. Furthermore, this review highlighted the importance of structural-functional correlations, including surface area, pore distribution, crystallinity, and thermal stability, in optimizing adsorbents' adsorption capacity and reusability. The study also provides critical insights into the effects of pH, temperature, ionic strength, and competitive adsorption in multicomponent systems, furnishing valuable details about the design of high-performance and sustainable chitosan-based adsorbents.

Remediation strategies of antiretroviral drugs in the aquatic environment: current trend and future perspectives

The presence of antiretroviral drugs (ARVs) in the aquatic environment highlights the inadequacy of traditional wastewater treatment plants in their remediation. Moreover, the fate and associated human and ecotoxicological impact of those compounds are not well established. In fact, research focusing on effective alternative treatment solutions still seems lacking. However, a growing interest in remediation techniques for pharmaceutical residues, including ARVs in wastewater, has been noticed recently. The main objective of this review is to share updated information and literature on the recent advances in wastewater treatment strategies to eliminate traces of ARVs from wastewater. Research gaps and possible ways forward for further research in the development of effective alternative treatments are well narrated in the current review. Furthermore, useful information can be derived from the highlighted biodegradation mechanisms to better understand the environmental fate of these compounds. An overview of different treatment methods is given, with particular emphasis on the removal efficiencies, reaction kinetics, degradation mechanisms, and process limitations. A summary of the environmental occurrence of ARVs is provided, as well as the status of the global HIV prevalence and antiretroviral therapy.

Acyclovir contamination in environment: Occurrence, transformation, toxicity, risk, and evaluation as a pharmaceutical indicator

Acyclovir (ACV), a widely used antiviral medication effective against herpes simplex viruses (HSV), is raising concern due to its pervasive presence in global water and the associated potential risks. ACV can undergo transformation under varying conditions, leading to the generation of diverse transformation products that may exhibit heightened toxicity. This review aims to present a comprehensive overview of the environmental impact of ACV. We compile data on ACV concentrations in different water sources worldwide to shed light on its global prevalence. The levels of ACV detected in both wastewater and natural water sources generally remain at low concentrations, typically in the range of ng L-1 level. ACV poses minimal threats to aquatic organisms and humans in comparison to its transformation products, and conventional wastewater treatment methods utilizing biological processes can reduce ACV concentrations, yet only achieve transformation rather than complete elimination of risks, as the intermediates often demonstrate elevated toxicity levels and increased persistence. Additionally, perspectives are proposed to inspire future research on risk assessment of ACV, its intermediates and other pharmaceuticals. Given the challenges in keeping pace with the proliferation of chemical varieties, prioritizing and optimizing risk assessment methodologies is imperative. To this end, the suitability of ACV indicators is evaluated by summarizing data across diverse water bodies.

Effects of acetaminophen exposure on behavior and erythrocyte nuclear morphology of juvenile Oreochromis niloticus

The occurrence of pharmaceuticals in the environment can have undesirable effects on nontarget animals, including fish. The present experiment assessed the effects of subchronic exposure to waterborne acetaminophen (N-acetyl-p-aminophenol) (APAP) on selected behavioral aspects (physical avoidance response, ventilation rate, and food detection rate) and erythrocyte nuclear abnormality (ENA) in juvenile Oreochromis niloticus. Two groups of fish were exposed to APAP dissolved in aged municipal water (T1: 2 mg/L and T2: 10 mg/L) for 8 weeks in three replicates (n = 7 fish per tank), alongside a control group (C) without APAP. APAP-exposed fish spent significantly (p < .05) longer time to detect food (T1: 32.6 ± 4.55 s and T2: 39.6 ± 4.66 s) compared to the control group (19.9 ± 2.46 s). Both APAP-exposed groups exhibited attenuated physical avoidance responses (76.7%, 68.7%, and 87.3% in T1, T2, and C, respectively) and a lower mean ventilation rate compared to the control group (194.5 ± 15.5, 179.1 ± 11.6, and 233.2 ± 19.0 per min in T1, T2, and C, respectively). The frequency occurrence of ENA types such as bi-nucleated, notched nuclei, lobed nuclei, and blebbed nuclei (except micronuclei) was significantly higher (p < .05) in APAP-exposed groups compared to the control, with more pronounced effects in the T2 group. The study concludes that APAP exposure prompts significant alterations in behavior and erythrocyte nuclear morphology, emphasizing the value of monitoring and regulating the entry of pharmaceuticals, including APAP, into aquatic environments to prevent unintended effects on non-target organisms like Oreochromis niloticus.

Biodegradation of non-steroidal anti-inflammatory drug loxoprofen by a hyper lignin-degrading fungus Phanerochaete sordida YK-624 under non-ligninolytic conditions

Loxoprofen has been widely used as a non-steroidal anti-inflammatory drug globally and it can also persist in the environment. Although it is known to be a non-toxic drug, its presence may still pose a potential risk to organisms in the environment. Here, the hyper lignin-degrading fungus Phanerochaete sordida YK-624 was used to study the degradation of loxoprofen. This fungus showed excellent loxoprofen biodegradation ability with 90.4% and 93.4% after one day of incubation at lower concentrations of 0.01 and 0.005 mM, respectively. And at a higher concentration of 0.1 mM, a significant removal of 94.2% was also observed after 10 days of incubation. In this study, four metabolites were isolated and determined by HR-ESI-MS and NMR. Furthermore, LC/MS analysis suggested the presence of intermediate hydroxy loxoprofen. In addition, loxoprofen-OH was also identified as a metabolite of loxoprofen through comparison with the synthesized compounds. In this metabolism of loxoprofen, cytochrome P450 may play a significant role. Interestingly, P. sordida YK-624 showed enantioselectivity in the degradation process of loxoprofen. By these results, three degradation pathways of loxoprofen by P. sordida YK-624 were hypothesized. To the best of our knowledge, this is the first report describing the potential degradation mechanisms of loxoprofen by a white-rot fungus.

Degradation Acyclovir Using Sodium Hypochlorite: Focus on Byproducts Analysis, Optimal Conditions and Wastewater Application

In recent years, the environmental impact of pharmaceutical residues has emerged as a pressing global concern, catalyzed by their widespread usage and persistence in aquatic ecosystems. Among these pharmaceuticals, acyclovir (ACV) stands out due to its extensive prescription during medical treatments for herpes simplex virus, chickenpox, and shingles, as well as its heightened usage amidst the COVID-19 pandemic. ACV is excreted largely unchanged by the human body, leading to significant environmental release through wastewater effluents. The urgency of addressing ACV's environmental impact lies in its potential to persist in water bodies and affect aquatic life. This persistence underscores the critical need for effective degradation strategies that can mitigate its presence in aquatic systems. This study focuses on employing sodium hypochlorite as an oxidative agent for the degradation of ACV, leveraging its common use in wastewater treatment plants. Our research aims to explore the kinetics of ACV degradation, identify and characterize its degradation byproducts, and optimize the conditions under which complete degradation can be achieved. By assessing the efficiency of sodium hypochlorite in real wastewater samples, this study seeks to provide practical insights into mitigating ACV contamination in aquatic environments. The novelty of this research lies in its comprehensive approach to understanding the degradation pathways of ACV and evaluating the feasibility of using sodium hypochlorite as a sustainable solution in wastewater treatment. By addressing the environmental concerns associated with ACV and offering practical solutions, this study contributes to the broader goal of sustainable pharmaceutical waste management and environmental stewardship.

Occurrence of pharmaceuticals in Latin America: case study on hazard assessment and prioritization in Costa Rica

Pharmaceuticals are considered as contaminants of emerging concern, and their occurrence in diverse environmental matrices has been described during the last 25 years. Nonetheless, pharmaceutical occurrence has not been evenly described worldwide, and reports from some geographical areas such as most parts of Latin America are scarce. This work aims to address the situation of water pollution due to pharmaceuticals in Latin America by means of two main goals: i. First, reviewing the monitoring studies performed in Latin America on this topic (period 2009-2024), which were conducted in Brazil, Mexico, Colombia, Ecuador, Peru and Argentina, to highlight the most frequently detected compounds from each therapeutic group in the region. ii. Second, analyzing the case of Costa Rica through the hazard assessment and prioritization of pharmaceuticals based on the monitoring performed in this country (years 2011; 2018-2019). The monitoring in Costa Rica comprised a total of 163 sampling points: wastewater treatment plants (WWTPs) (14 urban WWTPs plus two landfill WWTPs; total samples n = 44 influents and n = 34 effluents), nine hospital effluents (n = 32), wastewater from livestock farms (six swine farms and seven dairy farms; n = 23 influents and n = 37 effluents), 64 continental surface water sampling points (n = 137), and 61 coastal seawater sampling points (n = 61). Risk assessment of detected concentrations by the hazard quotient (HQ) approach (period 2018-2019) revealed a total of 25 medium or high-hazard compounds (out of 37 detected compounds). The prioritization approach (which included the Frequency of Appearance (FoA), the Frequency of PNEC exceedance (FoE), and the Extent of predicted no-effect concentration (PNEC) exceedance (EoE)), showed a critical list of nine pharmaceuticals: caffeine, diphenhydramine, acetaminophen, lovastatin, gemfibrozil, ciprofloxacin, ibuprofen, doxycycline and norfloxacin. These compounds should be taken into account as a first concern during the implementation of environmental policies related to pharmaceutical products in the region.

