Fate of pharmaceutical active compounds (PhACs) from River Yamuna, India: An ecotoxicological risk assessment approach.

The river Yamuna is a major tributary of river Ganges and is a major source of freshwater in the National Capital Territory (NCT) catering 16.8 million people. This is the first report on occurrence, fate and ecotoxicological risk assessment of various pharmaceuticals active compounds (PhACs) in the Yamuna river. In this study, spatial and temporal distribution of nine PhACs "aspirin, ibuprofen, paracetamol, caffeine, ranitidine, diclofenac, carbamazepine, codeine, and diazepam", belonging to different therapeutic groups have been reported. Nine PhACs were analyzed in all the samples collected from the NCT stretch of river Yamuna. No specific trend in the distribution of the pharmaceutical residues was observed, however, the results revealed comparably higher PhACs contamination at YMN-2 (downstream Wazirabad, at this point, Najafgarh drain joins river Yamuna). Ecotoxicological risk assessment was carried out using Hazard quotients (HQ) for normal and worst case scenarios. The HQ showed that the levels of PhACs present in the samples were insufficient to cause acute toxicity to the flora and fauna of the river Yamuna. However, such residues could possibly cause chronic toxicity to the aquatic life and human beings as a huge amount of water of the river Yamuna is used for the drinking purposes in the NCT Delhi, the state capital of India.

Evaluation of Effect of Statins on Erythropoietin Resistance in Patients of Chronic Kidney Disease on Maintenance Haemodialysis.

METHODS: Thirty adult patients of end stage renal disease with erythropoietin hyporesponsiveness undergoing maintenance hemodialysis were included in the study. Patients were divided randomly into two groups of 15 patients each. Group A were given atorvastatin in a dose of 20 mg once daily for a period of 4 months along with erythropoietin 6000 IU S/C and IV iron 100mg twice weekly after each hemodialysis. Group B was given erythropoietin 6000 IU S/C and IV iron 100 mg twice weekly after each hemodialysis without addition of atorvastatin for 4 months. Hematological, renal parameters, inflammatory parameters such as erythrocyte sedimentation rate, highly sensitive C reactive protein, serum ferritin and erythropoietin resistance index were done at baseline and then two monthly intervals for 4 months. RESULTS: At the end of study, in group A hemoglobin and haematocrit significantly increased (p <0.001 for both) while HsCRP, ESR and erythropoietin resistance index decreased significantly (p=0.001, 0.001 and <0.001 respectively). In group B, the increase in hemoglobin and haematocrit were not statistically significant (p >0.05) similarly fall in HsCRP and ERI were also not significant statistically (p >0.05). The mean rise in hemoglobin between subsequent months was higher in group A as compared to group B which was statically significant. CONCLUSION: Statin can be used as an adjuvant to erythropoietin in management of anemia in patients of chronic kidney disease, who show hyporesponsiveness to increased doses of erythropoietin, by its anti-inflammatory properties.

Occurrences and fate of selected human antibiotics in influents and effluents of sewage treatment plant and effluent-receiving river Yamuna in Delhi (India).

Antibiotics consumption has increased worldwide, and their residues are frequently reported in aquatic environments. It is believed that antibiotics reach aquatic water bodies through sewage. Medicine consumed for healthcare practices are often released into sewage, and after sewage treatment plant, it reaches the receiving water bodies of lakes or rivers. In the present study, we determined the fate of some commonly used antibiotics in a sewage treatment plant (STP) located in Delhi and the environmental concentration of these antibiotics in the Yamuna River, which receives the sewage and industrial effluent of Delhi. There are many reports on antibiotics occurrences in STP and river water worldwide, but monitoring data from the Indian subcontinent is sparse. Samples were taken from a STP and from six sampling sites on the Yamuna River. Several antibiotics were tested for using offline solid-phase extraction followed by high-performance liquid chromatography equipped with photodiode array analysis. Recoveries varied from 25.5-108.8 %. Ampicillin had the maximum concentration in wastewater influents (104.2 ± 98.11 µg l(-1)) and effluents (12.68 ± 8.38 µg l(-1)). The fluoroquinolones and cephalosporins had the lower concentrations. Treatment efficiencies varied between 55 and 99 %. Significant amounts of antibiotics were discharged in effluents and were detected in the receiving water body. The concentration of antibiotics in the Yamuna River varied from not detected to 13.75 µg l(-1) (ampicillin) for the compounds investigated.

