Municipal solid waste treatment for bioenergy and resource production: Potential technologies, techno-economic-environmental aspects and implications of membrane-based recovery.

World estimated municipal solid waste generating at an alarming rate and its disposal is a severe concern of today's world. It is equivalent to 0.79 kg/d per person footprint and causing climate change; health hazards and other environmental issues which need attention on an urgent basis. Waste to energy (WTE) considers as an alternative renewable energy potential to recover energy from waste and reduce the global waste problems. WTE reduced the burden on fossil fuels for energy generation, waste volumes, environmental, and greenhouse gases emissions. This critical review aims to evaluate the source of solid waste generation and the possible routes of waste management such as biological landfill and thermal treatment (Incineration, pyrolysis, and gasification). Moreover, a comparative evaluation of different technologies was reviewed in terms of economic and environmental aspects along with their limitations and advantages. Critical literature revealed that gasification seemed to be the efficient route and environmentally sustainable. In addition, a framework for the gasification process, gasifier types, and selection of gasifiers for MSW was presented. The country-wise solutions recommendation was proposed for solid waste management with the least impact on the environment. Furthermore, key issues and potential perspectives that require urgent attention to facilitate global penetration are highlighted. Finally, practical implications of membrane and comparison membrane-based separation technology with other conventional technologies to recover bioenergy and resources were discussed. It is expected that this study will lead towards practical solution for future advancement in terms of economic and environmental concerns, and also provide economic feasibility and practical implications for global penetration.

Prescription analysis and cost of antidepressant drugs in major depressive disorder outpatients at the tertiary care hospital of Pakistan: a prospective approach.

OBJECTIVES: To assess prescribing care indicators, utilization pattern, cost per prescription, cost ratios, and percent cost variation of antidepressants (ADs). METHOD: A prospective cross-sectional study was carried out at the tertiary care hospital of Peshawar, Pakistan among major depressive disorder (MDD) outpatients from July 2019 to February 2020. The ideal standards for World Health Organization (WHO) prescribing care indicators were used. The ePharma Guide was used to calculate the cost in Pakistani rupees (Rs) and United States dollar (USD) 2021 (exchange rate: 1 USD = 154.43 Rs). RESULTS: A total of 296 MDD patients received 846 drugs (average 2.86; range:1-8), of which 366 were ADs (average number ADs/prescription; 1.23). About 23% (n = 68) of patients received more than one AD. Only 21 (5.7%) generic ADs were prescribed, and 346 (94.5%) ADs were prescribed from the hospital formulary list. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (67.5%). The average cost of ADs per prescription per month was 700.95 Rs (4.54 USD). Escitalopram (5.69 Rs; 0.04 USD) showed highest cost ratio and maximum percentage cost variation (468.97%). CONCLUSION: This study observed low generic prescribing, a higher prescribing trend of SSRI, wide differences in cost ratio and percentage cost variation among ADs.

Cost analysis of registered brands of oral antidepressant drugs in Pakistan: a descriptive analysis.

Background and objective: Depression is a global public health threat, and its treatment constitutes drugs in psychopharmacology, a domain that is rapidly growing with the addition of newer agents in market that are of high cost. Therefore, the present study aims to investigate the number of registered brands and price variation of oral antidepressants in Pakistan. Methods: A descriptive observational study was carried out to analyze the cost of oral antidepressants in Pakistan. Pharma guide 2019 was used to derive the cost of antidepressants marketed in Pakistan. The details about the number of registered brands and maximum and minimum prices of antidepressant drugs were calculated. Results: Sixteen drugs in 38 formulations were registered in 607 brands in Pakistan. Variations among 38 different formulations range from 0% to 746.39%. Out of these 38 formulations, 31 had variations below 200%, while 7 formulations had price variation above 200%. The highest price (746.39%) variation was observed for citalopram 20 mg (price per tablet PKR 6.79 to PKR 57.47) and no (0%) price variation was for bupropion 75 mg (price per tablet PKR 10). Conclusion: The study revealed wide variations in the number of registered brands and prices of oral tablets of antidepressants in Pakistan. The government needs to devise effective strategies to implement established policies to ensure uniformity in price, quality, and effectiveness with the ultimate goal to reduce treatment cost. Also, measures should be taken to inform prescribers about cost variation of drugs as prerequisite for cost-effective treatments to ultimately reduce treatment cost and financial burden and improve patient's adherence to therapy.