Acyclovir eco-geno-toxicity in freshwater organisms

This study explores the eco-geno-toxic impact of Acyclovir (ACV), a widely used antiviral drug, on various freshwater organisms, given its increasing detection in surface waters. The research focused on non-target organisms, including the green alga Raphidocelis subcapitata, the rotifer Brachionus calyciflorus, the cladoceran crustacean Ceriodaphnia dubia, and the benthic ostracod Heterocypris incongruens, exposed to ACV to assess both acute and chronic toxicity. The results indicate that while acute toxicity occurs at environmentally not-relevant concentrations, a significant chronic toxicity for C. dubia (EC50 = 0.03 µg/L, NOEC = 0.02·10-2 µg/L), highlighted substantial environmental concern. Furthermore, DNA strand breaks and reactive oxygen species detected in C. dubia indicate significant increase at concentrations exceeding 200 µg/L. Regarding environmental risk, the authors identified chronic exposures to acyclovir causing inhibitory effects on reproduction in B. calyciflorus at hundreds of µg/L and hundredths of µg/L for C. dubia as environmentally relevant environmental concentrations. The study concludes by quantifying the toxic and genotoxic risks of ACV showing a chronic risk quotient higher than the critical value of 1and a genotoxic risk quotient reaching this threshold, highlighting the urgent need for a broader risk assessment of ACV for its significant implications for aquatic ecosystems.

Detection of Pharmaceutically Active Compounds in Tap Water Samples by Direct Injection HPLC/MS-MS: A Danger Signal in Deficiency in Residue Management

To date, there is an increased risk to public health and the environment due to the presence of pharmaceutically active compounds within drinking water supply and distribution networks. Owing to this, a direct injection-HPLC/MS-MS method was developed for the simultaneous determination of 16 active pharmaceutical compounds in tap water samples: amoxicillin, ampicillin, cephalexin, cefotaxime, cefuroxime, ciprofloxacin, clarithromycin, clindamycin, chloramphenicol, cyproterone, erythromycin, flutamide, spironolactone, sulfamethoxazole, tamoxifen, and trimethoprim. Limits of detection (LOD) ranged from 0.2 to 6.0 µg/L while quantification limits (LOQ) from 0.3 to 20 µg/L. Recovery percentages were between 70 and 125%. Total analysis time was short, with all compounds being resolved in less than 2.1 min. Of the 22 tap water samples collected and analyzed, the highest concentrations corresponded to amoxicillin (147 µg/L) and ciprofloxacin (44 µg/L). The findings could set a precedent for establishing safe levels of these compounds and increasing standards for tap water quality in this region.

Theory-guided unraveling of the mechanism underlying Cu1.0/Mn1.0-ZnO with dual reaction centers for enhanced peroxymonosulfate activation

Developing efficient catalytic systems for water contamination removal is a topic of great interest. However, the use of heterogeneous catalysts faces challenges due to insufficient active sites and electron cycling. In this study, results from first-principles calculations demonstrate that dual reaction centers (DRCs) are produced around the Cu and Mn sites in Cu1.0/Mn1.0-ZnO due to the electronegativity difference. Experimental results reveal the material with DRCs greatly enhances electron transfer efficiency and significantly impacts the oxidation and reduction of peroxymonosulfate (PMS). In addition, the self-consistent potential correction (SCPC) method was introduced to correct the energy and charge of charged periodic systems simulating a catalytic process, resulting in more precise catalytic results. Specifically, the material exhibits a preference for adsorbing negatively charged PMS anions at electron-deficient Mn sites, facilitating PMS oxidation for the generation of 1O2, and PMS reduction around the electron-rich Cu for the formation of •OH and SO4•-. The major reactive oxygen species is 1O2, showcasing effective performance in various degradation systems. Overall, our work provides novel insights into the persulfate-based heterogeneous catalytic oxidation process, paving the way for the development of high-performance catalytic systems for water purification.

Hydroxylated transformation products of pharmaceutical active compounds: Generation from processes used in wastewater treatment plants and its environmental monitoring

Pharmaceutical active compounds (PhACs) are organic pollutants detected in wastewater and aquatic environments worldwide in concentrations ranging from ng L-1 to μg L-1. Wastewater effluents containing PhACs residues is discharged in municipal sewage and, subsequently collected in municipal wastewater treatment plants (WWTPs) where are not entirely removed. Thus, PhACs and its transformation products (TPs) are discharged into water bodies. In the current work, the transformation of PhACs under treatments used in municipal WWTPs such as biological, photolysis, chlorination, and ozonation processes was reviewed. Data set of the major transformation pathways were obtained of studies that performed the PhACs removal and TPs monitoring during batch-scale experiments using gas and liquid chromatography coupled with tandem mass spectrometry (GC/LC-MS/MS). Several transformation pathways as dealkylation, hydroxylation, oxidation, acetylation, aromatic ring opening, chlorination, dehalogenation, photo-substitution, and ozone attack reactions were identified during the transformation of PhACs. Especially, hydroxylation reaction was identified as transformation pathway in all the processes. During the elucidation of hydroxylated TPs several isobaric compounds as monohydroxylated and dihydroxylated were identified. However, hydroxylated TPs monitoring in wastewater and aquatic environments is a topic scarcely studied due to that has no environmental significance, lack of available analytic standars of hydroxylated TPs and lack of analytic methods for their identification. Thus, screening strategy for environmental monitoring of hydroxylated TPs was proposed through target and suspect screening using GC/LC-MS/MS systems. In the next years, more studies on the hydroxylated TPs monitoring are necessary for its detection in WWTPs effluents as well as studies on their environmental effects in aquatic environments.

Occurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica

This work aims to determine the occurrence, hazard and prioritization of pharmaceuticals from hospital wastewater in Costa Rica through the monitoring of 70 compounds and assessing their environmental risk through a hazard quotient approach (HQ). Moreover, the quantification of selected antibiotic resistance genes (ARGs) was conducted for the first time in this matrix in this geographical location. Thirty-four pharmaceuticals were detected, being caffeine, 1,7-dimethylxanthine, acetaminophen, ibuprofen, naproxen, ciprofloxacin and ketoprofen the most frequent (>50% of the samples). Eighteen pharmaceuticals exhibited high hazard (HQ ≥ 1), while five more showed medium hazard (1 > HQ ≥ 0.1). Prioritization, which also included frequency parameters, revealed caffeine, lovastatin, diphenhydramine, acetaminophen, ibuprofen, ciprofloxacin, and sildenafil as the compounds of major concern. Similarly, cumulative hazard per sample (ΣHQ) estimated high hazard towards aquatic organisms in every sample. All selected ARGs, except mcr-1 (polymyxin resistance), were detected. Among genes conferring resistance to beta-lactams, blaCTX-M and blaKPC were the most abundant, related to resistance to cephalosporins and carbapenems. Ecotoxicological evaluation showed mostly low toxicity towards Daphnia magna and Vibrio fischeri, contrary to the marked effect observed towards Lactuca sativa. These findings provide relevant and novel information on the risk posed by hospital wastewater and their pharmaceutical content in the Latin American environmental context.

Performance of a Pilot-Scale Continuous Flow Ozone-Based Hospital Wastewater Treatment System

Antimicrobial resistance (AMR) is becoming a global concern. Recently, research has emerged to evaluate the human and environmental health implications of wastewater from medical facilities and to identify acceptable wastewater treatment methods. In this study, a disinfection wastewater treatment system using an ozone-based continuous flow system was installed in a general hospital located in Japan. The effectiveness of antimicrobial-resistant bacteria (ARB) and antimicrobials in mitigating the environmental impact of hospital wastewater was evaluated. Metagenomic analysis was conducted to characterize the microorganisms in the wastewater before and after treatment. The results demonstrated that ozone treatment enables effective inactivation of general gut bacteria, including Bacteroides, Prevotella, Escherichia coli, Klebsiella, DNA molecules, and ARGs, as well as antimicrobials. Azithromycin and doxycycline removal rates were >99% immediately after treatment, and levofloxacin and vancomycin removal rates remained between 90% and 97% for approximately one month. Clarithromycin was more readily removed than the other antimicrobials (81-91%), and no clear removal trend was observed for ampicillin. Our findings provide a better understanding of the environmental management of hospital wastewater and enhance the effectiveness of disinfection wastewater treatment systems at medical facilities for mitigating the discharge of pollutants into aquatic environments.

