Comparing the performance of Cyperus papyrus and Typha domingensis for the removal of heavy metals, roxithromycin, levofloxacin and pathogenic bacteria from wastewater

Abstract Contamination of heavy metals and antibiotics would threaten the water and soil resources. Phytoremediation can be potentially used to remediate metal and antibiotics contaminated sites. The current study was carried out over a period of 12 months to assess the efficiency of the macrophytes Typha domingensis and Cyperus papyrus with different substrate materials to remove heavy metals and two antibiotics, roxithromycin and levofloxacin, from wastewater for reuse in agriculture. The concentrations of seven heavy metals (copper, nickel, iron, cadmium, zinc, lead, and chromium) in water and plant tissues were determined. The results showed that C. papyrus had a greater capacity than T. domingensis to remove biochemical oxygen demand (BOD) (80.69%), chemical oxygen demand (COD) (69.87%), and ammonium (NH4+) (69.69%). Cyperus papyrus was more effective in retaining solid pollutants. The bioaccumulation factors (BCF) roots of C. papyrus were higher levels of most metals than those of T. domingensis. The highest root–rhizome translocation factor (TF) values of C. papyrus were higher than T. domingensis. The bacterial indicators (total and fecal coliforms, as well as Faecal streptococci) and the potential pathogens (Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa) showed removal efficiencies ranging between 96.9% and 99.8%. The results indicated that the two systems could significantly reduce the concentration of antibiotics in wastewater, with roxithromycin showing higher elimination rates than levofloxacin. The results showed maximum removal of the heavy metals in constructed wetlands CWs planted with T. domingensis. The presence of zeolite and C. papyrus in the effluent of CWs significantly improved treatment capacity and increased pollutant removal efficiency

Optimization study of the adsorption of malachite green removal by MgO nano-composite, nano-bentonite and fungal immobilization on active carbon using response surface methodology and kinetic study

Abstract Malachite green a typical organic dye containing triarylmethane, is discharged in wastewater by textile and leather manufacturing plants. MG can pollute the environment, and it represents a major hazard to humans and various living organisms. We have thus worked toward developing the optimum dye-absorptive material, which should possess the following characteristics: excellent adsorption capacity, good selectivity, favorable recycling and reuse potential, and ease and quickness of adsorption. In this study, nano-bentonite, novel hybrid MgO-impregnated clay, and fungal composites were synthesized for Malachite green removal from aqueous solution. Response surface methodology (RSM) was used for the optimization of the synthesis of adsorbents to achieve simultaneous maximum malachite green removal. The composites were characterized by Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and X-ray diffraction (XRD). According to the obtained results, MgO-impregnated clay exhibits a exhibited a higher adsorption capacity of MG than nano-bentonite and pure bentonite. The malachite green adsorption isotherm on MgO-impregnated clay corresponded with the Freundlich isotherm. However, the Langmuir adsorption isotherm was a superior fit for nano-bentonite. The adsorption activities of nano-bentonite and MgO-impregnated clay were fitted into a pseudo-second-order kinetic model. Based on the root-mean-square error, bias, and accuracy, statistical research has shown that the Halden model has optimal accuracy. In addition, despite being recycled numerous times, the adsorbent maintained its high structural stability and removal effectiveness for nano-bentonite (94.5–86%) and MgO-impregnated clay (92–83%)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Adsorptive removal of levofloxacin and antibiotic resistance genes from hospital wastewater by nano-zero-valent iron and nano-copper using kinetic studies and response surface methodology

Abstract In the twenty-first century, water contamination with pharmaceutical residues is becoming a global phenomenon and a threat. Antibiotic residues and antibiotic resistance genes (ARGs) are recognized as new emerging water pollutants because they can negatively affect aquatic ecosystems and human health, thereby posing a complex environmental problem. These nano-adsorbents of the next generation can remove these pollutants at low concentrations. This study focuses on the chemical synthesis of copper oxide nanoparticles (CuONPs) and nano-zero-valent iron (nZVI) used as nano-adsorbents for levofloxacin removal from water samples and antibiotic-resistant genes. The CuONPs and nZVI are initially characterized by transmission electron microscopy, scanning electron microscopy, and X-ray diffraction. The levofloxacin adsorption isotherm on the CuONPS and nZVI shows the best fit with the Langmuir isotherm model, exhibiting correlation coefficients (R 2) of 0.993 and 0.999, respectively. The adsorption activities of CuONPS and nZVI were fitted to a pseudo-second-order kinetic model with correlation coefficients (R 2) of 0.983 and 0.994, respectively. The maximum levofloxacin removal capacity was observed at (89%), (84%), (89%), (88%) and (71.6) at pH 7 and adsorbent dose(0.06 mg/L), initial LEV concentration (1 mg/L), temperature 25 °C, and contact time 120 min for CuONPs. Removal efficiency was (91%), (90.6%), (91%), (89%), and (80%), at pH 7, adsorbent dose(0.06), initial LEV concentration (1 mg/L), temperature 35 °C, and contact time 120 min. The levofloxacin adsorption is an exothermic process for nZVI and CuONPs, according to thermodynamic analysis. A thermodynamic analysis indicated that each adsorption process is spontaneous. Several genera, including clinically pathogenic bacteria (e.g., Acinetobacter_baumannii, Helicobacter_pylori, Escherichia_coli, Pseudomonas_aeruginosa, Clostridium_beijerinckii, Escherichia/Shigella_coli, Helicobacter_cetorum, Lactobacillus_gasseri, Bacillus_cereus, Deinococcus_radiodurans, Rhodobacter_sphaeroides, Propionibacterium_acnes, and Bacteroides_vulgatus) were relatively abundant in hospital wastewater. Furthermore, 37 antibiotic resistance genes (ARGs) were quantified in hospital wastewater. The results demonstrated that 95.01% of nZVI and 91.4% of CuONPs are effective adsorbents for removing antibiotic-resistant bacteria from hospital effluent. The synthesized nZVI and CuONPs have excellent reusability and can be considered cost effective and eco-friendly adsorbents. Graphical Abstrac

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially