Investigating the nutritional viability of marine-derived protein for sustainable future development

Marine-derived proteins are emerging as a pivotal resource with diverse applications in food, pharmaceuticals, and biotechnological industries. The marine environment offers many protein sources, including fish, shellfish, algae, and microbes, which garnered attention due to their nutritional composition. Evaluating their protein and amino acid profiles is essential in assessing their viability as substitutes for conventional protein sources. Continuously exploiting marine ecosystems for protein extraction has led to significant environmental impacts. The optimization of aquacultural practices and implementation of innovative practices are imperative for the sustainable production of marine-based protein. This review will discuss the different sources of marine proteins, their nutritional profile, and their associated environmental impact. It also reviews the relationship between aquaculture advancements and regulatory frameworks toward attaining sustainable practices, alongside exploring the challenges and potentials in utilizing marine sources for protein production.

Patient-centered mild traumatic brain injury interventions in the emergency department

INTRODUCTION

Traumatic brain injury (TBI) results in 2.5 million emergency department (ED) visits per year in the US, with mild traumatic brain injury (mTBI) accounting for 90% of cases. There is considerable evidence that many experience chronic symptoms months to years later. This population is rarely represented in interventional studies. Management of adult mTBI in the ED has remained unchanged, without consensus of therapeutic options. The aim of this review was to synthesize existing literature of patient-centered ED treatments for adults who sustain an mTBI, and to identify practices that may offer promise.

METHODS

A systematic review was conducted using the PubMed and Cochrane databases, while following PRISMA guidelines. Studies describing pediatric patients, moderate to severe TBI, or interventions outside the ED were excluded. Two reviewers independently performed title and abstract screening. A third blinded reviewer resolved discrepancies. The Mixed Methods Appraisal Tool (MMAT) was employed to assess the methodological quality of the studies.

RESULTS

Our search strategy generated 1002 unique titles. 95 articles were selected for full-text screening. The 26 articles chosen for full analysis were grouped into one of the following intervention categories: (1) predictive models for Post-Concussion Syndrome (PCS), (2) discharge instructions, (3) pharmaceutical treatment, (4) clinical protocols, and (5) functional assessment. Studies that implemented a predictive PCS model successfully identified patients at highest risk for PCS. Trials implementing discharge related interventions found the use of video discharge instructions, encouragement of daily light exercise or bed rest, and text messaging did not significantly reduce mTBI symptoms. The use of electronic clinical practice guidelines (eCPG) and longer leaves of absence from work following injury reduced symptoms. Ondansetron was shown to reduce nausea in mTBI patients. Studies implementing ED Observation Units found significant declines in inpatient admissions and length of hospital stay. The use of tablet-based tasks was found to be superior to many standard cognitive assessments.

CONCLUSION

Validated instruments are available to aid clinicians in identifying patients at risk for PCS or serious cognitive impairment. EDOU management and evidence-based modifications to discharge instructions may improve mTBI outcomes. Additional research is needed to establish the therapeutic value of medications and lifestyle changes for the treatment of mTBI in the ED.

Tackling medicine shortages during and after the COVID-19 pandemic: Compilation of governmental policy measures and developments in 38 countries

In response to increasing shortages of medicines, governments have implemented legislative and non-legislative policy measures. This study aimed to map these policies across high-income countries in Europe and beyond as of 2023 and to analyse developments in governmental approaches since the beginning of the pandemic. Information was collated from 38 countries (33 European countries, Australia, Brazil, Canada, Israel and Saudi Arabia) based on a survey conducted with public authorities involved in the Pharmaceutical Pricing and Reimbursement Information (PPRI) network in 2023. 34 countries requested pharmaceutical companies to notify national registers of upcoming shortages and 20 countries obliged manufacturers and/or wholesalers to stock supply reserves of critically needed medicines. Further common measures included export bans for defined medicines (18 countries), regulatory measures to facilitate import and use of alternative medicines (35 countries) and multi-stakeholder coordination (28 countries). While the legislation of 26 countries allows imposing sanctions, particularly for non-compliance to reporting requirements, fines were rather rarely imposed. Since 2022, at least 18 countries provided financial incentives, usually in the form of price increases of some off-patent medicines. Overall, several policies to address medicine shortages were taken in recent years, in some countries as part of a comprehensive package (e.g., Australia, Germany). Further initiatives to secure medicine supply in a sustainable manner were being prepared or discussed.

Effect of pyrolysis temperature and molecular weight on characterization of biochar derived dissolved organic matter from invasive plant and binding behavior with the selected pharmaceuticals

A comprehensive understanding of the characteristics of biochar released-dissolved organic matter (BDOM) derived from an invasive plant and its impact on the binding behavior of pharmaceuticals is essential for the application of biochar, yet has received less attention. In this study, the binding behavior of BDOM pyrolyzed at 300-700 °C with sulfathiazole, acetaminophen, chloramphenicol (CAP), and carbamazepine (CMZ) was investigated based on a multi-analytical approach. Generally, the pyrolysis temperature exhibited a more significant impact on the spectral properties of BDOM and pharmaceutical binding behavior than those of the molecular weight. With increased pyrolysis temperature, the dissolved organic carbon decreased while the proportion of the protein-like substance increased. The highest binding capacity towards the drugs was observed for the BDOM pyrolyzed at 500 °C with the molecular weight larger than 0.3 kDa. Moreover, the protein-like substance exhibited higher susceptive and released preferentially during the dialysis process and also showed more sensitivity and bound precedingly with the pharmaceuticals. The active binding points were the aliphatic C-OH, amide II N-H, carboxyl CO, and phenolic-OH on the tryptophan-like substance. Furthermore, the binding affinity of the BDOM pyrolyzed at 500 °C was relatively high with the stability constant (logKM) of 4.51 ± 0.52.

[Cost-effectiveness analysis of fracture liaison services in Catalonia]

OBJECTIVE

To assess the cost-effectiveness of Fracture Liaison Service (FLS) compared to the standard of care for secondary prevention of fragility fractures form the perspective of the Catalan Health Service.

METHODS

Cost-utility assessment through a Markov model that simulated disease progression of a patients' cohort candidates to initiate antiosteoporotic treatment after a fragility fracture. A time horizon of 10 years and a 6-month duration per cycle was established. Clinical, economics and quality of life parameters were obtained from the literature and derived from four Catalan FLS. The Catalan Health Service perspective was adopted, considering direct health costs expressed in 2022 euros. A 3% discount rate was applied on costs and outcomes. Uncertainty was assessed through multiple sensitivity analyses.

RESULTS

Compared to the standard of care, FLS would promote antiosteoporotic initiation and persistence, reducing the incidence and mortality associated with subsequent fragility fractures. This incremental clinical benefit was estimated at 0.055 years and 0.112 quality-adjusted life years (QALYs) per patient. A higher cost (€1,073.79 per patient) was estimated, resulting into an incremental cost-utility ratio of €9,602.72 per QALYs gained. The sensitivity analyses performed were consistent, corroborating the robustness and conservative approach of the base-case.

CONCLUSIONS

The introduction of FLS for the secondary prevention of FF would represent a cost-effective strategy from the Catalan Health Service perspective.

Analytical comparison between batch and continuous direct compression processes for pharmaceutical manufacturing using an innovative UV-Vis reflectance method and chemometrics

Advancements in industrial technologies and the application of quality by design (QbD) guidelines are shifting the attention of manufacturers towards innovative production techniques. In the pharmaceutical field, there is a significant focus on the implementation of continuous processes, in which the production stages are carried out continuously, without the need to interrupt the process and store the production intermediates, as in traditional batch production. Such innovative production techniques also require the development of proper analytical methods able to analyze the products in-line, while still being processed. The present study aims to compare a traditional batch manufacturing process with an alternative continuous one. To this end, a real pharmaceutical formulation was used, substituting the active pharmaceutical ingredient (API) with riboflavin, at the concentration of 2 %w/w. Moreover, a direct and non-destructive analytical method based on UV-Vis reflectance spectroscopy was applied for the quantification of riboflavin in the final tablets, and compared with a traditional absorbance analysis. Good results were obtained in the comparison of both the two manufacturing processes and the two analytical methods, with R2 higher than 0.9 for all the calculated calibration models and predicted riboflavin concentrations that never significantly overcame the 15 % limits recommended by the pharmacopeia. The continuous production method demonstrated to be as reliable as the batch one, allowing to save time and money in the production step. Moreover, UV-Vis reflectance was proved to be an interesting alternative to absorption spectroscopy, which, with the proper technology, could be implemented for in-line process control.