Multi-target analysis of cytostatics in hospital effluents over a 9-month period

The consumption of cytostatics, pharmaceuticals prescribed in chemotherapy, is increasing every year and worldwide, along with the incidence of cancer. The presence and the temporal evolution of cytostatics in wastewaters from a Portuguese hospital center was evaluated through a 9-month sampling campaign, comprising a total of one hundred and twenty-nine samples, collected from May 2019 to February 2020. Eleven cytostatics out of thirteen pharmaceuticals were studied, including flutamide, mycophenolate mofetil and mycophenolic acid, which have never been monitored before. Target analytes were extracted and quantified by solid-phase extraction coupled to liquid-chromatography-tandem mass spectrometry analysis; the method was fully validated. All pharmaceuticals were detected in at least one sample, bicalutamide being the one found with higher frequency (detected in all samples), followed by mycophenolic acid, which was also the compound detected at higher concentrations (up to 5340 ± 211 ng/L). Etoposide, classified as carcinogenic to humans, was detected in 60% of the samples at concentrations up to 142 ± 15 ng/L. The risk from exposure to cytostatics was estimated for aquatic organisms living in receiving bodies. Cyclophosphamide, doxorubicin, etoposide, flutamide, megestrol and mycophenolic acid are suspected to induce risk. Long-term and synergic effects should not be neglected, even for the cytostatics for which no risk was estimated.

Evaluation of acyclovir adsorption on granular activated carbon from aqueous solutions: batch and fixed-bed parametric studies

The present study is aimed to assess the adsorptive potential of carbonaceous material for the acyclovir (ACVR) removal from the aquatic environment using batch and fixed-bed processes. In batch mode, the impact of various process conditions (contact time, pH, adsorbent dose, initial ACVR concentration, and temperature) on ACVR adsorption was investigated. Experimental results revealed that Langmuir isotherm and the pseudo-second-order kinetic model adequately represent the ACVR adsorption mechanism, indicating homogeneous adsorption. The process was found exothermic and spontaneous. Thermodynamic studies concluded that adsorption is a result of both physisorption and chemisorption. To understand the dynamic regime for the design of large-scale column studies, experimental data obtained from breakthrough curve were fitted to various analytical kinetic models. Yan model followed by Thomas model demonstrated a greater correlation of breakthrough data, confirming that the results are significant and are in line with Langmuir isotherm and pseudo-second-order kinetic. G-AC exhibits sufficient adsorption capacity for ACVR. Hence, it is concluded that it can be used in a fixed-bed column in continuous mode for the treatment of ACVR-contaminated wastewater.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s11696-023-02810-7.

Anticancer drugs in wastewater and natural environments: A review on their occurrence, environmental persistence, treatment, and ecological risks

The consumption of anticancer drugs (also known as chemotherapy drugs or antineoplastic drugs) has augmented over the last decades due to increased cancer incidence. Although there is an increasing concern about the presence of pharmaceutical compounds in natural environments and urban/domestic wastewater, anticancer drugs used in chemotherapy and anticancer medication have received less attention. In this review, the occurrence, environmental persistence, and known and potential ecological impacts of anticancer drugs is discussed. This review shows that these compounds are being increasingly detected in effluents of hospitals, influents and effluents of wastewater treatment plants, river surface water and sediments, groundwater, and even drinking water. Anticancer drugs can impact aquatic organisms such as algae, crustaceans, rotifers, and fish and may promote changes in soil and water microbial communities that may alter ecosystem functioning. Our knowledge of technologies for the removal of anticancer drugs is still limited, and these drugs can be dispersed in nature in a diffuse way in an uncontrolled manner. For this reason, an improved understanding of the presence, persistence, and ecological impacts of anticancer drugs in wastewater and natural environments is needed to help design management strategies, protect aquatic microorganisms, and mitigate potential ecological impacts.

Assessing the risks of capecitabine and its active metabolite 5-fluorouracil to freshwater biota

Capecitabine (CAP, prodrug) and 5-fluorouracil (5-FU, its active metabolite) are two of the most prominent cytostatics, for which no clear picture can be drawn regarding potential concentrations of effect for freshwater biota, with CAP being grouped in the least studied cytostatic, whereas 5-FU has been classified as of no and of high environmental risk. Accordingly, the present work aimed to assess the ecotoxicity of CAP and 5-FU in three freshwater species, which included a 72-h assay with the producer Raphidocelis subcapitata; a 96-h assay with the invertebrate secondary consumer Hydra viridissima; and a 96-h assay with embryos of the vertebrate secondary consumer Danio rerio. The following endpoints were monitored: yield and population growth rate for the algae; mortality, morphological alterations, and post-exposure feeding rates for the cnidarian; and mortality, hatching, and malformations for the fish. Overall, organisms' sensitivity to CAP decreased in the following order: R. subcapitata > H. viridissima > D. rerio, whereas for 5-FU, it decreased in the following order: H. viridissima > D. rerio > R. subcapitata. For CAP, no median lethal effective concentrations (LC/EC₅₀) were possible to compute for D. rerio, with no significant mortality or malformations registered in embryos exposed at concentrations up to 800 mg L^-1. For R. subcapitata, the EC₅₀s were 0.077 and 0.63 mg L^-1 for yield and growth rate, respectively, and for H. viridissima, the EC_50,30 min for feeding was 22.0 mg L^-1. For 5-FU, no EC_50s could be computed for R. subcapitata, whilst the EC_50s for H. viridissima mortality and feeding were 55.4 and 67.9 mg L^-1, respectively, and for D. rerio, the LC_50,96 h and EC_50,96 h (hatching and abnormalities) were 4546, 4100, and 2459 mg L^-1, respectively. Assuming similar modes of action for both compounds and their co-occurrence, the combined risk quotient of the two chemicals was determined to be 7.97, which represents a risk for freshwater biota. Anticipating the increased consumption of these compounds and cancer development trends worldwide, these impacts may be further aggravated.

A critical review over the removal of paracetamol (acetaminophen) from synthetic waters and real wastewaters by direct, hybrid catalytic, and sequential ozonation processes

Paracetamol (PCT) or acetaminophen is a widely prescribed drug to treat fever and mild to moderate pain. The PCT uptake by animals and humans is not complete, being excreted through their urine to contaminate the aquatic/natural environments. Trace amounts of this drug have been found in sewage sludge, hospital wastewaters, wastewater plant treatments, surface waters, and even drinking water. PCT denatures proteins and oxidize lipids in cells with damage of their genetic code. Its toxicity over macrophytes, protozoan, algae, bacteria, and fishes has been reported. Ozonation methods have been proposed as efficient treatments to solve this pollution. This comprehensive and critical review is focused on the application of ozonation processes to remove PCT polluted water from different sources, like natural waters, synthetic waters, and real wastewaters. The fundamentals, operating variables, and best results by direct ozonation and hybrid catalytic ozonation are described, with attention to produced reactive oxygen species and their oxidative action. Single ozonation, catalytic modification of materials, and hybrid non-catalytic processes are detailed as direct ozonation methods. Ozonation with metal-based catalysts and photolytic and photocatalytic ozonation as hybrid catalytic methods are analyzed. Sequential non-biological and biological treatments with ozone and ozonation for wastewater remediation in treatment plants are described. Reaction sequences proposed for PCT mineralization are finally discussed, showing the initial formation of hydroquinone and 2-hydroxy-4-(N-acetyl)-aminophenol and their consecutive evolution to ultimate carboxylic acids like oxalic and oxamic. The ability of the methods to destroy these acids and their iron- and/or copper-complexes explains their mineralization performance.

Contributions towards the hazard evaluation of two widely used cytostatic drugs

Cytostatic drugs are one of the most important therapeutic options for cancer, a disease that is expected to affect 29 million individuals by 2040. After being excreted, cytostatics reach wastewater treatment plants (WWTPs), which are unable to efficiently remove them, and consequently, they will be released into the aquatic environment. Due to the highly toxic properties of cytostatics, it is particularly relevant to evaluate their potential ecological risk. Yet, cytostatics toxicity data is still not available for various species. In this work, the ecotoxicity of two widely consumed cytostatics, cyclophosphamide (CYP-as a model cytostatic) and mycophenolic acid (MPA-as a priority cytostatic), was evaluated on three freshwater species-Raphidocelis subcapitata, Brachionus calyciflorus, and Danio rerio, and the risk quotient (RQ) was assessed. Both drugs significantly affected the yield and growth inhibition of the microalgae, while for rotifers, the least sensitive species, only significant effects were registered for CYP. These drugs also caused significant effects on the mortality and morphological abnormalities on zebrafish. The estimation of the RQ discloses that CYP seems to pose a low risk to aquatic biota while MPA poses a very high risk. Altogether, these results emphasize the need for more complete environmental risk assessments, to properly prioritize and rank cytostatics according to their potentially toxic effects on the environment and aquatic biota.

Are cytostatic drugs in surface waters a potential threat?

