Fatal case of cephalexin-induced toxic epidermal necrolysis

Occurrence and fate of pharmaceutical pollutants in wastewater: Insights on ecotoxicity, health risk, and state-of-the-art removal

Pharmaceutical active compound (PhAC) residues are considered an emerging micropollutant that enters the aquatic environment and causes harmful ecotoxicity. The significant sources of PhACs in the environment include the pharmaceutical industry, hospital streams, and agricultural wastes (animal husbandry). Recent investigations demonstrated that wastewater treatment plants (WWTPs) are an important source of PhACs discharging ecosystems. Several commonly reported that PhACs are detected in a range level from ng L-1 to μg L-1 concentration in WWTP effluents. These compounds can have acute and chronic adverse impacts on natural wildlife, including flora and fauna. The approaches for PhAC removals in WWTPs include bioremediation, adsorption (e.g., biochar, chitosan, and graphene), and advanced oxidation processes (AOPs). Overall, adsorption and AOPs can effectively remove PhACs from wastewater aided by oxidizing radicals. Heterogeneous photocatalysis has also proved to be a sustainable solution. Bioremediation approaches such as membrane bioreactors (MBRs), constructed wetlands (CWs), and microalgal-based systems were applied to minimize pharmaceutical pollution. Noteworthy, applying MBRs has illustrated high removal efficiencies of up to 99%, promising prospective future. However, WWTPs should be combined with advanced solutions, e.g., AOPs/photodegradation, microalgae-bacteria consortia, etc., to treat and minimize their accumulation. More effective and novel technologies (e.g., new generation bioremediation) for PhAC degradation must be investigated and specially designed for a low-cost and full-scale. Investigating green and eco-friendly PhACs with advantages, e.g., low persistence, no bioaccumulation, less or non-toxicity, and environmentally friendly, is also necessary.

Toxic Epidermal Necrolysis in a Critically Ill African American Woman: A Case Report Written With ChatGPT Assistance

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening spectrum diseases in which a medication triggers a mucocutaneous reaction associated with severe necrosis and loss of epidermal integrity. The disease has a high mortality rate that can be assessed by dermatology scoring scales based on an affected total body surface area (TBSA). Sloughing of <10% TBSA is considered SJS, with a mortality of 10%. Sloughing of >30% TBSA is termed TEN, with an increased mortality rate of 25% to 35%. We present a case and management of TEN that involved >30% TBSA in a critically ill African American woman. Identification of the offending agent was difficult due to complicated medication exposure throughout her multi-facility care management. This case conveys the importance of close monitoring of a critically ill patient during a clinical course involving SJS-/TEN-inducing drugs. We also discuss the potential increased risks for SJS/TEN in the African American population due to genetic or epigenetic predispositions to skin conditions. This case report also contributes to increasing skin of color representation in the current literature. Additionally, we discuss the use of Chat Generative Pre-trained Transformer (ChatGPT, OpenAI LP, OpenAI Inc., San Francisco, CA, USA) and list its benefits and errors.