Application of 3D printing in early phase development of pharmaceutical solid dosage forms

Three-dimensional printing (3DP) is an emerging technology, offering the possibility for the development of dose-customized, effective, and safe solid oral dosage forms (SODFs). Although 3DP has great potential, it does come with certain limitations, and the traditional drug manufacturing platforms remain the industry standard. The consensus appears to be that 3DP technology is expected to benefit personalized medicine the most, but that it is unlikely to replace conventional manufacturing for mass production. The 3DP method, on the other hand, could prove well-suited for producing small batches as an adaptive manufacturing technique for enabling adaptive clinical trial design for early clinical studies. The purpose of this review is to discuss recent advancements in 3DP technologies for SODFs and to focus on the applications for SODFs in the early clinical development stages, including a discussion of current regulatory challenges and quality controls.

Has pharmaceutical innovation reduced the average cost of U.S. health care episodes?

A number of authors have argued that technological innovation has increased U.S. health care spending. We investigate the impact that pharmaceutical innovation had on the average cost of U.S. health care episodes during the period 2000-2014, using data from the Bureau of Economic Analysis' Health Care Satellite Account and other sources. We analyze the relationship across approximately 200 diseases between the growth in the number of drugs that have been approved to treat the disease and the subsequent growth in the mean amount spent per episode of care, controlling for the growth in the number of episodes and other factors. Our estimates indicate that mean episode cost is not significantly related to the number of drugs ever approved 0-4 years before, but it is significantly inversely related to the number of drugs ever approved 5-20 years before. This delay is consistent with the fact (which we document) that utilization of a drug is relatively low during the first few years after it was approved, and that some drugs may have to be consumed for several years to have their maximum impact on treatment cost. Our estimates of the effect of pharmaceutical innovation on the average cost of health care episodes are quite insensitive to the weights used and to whether we control for 3 covariates. Our most conservative estimates imply that the drugs approved during 1986-1999 reduced mean episode cost by 4.7%, and that the drugs approved during 1996-2009 reduced mean episode cost by 2.1%. If drug approvals did not affect the number of episodes, the drugs approved during 1986-1999 would have reduced 2014 medical expenditure by about $93 billion. However, drug approvals may have affected the number, as well as the average cost, of episodes. We also estimate models of hospital utilization. The number of hospital days is significantly inversely related to the number of drugs ever approved 10-19 years before, controlling for the number of disease episodes. Our estimates imply that the drugs approved during 1984-1997 reduced the number of hospital days by 10.5%. The hospital cost reduction was larger than expenditure on the drugs.

Out-of-pocket pharmaceutical expenditure and its determinants among Iranian households with elderly members: a double-hurdle model

OBJECTIVES

The population of older adults continues to grow in Iran, with pharmaceutical costs as a leading driver of household health-related costs. The present study was conducted to estimate the out-of-pocket pharmaceutical expenditure and its socioeconomic predictors among households with the elderly in Iran.

METHOD

This study is a secondary analysis using 2019 national household expenditure and income survey data in Iran. The sample size was 9381 households with at least one member older than 65. The double-hurdle model in STATA 16 was used to examine the association between independent variables and households' out-of-pocket pharmaceutical expenditures.

RESULTS

The mean out-of-pocket pharmaceutical expenditures for each household with elderly member was $8065 per year. There was a positive association between the (female) gender of the household head, urban residence, employment status, insurance expenditure and a higher level of education of the head of the household with the out-of-pocket pharmaceutical expenditures (P < 0.05). The income of elderly households did not affect these expenditures (P > 0.05).

CONCLUSIONS

This study showed that the socioeconomic characteristics of elderly families not only influenced their decision to enter the medicine market, but also the rate of medicine purchase. It is helpful to manage and control the pharmaceutical costs among the elderly.

Understanding pharmaceutical exposure and the potential for effects in marine biota: A survey of bonefish (Albula vulpes) across the Caribbean Basin

Most research on pharmaceutical presence in the environment to date has focused on smaller scale assessments of freshwater and riverine systems, relying mainly on assays of water samples, while studies in marine ecosystems and of exposed biota are sparse. This study investigated the pharmaceutical burden in bonefish (Albula vulpes), an important recreational and artisanal fishery, to quantify pharmaceutical exposure throughout the Caribbean Basin. We sampled 74 bonefish from five regions, and analyzed them for 102 pharmaceuticals. We assessed the influence of sampling region on the number of pharmaceuticals, pharmaceutical assemblage, and risk of pharmacological effects. To evaluate the risk of pharmacological effects at the scale of the individual, we proposed a metric based on the human therapeutic plasma concentration (HTPC), comparing measured concentrations to a threshold of 1/3 the HTPC for each pharmaceutical. Every bonefish had at least one pharmaceutical, with an average of 4.9 and a maximum of 16 pharmaceuticals in one individual. At least one pharmaceutical was detected in exceedance of the 1/3 HTPC threshold in 39% of bonefish, with an average of 0.6 and a maximum of 11 pharmaceuticals exceeding in a Key West individual. The number of pharmaceuticals (49 detected in total) differed across regions, but the risk of pharmacological effects did not (23 pharmaceuticals exceeded the 1/3 HTPC threshold). The most common pharmaceuticals were venlafaxine (43 bonefish), atenolol (36), naloxone (27), codeine (27), and trimethoprim (24). Findings suggest that pharmaceutical detections and concentration may be independent, emphasizing the need to monitor risk to biota regardless of exposure diversity, and to focus on risk quantified at the individual level. This study supports the widespread presence of pharmaceuticals in marine systems and shows the utility of applying the HTPC to assess the potential for pharmacological effects, and thus quantify impact of exposure at large spatial scales.

Kinetic constants and transformation products of ornidazole during ozonation

Ornidazole (ONZ), a nitroimidazole antibiotic detected in water bodies, may negatively impact the aquatic ecosystem. Its reaction kinetics during ozonation which is a feasible and applicable technology to control the contamination of emerging contaminants, however, has not been reported in literature. In this study, we measured the apparent second-order kinetic constant of ONZ with ozone molecules via the excessive ozone method and the competing method which led to an average value of 103.8 ± 2.7 M-1 s-1 at pH 7. The apparent second-order kinetic constant of ONZ with HO• was calculated to be 4.65 × 109 M-1 s-1 with the concept of Rct measured via para-chlorobenzoic acid as a probe. The transformation products (TPs) of ONZ during ozonation at pH 3 and pH 11 were separately analyzed with HPLC-MS/MS and some unique products were found at pH 11, reflecting the influence of HO•. The toxicity of individual TPs was predicted with the tool of T.E.S.T. It was found that 62% of 21 identified TPs could be more toxic than ONZ in terms of at least one acute toxicity endpoint, including chlorinated amines and N-oxides. The analysis with a respirometer further revealed that the toxicity of mixing TPs generated at HO• rich conditions was slightly lower than O3 dominated conditions. In general, this study provides the basic kinetic data for designing ozonation processes to eliminate ONZ and the important reference for understanding the toxicity evolution of ONZ during ozonation.

Medicating the coast in a metropolitan city: Enantiomeric profiles and joint probabilistic risk assessment of antidepressants and antihistamines

Pharmaceuticals are receiving increasing attention as emerging contaminants in the aquatic environment. Herein, we investigated the occurrence of 11 antidepressants, 6 antihistamines and 4 metabolites in treated wastewater effluents, rivers, stormwater, and seawater in Hong Kong, with special focus on chirality. The average levels of ∑pharmaceuticals ranged from 0.525 to 1070 ng/L in all samples and the total annual mass load of target pharmaceuticals in the marine environment of Hong Kong was 756 kg/y. Antihistamines accounted for >80 % of ∑pharmaceuticals, with diphenhydramine and fexofenadine being predominant. The occurrence and enantiomeric profiles of brompheniramine and promethazine sulfoxide were reported in global natural waters for the first time. Among chiral pharmaceuticals, mirtazapine and fexofenadine exhibited R-preference, while others mostly exhibited S-preference, implying that the ecological risks derived from achiral data for chiral pharmaceuticals may be biased. The joint probabilistic risk assessment of fluoxetine revealed that R-fluoxetine and rac-fluoxetine presented different ecological risks from that of S-fluoxetine; Such assessment also revealed that target pharmaceuticals posed only minimal to low risks, except that diphenhydramine posed an intermediate risk. As estimated, 10 % aquatic species will be affected when the environmental level of diphenhydramine exceeds 7.40 ng/L, which was seen in 46.9 % samples. Collectively, this study highlights further investigations on the enantioselectivity of chiral pharmaceuticals, particularly on environmental behavior and ecotoxicity using local aquatic species as target organisms.

Long-term effects of the global budget program and periodic price adjustment on antibacterial agents: A nationwide decomposition analysis between 2001 and 2016

BACKGROUND

Previous studies have shown that financial strategies are beneficial for improving the appropriate use of antibiotics within a limited period of time. Long-term effects have rarely been explored.

METHODS

This study evaluated the changes in expenditure and prescription patterns of antibacterial agents under the global budget (GB) program and drug price adjustment of a National Health Insurance scheme. Two structural methods, that is, the Laspeyres method and Fisher's Ideal Index decomposition method, were used to illustrate the impacts of price, volume, and drug change.