Cytostatic drugs are pharmaceuticals administered to cancer patients under chemotherapy. Their occurrence in surface waters has been reported worldwide, increasing environmental and human health concerns. This work addresses a question of worldwide interest: are these hazardous pharmaceuticals in surface waters a potential threat? For the first time, this study brings information on the presence of cytostatic drugs in Portuguese rivers. Furthermore, cutting-edge data on the occurrence of two cytostatic drugs is provided; up to the authors' best knowledge, flutamide and mycophenolate mofetil have never been monitored in worldwide surface waters. Nine out of thirteen cytostatic drugs were detected in Portuguese rivers. Despite bicalutamide being the cytostatic most frequently detected, the highest concentration was recorded for cyproterone (19 ± 3 ng/L). Three different scenarios were considered to estimate the risks from the exposure of humans to cytostatic drugs via surface waters. Two scenarios are associated with bathing practices in rivers, particularly in the spring and summer seasons (river beaches): (i) the exposure to cytostatic drugs by dermal contact with contaminated water and (ii) the exposure by accidental ingestion of contaminated water, which is less likely but also occurs. The third exposure scenario is related to (iii) the long-life consumption of drinking water produced from river water capture, under worst-case conditions, i.e. negligible degradation of cytostatic drugs at drinking water treatment plants. It was concluded that the third exposure context to cytostatics could represent a risk to children, if the highest concentration ever reported in the literature for cyclophosphamide in surface waters is considered. Still, attending to the carcinogenicity of some of these compounds (e.g., cyclophosphamide, chlorambucil, etoposide and tamoxifen), health risks might always be expected, regardless of the contamination level. Furthermore, health risks associated with synergic effects and/or long-term exposures cannot be ruled out, even for the remaining cytostatics/exposure contexts.

Fate of selected pharmaceuticals in hospital and municipal wastewater effluent: occurrence, removal, and environmental risk assessment

The concentrations and distribution of β-blockers, lipid regulators, and psychiatric and cancer drugs in the influent and effluent of the municipal wastewater treatment plant (WWTP) and the effluent of 16 hospitals that discharge into the wastewater treatment plant mentioned in this study at two sampling dates in summer and winter were examined. The pharmaceutical contribution of hospitals to municipal wastewater was determined. The removal of target pharmaceuticals was evaluated in a WWTP consisting of conventional biological treatment using activated sludge. Additionally, the potential environmental risk for the aquatic receiving environments (salt lake) was assessed. Beta-blockers and psychiatric drugs were detected in high concentrations in the wastewater samples. Atenolol (919 ng/L) from β-blockers and carbamazepine (7008 ng/L) from psychiatric pharmaceuticals were detected at the highest concentrations in hospital wastewater. The total pharmaceutical concentration determined at the WWTP influent and effluent was between 335 and 737 ng/L in summer and between 174 and 226 ng/L in winter. The concentrations detected in hospital effluents are higher than the concentrations detected in WWTP. The total pharmaceutical contributions from hospitals to the WWTP in summer and winter were determined to be 2% and 4%, respectively. Total pharmaceutical removal in the WWTP ranged from 23 to 54%. According to the risk ratios, atenolol could pose a high risk (risk quotient > 10) for fish in summer and winter. There are different reasons for the increase in pharmaceutical consumption in recent years. One of these reasons is the COVID-19 pandemic, which has been going on for 2 years. In particular, hospitals were operated at full capacity during the pandemic, and the occurrence and concentration of pharmaceuticals used for the therapy of COVID-19 patients has increased in hospital effluent. Pandemic conditions have increased the tendency of people to use psychiatric drugs. It is thought that beta-blocker consumption has increased due to cardiovascular diseases caused by COVID-19. Therefore, the environmental risk of pharmaceuticals for aquatic organisms in hospital effluent should be monitored and evaluated.

Tracking Fluorine during Aqueous Photolysis and Advanced UV Treatment of Fluorinated Phenols and Pharmaceuticals Using a Combined 19F-NMR, Chromatography, and Mass Spectrometry Approach

Fluorine incorporation into organic molecules has increased due to desirable changes in the molecular physiochemical properties. Common fluorine motifs include: aliphatic fluorines and -CF₃, or -F containing groups bonded directly onto an aromatic (Ar-CF₃ and Ar-F) or heteroaromatic ring. Photolysis of these compounds, either in natural or engineered systems, is a potential source of new fluorinated byproducts. Given the potential persistence and toxicity of fluorinated byproducts, monitoring of product formation during photolysis of various fluorinated motifs is needed. ¹⁹F-NMR is a means to detect and quantify these species. Ar-CF₃ and Ar-F model compounds (2-, 3-, and 4-(trifluoromethyl)phenol, 2-, 3-, 4-fluorophenol, and 2,6-, 3,5-difluorophenol) were photolyzed under a variety of aqueous conditions: pH 5, pH 7, pH 10, 1 mM H₂O₂ at pH 7 to form •OH, and 0.5 mM SO₃ ^2- at pH 10 to form e_aq ^-. Pharmaceuticals with the Ar-CF₃ (fluoxetine) and Ar-F plus pyrazole-CF₃ (sitagliptin) motifs were treated similarly. Parent molecule concentrations were monitored with high pressure liquid chromatography with a UV detector. Fluorine in the parent and product molecules was quantified with ¹⁹F-NMR and complete fluorine mass balances were obtained. High resolution mass spectrometry was used to further explore product identities. The major product for Ar-F compounds was fluoride. The Ar-CF₃ model compounds led to fluoride and organofluorine products dependent on motif placement and reaction conditions. Trifluoroacetic acid was a product of 4-(trifluoromethyl)phenol and fluoxetine. Additional detected fluoxetine products identified using mass spectrometry resulted from addition of -OH to the aromatic ring, but a dealkylation product could not be distinguished from fluoxetine by ¹⁹F-NMR. Sitagliptin formed multiple products that all retained the pyrazole-CF₃ motif while the Ar-F motif produced fluoride. ¹⁹F-NMR, mass spectrometry, and chromatography methods provide complementary information on the formation of fluorinated molecules by modification or fragmentation of the parent structure during photolysis, allowing screening for fluorinated photoproducts and development of fluorine mass balances.

Interface Engineering of Co(OH)2 Nanosheets Growing on the KNbO3 Perovskite Based on Electronic Structure Modulation for Enhanced Peroxymonosulfate Activation

Material-enhanced heterogonous peroxymonosulfate (PMS) activation on emerging organic pollutant degradation has attracted intensive attention, and a challenge is the electron transfer efficiency from material to PMS for radical production. Herein, an interface architecture of Co(OH)₂ nanosheets growing on the KNbO₃ perovskite [Co(OH)₂/KNbO₃] was developed, which showed high catalytic activity in PMS activation. A high reaction rate constant (k₁) of 0.631 min^-1 and complete removal of pazufloxacin within 5 min were achieved. X-ray photoelectron spectroscopy, X-ray absorption near edge structure spectra, and density functional theory (DFT) calculations revealed the successful construction of the material interface and modulated electronic structure for Co(OH)₂/KNbO₃, resulting in the hole accumulation on Co(OH)₂ and electron accumulation on KNbO₃. Bader topological analysis on charge density distribution further indicates that the occupations of Co-3d and O-2p orbitals in Co(OH)₂/KNbO₃ are pushed above the Fermi level to form antibonding states (σ*), leading to high chemisorption affinity to PMS. In addition, more reactive Co(II) with the closer d-band center to the Fermi level results in higher electron transfer efficiency and lower decomposition energy of PMS to SO₄^•-. Moreover, the reactive sites of pazufloxacin for SO₄^•- attack were precisely identified based on DFT calculation on the Fukui index. The pazufloxacin pathways proceeded as decarboxylation, nitroheterocyclic ring opening reaction, defluorination, and hydroxylation. This work can provide a potential route in developing advanced catalysts based on manipulation of the interface and electronic structure for enhanced Fenton-like reaction such as PMS activation.

An assessment of hospital wastewater and biomedical waste generation, existing legislations, risk assessment, treatment processes, and scenario during COVID-19

Hospitals release significant quantities of wastewater (HWW) and biomedical waste (BMW), which hosts a wide range of contaminants that can adversely affect the environment if left untreated. The COVID-19 outbreak has further increased hospital waste generation over the past two years. In this context, a thorough literature study was carried out to reveal the negative implications of untreated hospital waste and delineate the proper ways to handle them. Conventional treatment methods can remove only 50%-70% of the emerging contaminants (ECs) present in the HWW. Still, many countries have not implemented suitable treatment methods to treat the HWW in-situ. This review presents an overview of worldwide HWW generation, regulations, and guidelines on HWW management and highlights the various treatment techniques for efficiently removing ECs from HWW. When combined with advanced oxidation processes, biological or physical treatment processes could remove around 90% of ECs. Analgesics were found to be more easily removed than antibiotics, β-blockers, and X-ray contrast media. The different environmental implications of BMW have also been highlighted. Mishandling of BMW can spread infections, deadly diseases, and hazardous waste into the environment. Hence, the different steps associated with collection to final disposal of BMW have been delineated to minimize the associated health risks. The paper circumscribes the multiple aspects of efficient hospital waste management and may be instrumental during the COVID-19 pandemic when the waste generation from all hospitals worldwide has increased significantly.

