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Endocrine-disrupting compounds (EDCs) are emerging contaminants of concern (ECC) that disturb endocrine hormones and system functionality even at very low concentrations (i.e. µg/L or ng/L levels). Hence, EDCs are found in all components of the environment including surface and groundwater, wastewater, soil, outdoor and indoor air and in the contaminated foods from a variety of sources (run off from agricultural activities, sewage treatment plants, leakage from septic tanks etc.), and the effects are more severe as the majority of EDCs do not have standard regulations. The environmental mobility of EDCs is higher as conventional wastewater treatment does not degrade efficiently and the development of effective and sustainable removal technologies specifically designed for the removal of those emerging micropollutants is essential. Accordingly, EDCs cause various public health diseases such as reproductive abnormalities, obesity, various cancer types, cardiovascular risks, metabolic disorders, epigenetic alterations, autism, etc. This paper reviews the existing and emerging treatment technologies for the removal of phenolic based EDCs, such as natural estrogens (estrone (E1), 17ß-estradiol (E2), estriol (E3)), synthetic estrogen 17α-ethinylestradiol (EE2) and phenolic xenoestrogens (4-nonyl phenols (4-NP) and bisphenol-A (BPA)) from the contaminated environment. These includes advanced oxidation processes (AOP), adsorption processes, membrane based filtration, bioremediation, phytoremediation and other integrated approaches. The sustainability of EDCs removal can be assured through the use of combined processes (i.e. low-cost - biological and adsorption methods with efficient and costly - AOPs) techniques through system integration to achieve better removal efficiency than using a single treatment technique. Besides, the public health concerns and future research perspectives of EDCs are also highlighted.
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PURPOSE: Irrational antibiotic use is a worldwide problem. One of the main reasons for excessive use of antibiotics is the failure to follow the clinical guidelines. Inappropriate use of antibiotics for infectious diarrhea is associated with the risk of increasing the development of antimicrobial resistance and the cost of health care. We therefore pursued to assess the appropriateness of the management of diarrhea in children in Addis Ababa. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted in the health centers of Addis Ababa, Ethiopia, between September 2014 and February 2015. Demographic characteristics, signs of dehydration, stool characteristics, drug types and other relevant information have been collected. Data analysis was performed using version 20 of the SPSS. Logistic regression was used to examine the association between dependent and independent variables. Indicators for the appropriateness of diarrhoea management have been established on the basis of the Standard Treatment Guideline and the guidelines of the World Health Organization. RESULTS: A total of 803 medical records of children have been checked. Of this, 54.4% had received inappropriate management. At least one antimicrobial was prescribed to 73.2% of the children who visited the health centres. Oral rehydration solution (ORS) and zinc were prescribed only in 66.7% and 47.5%, respectively. Appropriate management among children diagnosed with dysentery was found to be 6.38 times higher adjusted odds ratios (AOR=6.38 (3.11, 13.63)) than children with watery diarrhea. Although antibiotics are prescribed inappropriately for most children, it is appropriate when the diarrhea is bloody. Appropriate management of diarrhoea among infants aged 2-11 months was 54% less compared to children aged 12-59 months (AOR=0.46 (0.24, 0.90)). CONCLUSION: The magnitude of inadequate antibiotic prescription while managing diarrhoea in our setting was high. On the contrary, a low prescribing rate of ORS and zinc was observed. Our result highlights the need for urgent action to prevent the development of antibiotic-resistant microorganisms. Health-care professionals should have clear information on the risks of inadequate diarrhoea treatment in children under five.
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BACKGROUND: Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia. It affects millions of people globally. In spite of many antidiabetic drugs that are available, an adequate level of control remains challenging. Hydroxychloroquine is an immunomodulatory drug that has been used for the treatment of malaria and autoimmune diseases. There is an emerging evidence that suggests its beneficial effect against diabetes mellitus. Therefore, this systematic review is aimed at discoursing the role of hydroxychloroquine against diabetes mellitus and its potential mechanisms of actions. METHODS: A systematic and manual searching was carried out to retrieve relevant articles (preclinical and clinical studies) published from January 2014 to July 2019. Electronic databases including PubMed and Scopus as well as clinicaltrials.gov have been searched using different searching terms: "hydroxychloroquine," "diabetes mellitus," "hyperglycemia," and "insulin resistance." The MeSH terms (PubMed) and text words were combined with "AND" or "OR." In addition, manual searching of Google Engine and Google Scholar was conducted. Quality assessment of all the included studies was performed using CAMARADES (preclinical studies) and the Newcastle-Ottawa Scale and Cochrane Collaboration's tools (clinical studies). RESULTS: A total of eighteen studies (three experimental and fifteen clinical studies) were found to be eligible for the present systematic review. Among the included clinical studies (six randomized control trials, five observational studies, and four cohort studies), about 55,776 study participants were involved. Most of these studies showed significant improvement of lipid profile and insulin levels and substantial diminution of hemoglobin A1c, fasting plasma glucose, and postprandial blood glucose levels. Reduction in lysosomal degradation of the internal insulin-insulin receptor complex and enhancement in insulin sensitivity and adiponectin levels are some of the hypothesized mechanisms for the antidiabetic effect of hydroxychloroquine. CONCLUSION: The current review provides preliminary evidence for potential antidiabetic properties of hydroxychloroquine. Though the provided available data were promising, further clinical trials and mechanistic studies are needed to determine its long-term effects.