COVID-19 associated mucormycosis: A Descriptive Multisite Study from India.

BACKGROUND AND AIMS: Mucormycosis is an invasive fungal infection and carries a significant morbidity and mortality. A number of cases of mucormycosis have been reported in association with COVID-19. In this study, a consortium of clinicians from various parts of India studied clinical profile of COVID-19 associated mucormycosis (CAM) and this analysis is presented here. METHODS: Investigators from multiple sites in India were involved in this study. Clinical details included the treatment and severity of COVID-19, associated morbidities, as well as the diagnosis, treatment and prognosis of mucormycosis. These data were collected using google spreadsheet at one centre. Descriptive analysis was done. RESULTS: There were 115 patients with CAM. Importantly, all patients had received corticosteroids. Diabetes was present in 85.2% of patients and 13.9% of patients had newly detected diabetes. The most common site of involvement was rhino-orbital. Mortality occurred in 25 (21.7%) patients. On logistic regression analysis, CT scan-based score for severity of lung involvement was associated with mortality. CONCLUSION: Universal administration of corticosteroids in our patients is notable. A large majority of patients had diabetes, while mortality was seen in ∼1/5th of patients, lower as compared to recently published data.

Annual incidence of visceral leishmaniasis in an endemic area of Bihar, India.

The study presents the findings of a population-based survey of the annual incidence of visceral leishmaniasis (VL) in the rural areas of one VL-endemic district in Bihar, India. Stratified multi-stage sampling was applied in the selection of blocks, villages, hamlets, and households. We screened 15 178 households (91 000 individuals) in 80 villages in 7 of 27 administrative blocks of the district, East Champaran. We identified 227 VL cases that occurred in the past 12 months: 149 treated individuals who survived, 14 who died from VL, and 64 active cases. The high-incidence stratum had an estimated incidence of 35.6 cases per 10 000 persons per year (90% CI: 27.7-45.7). The annual incidence rate in the medium stratum areas was 16.8 cases per 10 000 (90% CI: 9.3-30.6). The combined annual incidence rate for the high and medium areas combined was 21.9 cases per 10 000 per year, (90% CI: 14.0-34.2). The Government of India's VL elimination goal is to reduce the VL incidence to one case per 10 000 at the sub-district level; thus, a 35-fold reduction will be required in those areas with the highest VL incidence.

The economic impact of visceral leishmaniasis on rural households in one endemic district of Bihar, India.

OBJECTIVE: To estimate the economic burden of visceral leishmaniasis (VL) on the rural population of one VL endemic district of Bihar, the state with 85% of India's cases. METHODS: Using a survey of a stratified multistage sampling of 15 178 households with 214 individuals with VL in the previous 12 months, the study provides data on VL treatment expenditures, financing and days of work lost in the context of overall household expenditures, income sources and assets. RESULTS: Median household expenditures on VL treatment represent, on average, 11% of annual household expenditures and an estimated 7 months of an individual's income at the daily wage in rural Bihar. With 87% of households forced to take out loans to finance disease costs, VL can contribute to a spiral of increasing poverty. The current pattern of VL treatment, with multiple visits and treatments for a single episode of illness, significantly increases the economic burden on the household. CONCLUSION: India's National Elimination Program to make effective treatments accessible to the rural poor, if combined with expanded efforts to improve timely access to diagnosis by conducting rapid diagnostic tests closer to the community (and mobilizing the rural population to seek effective treatment earlier), can reduce VL's economic burden on India's rural households.

Applicability of immobilized wood-rotting fungal biomass for biosorption of basic dye Alcian Blue.