Evaluation of the Correspondence between the Concentration of Antimicrobials Entering Sewage Treatment Plant Influent and the Predicted Concentration of Antimicrobials Using Annual Sales, Shipping, and Prescriptions Data

The accuracy and correspondence between the measured concentrations from the survey and predicted concentrations on the basis of the three types of statistical antimicrobial use in Japan was evaluated. A monitoring survey of ten representative antimicrobials: ampicillin (APL), cefdinir (CDN), cefpodoxime proxetil (CPXP), ciprofloxacin (CFX), clarithromycin (CTM), doxycycline (DCL), levofloxacin (LFX), minocycline (MCL), tetracycline (TCL), and vancomycin (VMC), in the influent of sewage treatment plant (STP) located in urban areas of Japan, was conducted. Then, the measured values were verified in comparison with the predicted values estimated from the shipping volumes, sales volumes, and prescription volumes based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). The results indicate that the correspondence ratios between the predicted concentrations calculated on the basis of shipping and NDB volumes and the measured concentrations (predicted concentration/measured concentration) generally agreed for the detected concentration of antimicrobials in the STP influent. The correspondence ratio on the basis of shipping volume was, for CFX, 0.1; CTM, 2.9; LFX, 0.5; MCL, 1.9; and VMC, 1.7, and on the basis of NDB volume the measured concentration was CFX, 0.1; CTM, 3.7; DCL, 0.4; LFX, 0.7; MCL, 1.9; TCL, 0.6; and VMC, 1.6. To our knowledge, this is the first report to evaluate the accuracy of predicted concentrations based on sales, shipping, NDB statistics and measured concentrations for antimicrobials in the STP influent.

Migration, Transformation and Removal of Macrolide Antibiotics in The Environment: A Review

Macrolide antibiotics (MAs), as a typical emerging pollutant, are widely detected in environmental media. When entering the environment, MAs can interfere with the growth, development and reproduction of organisms, which has attracted extensive attention. However, there are few reviews on the occurrence characteristics, migration and transformation law, ecotoxicity and related removal technologies of MAs in the environment. In this work, combined with the existing relevant research, the migration and transformation law and ecotoxicity characteristics of MAs in the environment are summarized, and the removal mechanism of MAs is clarified. Currently, most studies on MAs are based on laboratory simulation experiments, and there are few studies on the migration and transformation mechanism between multiphase states. In addition, the cost of MAs removal technology is not satisfactory. Therefore, the following suggestions are put forward for the future research direction. The migration and transformation process of MAs between multiphase states (such as soil-water-sediment) should be focused on. Apart from exploring the new treatment technology of MAs, the upgrading and coupling of existing MAs removal technologies to meet emission standards and reduce costs should also be concerned. This review provides some theoretical basis and data support for understanding the occurrence characteristics, ecotoxicity and removal mechanism of MAs.

Pharmaceutical compounds used in the COVID-19 pandemic: A review of their presence in water and treatment techniques for their elimination

During the COVID-19 pandemic, high consumption of antivirals, antibiotics, antiparasitics, antiprotozoals, and glucocorticoids used in the treatment of this virus has been reported. Conventional treatment systems fail to efficiently remove these contaminants from water, becoming an emerging concern from the environmental field. Therefore, the objective of the present work is to address the current state of the literature on the presence and removal processes of these drugs from water bodies. It was found that the concentration of most of the drugs used in the treatment of COVID-19 increased during the pandemic in water bodies. Before the pandemic, Azithromycin concentrations in surface waters were reported to be in the order of 4.3 ng L-1, and during the pandemic, they increased up to 935 ng L-1. Laboratory scale studies conclude that adsorption and advanced oxidation processes (AOPs) can be effective in the removal of these drugs. Up to more than 80% removal of Azithromycin, Chloroquine, Ivermectin, and Dexamethasone in aqueous solutions have been reported using these processes. Pilot-scale tests achieved 100% removal of Azithromycin from hospital wastewater by adsorption with powdered activated carbon. At full scale, treatment plants supplemented with ozonation and artificial wetlands removed all Favipiravir and Azithromycin, respectively. It should be noted that hybrid technologies can improve removal rates, process kinetics, and treatment cost. Consequently, the development of new materials that can act synergistically in technically and economically sustainable treatments is required.

Sensitivity of Zebrafish Embryogenesis to Risk of Fotemustine Exposure

Several anthropogenic products in wastewater are considered a threat to the aquatic environment. In addition to common industrial pollutants, levels of pharmaceuticals have been increasingly found in the environment in recent years, which may present a strong risk to the aquatic species that live there. The constant consumption of biologically active chemicals for human health has been matched by an increase in the leaking of these compounds in natural habitats over the last two decades. This study is aimed at evaluating the developmental toxicity of fotemustine in the ecological environment. Zebrafish embryos were exposed to doses of 25, 50 and 100 µg/mL from 4 h post-fertilization to 120 h. This study confirms that fotemustine exposure at 50 and 100 µg/mL affects the survival and hatching rate, morphology score and body length. Additionally, it significantly disturbs the antioxidant defense system and increases ROS in zebrafish larvae. From the molecular point of view, fotemustine exposure strongly induces apoptosis, endoplasmic reticulum stress (ERS) and the Wnt signaling pathway.

Occurrence of Pharmaceutically Active Compounds and Potential Ecological Risks in Wastewater from Hospitals and Receiving Waters in Sri Lanka

The presence of pharmaceutically active compounds (PACs) in the environment and their associated hazards is a major global health concern; however, data on these compounds are scarce in developing nations. In the present study, the existence of 39 non-antimicrobial PACs and six of their metabolites in wastewater from hospitals and adjacent surface waters in Sri Lanka was investigated from 2016 to 2018. The highest amounts of the measured chemicals, including the highest concentrations of atorvastatin (14,620 ng/L) and two metabolites, mefenamic acid (12,120 ng/L) and o-desmethyl tramadol (8700 ng/L), were detected in wastewater from the largest facility. Mefenamic acid, gemfibrozil, losartan, cetirizine, carbamazepine, and phenytoin were detected in all the samples. The removal rates in wastewater treatment were 100% for zolpidem, norsertaline, quetiapine, chlorpromazine, and alprazolam. There was substantial variation in removal rates of PACs among facilities, and the overall data suggest that treatment processes in facilities were ineffective and that some PAC concentrations in the effluents were increased. The estimated risk quotients revealed that 14 PACs detected in water samples could pose low to high ecological risk to various aquatic organisms. Compounds such as ibuprofen, tramadol, and chlorpromazine detected in untreated and treated wastewater at these facilities pose a high risk to several aquatic organisms. Our study provides novel monitoring data for non-antimicrobial PAC abundance and the associated potential ecological risk related to hospitals and urban surface waters in Sri Lanka and further offers valuable information on pre-COVID-19 era PAC distribution in the country. Environ Toxicol Chem 2022;41:298-311. © 2021 SETAC.

Transformation products of pharmaceuticals in the environment: Their fate, (eco)toxicity and bioaccumulation potential

Nowadays, a huge scientific attention is being paid to the chemicals of emerging concern, which may pose a significant risk to the human and whole ecosystems. Among them, residues of pharmaceuticals are a widely investigated group of chemicals. In recent years it has been repeatedly demonstrated that pharmaceuticals are present in the environment and that some of them can be toxic to organisms as well as accumulate in their tissues. However, even though the knowledge of the presence, fate and possible threats posed by the parent forms of pharmaceuticals is quite extensive, their transformation products (TPs) have been disregarded for long time. Since last few years, this aspect has gained more scientific attention and recently published papers proved their common presence in the environment. Also the interest in terms of their toxicity, bioconcentration and stability in the environment has increased. Therefore, the aim of our paper was to revise and assess the current state of knowledge on the fate and effects resulting from the presence of the pharmaceuticals' transformation drugs in the environment. This review discusses the metabolites of compounds belonging to six major pharmaceutical groups: SSRIs, anticancer drugs, antibiotics, antihistamines, NSAIDs and opioids, additionally discussing other individual compounds for which literature data exist. The data presented in this paper prove that some TPs may be as harmful as their native forms, however for many groups of drugs this data is still insufficient to assess the risk posed by their presence in the environment.