RESULTS

During the first 5 years of the GB program (ie, 2001-2006), the expenses of antibacterial agents increased by 54.1%, while the volume decreased by 11% to 21.3%. Therapeutic choice was the predominant cause of expense growth. In the second and third 5-year periods (ie, 2006-2011 and 2011-2016), the driving force of therapeutic choice gradually decreased. The antibacterial expense remained stable with a slight increase in prescription volume. Periodic price adjustment contributed steadily to cost containment, by 21.9% to 39.9%.

CONCLUSIONS

The GB program led to a remarkable increase in antibacterial expenses mainly attributed to therapeutic choice, especially in the early stage. In contrast, periodic price adjustment, provided steady benefits to pharmaceutical budget control without a noticeable increase in drug volume.

Outer packaging labelling of medicines in Southern African Development Community (SADC) countries: comparative analysis of requirements and transition terms for harmonisation

INTRODUCTION

The COVID-19 pandemic highlighted an urgent need for harmonised requirements for the regulation of medicines. To fully implement harmonised medicines regulations across Africa, common technical standards of medicine regulations are needed. One such technical standard is the labelling of medicines on outer packaging. In this study, we compared outer packaging labelling requirements and transition terms for harmonization for countries in the Southern African Development Community (SADC) region.

METHODS

Data on legislation and/or regulatory guidelines for medicine outer packaging labelling from National Medicines Regulatory Authorities (NMRAs) were obtained for countries in the SADC region (n = 16) by February 2023. A detailed comparative content analysis was conducted to determine alignment with the requirements of the Southern African Development Community (SADC) harmonised labelling guidelines to assess readiness levels of each country to transition to the SADC harmonised labelling guideline for outer packaging of medicines.

RESULTS

Content analysis showed at least 11 out of 16 countries require national legal reform to transition to the SADC harmonised labelling guideline. In all cases where countries specified labelling requirements for outer packaging of medicines, these were stipulated in national medicines legislation.

CONCLUSION

Even though there is a high level of alignment across the countries in terms of national labelling requirements, most countries in the SADC region would still require national legislative reform to transition to regional harmonised labelling requirements and then ultimately to continental requirements of the African Medicines Agency (AMA).

Characteristics of microplastic-derived dissolved organic matter and its binding with pharmaceuticals unveiled by fluorescence spectroscopy and two-dimensional correlation spectroscopy

Microplastics were an extensively detected pollutant in the environment, but microplastic-derived dissolved organic matter (MP-DOM) has received less attention, much less its impact on the binding behavior of pollutants (e.g., pharmaceuticals). In this study, DOM derived from two typical MPs, i.e., polyethylene terephthalate (PET) and polystyrene (PS) was generated by UV irradiation (a widely used way for MPs' aging treatment) and characterized by multiple spectroscopic techniques and methods. Chloramphenicol (CAP) and carbamazepine (CBZ) were selected to investigate the binding mechanism between MP-DOM and pharmaceuticals. After UV irradiation, the concentration of the dissolved organic carbon, colored DOM, and carboxyl/carbonyl groups of MP-DOM increased. Moreover, the humic-like substance released preceding and more under UV irradiation. Furthermore, the protein-like substances on PET-DOM and the humic-like substances on PS-DOM were positively correlated to the binding capacity to the pharmaceuticals, respectively. 2D-COS results revealed that the fluorescent materials having more oxygen-containing functional groups for MP-DOM preferentially interacted with the pharmaceuticals. Overall, the higher fluorescence quenching was related to the protein-like substance, CBZ, and PET-DOM as compared to the humic-like substance, CAP, and PS-DOM. It was verified by the relatively high binding ability (logKM) for them (the protein-like substance: 5.15; CBZ: 4.61; PET: 4.48). This study first proved the environmental reactivity of MP-DOM to the pharmaceuticals highlighting the significance of the spectral properties for the binding behavior of MP-DOM with pharmaceuticals and the competitive sorption role of MP-DOM to the pollutants in the natural environment.

Application of passive sampling device for exploring the occurrence, distribution, and risk of pharmaceuticals and pesticides in surface water

Pharmaceuticals and pesticides are compounds of high concern in surface waters around the world. However, few studies have used passive sampling methods to screen and detect these compounds in natural waters. In this study, a self-developed passive sampler was employed to measure pharmaceuticals and pesticides in the rivers of Nanjing, China. A total of 41 pharmaceuticals and 11 pesticides were detected, among which antibiotic and insecticide were the predominant classes, respectively. Valproic acid, caffeine and triclosan from the pharmaceuticals, and isoprocarb and imidacloprid from the pesticides were found frequently with high concentrations. At most sampling sites, the concentration ratios of caffeine versus carbamazepine exceeded 10, and even above 50, indicating relatively poor efficiency of wastewater treatment, or possibly the direct discharge of raw sewage, or other unknown source of pollution. It was found that the concentrations and ecological risks in the northern area of Yangtze River were higher than those in the southern area of Yangtze River, implying that economic development and population density were not the main contributors to the discovered pollution. The total concentration of pharmaceuticals and pesticides in Qinhuai River increased gradually with the direction of water flow, demonstrating the success of water diversion project in flushing and scouring pollutants.

Pharmaceutical demand response to utilization management

Prescription drug insurance increasingly imposes prior authorization (requiring providers to request coverage before claim approval) to manage utilization. Prior authorization has been criticized because of its administrative burden on providers. The primary alternative to managing utilization is imposing out-of-pocket (OOP) payment to incentivize beneficiaries to seek lower-cost care, effectively providing beneficiaries with partial insurance. Would beneficiaries prefer indirectly paying for prior authorization through higher premiums; or would they prefer prior authorization was replaced by higher OOP costs? This tradeoff depends on how much OOP costs could be displaced by prior authorization, which depends on their relative impact on demand. I estimate the effect of prior authorization and OOP costs on pharmaceutical demand in Medicare Part D, addressing endogeneity caused by unobserved drug quality and selection into plans. Despite criticism of prior authorization, I find that Medicare beneficiaries would prefer higher premiums to pay for prior authorization, over higher OOP costs.

Use of Mean Kinetic Temperature for Pharmaceuticals in Japan and Stability Monitoring in the 21st Century

BACKGROUND

The guidelines of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH), which was established in 1990 to streamline and standardize drug-approval review standards across Japan, the United States, and Europe. The ICH guidelines were established approximately 30 years ago, and, since then, temperatures have risen owing to global warming. Therefore, I verified whether the ICH guidelines correspond to the latest climate by using the Arrhenius equation, which is the basis for the ICH guidelines.

METHODS

This study used an excerpt of the test conditions described in the ICH guidelines to calculate the mean kinetic temperature (MKT) for major Japanese cities based on temperature data from 1991 to 2020 (measured by the Japan Meteorological Agency).

RESULTS

The study confirmed that the temperature conditions prescribed by the ICH guidelines for long-term storage tests were satisfied (see Fig. 1). Additionally, as drugs can be exposed to temperatures outside the specified range during distribution from the manufacturer to the final customer, data logs/loggers were utilized to calculate the MKT using the temperature history during transportation and storage.

Exposure to the pharmaceutical buspirone alters locomotor activity, anxiety-related behaviors, and transcripts related to serotonin signaling in larval zebrafish (Danio rerio)

Buspirone is a pharmaceutical used to treat general anxiety disorder by acting on the dopaminergic and serotoninergic system. Buspirone, like many human pharmaceuticals, has been detected in municipal wastewater; however, the environmental exposure risks are unknown for this psychoactive compound. We studied the effects of buspirone on the behavior of zebrafish, focusing on locomotor and anxiolytic behavior. We also measured transcripts associated with oxidative stress, neurotoxicity, and serotonin signaling to identify potential mechanisms underlying the behavioral changes. Concentrations ranged from environmentally relevant (nM) to physiologically active concentrations typical of human pharmaceuticals (μM). Buspirone treatment did not impact survival, nor did it induce deformities in zebrafish treated for 7 days up to 10 μM. There was a positive relationship between locomotor activity and buspirone concentration in dark periods of the visual motor response test. In the light-dark preference test, both the average time per visit to the dark zone and the percent cumulative duration in the dark zone were increased by 1 μM buspirone. Transcript levels of ache, manf, and mbp were decreased in larvae, while the expression of gap43 was increased following exposure to buspirone, indicating potential neurotoxic effects. There was also reduced expression of serotonin-related genes encoding receptors, transporters, and biosynthesis enzymes (i.e., 5ht1aa, sertb, and tph1a). These data increase understanding of the behavioral and molecular responses in zebrafish following waterborne exposure to neuroactive pharmaceuticals like buspirone.

