Reviewing the role of microplastics as carriers for microorganisms in absorbing toxic trace elements.

The pervasive presence of microplastics in various settings, such as freshwater and marine ecosystems, has sparked serious concerns. Microplastics can operate as possible transporters for hazardous trace elements or microbes, even though they are not naturally able to actively absorb these compounds. The binding sites on the plastic's surface or the complexes that are formed with the organic material on the plastic are how this adsorption process takes place. Microplastics' surfaces also seem to be attractive to microorganisms, such as bacteria and algae. Microorganisms can adhere to the rough surface of microplastics, which facilitates their colonization and formation of biofilms. Numerous bacteria, including ones that have the ability to absorb hazardous trace elements, can be found in these biofilms. Microplastics and microbes can interact in ways that are advantageous and detrimental. Microplastics have the ability to act as a substrate for microbial growth, which could lead to an increase in the quantity of microorganisms in the surrounding environment. On the other hand, microplastics may make it easier for microbes to spread to new areas, which could help dangerous or deadly species proliferate. Research is still ongoing to determine the degree to which microplastics serve as carriers of microbes and hazardous trace elements. Comprehending the implications of microplastics, pollutants, and microorganisms in a variety of environmental conditions is difficult due to their complex interplay. This review provides a detailed description of the complexity of the problem and used the examples related to microplastics, its environmental effects, and impacts on human health.

Removal of pharmaceutical contaminants from hospital wastewater using constructed wetlands: a review.

AbstractPharmaceutical compounds are a significant source of environmental pollution, particularly in hospital wastewater, which contains high concentrations of such compounds. Constructed wetlands have emerged as a promising approach to removing pharmaceutical compounds from wastewater. This paper aims to review the current state of knowledge on the removal of pharmaceutical compounds from hospital wastewater using constructed wetlands, including the mechanism of removal, removal efficiency, and future prospects. Pharmaceutical contaminants have been considered to be one of the most emerging pollutants in recent years. In this review article, various studies on constructed wetlands are incorporated in order to remove the pharmaceutical contaminants. The nature of constructed wetland can be explained by understanding the types of constructed wetland, characteristics of hospital wastewater, removal mechanism, and removal efficiency. The results of the review indicate that constructed wetlands are effective in removing pharmaceutical compounds from hospital wastewater. The removal mechanism of these compounds involves a combination of physical, chemical, and biological processes, including adsorption, degradation, and uptake by wetland plants. The removal efficiency of constructed wetlands varies depending on several factors, including the type and concentration of pharmaceutical compounds, the design of the wetland system, and the environmental conditions. Further research is necessary to optimize the performance of these systems, particularly in the removal of emerging contaminants, to ensure their effectiveness and long-term sustainability.

Comparison of constructed wetland performance coupled with aeration and tubesettler for pharmaceutical compound removal from hospital wastewater.

Pharmaceutical compounds being able to alter, retard, and enhance metabolism has gained attention in recent time as emerging pollutant. However, hospitals which are part of every urban landscape have yet to gain attention in terms of its hospital wastewater treatment to inhibit pharmaceutical compounds from reaching environment. Hence this study evaluated performance of constructed wetland in combination with tubesettler and aeration based on removal efficiency and ecological risk assessment (HQ). The removal efficiency of constructed wetland with plantation was higher by 31% (paracetamol), 102% (ibuprofen), 46%, (carbamazepine), 57% (lorazepam), 54% (erythromycin), 31% (ciprofloxacin) and 20% (simvastatin) against constructed wetland without plantation. Constructed wetland with aeration efficiency increased for paracetamol, ibuprofen, carbamazepine, lorazepam, erythromycin, ciprofloxacin, and simvastatin removal efficiency were higher by 58%, 130%, 52%, 79%, 107%, 57%, and 29% respectively. In constructed wetland with plantation, removal efficiency was higher by 20% (paracetamol), 13% (ibuprofen), 4% (carbamazepine), 14% (lorazepam), 34% (erythromycin), 19% (ciprofloxacin) and 7% (simvastatin). High ecological risk was observed for algae, invertebrate and fish with hazard quotient values in range of 2.5-484, 10-631 and 1-78 respectively. This study concludes that if space is the limitation at hospitals aeration with constructed wetland can be adopted. If space is available, constructed wetland with tubesettler is suitable, economic and environmentally friendly option. Future research works can focus on evaluating other processes combination with constructed wetland.

Encapsulating peritoneal sclerosis: a single-center experience and review of the literature.

