Management and treatment of environmental impacts from wastewater treatment plants (WWTPs) is a major, worldwide, sustainability challenge. One issue associated with WWTP operation is the potential for groundwater contamination via leaking or infiltration of wastewater, particularly with inorganic nutrients (ammonia and nitrate) as well as persistent organic compounds. Despite the potential for such contamination to create environmental and health risks, conventional methods, such as the assessment of major ions, nutrients, bacteriological indicators and conventional tracers (such as stable and radiogenic isotopes) are often unable to provide accurate delineation of multiple potential sources of contamination. This is particularly important for WWTPs which often occur in urban, peri-urban or intensively farmed agricultural areas where multiple potential sources (such as livestock, fertilisers, wastewater irrigation, and domestic septic systems) may contribute similar contaminants. This review explores the applicability of promising novel groundwater tracers, such as Contaminants of Emerging Concern (CECs) and isotopic tracers, which can be used in conjunction with conventional tracers (i.e. 'co-tracers') to provide a more definitive assessment of contaminant sources, plume delineation and even (potentially) indicating the age of contamination (e.g., recent vs. legacy). The suitability of the novel groundwater tracers is evaluated according to four key criteria: (i). sufficient presence in raw wastewater and/or treated effluents; (ii) diagnostic of WWTP impacts as opposed to other potential off-site contamination sources; (iii) persistence in the subsurface environment; and (iv) amenable to rapid and sensitive analysis. Further analysis of various classes of CECs along with improved detection limits associated with improvements in analytical methodologies should allow for future application of promising groundwater tracers, providing WWTP operators and regulatory authorities a more definitive toolbox with which to assess groundwater contamination associated with site operations. These include: persistent pharmaceuticals and personal care products (carbamazepine, crotamiton, primidone, atenolol and sulfamethoxazole), artificial sweeteners (acesulfame, sucralose, saccharin and cyclamate) and potentially, certain pesticides (atrazine and simazine).

In this study, we comparatively investigated the degradation of 12 trace organic chemicals (TOrCs) during UV/H2O2 and UV/peroxydisulfate (PDS) processes. Second-order rate constants for the reactions of iopromide, phenytoin, caffeine, benzotriazole, and primidone with sulfate radical (SO4•-) were determined for the first time. Experiments were conducted in buffered pure water and wastewater effluent with spiked TOrCs. UV/PDS degraded all TOrCs more efficiently than UV/H2O2 in buffered pure water due to the higher yield of SO4•- than that of hydroxyl radical (•OH) at the same initial molar dose of PDS and H2O2, respectively. UV/PDS showed higher selectivity toward TOrCs removal than UV/H2O2 in wastewater effluent. Compounds with electron-rich moieties, such as diclofenac, venlafaxine, and metoprolol, were eliminated faster in UV/PDS whereas UV/H2O2 was more efficient in degrading compounds with lower reactivity to SO4•-. The fluence-based rate constants ( [Formula: see text] ) of TOrCs in wastewater effluent linearly increased as a function of initial H2O2 dose during UV/H2O2, possibly due to the constant scavenging impact of the wastewater matrix on •OH. However, exponential increase of kobs-UV/PDS with increasing PDS dose was observed for most compounds during UV/PDS, suggesting the decreasing scavenging effect of the water matrix (electron-rich site of effluent organic matter (EfOM)) after initial depletion of SO4•- at low PDS dose. Fulvic and humic-like fluorophores appeared to be more persistent during UV/H2O2 compared to aromatic protein and soluble microbial product-like fluorophores. In contrast, UV/PDS efficiently degraded all identified fluorophores and showed less selectivity toward the fluorescent EfOM components. Removal pattern of TOrCs during pilot-scale UV/PDS was consistent with lab-scale experiments, however, overall removal rates were lower due to the presence of higher concentration of EfOM and nitrite.

Acar T, Alkan G, Çaksen H, Ertekin B, Ergin M, Koçak S, Cander B. Phenytoin induced dystonia. Turk J Pediatr 2018; 60: 111-112. The abnormalities of dopaminergic activity in the basal ganglia have been emphasized to be effective in dystonia. We hereby report a case of a 2.5-year-old male patient who presented with tonic-clonic sezures and who developed dystonia after being given phenytoin. Biperidene hydrochloride was administered intramuscularly; primidone was added to the treatment regimen. After a 7-day-follow-up at the hospital, the patient had no dystonia and was discharged.