Increased bat hunting at polluted streams suggests chemical exposure rather than prey shortage

Streams and their riparian areas are important habitats and foraging sites for bats feeding on emergent aquatic insects. Chemical pollutants entering freshwater streams from agricultural and wastewater sources have been shown to alter aquatic insect emergence, yet little is known about how this impacts insectivorous bats in riparian areas. In this study, we investigate the relationships between the presence of wastewater effluent, in-stream pesticide toxicity, the number of emergent and flying aquatic insects, and the activity and hunting behaviour of bats at 14 streams in southwestern Germany. Stream sites were located in riparian forests, sheltered from direct exposure to pollutants from agricultural and urban areas. We focused on three bat species associated with riparian areas: Myotis daubentonii, M. cf. brandtii, and Pipistrellus pipistrellus. We found that streams with higher pesticide toxicity and more frequent detection of wastewater also tended to be warmer and have higher nutrient and lower oxygen concentrations. We did not observe a reduction of insect emergence, bat activity or hunting rates in association with pesticide toxicity and wastewater detections. Instead, the activity and hunting rates of Myotis spp. were higher at more polluted sites. The observed increase in bat hunting at more polluted streams suggests that instead of reduced prey availability, chemical pollution at the levels measured in the present study could expose bats to pollutants transported from the stream by emergent aquatic insects.

Characterization of urban sources of antibiotics and antibiotic-resistance genes in a Dutch sewer catchment

A one year study was conducted in the city of Nijmegen, The Netherlands, to characterize various urban sources of antibiotics and antibiotic resistant genes (ARGs) in wastewater within a single sewer catchment. Prevalence of ermB, tet(W), sul1, sul2, intl1, and 16S rRNA gene was determined at 10 locations within the city. Sampling locations included a nursing home, a student residence, a hospital and an industrial area, among others. Wastewater concentrations of 23 antibiotics were measured using passive sampling. Additionally, excreted loads of 22 antibiotics were estimated based on ambulatory prescription and clinical usage data. Genes sul1 and intl1 were most abundant across most locations. Ciprofloxacin and amoxicillin together contributed over 92 % of the total estimated antibiotic selective pressure at all sampling points. The present study highlights the prominent role that hospitals can have in the prevalence and proliferation of ARGs in urban wastewater. Furthermore, results suggest that even short-term changes in the therapeutic regimen prescribed in hospitals may translate into shifting ARG abundance patterns in hospital wastewater. The methods applied present an opportunity to identify emission hotspots and prioritize intervention options to limit ARG spread from urban wastewater to the environment.

Tracing COVID-19 drugs in the environment: Are we focusing on the right environmental compartment?

The Coronavirus Disease 2019 (COVID-19) pandemic led to over 770 million confirmed cases, straining public healthcare systems and necessitating extensive and prolonged use of synthetic chemical drugs around the globe for medical treatment and symptom relief. Concerns have arisen regarding the massive release of active pharmaceutical ingredients (APIs) and their metabolites into the environment, particularly through domestic sewage. While discussions surrounding this issue have primarily centered on their discharge into aquatic environments, particularly through treated effluent from municipal wastewater treatment plants (WWTPs), one often overlooked aspect is the terrestrial environment as a significant receptor of pharmaceutical-laden waste. This occurs through the disposal of sewage sludge, for instance, by applying biosolids to land or non-compliant disposal of sewage sludge, in addition to the routine disposal of expired and unused medications in municipal solid wastes. In this article, we surveyed sixteen approved pharmaceuticals for treating COVID-19 and bacterial co-infections, along with their primary metabolites. For this, we delved into their physiochemical properties, ecological toxicities, environmental persistence, and fate within municipal WWTPs. Emphasis was given on lipophilic substances with log Kow >3.0, which are more likely to be found in sewage sludge at significant factions (25.2%-75.0%) of their inputs in raw sewage and subsequently enter the terrestrial environment through land application of biosolids, e.g., 43% in the United States and as high as 96% in Ireland or non-compliant practices of sewage sludge disposal in developing communities, such as open dumping and land application without prior anaerobic digestion. The available evidence underscores the importance of adequately treating and disposing of sewage sludge before its final disposal or land application in an epidemic or pandemic scenario, as mismanaged sewage sludge could be a significant vector for releasing pharmaceutical compounds and their metabolites into the terrestrial environment.

Antidepressants and their metabolites primarily affect lysosomal functions in the marine mussel, Mytilus galloprovincialis

Antidepressants widely occur as emerging contaminants in marine coastal waters, with concentrations reported in the low ng/L range. Although at relatively lower levels with respect to other pharmaceuticals, antidepressants - fluoxetine (FLX) in particular - have attracted attention because of their striking effects exerted at low doses on marine invertebrates. In this study, the effects of four antidepressants including FLX, sertraline (SER), and citalopram, as members of the selective serotonin reuptake inhibitor (SSRI) class, and venlafaxine (VEN) as a member of the serotonin and norepinephrine reuptake inhibitor (SNRI) class, were evaluated in the mussel Mytilus galloprovincialis. In addition, the effects of two main metabolites of FLX and VEN, i.e., norfluoxetine (NFL) and O-desmethylvenlafaxine (ODV) respectively, were compared to those of the parent compounds. Eight concentrations of each drug (0.5-500 ng/L range) were tested on the early life stage endpoints of gamete fertilization and larval development at 48 h post fertilization (hpf). Egg fertilization was reduced by all compounds, except for VEN. Larval development at 48 hpf was affected by all SSRIs, but not by SNRIs. The above effects were significant but never exceeded 20 % of control values. Adult mussels were exposed in vivo for 7 days to environmental concentrations of the drugs (0.5, 5, and 10 ng/L) and a battery of eight biomarkers was assessed. Antidepressants primarily targeted lysosomal functions, decreasing haemocyte lysosome membrane stability (up to 70 % reduction) and increasing of the lysosome/cytosol ratio (up to 220 %), neutral lipid (up to 230 %), and lipofuscin (up to 440 %) accumulation in digestive gland. Only SER and NFL significantly affected catalase and glutathione-S-transferase activities in gills and digestive gland. NFL and ODV, were effective and sometimes more active than the parent compounds. All compounds impaired mussel health status, as indicated by the low to high stress levels assigned using the Mussel Expert System.

Degradation of the antibiotic ciprofloxacin in urine by electrochemical oxidation with a DSA anode

Ciprofloxacin (CIP) is a commonly prescribed fluoroquinolone antibiotic that, even after uptake, remains unmetabolized to a significant extent-over 70%. Unmetabolized CIP is excreted through both urine and feces. This persistent compound manages to evade removal in municipal wastewater facilities, leading to its substantial accumulation in aquatic environments. This accumulation raises concerns about potential risks to the health of various living organisms. Herein, we present a study on the remediation of CIP in synthetic urine by electrochemical oxidation in an undivided cell with a DSA (Ti/IrO2) anode and a stainless-steel cathode. Physisorbed hydroxyl radical formed at the anode surface from water discharge and free chlorine generated from Cl- oxidation were the main oxidizing agents. The effect of pH and current density (j) on CIP degradation was examined, and its total removal was easily achieved at pH ≥ 7.0 and j ≥ 60 mA cm-2 due to the action of free chlorine. The CIP decay always followed a pseudo-first-order kinetics. The components of the synthetic urine were also oxidized. The main nitrogenated species released was NH3. A very small concentration of free chlorine was quantified at the end of the treatment, thus demonstrating the good performance of electrochemical oxidation and its effectiveness to destroy all the organic pollutants. The present study demonstrates the simultaneous oxidation of the organic components of urine during CIP degradation, thus showing a unique perspective for its electrochemical oxidation that enhances the environmental remediation strategies.

Green surface functionalization of chitosan with spent tea waste extract for the development of an efficient adsorbent for aspirin removal

This study investigates the feasibility of spent tea waste extract (STWE) as a green modifying agent for the modification of chitosan adsorbent towards aspirin removal. Response surface methodology based on Box-Behnken design was employed to find the optimal synthesis parameters (chitosan dosage, spent tea waste concentration, and impregnation time) for aspirin removal. The results revealed that the optimum conditions for preparing chitotea with 84.65% aspirin removal were 2.89 g of chitosan, 18.95 mg/mL of STWE, and 20.72 h of impregnation time. The surface chemistry and characteristics of chitosan were successfully altered and improved by STWE, as evidenced by FESEM, EDX, BET, and FTIR analysis. The adsorption data were best fitted to pseudo 2nd order, followed by chemisorption mechanisms. The maximum adsorption capacity of chitotea was 157.24 mg/g, as fitted by Langmuir, which is impressive for a green adsorbent with a simple synthesis method. Thermodynamic studies demonstrated the endothermic nature of aspirin adsorption onto chitotea.