Chronic toxicity and environmental risk assessment of antivirals in Ceriodaphnia dubia and Raphidocelis subcapitata

Antiviral drugs are a class of medications used for treating viral infections. Due to their widespread use, especially in cases of pandemics and limited human metabolism, antivirals have been detected in multiple environmental matrices. This study aims to evaluate the chronic effects of acyclovir, efavirenz, lamivudine and zidovudine using Ceriodaphnia dubia and Raphidocelis subcapitata. The results with R. subcapitata showed the following toxicities: zidovudine (IC₅₀ = 5.442 mg L^-1) < acyclovir (IC₅₀ = 3.612 mg L^-1) < lamivudine (IC₅₀ = 3.013 mg L^-1) < efavirenz (IC₅₀ = 0.034 mg L^-1). The results of the chronic bioassay with C. dubia demonstrated that zidovudine is the least toxic (EC₅₀ = 5.671 mg L^-1), followed by acyclovir (EC₅₀ = 3.062 mg L^-1), lamivudine (EC₅₀ = 1.345 mg L^-1) and efavirenz (EC₅₀ = 0.026 mg L^-1). Both species have been shown to be sensitive to efavirenz. A risk quotient (RQ) was calculated, and efavirenz had an RQ greater than 1 for both species, and lamivudine had an RQ greater than 1 for C. dubia, representing a high ecological risk for these organisms. Antivirals pose a significant environmental risk to aquatic organisms and should be taken into consideration in future monitoring of water sources.

Multi-Matrix Approach for the Analysis of Bicalutamide Residues in Oncology Centers by HPLC-FLD

Cytostatics are toxic pharmaceuticals, whose presence in surfaces puts healthcare workers at risk. These drugs might also end up in hospital effluents (HWW), potentially damaging aquatic ecosystems. Bicalutamide is a cytostatic extensively consumed worldwide, but few analytical methods exist for its quantification and most of them require advanced techniques, such as liquid chromatography mass spectrometry (LC-MS), which are very complex and expensive for large monitoring studies. Therefore, a simple but reliable multi-matrix high performance liquid chromatographic method, with fluorescence detection, was developed and validated to rapidly screen abnormal concentrations of bicalutamide in HWW and relevant contamination levels of bicalutamide in indoor surfaces (>100 pg/cm2), prior to confirmation by LC-MS. The method presents good linearity and relatively low method detection limits (HWW: 0.14 ng/mL; surfaces: 0.28 pg/cm2). Global uncertainty was below 20% for concentrations higher than 25 ng/mL (HWW) and 50 pg/cm2 (surfaces); global uncertainty was little affected by the matrix. Therefore, a multi-matrix assessment could be achieved with this method, thus contributing to a holistic quantification of bicalutamide along the cytostatic circuit. Bicalutamide was not detected in any of the grab samples from a Portuguese hospital, but an enlarged sampling is required to conclude about its occurrence and exposure risks.

The association between antimicrobials and the antimicrobial-resistant phenotypes and resistance genes of Escherichia coli isolated from hospital wastewaters and adjacent surface waters in Sri Lanka

The presence of antimicrobials, antimicrobial-resistant bacteria (ARB), and the associated antimicrobial resistance genes (ARGs) in the environment is a global health concern. In this study, the concentrations of 25 antimicrobials, the resistance of Escherichia coli (E. coli) strains in response to the selection pressure imposed by 15 antimicrobials, and enrichment of 20 ARGs in E. coli isolated from hospital wastewaters and surface waters were investigated from 2016 to 2018. In hospital wastewaters, clarithromycin was detected at the highest concentration followed by sulfamethoxazole and sulfapyridine. Approximately 80% of the E. coli isolates were resistant, while 14% of the isolates exhibited intermediate resistance against the tested antimicrobial agents. Approximately 61% of the examined isolates were categorized as multidrug-resistant bacteria. The overall abundance of phenotypes that were resistant toward drugs was in the following order: β-lactams, tetracycline, quinolones, sulfamethoxazole/trimethoprim, aminoglycosides, and chloramphenicol. The data showed that the E. coli isolates frequently harbored bla_TEM, bla_CTX-M, tetA, qnrS, and sul2. These results indicated that personal care products were significantly associated with the presence of several resistant phenotypes and resistance genes, implying their role in co-association with multidrug resistance. Statistical analysis also indicated a disparity specific to the site, treatment, and year in the data describing the prevalence of ARB and ARGs and their release into downstream waters. This study provides novel insights into the abundance of antimicrobial, ARB and ARGs in Sri Lanka, and could further offer invaluable information that can be integrated into global antimicrobial resistance databases.

Interaction of pharmaceutical metabolites with blood proteins and membrane lipids in the view of bioconcentration: A preliminary study based on in vitro assessment

Pharmaceuticals pose a real threat to the environment, which has been proven in many studies to date. However, still little is known about the transformation products (TPs) of these compounds, which can also interact with organisms, causing adverse effects like noticeable toxicity or bioconcentration. Many recent works confirm that metabolites of pharmaceuticals are present in the environment, and preliminary studies suggest that they may be equally dangerous to or even more so than their parent compounds. Additionally, it has been proven that some of them have high hydrolytic stability, thus they may be persistent in the environment. This property also increases the likelihood that these compounds will be uptaken and accumulated in the tissues of organisms. Therefore, the aim of the present study was to preliminarily estimate the affinity of the transformation products of selected drugs for blood proteins and cell membrane-forming lipids, considered as important sorption phases during distribution in a living organism. In this study, it was shown that although the examined metabolites do not have a strong affinity for membrane lipids, they exhibit relatively strong binding to proteins, which may considerably affect the distribution of TPs in an organism and may indicate a non-classical process of bioconcentration. The results obtained confirm that the TPs of pharmaceuticals should be given much more attention and their potential for bioconcentration should be further determined.

Anticancer drugs in the aquatic ecosystem: Environmental occurrence, ecotoxicological effect and risk assessment

Anticancer drugs are a group of therapeutic agents used to enhance cell death in targeted cell types of neoplasia. Because of frequent use and eventual discharge, they have been often detected in wastewater from pharmaceutical factories and hospitals, domestic wastewater, and surface waters. The occurrence of these drugs in aquatic ecosystems and their effects on aquatic organisms have been poorly characterized. This review focuses on the global occurrence of major classes of anticancer drugs in water and sediments of freshwater ecosystems and their ecotoxicological effects at different biological levels. While the availability of data is fairly limited, concentrations of most anticancer drugs range from < 2 ng/L to 762 µg/L in receiving water, while levels in sediments and sludge vary from 0.25 to 42.5 µg/kg. Their detection frequencies were 58%, 52% (78%) and 59% in hospital wastewater, wastewater treatment plant effluents (influents) and surface water, respectively. Predicted log K_ow values of vincristine, imatinib mesylate and tamoxifen are higher than 3 and have estimated half-lives>60 d in waters using quantitative structure-activity relationship models, indicating high potential for persistence and bioaccumulation. Based on a species sensitivity distribution evaluation of 9 compounds, crustaceans are most sensitive to anticancer drugs. The most hazardous compound is cisplatin which has a hazard concentration at the 5th percentile. For Daphnia magna, the acute toxicities of major classes of anticancer drugs are ranked as platinum complexes > endocrine therapy agents > antibiotics > antimetabolite agents > alkylating agents. Using hazard quotient analysis based primarily on the lowest observed effect concentrations (LOECs), cyclophosphamide, cisplatin, 5-fluorouracil, imatinib mesylate, bicalutamide, etoposide and paclitaxel have the highest hazard for aquatic organisms. Further research is needed to identify appropriate chronic endpoints for risk assessment thresholds as well as to better understand the mechanisms of action and the potential multigenerational toxicity, and trophic transfer in ecosystems.

A Rapid Analytical Approach for Monitoring Pharmaceuticals in Hospital Wastewater—A DPX-Based Procedure with Environmentally-Friendly Extraction Phase Coupled to High Performance Liquid Chromatography–Diode Array/Fluorescence Detectors

In this study, a novel analytical methodology based on disposable pipette extraction (DPX) was developed using an alternative extraction phase for the extraction/determination of six pharmaceutical compounds, including carbamazepine, diclofenac, naproxen, fluoxetine, losartan and 17α-ethinylestradiol, in samples of hospital wastewater by high-performance liquid chromatography coupled to diode array and fluorescence detectors. The performance of three extraction phases was examined, including 3-n-propyl (3-methylpyridinium) silsesquioxane chloride (Si3Py+Cl−), the conductive polymer polypyrrole (PPy), and polypyrrole modified with cetyltrimethylammonium bromide (PPy.CTAB). The optimization of the experimental parameters was performed through univariate and multivariate approaches. The optimized condition was obtained with the use of 20 mg of Si3Py+Cl− as extraction phase; six extraction cycles with 700 μL of sample in each cycle and 15 s of extraction time; three desorption cycles with 100 μL of ACN (same aliquot) and 15 s of desorption time; and sample pH adjusted at 3.5 and addition of 15% (w/v) of NaCl in the sample. The methodology proposed exhibited environmentally-friendly aspects with a significantly reduced volume of organic solvent (only 100 µL) and a small amount of extraction phase (20 mg). In addition, the extraction phase employed exhibits a simple synthetic procedure, low cost, and high stability in organic solvent. Moreover, the method developed exhibits high throughput (extraction time of 6.5 min per sample), and robustness. The analytical figures of merit were obtained using hospital wastewater, and the values were very satisfactory. The correlation coefficients were higher than 0.9710. LODs and LOQs ranged from 0.030 µg L−1 to 1.510 µg L−1 and 0.10 µg L−1 to 5.00 µg L−1, respectively. Relative recoveries varied from 80 to 127%, and intra-day (n = 3) and inter-day (n = 9) precision was lower than 19%.

