Using a targeted ecopharmacovigilance intervention to control antibiotic pollution in a rural aquatic environment.

The "targeted ecopharmacovigilance (EPV)" strategy emphasizes the control of environmental pollution by high-priority hazardous pharmaceuticals from principal pollution sources especially in areas that are high risk as a result of drug administration. We conducted a prospective empirical study to explore the possibility of using a targeted EPV intervention as an optimized management tool for the control of aquatic pollution by antibiotics, a common type of pharmaceutical residue, in a rural area in China. Because of the notably high levels of ofloxacin in the studied aquatic environment and the well-accepted environmental risks posed by fluoroquinolone residues, ofloxacin was selected as the targeted high-priority antibiotic pollutant. Based on the main sources of antibiotic pollution in the studied rural aquatic environment, which had been traced previously, a five-step targeted EPV intervention was designed and conducted from Feb 2018 to Jan 2019. The results showed that the residual levels of ofloxacin in the studied Chinese rural aquatic environment significantly decreased during the targeted EPV intervention. Importantly, the EPV measures targeting ofloxacin were found to effectively reduce the environmental pollution by other non-targeted antibiotics. The data from a survey of 45 participants (42 residents and 3 clinicians) and 12 program committee members revealed that the targeted EPV intervention was acceptable to both participants and organizers and could be used as an economical and feasible solution for addressing antibiotic pollution in aquatic environments.

Preliminary Clinical Evaluation of Acupuncture Therapy in Patients With Postpartum Sciatica.

INTRODUCTION: This study evaluated clinical outcomes following acupuncture treatment of postpartum sciatica. METHODS: One hundred eleven women with postpartum sciatica were enrolled in an acupuncture group (n = 86) or a control group (n = 25), according to their preference. Participants in the acupuncture group attended acupuncture therapy sessions 3 times a week for 4 weeks, while participants in the control group were assigned to bed rest. Outcome measures included the Roland Disability Questionnaire for sciatica, a visual analog scale for leg pain, and patient-reported perceived recovery. In addition, participants were surveyed after treatment to assess the acceptability of acupuncture therapy. RESULTS: The outcome scores for disability and leg pain were significantly lower in the acupuncture group compared with the control group (P < .05). All 86 women in the treatment group stated that acupuncture improved their well-being after treatment. At one month after treatment, 98% of participants in the treatment group reported recovery compared with 24% of the control group participants (P < .001). After treatment, 95% of lactating women in the acupuncture group believed that acupuncture had no significant interference with breast milk production. No adverse effects of acupuncture were reported. All participants in the acupuncture group stated they would choose acupuncture in case of relapse. However, the recurrence rate of sciatica in the acupuncture group (32%) was comparable to that of the control group (35%) at the one-year follow-up interview. DISCUSSION: Compared with bed rest, acupuncture might be an effective and acceptable strategy to relieve symptoms of postpartum sciatica.

Targeted eco-pharmacovigilance for ketoprofen in the environment: Need, strategy and challenge.

Implementing "targeted" eco-pharmacovigilance(EPV) which focuses on individual or specific pharmaceuticals on a prioritised basis is a feasible, economical and customized approach to reduce the environmental concentrations and risks of pharmaceuticals. Non-steroidal anti-inflammatory drugs(NSAIDs) remaining in environment are a kind of priority hazard substances, due to a notable case that diclofenac residues caused the loss of more than 99% of vultures across the Indian sub-continent. Ketoprofen, as another widely used NSAID with comparable or even higher global consumption than diclofenac, in the environment has been shown to present a potential risk to non-target terrestrial and aquatic species. Based on the review of 85 articles reporting the analyses of ketoprofen residues in environment since 2010, we found that this NSAID frequently present in various environmental compartments around the world. Therefore, it is urgent to implement EPV targeting ketoprofen pollution. Here, we provide some recommendations for implementing the targeted EPV for ketoprofen, including: Closely monitoring ketoprofen in the natural environment; Reducing the residues of ketoprofen through source control; Encouraging urine source separation and treatment; Limiting the application of veterinary ketoprofen; Designing and constituting a framework system of targeted EPV. But some challenges, such as ambiguity in the accountability of the main bodies responsible for continued monitoring of ketoprofen residues, the lack of optimized urine source separation scenarios and procedure, the need for detailed design and application schemes of the framework system of targeted EPV, etc. should be addressed.

Eco-pharmacovigilance of non-steroidal anti-inflammatory drugs: Necessity and opportunities.

Eco-pharmacovigilance (EPV) is a practical and powerful approach to minimize the potential risks posed by pharmaceutical residues in environment. However, it is impracticable to practise rigorous and unitary EPV process for all the existing and new pharmaceuticals. Here, we focused on non-steroidal anti-inflammatory drugs (NSAIDs), and discussed the necessity and potential opportunities of practising EPV of NSAIDs. We found that the consumption of NSAIDs is huge and ubiquitous across the globe. NSAIDs were worldwidely reported as one of the most dominant and frequently detected groups in environmental matrices including wastewater, surface water, suspended solids, sediments, groundwater, even drinking water. Besides, there is definitive evidence for the adverse impacts of NSAID residues on scavenging birds and aquatic species. These data suggested the necessity of implementing EPV of NSAIDs. From the perspective of drug administration, we identified some things that can be done as management practice options for EPV implementation on NSAIDs.