In this study potential applicability of immobilised biomass of a wood-rotting dead macro-fungus Fomitopsis carnea are explored for the removal of the basic dye Alcian Blue. Effect of several parameters viz., temperature, pH and salt were studied in batch mode. In view of reutilization of the dye as well as the biosorbent, desorption/regeneration experiments were conducted. Desorption/regeneration studies could also be helpful in determining dye sorption mechanism. Studies indicate that the immobilized biosorbent could remove Alcian Blue efficiently. The experimental equilibrium data were modeled using the Langmuir equation. Dye uptake capacity of the biosorbent was observed to increase with rise in temperature and indicates chemisorption and/or ion exchange. The uptake was 11.1, 13.2, 16.4 and 24.2 mg/g at 10, 20, 30 and 40 degrees C respectively. Higher removal of dye was also observed at higher pH. However, increased salt concentration from 0 mmol/L to 100 mmol/L reduced from 89 to 85%. Desorption of dye could be possible up to 51% using 0.1 M hydrochloric/acetic acids and thus suggests that ion-exchange and chemisorption could be the possible dye sorption mechanism.

Efficiency evaluation of sewage treatment plants with different technologies in Delhi (India).

Physical, chemical and microbiological efficiencies of Sewage Treatment Plants (STPs) located in Delhi's watershed in context of different treatment technologies employed in these plants have been determined. There were in all seventeen STPs treating domestic wastewater which were studied over a period of 12 months. These STPs were based on Conventional Activated sludge process (ASP), Extended aeration (Ex. Aeration), physical, chemical and biological removal treatment (BIOFORE) and oxidation pond treatment process. Results suggests that except "Mehrauli" STP which was based on Extended aeration process and "Oxidation pond", effluents from all other STPs exceeded FC standard of 10(3) MPN/100 ml for unrestricted irrigation criteria set by National river conservation directorate (NRCD). Actual integrated efficiency (IE(a)) of each STP was evaluated and compared with the standard integrated efficiency (IE(s)) based upon physical, biological and microbiological removal efficiencies depending upon influent sewage characteristics. The best results were obtained for STPs employing extended aeration, BIOFORE and oxidation pond treatment process thus can be safely used for irrigation purposes.

One-year continuation of postpartum intrauterine contraceptive device: findings from a retrospective cohort study in India.

OBJECTIVE: To evaluate outcomes of a national postpartum (within 48 h of delivery) copper intrauterine device placement (PPCuIUD) program in six "high-focus states" with high unmet family planning need in India. STUDY DESIGN: We identified high-volume district hospitals that provided PPCuIUD in six (Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Madhya Pradesh and Chhattisgarh) Indian states (two per state). Each selected hospital maintained a list of PPCuIUD acceptors with contact phone numbers. We randomly selected 100 women at each site for inclusion in a telephone survey of IUD outcomes at 1 year. Questions regarded IUD expulsion, discontinuation because of symptoms (e.g., pain, bleeding, discharge), discontinuation for other reasons and use of alternative contraception if discontinuation reported. RESULTS: We could contact 844 of the 1200 randomly selected women, of whom 673 (79.7%) had postplacental insertion (within 10 min of delivery), while 171 (20.3%) had an early postpartum insertion (between 10 min to 48 h after delivery). Of those contacted, 530 women (62.8%) reported continuing with the method beyond 1 year, 63 (7.5%) reported having an expulsion, 163 (19.3%) reported having removals for associated side effects (bleeding, pain and discharge), and 88 (10.4%) reported having removals for other reasons. After removal or expulsion, almost half of the women (46.5%) did not switch to any other modern contraceptive method. CONCLUSION: PPCuIUD continuation rate at 1 year was 62.8%. Most removals within 1 year were due to associated side effects. Almost half of the women discontinuing PPCuIUD did not switch to an alternative modern contraceptive method. IMPLICATIONS: The 1-year continuation rate of PPCuIUD achieved through a large-scale national program in India is satisfactory. The program though needs to address the low uptake of other modern contraceptive methods after discontinuation.

Evaluation of adsorption potential of adsorbents: a case of uptake of cationic dyes.