Encapsulating peritoneal sclerosis (EPS) is a serious and often fatal complication of long-term PD with severe malnutrition and poor prognosis. It causes progressive obstruction and encapsulation of the bowel. This retrospective study reviews our experience and that reviewed in the literature concerning EPS. It refers to a total of 1966 patients treated with chronic PD between 1974 and 2008. Twenty one of them (1.1%) developed EPS, with the incidence increasing with the duration of PD. Mean age of our patients with EPS was 43, ranging from 18 to 71 years, 8 were men and 13 women with a mean body mass index (BMI) of 21.6 kg/m(2). Only one patient had Type II diabetes, 15 patients had glomerular disease, and six of these 15 had an autoimmune disease such as Wegener's granulomatosis and SLE. Thirteen patients developed EPS while on PD, 7 within 2 years after transfer to HD, and only one after renal transplantation. However, 7 patients had a previous renal transplant before returning to PD and subsequently developing EPS. Interestingly, we did not observe more episodes of EPS after transplantation. In the patients who developed EPS, the peritonitis rate over the period of observation was 1/15.6 pt-months and was due to Staphylococcus aureus, coagulase-negative staphylococcus, Pseudomonas and fungi. A history of peritonitis was not a prerequisite for developing EPS, since one patient had no episodes of peritonitis and 4 had just one previous episode. Fifteen patients presented with peritonitis within 4 months before the diagnosis of EPS with particularly virulent micro-organisms such as S. aureus, Candida, Pseudomonas, Corynebacterium, and Peptostreptococcus. Eleven patients were treated with hypertonic dextrose solutions (4.25 g/dl of dextrose) and seven with icodextrin, indirectly suggesting problems with ultrafiltration. Nine of 21 patients were on beta-blockers. The diagnosis of EPS was made either surgically or radiologically with signs of small bowel obstruction in combination with severe malnutrition. Eleven of our patients (52%) had evidence of small bowel obstruction and 14 patients required total parenteral nutrition (TPN). Tamoxifen (10-20 mg daily) was started in 6 patients, 4 of whom are alive and 2 deceased 3 and 5 years after EPS was diagnosed. Of the 12 patients who were not given tamoxifen, 2 are alive and 10 died. No side effects of tamoxifen were reported. Only 7 of our patients (33%) died during the first year after the diagnosis of EPS. Currently, 4 patients are on HD and 3 have had a renal transplant. Six patients of the fourteen who underwent surgery (42.8%) died within the first 6 months after operation and five died after an average of 6.6 years, mostly due to cardiovascular causes, three are still alive. As EPS becomes more prevalent with longer duration of PD, large multicenter prospective studies are needed to establish its incidence and identify risk factors, therapeutic approach, and prognosis.

Two icodextrin exchanges per day in peritoneal dialysis patients with ultrafiltration failure: one center's experience and review of the literature.

BACKGROUND: At present, only one exchange of an icodextrin-based solution is recommended to increase peritoneal ultrafiltration (UF) during long-dwell exchanges in peritoneal dialysis (PD) patients with impaired UF. AIM: To review our experience with two icodextrin exchanges per day on net UF and body weight in PD patients with poor UF. METHODS: Data were analyzed on nine patients with poor UF on chronic PD who were given two icodextrin exchanges per day for 6 months and had various clinical and biochemical parameters assessed monthly. RESULTS: Administration of icodextrin twice daily reduced the body weight in six of nine patients by an average of 2.9 ± 1.2 kg, a reduction that was maintained throughout the study; two patients gained 0.5 kg; and, in one patient, the measurements were inadequate. Mean blood pressure was reduced. Mean serum creatinine increased slightly. Serum sodium levels decreased from a mean baseline level of 134 ± 3 to 132 ± 4 mmol/L at three and six months. Among the diabetics in this group, average daily insulin requirements were 44 ± 35 units/day at baseline and 40 ± 23 units/day after 6 months. Hb1Ac levels remained stable throughout the study period. CONCLUSION: The use of two icodextrin exchanges per day reduced body weight in six of the nine patients and appeared to be safe. Long-term prospective studies are needed to assess the contribution of twice-daily icodextrin to the management of peritoneal dialysis patients with ultrafiltration failure and its long-term safety.

Discordant PD catheter and effluent culture results. The limited clinical relevance of culturing PD catheters.

OBJECTIVES: To determine if discordance in culture results between the effluent and the tip of the peritoneal catheter had an effect on outcome in patients whose peritoneal dialysis (PD) catheter was removed mostly for nonresolving peritonitis. Reasons for and outcomes of PD catheter removal were also analyzed. METHODS: We retrospectively reviewed the charts of all PD patients with recent peritonitis for which the PD catheter was removed between 1 January 2003 and 30 April 2009. Data including basic demographics, the organism isolated from effluent and from the PD catheter, reason for catheter removal, duration of hospitalization, and development of intra-abdominal collection were extracted as well as mortality within 8 weeks post removal and return to PD after catheter removal. RESULTS: Fungal peritonitis was the most common reason for PD catheter removal. 20% of the patients developed an intra-abdominal collection. Mortality related to PD catheter removal was low (3/53; 5.6%). The patients (n =53) were divided into 3 groups: group 1 (n = 20) had the same culture result of effluent and catheter tip; group 2 (n = 19) had a negative culture of the catheter tip; and group 3 (n = 14) had different organism(s) growing from effluent and catheter tip. We found no remarkable differences in duration of PD, catheter age, peritonitis rate, or mortality. Patients in group 1 had significantly more fungal peritonitis than the other 2 groups. In only 4 of the 53 patients (7.5%), the anti-infectious management was changed according to the catheter culture result. CONCLUSIONS: Discordant results between catheter tip culture and effluent culture did not have a significant impact on patient outcome. Sending PD catheters for culture has limited clinical importance.

Assisted peritoneal dialysis: what is it and who does it involve?

Together with the obvious increase of elderly patients with end-stage renal disease (ESRD), utilization of peritoneal dialysis (PD) has declined since the mid-1990s in a number of countries--a decline that is particularly marked in this elderly ESRD population. A major obstacle that affects any dialysis modality in elderly patients is the greater disease burden than is seen in younger patients. However; this factor may be overcome if patients start PD with assistance provided by visiting helpers (nurses or others) or people at home, mostly family members. Assisted PD (aPD) is suitable for; but not limited to, elderly patients who are unable to perform PD for themselves at home. Important considerations of an assisted model of care include frequency of visits, type of health care, and tasks to be performed for the patient at home. Clinical experience worldwide shows that aPD offers acceptable survival for most elderly and disabled patients, with no significant difference in modality-related complications from those seen in self-performed PD. Elderly patients on aPD experience more frequent hospitalizations, with longer hospital stays. Costs of aPD vary from country to country, depending on the frequency of visits and on reimbursement policies. Most authors believe that aPD can be cost-effective when compared with in-center hemodialysis.