Harmonisation of read-across methodology for drug substance extractables and leachables (E&Ls)

Health-based exposure limits (HBELs) are derived for leachables from polymeric components that interact with the drug substance which exceed a safety concern threshold (SCT). However, given the nature of leachables, there is not always chemical-specific toxicology data. Read-across methodology specific to extractables and leachables (E&Ls) was developed based on survey data collected from 11 pharmaceutical companies and methodology used in other industries. One additional challenge for E&L read-across is most toxicology data is from the oral route of administration, whereas the parenteral route is very common for the leachable HBEL derivation. A conservative framework was developed to estimate oral bioavailability and the corresponding oral to parenteral extrapolation factor using physical chemical data. When this conservative framework was tested against 73 compounds with oral bioavailability data, it was found that the predicted bioavailability based on physico-chemical properties was conservatively greater than or equal to the experimental bioavailability 79% of the time. In conclusion, an E&L read-across methodology has been developed to provide a consistent, health protective framework for deriving HBELs when toxicology data is limited.

Layered double hydroxides and their tailored hybrids/composites: Progressive trends for delivery of natural/synthetic-drug/cosmetic biomolecules

Layered double hydroxides (LDHs) are well-known and important class of hydrotalcite-type anionic clays (HTs) materials that are cost-effective with additional advantages of facile synthesis, composition, tenability, and reusability. These convincing characteristics are liable for their applications in various fields related to energy, environment, catalysis, biomedical, and biotechnology. HTs/LDHs are generally synthesized from low cost abundantly available chemical precursors through the aqueous synthetic pathways under mild reaction conditions. These materials can be termed green materials based on their non-toxic nature, availability of precursors, facile and low-cost production using aqueous medium conditions with less hazardous effluents. Diverse and fascinating characteristics have been attributed to HTs/LDHs like anion exchange ability, surface basicity, biocompatibility, controlled release of the anion specific area, porosity, easy surface modification, and pH dependent biodegradability. Hence, HTs/LDHs and their modified and/or functionalized nanohybrids/nanocomposites are reported as the potential drug delivery carriers with a capability to stabilize the susceptible bioactive molecules, may enhance the solubility of poorly soluble drugs along with controlled drug/bioactive molecule release and delivery. These clay and bioactive hybrid materials have good biocompatibility, less cytotoxicity, and better site-targeting with improved cellular uptake than that of free parent biomolecules. These lamellar solids of micro/nanostructure are compatible, host-guest materials and able to fabricate with drugs/cosmeceutical/bio- or synthetic polymers without any change in their molecular structure and reactivity along with improvement in their stabilities. Other important features are facile synthesis, basicity, high stability with easy storage, and efficient administration with low bio-toxicity. This study enlightens the applications of HTs/LDHs along with their hybrids/composites in the field of drug/cosmeceutical/gene delivery systems of natural/synthetic biomolecules.

Cost effectiveness of using trastuzumab biosimilars compared to trastuzumab original drugs to treat breast cancer in a hospital setting

INTRODUCTION

Subcutaneous (SC) drug administration, such as the Herceptin® in an oncology day hospital reduces the administration time of trastuzumab. In the context of combination therapy administration, this time-saving may be called into question. The challenge posed by the deployment of much less expensive IV biosimilar forms raises questions about the cost-effectiveness of SC administration.

METHODS

Using data from a french Diagnostic Related Groups regarding prescriptions of intravenous Herceptin® (HIV), Herceptin® biosimilar IV (BSIV), and Herceptin® subcutaneous (HSC), we conducted two simulations. This simulation involved replacing all HSC with BSIV in combination therapy administration (Simulation 1) and subsequently substituting IV forms with SC forms only when prescribed as monotherapy (Simulation 2). A cost-benefit analysis was conducted based on these two simulations, from the hospital's perspective, for Normandy's population over a 1-year timeframe.

RESULTS

In Simulation 1, there was an average cost-saving of €12 per patient per year, but it resulted in a loss of 10140 min, equivalent to 10 min per patient per year when compared to the current situation. Simulation 2 yielded average cost-savings for the hospital amounting to €51 per patient per year, along with a time-saving of 67 min per patient per year compared to the current situation.

CONCLUSIONS

The development of a program aimed at optimizing the prescription of Trastuzumab holds the potential to deliver significant cost-savings to hospitals while enhancing the quality of service provided to the patients. This optimization involves using H SC in monotherapy and BS IV in combination therapy administration.

Elucidating the hydrotropism behaviour of aqueous caffeine and sodium benzoate solution through NMR and neutron total scattering analysis

Hydrotropism is a convenient way to increase the solubility of drugs by up to several orders of magnitude, and even though it has been researched for decades with both experimental and simulation methods, its mechanism is still unknown. Here, we use caffeine/sodium benzoate (CAF-SB) as model system to explore the behaviour of caffeine solubility enhancement in water through NMR spectroscopy and neutron total scattering. 1H NMR shows strong interaction between caffeine and sodium benzoate in water. Neutron total scattering combined with empirical potential structure refinement, a systematic method to study the solution structure, reveals π-stacking between caffeine and the benzoate anion as well as Coulombic interactions with the sodium cation. The strongest hydrogen bond interaction in the system is between benzoate and water, which help dissolve CAF-SB complex and increase the solubility of CAF in water. Besides, the stronger interaction between CAF and water and the distortion of water structure are further mechanisms of the CAF solubility enhancement. It is likely that the variety of mechanisms for hydrotropism shown in this system can be found for other hydrotropes, and NMR spectroscopy and neutron total scattering can be used as complementary techniques to generate a holistic picture of hydrotropic solutions.

Treatment of pharmaceutical wastewater through activated sludge process-a critical review

The occurrence of pharmaceutical compounds in water is a rising issue in the environment. These drugs in the waste may be toxic to aquatic organisms and humans as they disrupt the endocrine system, cause genotoxicity, etc. Several techniques were used for the treatment of pharmaceutical wastewater, such as physical, chemical, physiochemical, and biological processes like adsorption, chemical coagulation, and activated sludge processes, but these techniques possess several merits and demerits, such as higher installation and operation costs. This technique is used to remove color and turbidity; reduce biochemical oxygen demand (BOD), chemical oxygen demand (COD), and total suspended solids (TSS) to permissible limits for reuse of effluent; and prevent diseases caused by pharmaceutical wastewater. This review focuses on the treatment of pharmaceutical wastewater containing drugs like antibiotics, depressants, and hormones, with the activated sludge process having several advantages like good quality effluent and low installation costs.

Determining suitable surfactant concentration ranges to avoid protein unfolding in pharmaceutical formulations using UV analysis

Protein stability is fundamental to maintain pharmaceutical efficacy in the nascent field of biologics. One particular property that is essential for therapeutic effect is retention of the folded 3-dimensional conformation, i.e. once unfolding has occurred the biologic is often rendered inactive. In this work we propose a modified form of a recently published UV spectroscopic method that identifies protein unfolding. In this study we determine concentration limits to avoid protein unfolding of two model surfactants, namely polysorbate 20 and polysorbate 80, by correlating surfactant concentration with percentage 'unfolded' for three model proteins. For each scenario two distinct regions were observed, firstly surfactant concentrations at which no unfolding had occurred, followed by a second region whereby unfolding steadily increased with surfactant concentration. In general for the combinations analysed in this study, this second region began to appear around ten times below the critical micellar concentration of each surfactant, regardless of the protein or polysorbate chosen. It is therefore proposed that this adapted method could be used by researchers in the early stages of formulation development as a convenient and simple screening tool to confirm the 'onset of unfolding' concentration for protein-surfactant formulations, thus helping to optimise surfactant concentration selection in pharmaceutical formulations to maintain the benefits of surfactants yet avoid inadvertent unfolding.

Synthesis of highly efficient novel two-step spatial 2D photocatalyst material WS2/ZnIn2S4 for degradation/reduction of various toxic pollutants

In this article, we report the synthesis, characterization of novel biofriendly 2D/2D heterostructure WS2/ZnIn2S4 material in which 2D WS2 nanosheets are uniformly distributed spatially onto the spherically arranged 2D leaves of ZnIn2S4. We then studied the in-depth photocatalytic degradation activity of this novel nanocomposite and its pristine component materials on cationic dye: malachite green, anionic dye: congo red and reduction of heavy metal: chromium(VI) and the degradation efficiency of composite material was also tested on rhodamine-B, methylene blue, methyl orange dyes and acetaminophen/paracetamol drug. Form factor, structure factor and shape factor analysis has been carried out using X-ray diffractometry (XRD). Bond vibrations, functional groups and phonon vibration mode analysis has been done based on Fourier transform infrared (FTIR) spectroscopy and Raman spectroscopy. Morphological and compositional analysis has been done using field emission scanning electron microscopy (FE-SEM), energy dispersive X-ray spectroscopy (EDAX) and X-ray photoelectron spectroscopy (XPS), high-resolution transmission electron microscopy (HR-TEM). Surface area and pore size/distribution was characterized using Brunauer-Emmett-Teller (BET) method and Barrett-Joyner-Halenda Model. Degradation pathways and intermediate products are proposed using the high-performance liquid chromatography (HPLC). Photocatalytic activity of the nanocomposite WS2/ZnIn2S4 is compared with pristine ZnIn2S4 and pristine WS2, which shows more than 50% enhancement in both efficiency and rate of degradation/reduction for all the pollutants. A scavenger study was carried out to get insight of primary and secondary reactive oxygen species (ROS) taking part in degradation. Exciton lifetime, surface charge and stability, and flat band positions were studied based on time-correlated single photon counting (TCSPC) also known as time-resolved photoluminescence (TRPL), zeta potential, and Mott-Schottky respectively. Rate kinetics study was performed to analyze the physical and chemical behaviour of the nanocomposite with pollutants in consideration. Results show ∼100%, ∼90%, and ∼95% degradation efficiency by the heterostructure for malachite green (MG), congo red (CR), and reduction of heavy metal chromium (Cr(VI)) respectively within 5 min, which is a huge improvement as compared to pristine WS2 and pristine ZnIn2S4, both of which show the efficiencies of only ∼25% to∼75% in all the cases.