Adsorption potential of a commercial activated carbon (FS300) has been evaluated for the uptake of cationic dyes namely methylene blue (MB) and rhodamine B (RB). Though, there are numerous studies in literature which report the sorption of MB (more than 40 studies) and RB (more than 10), however none of these use a common parameter to report the capacity of the sorbent. A protocol, based on the equilibrium dye concentration has been proposed to measure the sorption potential of a sorbent. The Langmuir model can very well describe the experimental equilibrium data for both dyes (coefficient of correlation > 0.999). MB (Qm = 312.5 mg g(-1)) is more adsorbable than the RB (Qm = 144.9 mg g(-1)). Molecular weight and chemical structure of dye molecules seem to affect the dye uptake. The effect of pH on dye uptake has also been evaluated by varyingpH from 3 to 11. Uptake of MB increases with pH, wherein RB removal decreases with pH. Dyes could not be desorbed either by distilled water (0.06 and 0.11% for MB and RB respectively), or by 0.1 NHCl (0.136 and 3.0% for MB and RB respectively) indicating, chemical adsorption type of adsorbent-adsorbate interactions.

Disinfection of wastewater: comparative evaluation of chlorination and DHS-biotower.

The present study reports the onsite evaluation of two pilot scale disinfection units. One of the pilot plants is based on chlorination, and other is based on fixed film aerobic process (biotower). Evaluation study consisted of onsite monitoring of COD, BOD5 and TSS and fecal coliform over a period of three months. Samples were collected from the inlet and outlet of the pilot plants. These pilot plants were evaluated so as to have an appropriate disinfection technology for the treatment of the effluents from upflow anaerobic sludge blanket reactor (UASBR) based sewage treatment plants which could meet the biological quality standards. All the influents samples collected from both the pilot plants contained fecal coliform ranging from 105 to 10(6) MPN/100 ml. The results show that the fecal coliform removal is up to 98.2% and 100% forbiotower and chlorination, respectively. Both, the chlorination and down hanging sponge-biotower (DHS-biotower) improved the quality of effluent from the UASBRin terms of COD, BOD5 and TSS. Though chlorination performed better compared to the DHS-biotower, however, it has additional risk associated with the formation of trihalomethanes (THMs).

Biosorption of dyes using dead macro fungi: effect of dye structure, ionic strength and pH.

Biosorbents prepared from dead macro fungi, namely Fomes fomentarius and Phellinus igniarius, were applied for the uptake of Methylene Blue (MB) and Rhodamine B (RB). Equilibrium isotherm data could be well described by the Langmuir and Freundlich models. Methylene Blue was found to be more adsorbable than Rhodamine B. Langmuir monolayer coverage was determined as 204.38-232.73 mg/g and 25.12-36.82 mg/g for MB and RB, respectively. Molecular structure and ionic radius of dyes were found to be responsible for differences in their uptakes. Results showed that sorption of MB increased while that of RB decreased as pH of respective dye solutions changed from 3 to 11. An increase in ionic strength also exhibited an adverse effect on dye sorption capacity. Ionic strength and pH affected the sorption of MB more as compared to the sorption of RB. The presence of carboxylic (-ve) and amino (+ve) groups in RB could explain the lower sorption of RB compared to MB.

Integrated biological and advanced oxidation based treatment of hexamine bearing wastewater: Effect of cow-dung as a co-substrate.

This work examines the treatment of hexamethylenetetramine (HMT) bearing effluent from N, N-dinitroso pentamethylene tetra-mine producing industrial plants in India. Chemical treatment using Fenton's reagent and aerobic treatment using batch reactors with co-substrate were investigated. Aerobic batch reactors integrated with advanced oxidation process of Fenton's reagent provides effective treatment of HMT effluents. Influence of Fenton's reagent dose reaction/contact and effect of varying co-substrate with effluent initial concentration was observed. Higher dose 100 mL of Fenton's reagent with higher reaction time 20 h resulted better degradation (34.88%) of wastewater. HMT hydrolyzes in acidic environment to ammonia and formaldehyde. Formaldehyde under normal conditions is toxic for biological treatment processes. When hydrolysis and acidification in the reactors are accompanied by low pH, aerobic batch reactors with use of co-substrates glucose, sucrose, and cow-dung extract separately in different proportion to wastewater ranging from 0.67 to 4.00, degraded wastewater effectively. Higher proportion of co-substrate to wastewater resulted better degradation. The relationships between nitrate, pH, turbidity and COD are discussed.

Diseases associated with poor water and sanitation: hazards, prevention, and solutions.