Major congenital malformation risks in association with gestational exposure to antiepileptic drugs (AEDs) have been extensively studied. Less information is available on other adverse outcomes associated with the use of these drugs during pregnancy. This article critically examines the risk of fetal loss, intrauterine growth retardation (IUGR), and preterm birth following gestational exposure to 14 AEDs, based on information obtained from a recent network meta-analysis of mostly nonrandomized, observational studies. The AEDs studied were carbamazepine, clobazam, clonazepam, ethosuximide, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenobarbitone, phenytoin, primidone, topiramate, valproate, and vigabatrin. The results show that very few AEDs are significantly associated with each adverse outcome and that the implicated AEDs are different for different outcomes. Furthermore, when one discounts findings obtained in small sample analyses, almost no significant associations remain. Next, even these associations become questionable when one considers that they could have been due to confounding by indication. Finally, the few significant associations may have been false-positive findings because they were identified after performing a very large number of statistical tests. These caveats notwithstanding, guidance should err on the side of caution. Therefore, a conservative conclusion is that whereas analyses based on exposures in 2,000-4,000 pregnancies suggest that lamotrigine and carbamazepine are not associated with an increased risk of fetal loss, IUGR, and preterm birth, there is insufficient evidence to either firmly indict or firmly exonerate the other AEDs with regard to these outcomes.

The concentration profile, distribution and risk assessment of pharmaceutically active compounds (PhACs) in the coastal surface water from the Klang River estuary were measured. Surface coastal water samples were extracted using offline solid phase, applying polymeric C18 cartridges as extraction sorbent and measuring with liquid chromatography mass spectrometry-mass spectrometry (LC MS-MS) technique. Extraction method was optimized for its recovery, sensitivity and linearity. Excellent recoveries were obtained from the optimized method with percentage of recoveries ranging from 73 to 126%. The optimized analytical method achieved good sensitivity with limit of detection ranging from 0.05 to 0.15 ng L-1, while linearity of targeted compounds in the LC MS-MS system was more than 0.990. The results showed that amoxicillin has the highest concentration (102.31 ng L-1) followed by diclofenac (10.80 ng L-1) and primidone (7.74 ng L-1). The percentage of contribution (% of total concentration) for the targeted PhACs is in the following order; amoxicillin (92.90%) > diclofenac (3.95%) > primidone (1.23%) > dexamethasone (0.75%) > testosterone (0.70%) > sulfamethoxazole (0.33%) > progesterone (0.14%). Environmental risk assessment calculated based on deterministic approach (the RQ method), showed no present risk from the presence of PhACs in the coastal water of Klang River estuary. Nonetheless, this baseline assessment can be used for better understanding on PhACs pollution profile and distribution in the tropical coastal and estuarine ecosystem as well as for future comparative studies.

Environmental occurrence of CECs poses a great threat to both aquatic life and human health. The aim of this study was to optimize and validate SPE/LC-(ESI)MS-MS method for simultaneous quantitative monitoring of two sub-classes of CECs (pharmaceuticals and hormones) and to estimate the concentrations of select CECs in environmental water samples. For all the tested analytes, recoveries in laboratory reagent water were greater than 81%. Average percent (relative standard deviation) RSD of the analytes in recovery, repeatability, and reproducibility experiments were ≤ 10%. Determination coefficients (r2) of primidone, diclofenac, testosterone, and progesterone were estimated to be 0.9979, 0.9972, 0.9968, and 0.9962, respectively. Limits of detection (LOD) for primidone, diclofenac, testosterone, and progesterone were 4.63 ng/L, 5.36 ng/L, 0.55 ng/L, and 0.88 ng/L, respectively. Limits of quantification (LOQ) for primidone, diclofenac, testosterone, and progesterone were 14.72 ng/L, 17.06 ng/L, 1.766 ng/L, and 2.813 ng/L, respectively. Average recoveries in environmental water and wastewater samples were greater than 74% and RSD were ≤ 7%. Trace levels (68.33-125.70 ng/L) of primidone were detected in four environmental water samples, whereas diclofenac was not detected in any of the tested sample. Trace levels of progesterone were observed in two environmental samples (16.64 -203.73 ng/L), whereas testosterone was detected in STP inlet sample (178.16 ng/L).

Adverse effects of medications and self care products on the gingiva can be divided into inflammation, intrinsic discolouration, irritation, trauma, cytotoxicity, lichenoid reaction, and proliferation. This article deals with the last-mentioned type of adverse effects; the other 6 have been discussed in a previous article. Proliferation of the gingiva as an adverse effect of medications has been reported for anticonvulsants, calcineurin inhibitors, calcium channel blockers and isotretinoin. With regard to the anticonvulsants that have been registered in the Netherlands, proliferation of the gingiva is predominantly induced by phenytoin, but also by carbamazepine, ethosuximide, phenobarbital, gabapentin, levetiracetam, primidone and valproic acid. All calcineurin inhibitors registered in the Netherlands may induce the adverse effect. This is also the case for nearly all calcium channel blockers, but particularly for dihydropyridines. Presumably, proliferation of the gingiva may be prevented or reduced in a number of ways. The most important one is good oral hygiene. Furthermore, proteins and cells that play an important role [in the process of gingival proliferation] have been discovered and there are medications that have the potential to eliminate these proteins and cells.