Paracetamol mineralization strategy in laboratory scale using Aspergillus niger KCAC

The emergence of drug resistance, caused due the presence of pharmaceutical contaminant in the environment, highlights the critical need for pharmaceutical drugs management. Pharmaceutical drugs are sourced in wastewater as pharmaceutical industrial effluents, antibiotic misuse, and inappropriate disposal of expired pharmaceuticals, eventually ending up in sewage deposition. In this work, we aimed to degrade paracetamol (APAP) through the mycoremediation approach in laboratory scale. The isolated paracetamol degradation fungal strain, identified as Aspergillus niger KCAC efficiently degraded the drug into non-toxic metabolites. The results demonstrated that 99.6% degradation rate was achieved by Aspergillus niger KCAC. Unique, low-cost, eco-friendly bioformulation of the fungal isolate was prepared during the study using used vegetable cooking oil as substrate. The bioformulation showed extended shelf-life and can be used in future for large-scale application. Thus, this detailed investigation on paracetamol biodegradation may be useful in developing a wastewater treatment system effective against paracetamol-contaminated wastewater.

Application of Positron Emission Particle Tracking (PEPT) for the evaluation of powder behaviour in an incline linear blender for Continuous Direct Compression (CDC)

Positron Emission Particle Tracking (PEPT) is a non-invasive measurement technique which offers the ability to track the motion of individual particles with high temporal and spatial resolution, and thus build up an understanding of the bulk behaviour of a system from its microscopic (particle level) dynamics. Using this measurement technique, we have developed a series of novel metrics to better understand the behaviours of powders during the steady-state operation of a continuous blender system. Results are presented concerning the response of particle motion to processing parameters (mixing blade configuration and RPM), quantifying the motion in terms of predicted mixing performance. It was found that both increasing rpm and increasing hold-up mass (by selecting fewer transport blades and more mixing blades) provided improved mixing conditions. Interestingly, under specific conditions, there is evidence of convection-like mixing occurring at the interface of the transport and mixing region. This suggests the existence of a potential 'folding region' whereby powder is transported up the barrel (and away from the powder bulk bed) before being reconstituted back into the bulk mass. The results also provide valuable experimental data for the development, calibration and validation of future Discrete Element Method (DEM) simulations.

Freezing degradation of the anticonvulsant oxcarbazepine by bromate in water ice under sunlight irradiation

Ice plays a crucial role in contaminant transformation in seasonally ice-covered waters. In this study, the characteristics and mechanisms of an emerging contaminant oxcarbazepine (OXC) degradation by a disinfection by-product bromate ( [Formula: see text] ) in ice were explored via combined experiments and theoretical calculations. Results showed that 74.0 % and 86.4 % of OXC was degraded by [Formula: see text] in ice after 140 min in dark and 120 min under solar irradiation, respectively, while the reaction was negligible in water. The oxidation-reduction potential of [Formula: see text] solution at 1000 μmol L-1 was 56.9 % higher than that at 50 μmol L-1. The oxidation-reduction potential of [Formula: see text] solution at pH 2 was 14.8 %-109.5 % higher than those at other pH values. Enhanced OXC degradation by [Formula: see text] in ice could be attributed to increased [Formula: see text] oxidation capacity resulting from locally elevated [Formula: see text] and H+ concentrations. Hypobromous acid (HOBr), •OH, and Br• generated by direct photolysis under solar irradiation further promoted the OXC degradation in ice. Br• formed by the direct photolysis of accumulated HOBr under solar irradiation caused the generation of bromine-containing degradation products. Bromine-containing degradation products possessed higher potential toxicities, which could contribute to increase the secondary pollution of water environment.

Water brownness regulates the bioavailability of a fluoroquinolone antibiotic: UV-absorbance as a predictor of ciprofloxacin ecotoxicity

Dissolved organic carbon (DOC) is a powerful regulator of the ecotoxicity of ciprofloxacin (CIP), a widely applied fluoroquinolone antibiotic. In this study, we investigated the impact of DOC from a variety of sources on CIP bioavailability, using a cyanobacteria growth inhibition test with Microcystis aeruginosa. We analyzed the impact from two perspectives: (1) DOC concentration, and (2) water brownness, defined in this work as the light absorbance of DOC solutions. The toxicity tests were conducted with (1) unprocessed freshwater DOC in the naturally occurring state, (2) DOC extracted from a freshwater stream (Schwarzbach stream, Küchelscheid, Belgium), and (3) the commercial DOC product Suwannee River organic matter. Across all DOC sources investigated, a strong negative correlation was observed between CIP ecotoxicity and light absorbance at four wavelengths across the ultraviolet-visible range (e.g., A350), whereas CIP ecotoxicity correlated poorly with the DOC concentration. In addition, the interactions between CIP and DOC were modelled as a CIP-DOC binding process to allow the quantification of the inhibitory effects of DOC on CIP toxicity via binding constants (Kd,CIPx, with x being the ionic charge + or +/-, L g-1). Processed DOC sources showed higher binding potency than most of the unprocessed DOC sources, suggesting that toxicity tests employing only processed DOC potentially overestimates the impact of DOC in natural environments. Nonetheless, the light absorption coefficient (i.e., ε350) appeared a reliable predictor of the Kd,CIP+/- (and thus of the potential of the DOC source to reduce ecotoxicity of CIP) of both processed and unprocessed DOC. The relationship can be further incorporated into model simulations to estimate CIP bioavailability in dynamic environments. It is concluded that the brownness of water is a better predictor of the impact of DOC on CIP bioavailability than the DOC concentration itself.

The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review

Background

Clinical pharmacists have been shown to identify and resolve medication related problems post-discharge, however the impact on patient clinical outcomes is unclear.

Aims

To undertake a systematic review to identify, critically appraise and present the evidence on post-discharge hospital clinics that provide clinical pharmacist medication review; report the patient clinical outcomes measured; and describe the activities of the clinical pharmacist.

Methods

Published studies evaluating a patient clinical outcome following a post-discharge hospital clinic pharmacy service were included. All studies needed a comparative design (intervention vs control or comparator). Pubmed, Embase, CINAHL, PsycnINFO, Web of Science, IPA and APAIS-Health databases were searched to identify studies. The type of clinic and the clinical pharmacist activities were linked to patient clinical outcomes.

Results

Fifty-seven studies were included in the final analysis, 14 randomised controlled trials and 43 non-randomised studies. Three key clinic types were identified: post-discharge pharmacist review alone, inpatient care plus post-discharge review and post-discharge collaborative clinics. The three main outcome metrics identified were hospital readmission and/or representation, adverse events and improved disease state metrics. There was often a mix of these outcomes reported as primary and secondary outcomes. High heterogeneity of interventions and clinical pharmacist activities reported meant it was difficult to link clinical pharmacist activities with the outcomes reported.

Conclusions

A post-discharge clinic pharmacist may improve patient clinical outcomes such as hospital readmission and representation rates. Future research needs to provide a clearer description of the clinical pharmacist activities provided in both arms of comparative studies.

LC-HRMS method for study of pharmaceutical uptake in plants: effect of pH under aeroponic condition

Global climate changes cause water scarcity in many regions, and the sustainable use of recycled water appears crucial, especially in agriculture. However, potentially hazardous compounds such as pharmaceuticals can enter the food chain and pose severe risks. This paper aims to study the presence of selected pharmaceutical active compounds (PhACs) and their metabolites in crops grown in aeroponic conditions and evaluate the potential of PhAC plant uptake. A solvent extraction with an acidified mixture of acetonitrile and water followed by LC-HRMS was developed and validated for quantifying nine pharmaceuticals and their nine metabolites in three plants. We aimed for a robust method with a wide linear range because an extensive concentration range in different matrices was expected. The developed method proved rapid and reliable determination of selected pharmaceuticals in plants in the wide concentration range of 10 to 20,000 ng g-1 and limit of detection range 0.4 to 9.0 ng g-1. The developed method was used to study the uptake and translocation of pharmaceuticals and their metabolites in plant tissues from an aeroponic experiment at three different pH levels. Carbamazepine accumulated more in the leaves of spinach than in arugula. On the other hand, sulfamethoxazole and clindamycin evinced higher accumulation in roots than in leaves, comparable in both plants. The expected effect of pH on plants' uptake was not significant.