On-site chlorination responsible for effective disinfection of wastewater from hospital

Both hospital effluent and a model sewage treatment plant (STP) wastewater prepared by mixing STP influent and STP secondary effluent at a volume ratio of 1:9 were directly treated with chlorine for investigation of their effects on disinfection of antimicrobial-resistant bacteria (AMRB) and antimicrobial-susceptible bacteria (AMSB). The overall results indicate that the chlorine disinfection effectively inactivated the majority of AMRB and AMSB, expect for MRSA and Staphylococcus aureus in both wastewaters. No significant differences could further be observed in the taxonomic diversity of micro-organisms after the treatment. The degrees of disinfection given by the direct chlorination were comparable to those attained by combination of conventional activated sludge process and additional chlorine treatment at the STP. The results of this study evoked a recommendation to operate local chlorination treatment directly for the wastewater from medicinal facilities prior to its flow into the STP as sewage. Although additional disinfection treatment at the STP seems necessary to remove the recalcitrant MRSA and Staphylococcus aureus, the present study desirably contributes to a great reduction of the loads of STP and urgent prevention of spreading of infectious diseases in the present state.

The antineoplastic drugs cyclophosphamide and cisplatin in the aquatic environment - Review

Cyclophosphamide (CP) and Cisplatin (CDDP) are antineoplastic drugs widely used in the treatment of neoplastic diseases that have been detected in the aquatic environment. This review summarizes the current knowledge on the presence in the aquatic environment of these two drugs and their effects on freshwater and marine invertebrates, which includes good model species in ecotoxicology and risk assessment programs. The consumption levels, occurrence in freshwater and marine ecosystems, and the impacts exerted on aquatic organisms, even at low concentrations, justifies this review and the selection of these two drugs. Both pharmaceuticals were detected in different aquatic environments, with concentrations ranging from ng L^-1 up to 687.0 μg L^-1 (CP) and 250 μg L^-1 (CDDP). The available studies showed that CP and CDDP induce individual and sub-individual impacts on aquatic invertebrate species. The most common effects reported were changes in the reproductive function, oxidative stress, genotoxicity, cytotoxicity and neurotoxicity. The literature used in this review supports the need to increase monitoring studies concerning the occurrence of antineoplastic drugs in the aquatic environment since negative effects have been reported even at trace concentrations (ng L^-1). Furthermore, marine ecosystems should be considered as a priority since less is known on the occurrence and effects of antineoplastic drugs in this environment comparing to freshwater ecosystems.

Pharmaceuticals Market, Consumption Trends and Disease Incidence Are Not Driving the Pharmaceutical Research on Water and Wastewater

Pharmaceuticals enhance our quality of life; consequently, their consumption is growing as a result of the need to treat ageing-related and chronic diseases and changes in the clinical practice. The market revenues also show an historic growth worldwide motivated by the increase on the drug demand. However, this positivism on the market is fogged because the discharge of pharmaceuticals and their metabolites into the environment, including water, also increases due to their inappropriate management, treatment and disposal; now, worldwide, this fact is recognized as an environmental concern and human health risk. Intriguingly, researchers have studied the most effective methods for pharmaceutical removal in wastewater; however, the types of pharmaceuticals investigated in most of these studies do not reflect the most produced and consumed pharmaceuticals on the market. Hence, an attempt was done to analyze the pharmaceutical market, drugs consumption trends and the pharmaceutical research interests worldwide. Notwithstanding, the intensive research work done in different pharmaceutical research fronts such as disposal and fate, environmental impacts and concerns, human health risks, removal, degradation and development of treatment technologies, found that such research is not totally aligned with the market trends and consumption patterns. There are other drivers and interests that promote the pharmaceutical research. Thus, this review is an important contribution to those that are interested not only on the pharmaceutical market and drugs consumption, but also on the links, the drivers and interests that motivate and determine the research work on certain groups of pharmaceuticals on water and wastewater.

A comprehensive study of COVID-19 in wastewater

The COVID-19 pandemic has had an adverse effect on human health, economy, and diverse environments. Besides the general transmission of the virus through air droplets and human-to-human contact; it is also transmitted while infecting the digestive system, which subsequently is defecated through the feces. Such fecal transmission can cause a major environmental distress, causing community transmission. This chapter attempts to investigate thoroughly the types of aquatic water bodies and addresses their role in the viral dissemination to combat SARS-CoV-2. It further enlightens the need for wastewater-based epidemiology (WBE) studies for surveillance as well as for early warning signal. The study could provide a comprehensive approach for designing effective strategies in the context of COVID-19 to counter the viral transmission and its deactivation. It also serves as a working paper for scholars and strategy regulators for planning and development of a new set-up from the global to the local level.

Threat and sustainable technological solution for antineoplastic drugs pollution: Review on a persisting global issue

In the past 20 years, the discharge of pharmaceuticals and their presence in the aquatic environment have been continuously increasing and this has caused serious public health and environmental concerns. Antineoplastic drugs are used in chemotherapy, in large quantities worldwide, for the treatment of continuously increasing cancer cases. Antineoplastic drugs also contaminate water sources and possess mutagenic, cytostatic and eco-toxicological effects on microorganisms present in the aquatic environment as well as on human health. Due to the recalcitrant nature of antineoplastic drugs, the commonly used wastewater treatment processes are not able to eliminate these drugs. Globally, various anticancer drugs are being consumed during chemotherapy in hospitals and households by out-patients. These anti-cancer agents enter the water bodies in their original form or as metabolites via urine and faeces of the out-patients or the patients admitted in hospitals. Due to its high lipid solubility, the antineoplastic drugs accumulate in the fatty tissues of the organisms. These drugs enter through the food chain and cause adverse health effects on humans due to their cytotoxic and genotoxic properties. The United States Environmental Protection Agency (US-EPA) and the Organization for Economic Cooperation and Development (OECD) elucidated new regulations for the management of hazardous pharmaceuticals in the water environment. In this paper, the role of antineoplastic agents as emerging water contaminants, its transfer through the food chain, its eco-toxicological properties and effects, technological solutions and management aspects were reviewed.

Potential environmental toxicity of sewage effluent with pharmaceuticals

Sewage effluent effects on the biochemical parameters of Astyanax bimaculatus organs were investigateted. Treated sewage was collected in a treatment plant; 43 compounds, among them, pharmaceuticals and hormones, were investigated. Caffeine, ciprofloxacin, clindamycin, ofloxacin, oxytetracycline, paracetamol, sulfadiazine, sulfamethoxazole, sulfathiazole and tylosin waste was detected in the collected material. Fish were divided into four groups: control, TSE (treated sewage effluent), TSE + P (TSE with increased concentration of five pharmaceuticals) and PTSE (TSE + P post-treated with O₃/H₂O₂/UV). Biochemical parameters were evaluated in different organs after 14-day exposure. TBARS levels increased significantly in the brain of animals in the TSE and TSE + P groups in comparison to the control. There was significant reduction in TBARS levels recorded for the liver, muscle and gills of animals in the PTSE group in comparison to those of animals in the other groups. AChE activity reduced in the muscle of animals in the groups showing the highest pharmaceutical concentrations. CAT activity in the liver of animals in groups exposed to pharmaceutical effluent was inhibited. GST activity increased in brain of animals in the TSE + P and PTSE groups, whereas reduced levels of this activity were observed in liver of animals in the TSE group. Increased GST activity was observed in the brain of animals in TSE + P and PTSE groups. Based on integrated biomarker response values, the TSE + P group presented greater changes in the analyzed parameters. Results point out that pharmaceutical waste can cause oxidative stress, as well as affect biochemical and enzymatic parameters in Astyanax sp. Post-treatment can also reduce damages caused to fish, even in case of the likely formation of metabolites. Based on these results, these metabolites can be less toxic than the original compounds; however, they were not able to fully degrade the pharmaceutical waste found in the sewage, which can interfere in fish metabolism.