This paper examines one of the most staggering challenges facing the mankind, the challenge to conquer diseases associated with poor water and sanitation. Although rapid strides have been made in the last decade of the last century to provide improved water supply and sanitation, the world is still rampant with diseases. More than 1.1 billion individuals lack access to improved water supply and 2.4 billion lack access to improved sanitation in a world that boasts of human rights and sustainable development. The paper details the various types of diseases associated with water and suggests preventions and solution and also examines international development targets and the number of likely deaths from diseases associated with water. Even if the set targets are met successfully, an estimated 40 to 58 million lives would still be lost by the target year of 2015, while the massive efforts of international agencies and governments would be able to salvage an estimated 15 to 22 million lives. The threat of diseases associated with poor water qualities and services makes a fitting case for world resources, finances, and expertise to be focused and diverted to the Water and Sanitation (WATSAN) sector on an unprecedented scale and at a much higher pace than that envisaged in the targets to avoid the large scale death and misery.

Risk assessment of antibiotic residues in different water matrices in India: key issues and challenges.

Global detection of antibiotic substances in water matrices has considerably increased in the recent past. However, in India research on this issue is limited or generalised in the literature. Risks associated with the presence of antibiotics in the environment can be quantified using a hazard quotient (HQ) approach. Here, HQs were developed using the measured environmental concentration (MEC) approach for antibiotic residues in Indian water matrices previously reported in the literature. In the present study, environmental risk assessment, using the HQ index [HQ = measured environmental concentration (MEC)/predicted no effect concentration (PNEC)] for different antibiotics, was performed according to the guidelines of European Medicine Evaluation Agency (EMEA). MEC and PNEC levels were obtained from the literature. PNEC values were also calculated from EC50 using a safety factor when no PNECs were reported in the literature. HQs were obtained for industrial effluents (HQ = 10(4)) that were greater than any previously reported values. Ciprofloxacin, a fluoroquinolone antibiotic, seemed to present the greatest risk in India. The HQ indices for Indian water matrices were in the following order: industrial effluents > lake water > river water > hospital effluents > treated sewage ≃ groundwater. A very high HQ represents a potential environmental concern for aquatic environments in India and demands that immediate attention be devoted to regulating these compounds, especially in pharmaceutical industrial wastewater.

Volvulus of ileal S-pouch: A rare complication of ileal pouch anal anastomoses.

INTRODUCTION: Ileal pouch anal anastomosis (IPAA) after total proctocolectomy is a frequently performed surgery for medically refractory ulcerative colitis (UC). Volvulus of the ileal pouch as a complication of IPAA is extremely rare. We present a case of volvulus of S-type ileal pouch. PRESENTATION OF CASE: A 28 year old male, with history of total proctocolectomy with IPAA for severe UC in 2009 presented with signs of bowel obstruction. Emergency laparotomy was done and a volvulus of the S-type ileal pouch was derotated and pouchpexy done. DISCUSSION: The IPAA has a wide spectrum of complications, with obstruction of proximal small bowel occurring frequently. Volvulus of the ileal pouch is extremely rare with only 3 reported cases. Early diagnosis and intervention is important to salvage the pouch. Computed tomography (CT) may aid the diagnosis in stable patients. CONCLUSION: The diagnosis of ileal pouch volvulus although rare, should be kept in mind when dealing with patients complaining of recurrent obstruction following IPAA.

Monitoring of pathogenicity of effluents from the UASB based sewage treatment plant.

The microbial profile of an Upflow Anaerobic Sludge Blanket Reactor based sewage treatment plant located at a suburb of Delhi, India, and possible risk due to the pathogenicity of the treated wastewater was investigated. Frequency of occurrence of Salmonella, Shigella and Vibrio was 100% at all the stages of sewage treatment. However, recovery of Vibrio was the highest among all the pathogens. The order of removal of all the pathogens was same at the different stages of the treatment. Ratio of counts of fecal coliforms (FC) and fecal streptococci (FS) at different stages of treatment showed the origin of contamination was from the human source. The average density of FC in the treated sewage was 4.6 x 10(5) MPN/100 ml, which exceeds the prescribed limit of 1,000 MPN/100 ml for the FC. The proposed national standard were evaluated with the help of potential risk on the basis of indicator to pathogen ratio, and the concept of Infective Dose (ID(50)) causing infection in 50% exposed population. The analysis showed that the proposed microbial standards could adequately safeguard the risk against wastewater pathogenicity.