A synthesis on the sub-lethal toxicity of atenolol, a beta-blocker, in teleost fish

Blood pressure medications like atenolol are detected in aquatic ecosystems. The objectives here were to (1) map the global presence of atenolol in surface water and sewage; (2) present current knowledge regarding removal efficiency and degradation of atenolol; (3) identify biological endpoints sensitive to exposure; (4) reveal molecular biomarkers that may be useful for exposure studies in fish; (5) determine whether toxicology studies are within environmental relevance. In fish, atenolol exposure affects endocrine and immune systems, metabolism, and epigenetics. Fewer than half of all studies measuring biological responses use environmentally-relevant concentrations. Heart rate appeared most sensitive to atenolol exposure relative to other endpoints. Data are lacking for behavioral responses to atenolol. Molecular biomarkers for atenolol may include those associated with acute kidney injury, cholestasis, and hypertriglyceridemia. Head kidney and liver may therefore be useful for detecting atenolol-induced effects. This review synthesizes knowledge regarding atenolol-induced toxicity in fish.

Templated Reactive Crystallization of Active Pharmaceutical Ingredient in Hydrogel Microparticles Enabling Robust Drug Product Processing

Commercialization of most promising active pharmaceutical ingredients (APIs) is impeded either by poor bioavailability or challenging physical properties leading to costly manufacture. Bioavailability of ionizable hydrophobic APIs can be enhanced by its conversion to salt form. While salt form of the API presents higher solution concentration than the non-ionized form, poor physical properties resulting from particle anisotropy or non-ideal morphology (needles) and particle size distribution not meeting dissolution rate targets can still inhibit its commercial translation. In this regard, API physical properties can be improved through addition of non-active components (excipients or carriers) during API manufacture. In this work, a facile method to perform reactive crystallization of an API salt in presence of the microporous environment of a hydrogel microparticle is presented. Specifically, the reaction between acidic antiretroviral API, raltegravir and base potassium hydroxide is performed in the presence of polyethylene glycol diacrylamide hydrogel microparticles. In this bottom-up approach, the spherical template hydrogel microparticles for the reaction lead to monodisperse composites loaded with inherently micronized raltegravir-potassium crystals, thus improving API physical properties without hampering bioavailability. Overall, this technique provides a novel approach to reactive crystallization while maintaining the API polymorph and crystallinity.

3D printed graphite-based electrode coupled with batch injection analysis: An affordable high-throughput strategy for atorvastatin determination

This work integrated a lab-made conductive graphite/polylactic acid (Grp/PLA, 40:60% w/w) filament into a 3D pen to print customized electrodes (cylindrical design). Thermogravimetric analysis validated the incorporation of graphite into the PLA matrix, while Raman spectroscopy and scanning electron microscopy images indicated a graphitic structure with the presence of defects and highly porous, respectively. The electrochemical features of the 3D-printed Gpt/PLA electrode were systematically compared to that achieved using commercial carbon black/polylactic acid (CB/PLA, from Protopasta®) filament. The 3D printed Gpt/PLA electrode "in the native form" provided lower charge transfer resistance (Rct = 880 Ω) and a more kinetically favored reaction (K⁰ = 1.48 × 10^-3 cm s^-1) compared to the 3D printed CB/PLA electrode (chemically/electrochemically treated). Moreover, a method by batch injection analysis with amperometric detection (BIA-AD) was developed to determine atorvastatin (ATR) in pharmaceutical and water samples. Using the 3D printed Gpt/PLA electrode, a wider linear range (1-200 μmol L^-1), sensitivity (3-times higher), and lower detection limit (LOD = 0.13 μmol L^-1) were achieved when compared to the CB/PLA electrode. Repeatability studies (n = 15, RSD <7.3%) attested to the precision of the electrochemical measurements, and recovery percentages between 83 and 108% confirmed the accuracy of the method. Remarkably, this is the first time that ATR has been determined by the BIA-AD system and a low-cost 3D-printed device. This approach is promising to be implemented in research laboratories for quality control of pharmaceuticals and can also be useful for on-site environmental analysis.

Enhanced freezing-induced carbamazepine degradation by bromate under solar irradiation via the formation of hypobromous acid and hydroxyl radical

Ice is a crucial medium in cold regions and plays an important role in the transformation of pollutants. When waters receiving treated wastewater freeze in cold regions during winter, the emerging contaminant carbamazepine (CBZ) and the disinfection by-product bromate ( [Formula: see text] ) can coexist in ice. However, their interaction in ice remains poorly understood. Here, CBZ degradation by [Formula: see text] in ice was investigated via a simulation experiment. Results showed that 96% of CBZ was degraded by [Formula: see text] after 90 min in ice in dark, while the degradation was negligible in water. The time required for nearly 100% CBZ degradation by [Formula: see text] in ice under solar irradiation was 22.2% shorter than in dark. The production of hypobromous acid (HOBr) was responsible for the gradually accelerated CBZ degradation rate in ice. The HOBr generation time in ice under solar irradiation was 50% shorter than in dark. The formation of HOBr and hydroxyl radical by the direct photolysis of [Formula: see text] under solar irradiation enhanced the CBZ degradation in ice. CBZ was mainly degraded by deamidation, decarbonylation, decarboxylation, hydroxylation, molecular rearrangement, and oxidation reactions. Furthermore, 18.5% of degradation products exhibited lower toxicity than their parent CBZ. This work can provide new insights into the environmental behaviors and fate of emerging contaminants in cold regions.

Simultaneous removal of pharmaceuticals and heavy metals from aqueous phase via adsorptive strategy: A critical review

The coexistence of pharmaceuticals and heavy metals is regarded as a serious threat to aquatic environments. Adsorbents have been widely applied to the simultaneous removal of pharmaceuticals and metals from aqueous phase. Through a comprehensive review, behaviors that promote, inhibit, or have no effect on simultaneous adsorption of pharmaceuticals and heavy metals were found to depend on the system of contaminants and adsorbents and their environmental conditions, such as: characteristics of adsorbent and pollutant, temperature, pH, inorganic ions, and natural organic matter. Bridging and competition effects are the main reasons for promoting and inhibiting adsorption in coexisting systems, respectively. The promotion is more significant in neutral or alkaline conditions. After simultaneous adsorption, a solvent elution approach was most commonly used for regeneration of saturated adsorbents. To conclude, this work could help to sort out the theoretical knowledge in this field, and may provide new insights into the prevention and control of pharmaceuticals and heavy metals coexisting in wastewater.

An effective validation of analytical method for determination of a polar complexing agent: the illustrative case of cytotoxic bleomycin

The effectiveness of highly polar agents in cancer treatment is well recognized, but their physicochemical properties make their analytical determination a demanding task. Their analysis requires peculiar sample preparation and chromatographic separation, which heavily impacts the precision of such an analytical method. As a case study, we chose a polar cytotoxic bleomycin, which is a mixture of complexing congeners with relatively high molecular mass, a fact that creates an added challenge in regard to its detection via electrospray mass spectrometry. These issues combined lead to a deprived method performance, so the aim of this study is manifold, i.e., to optimize, validate, and establish quality performance measures for determination of bleomycin in pharmaceutical and biological specimens. Quantification of bleomycin is done at diametrically different concentration levels: at the concentrations relevant for analysis of pharmaceutical dosage forms it is based on a direct reversed-phase HPLC-UV detection, involving minimum sample pretreatment. On the contrary, analysis of bleomycin in biological specimens requires phospholipid removal and protein precipitation followed by HILIC chromatography with MS/MS detection of bleomycin A2 and B2 copper complexes being the predominant species. This study further attempts to solve the traceability issue in the absence of certified reference standards, determines measurement uncertainty, investigates BLM stability and method performance characteristics, and, last but not least, provides an explanatory example of how a method quality assurance procedure should be established in case of an exceedingly complex analytical method.

Typologies of child maltreatment and peer victimization and the associations with adolescent substance use: A latent class analysis

BACKGROUND

Child maltreatment and peer victimization are pervasive public health problems associated with adolescent substance use. Although child maltreatment has been identified as a risk factor for peer victimization, few studies have investigated their co-occurrence (i.e., polyvictimization). The study objectives were to: examine sex differences in the prevalence of child maltreatment, peer victimization, and substance use; identify polyvictimization patterns; and examine the associations between the identified typologies and adolescent substance use.

METHODS

Data were self-reported from a sample of adolescents aged 14 to 17 years (n = 2910) who participated in the provincially-representative 2014 Ontario Child Health Study. Latent class analysis with distal outcomes was conducted to identify typologies of six types of child maltreatment and five types of peer victimization and examine the associations between the polyvictimization typologies and use of cigarettes/cigars, alcohol, cannabis, and prescription drugs.