Nanoparticles impact in biomedical waste management

Effectual management of biomedical waste is obligatory for healthy human beings and for a safe environment. Mismanagement of biomedical waste is a community health problem. Safe and persistent methods for the management of biomedical waste are of vital importance. This article reviews the classification of biomedical waste, sources, colour-coding system of biomedical waste and salient features of biomedical waste rules in 2016, and the future prospective of nanoparticles. The untreated disposal of biomedical waste is associated with a huge amount of risk, so the efficient treatment for biomedical waste is most imperative. The review also highlights the current methods for disposal of biomedical waste, biological treatments given to biomedical waste water in the effluent treatment plant, and impacts due to the current method. Management of biomedical waste is a great challenge in developed and developing countries. To manage the biomedical waste there is a need for cost-effective, ecofriendly and less contaminating approaches for a greener and safe environment. The awareness regarding waste management is of great interest not only for the community but also for associated employees.

Iron metal-organic framework supported in a polymeric membrane for solid-phase extraction of anti-inflammatory drugs

A solid-phase extraction methodology using a MIL-101(Fe)/PVDF membrane was proposed as a useful alternative for the simultaneous determination of naproxen, diclofenac, and ibuprofen, three anti-inflammatory drugs (NSAIDs), in wastewater samples by HPLC-CCD analysis. The MIL-101(Fe) was prepared by a rapid microwave-assisted method and supported in a polymeric PVDF membrane. The prepared material was characterized by X-ray diffraction (XRD), nitrogen adsorption-desorption, scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), and Fourier-transform infrared spectroscopy (FT-IR). The factors that affect the extraction of the NSAIDs using the MIL-101(Fe)/PVDF membrane as the sample volume, the solution pH and the elution solvent were studied in detail. The selected conditions were 50 mL of sample solution at pH 3 and 5 mL of methanol: acetone (30:70, v v^-1) acidified with formic acid at 2% as elution solvent. The analytical method was linear with determination coefficients (r² ≥ 0.998) in the calibration ranges from 2 to 100 ng mL^-1 for naproxen, 20-200 ng mL^-1 for diclofenac, and 100-300 ng mL^-1 for ibuprofen. The intra and inter-day precision (repeatability and reproducibility, respectively) of the method (RSD%, n = 5) were lower than 4.8% and 7.1%, respectively. The accuracy reported as recovery percentages ranged from 82 to 118%, and the limits of detection were between 1.8 and 32.3 ng mL^-1. Moreover, MIL-101(Fe)/PVDF membrane exhibited improved adsorption efficiency compared to that of its analog MIL-101(Cr)/PVDF and the pristine PVDF membranes, obtaining in an easy and rapid (60 min) way a low-cost and low-toxic adsorbent with excellent stability, reusability, mechanic resistance, and simple operation which shows excellent performance.

Occurrence of caffeine in the freshwater environment: Implications for ecopharmacovigilance

Owing to the substantial consumption of caffeinated food, beverages, and medicines worldwide, caffeine is considered the most representative pharmaceutically active compound (PhAC) pollutant based on its high abundance in the environment and its suitability as an indicator of the anthropogenic inputs of PhACs in water bodies. This review presents a worldwide analysis of 132 reports of caffeine residues in freshwater environments. The results indicated that more than 70% of the studies reported were from Asia and Europe, which have densely populated and industrially developed areas. However, caffeine pollution was also found to affect areas isolated from human influence, such as Antarctica. In addition, the maximum concentrations of caffeine in raw wastewater, treated wastewater, river, drinking water, groundwater, lake, catchment, reservoir, and rainwater samples were reported to be 3.60 mg/L, 55.5, 19.3, 3.39, 0.683, 174, 44.6, 4.87, and 5.40 μg/L, respectively. The seasonal variation in caffeine residues in the freshwater environment has been demonstrated. In addition, despite the fact that there was a small proportion of wastewater treatment plants in which the elimination rates of caffeine were below 60%, wastewater treatment is generally believed to have a high caffeine removal efficiency. From a pharmacy perspective, we proposed to adopt effective measures to minimize the environmental risks posed by PhACs, represented by caffeine, through a new concept known as ecopharmacovigilance (EPV). Some measures of EPV aimed at caffeine pollution have been advised, as follows: improving knowledge and perceptions about caffeine pollution among the public; listing caffeine as a high-priority PhAC pollutant, which should be targeted in EPV practices; promoting green design and production, rational consumption, and environmentally preferred disposal of caffeinated medicines, foods, and beverages; implementing intensive EPV measures in high-risk areas and during high-risk seasons; and integrating EPV into wastewater treatment programs.

Radiolytic degradation of anticancer drug capecitabine in aqueous solution: kinetics, reaction mechanism, and toxicity evaluation

The occurrence of anticancer drugs in the environment has attracted wide attention due to its potential environmental risks. The aim of this study was to investigate degradation characteristics and mechanism of anticancer drug capecitabine (CPC) by electron beam (EB) irradiation. The results showed that EB was an efficient water treatment process for CPC. The degradation followed pseudo-first-order kinetics with dose constants ranged from 1.27 to 3.94 kGy^-1. Removal efficiencies in natural water filtered or unfiltered were lower than pure water due to the effect of water matrix components. The degradation was restrained by the presence of NO₂^-, NO₃^- and CO₃^2-, and fulvic acid due to competition of reactive radical •OH. It demonstrated that oxidizing radical played important role in irradiation process. The appropriate addition of H₂O₂ and K₂S₂O₈ providing with oxidizing agents •OH and •SO₄^- was favorable to improve degradation efficiency of CPC. The possible transformation pathways of CPC including cleavage of the ribofuranose sugar and defluorination were proposed based on intermediate products and were consistent with the theoretical calculation of charge and electron density distribution. Toxicity of CPC and intermediate products were estimated by ECOSAR program. It was found that CPC was transformed to low toxicity products with EB.

Sale-based estimation of pharmaceutical concentrations and associated environmental risk in the Japanese wastewater system

Information on sales and emission of selected pharmaceuticals were used to predict their concentrations in Japanese wastewater influent through a >300 of pharmaceuticals data sink. A combined wastewater-based epidemiology and environmental risk analysis follow was established. By comparing predicted environmental concentrations (PECs) of pharmaceuticals in wastewater influent against measured environmental concentrations (MECs) reported in previous studies, it was found that the model gave accurate results for 17 pharmaceuticals (0.5 < PEC/MEC < 2), and acceptable results for 32 out of 40 pharmaceuticals (0.1 < PEC/MEC < 10). Although the majority of pharmaceuticals considered in the model were antibiotics and analgesics, pranlukast, a receptor antagonist, was predicted to have the highest concentration in wastewater influent. With regard to the composition of wastewater effluent, the Estimation Program Interface (EPI) suite was used to predict pharmaceutical removal through activated sludge treatment. Although the performance of the EPI suite was variable in terms of accurate prediction of the removal of different pharmaceuticals, it could be an efficient tool in practice for predicting removal under extreme scenarios. By using the EPI suite with input data on PEC in the wastewater influent, the PEC values of pharmaceuticals in wastewater effluent were predicted. The concentrations of 26 pharmaceuticals were relatively high (>1 μg/L), and the PECs of 6 pharmaceuticals were extremely high (>10 μg/L) in wastewater effluent, which could be attributed to their high usage rates by consumers and poor removal rates in wastewater treatment plants (WWTPs). Furthermore, environmental risk assessment (ERA) was carried out by calculating the ratio of predicted no effect concentration (PNEC) to PEC of different pharmaceuticals, and it was found that 9 pharmaceuticals were likely to have high toxicity, and 54 pharmaceuticals were likely to have potential toxicity. It is recommended that this is further investigated in detail. The priority screening and environmental risk assessment results on pharmaceuticals can provide reliable basis for policy-making and environmental management.

Quantification of fluoroquinolones in wastewaters by liquid chromatography-tandem mass spectrometry

Antibiotics are the most consumed therapeutic classes worldwide and are released to the environment in their original form as well as potentially active metabolites and/or degradation products. Consequences of the occurrence of these compounds in the environment are primarily related to bacterial resistance development. This work presents a validated analytical method based on solid phase extraction (SPE) using HLB cartridges, followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) for quantification of seven different fluoroquinolone antibiotics, namely ciprofloxacin (CPF), enrofloxacin (ENR), lomefloxacin (LOM), norfloxacin (NOR), ofloxacin (OFL), prulifloxacin (PLF) and moxifloxacin (MOX) and its application to detect the target compounds in influents and effluents of wastewater treatment plants (WWTP). Linearity was established through calibration curves in solvent and matrix match using internal calibration method in the range of 50-1300 ng L^-1 and all the fluoroquinolones showed good linear fit (r² ≥ 0.991). Accuracy ranged between 80.3 and 92.9%, precision was comprised between 7.2 and 14.6%, and 10.7 and 18.1% for intra- and inter-batch determinations, respectively. Method detection and quantification limits ranged from 6.7 to 59.0 ng L^-1 and 22.3-196.6 ng L^-1, respectively. Influents and effluents of fifteen WWTPs of North of Portugal were analyzed. OFL was the fluoroquinolone found at the highest concentration, up to 4587.0 ng L^-1 and 987.9 ng L^-1, in influent and effluent, respectively. NOR and PLF were not detected.