RESULTS

Four typologies were identified: Low victimization (76.6 %), Violent home environment (16.0 %), High verbal/social peer victimization (5.3 %), and High polyvictimization (2.1 %). The Violent home environment and High verbal/social peer victimization typologies were associated with increased odds of adolescent substance use (adjusted odds ratio range: 2.06-3.61). The High polyvictimization typology showed increased, but non-significant, odds of substance use.

CONCLUSIONS

Adolescent-serving health and social services professionals should be aware of polyvictimization patterns and the impact on substance use. For some adolescents, polyvictimization may include exposure to multiple child maltreatment and peer victimization types. Upstream strategies to prevent child maltreatment and peer victimization are needed, which may also contribute to reductions in adolescent substance use.

Endophytic fungi mediates production of bioactive secondary metabolites via modulation of genes involved in key metabolic pathways and their contribution in different biotechnological sector

Endophytic fungi stimulate the production of an enormous number of bioactive metabolites in medicinal plants and affect the different steps of biosynthetic pathways of these secondary metabolites. Endophytic fungi possess a number of biosynthetic gene clusters that possess genes for various enzymes, transcription factors, etc., in their genome responsible for the production of secondary metabolites. Additionally, endophytic fungi also modulate the expression of various genes responsible for the synthesis of key enzymes involved in metabolic pathways of such as HMGR, DXR, etc. involved in the production of a large number of phenolic compounds as well as regulate the expression of genes involved in the production of alkaloids and terpenoids in different plants. This review aims to provide a comprehensive overview of gene expression related to endophytes and their impact on metabolic pathways. Additionally, this review will emphasize the studies done to isolate these secondary metabolites from endophytic fungi in large quantities and assess their bioactivity. Due to ease in synthesis of secondary metabolites and their huge application in the medical industry, these bioactive metabolites are now being extracted from strains of these endophytic fungi commercially. Apart from their application in the pharmaceutical industry, most of these metabolites extracted from endophytic fungi also possess plant growth-promoting ability, bioremediation potential, novel bio control agents, sources of anti-oxidants, etc. The review will comprehensively shed a light on the biotechnological application of these fungal metabolites at the industrial level.

Leaching of select per-/poly-fluoroalkyl substances, pharmaceuticals, and hormones through soils amended with composted biosolids

The use of organic amendments to enhance soil health is increasingly being identified as a strategy to improve residential landscapes while also reducing the need for external inputs (e.g., fertilizers, irrigation). Composted biosolids are a re-purposed waste product that can be used in organic amendments to improve the overall sustainability of a municipality by enhancing residential soil carbon content while simultaneously reducing waste materials. However, the biosolids-based feedstock of these compost products has the potential to be a source of organic contaminants. We conducted a laboratory-based soil column experiment to evaluate the potential for different commercially available compost products to act as a source of emerging organic contaminants in residential landscapes. We compared two biosolids-based compost products, a manure-based compost product, and a control (no compost) treatment by irrigating soil columns for 30 days and collecting daily leachate samples to quantify leaching rates of six hormones, eight pharmaceuticals, and seven per- and polyfluoroalkyl substances (PFAS). Detection of hormones and pharmaceuticals was rare, suggesting that compost amendments are likely not a major source of these contaminants to groundwater resources. In contrast, we detected three of the seven PFAS compounds in leachate samples throughout the study. Perfluorohexanoic acid (PFHxA) was more likely to leach from biosolids-based compost treatments than other treatments (p < 0.05) and perfluorobutane sulfonate (PFBS) was only detected in biosolids-based treatments (although PFBS concentrations did not significantly differ among treatments). In contrast, perfluorooctanoic acid (PFOA) was commonly detected across all treatments (including controls), suggesting potential PFOA experimental contamination. Overall, these results demonstrate that commercially available composted biosolids amendments are likely not a major source of hormone and pharmaceutical contamination. The detection of PFHxA at significantly higher concentrations in biosolids treatments suggests that biosolids-based composts may act as sources of PFHxA to the environment. However, concentrations of multiple PFAS compounds found in leachate in this study were lower than concentrations found in known PFAS hotspots. Therefore, there is potential for environmental contamination from PFAS leaching from composted biosolids, but leachate concentrations are low which should be considered in risk-benefit analyses when considering whether or not to use composted biosolids as an organic amendment to enhance residential soil health.

Trapping mode two-dimensional liquid chromatography for quantitative low-level impurity enrichment in pharmaceutical development

Trapping mode two-dimensional liquid chromatography (2D-LC) has recently found applications in pharmaceutical analysis to clean, refocus, and enrich analytes. Given its enrichment capability, 2D-LC with multiple trappings is appealing for low-level impurity monitoring that cannot be solved by single dimensional LC (1D-LC) or unenriched 2D-LC analysis. However, the quantitative features of multi-trapping 2D-LC remain largely unknown at impurity levels from parts-per-million (ppm) to 0.15% (w/w). We present a simple heart-cutting trapping mode 2D-LC workflow using only common components and software found in typical off-the-shelf 1D-LC instruments. This robust, turn-key system's quantitative capabilities were evaluated using a variety of standard markers, demonstrating linear enrichment for up to 20 trapping cycles and achieving a recovery of over 97.0%. Next, the trapping system was applied to several real-world low-level impurity pharmaceutical case studies including (1) the identification of two unknown impurities at sub-ppm levels resulting in material discoloration, (2) the discovery of a new impurity at 0.05% (w/w) co-eluted with a known impurity, making the undesired summation above the target specification, and (3) the quantification of a potential mutagenic impurity at 10-ppm level in a poorly soluble substrate. The recovery in all studies was better than 97.0% with RSD lower than 3.0%, demonstrating accuracy and precision of the 2D-LC trapping workflow. As no specialized equipment or software is required, we envision that the system could be used to develop low-impurity monitoring methods suitable for validation and potential execution in quality-control laboratories.

Unexpected neurotoxicity in chronic toxicity studies with a HBV viral expression inhibitor

The non-clinical safety profile of the small molecule hepatitis B virus viral expression inhibitor RG7834 was studied in a package consisting of safety pharmacology, genotoxicity, repeat dose toxicity and reproductive toxicity studies. The chronic monkey toxicity study identified dose- and time-dependent symptoms of polyneuropathy, with correlating nerve conduction velocity reductions and axonal degeneration in peripheral nerves and spinal cord, in all compound treatment groups with no evidence of reversibility after approximately 3 months of treatment cessation. Similar histopathological findings were observed in the chronic rat toxicity study. Subsequent in vitro neurotoxicity investigations and ion channel electrophysiology did not elucidate a potential mechanism for the late toxicity. However, based on similar findings observed with a structurally different molecule, an inhibition of their common pharmacological targets, PAPD5 & PAPD 7, was considered as a possible mechanism of toxicity. In conclusion, the marked neuropathies, only observed after chronic dosing, did not support further clinical development of RG7834 because of its foreseen clinical treatment duration of up to 48 weeks in chronic HBV patients.

Occurrence and fate of an emerging drug pollutant and its by-products during conventional and advanced wastewater treatment: Case study of furosemide

Conventional wastewater treatment systems are not designed to remove pharmaceutical compounds from wastewater. These compounds can be degraded into many other transformation products which are hardly, if at all, studied. In this context, we studied the occurrence and degradation of furosemide, a very frequently detected diuretic, along with its known degradation products in several types of wastewater. Influent and effluent from the Seine-Centre Wastewater Treatment Plant (WWTP) (Paris, France) as well as outlet of residential care homes (Dordogne, France) were analyzed by Ultra-Performance Liquid Chromatography-tandem Mass Spectrometry (UPLC-MS/MS) to quantify furosemide and its known degradation products, saluamine and pyridinium of furosemide. Oxidation experiments (chlorination, ozonation and UV photolysis with hydrogen peroxide) were then performed on furosemide solutions and on water from residential care facilities to study the degradation of furosemide by potential advanced processes, and also to identify unknown oxidation products by high-resolution mass spectrometry. Furosemide was well degraded in Seine-Centre WWTP (>75%) but did not increase the concentrations of its main degradation products. Saluamine and pyridinium of furosemide were already present at similar concentrations to furosemide in the raw wastewater (∼2.5-3.5 μg.L^-1), and their removal in the WWTPs were very high (>80%). Despite their removal, the three compounds remained present in treated wastewater effluents at concentrations of hundreds of nanograms per liter. Chlorination degraded furosemide without pyridinium production unlike the other two processes. Chlorination and ozonation were also effective for the removal of furosemide and pyridinium in residential care home water, but they resulted in the production of saluamine. To our knowledge this is the first evidence of saluamine and pyridinium of furosemide in real water samples in either the particulate or dissolved phase.