Determination of pharmaceutical residues and hormones in wastewater in Jordan
Chemicals released into the environment may have endocrine-disrupting effects in living organisms, including humans. The incidence of endocrine-related diseases and adverse physiological effects in wildlife is increasing, and there are indications that changes in the reproductive health of humans, including declining male fertility, birth defects, and breast and testicular cancer, could be linked to exposure to endocrine disrupting chemicals (EDCs). Most EDCs are synthetic organic chemicals (e.g. surfactants, pesticides, pharmaceuticals, brominated flame retardants, PAHs, PCBs, phthalates, etc.) introduced to the environment anthropogenically, although some (e.g. estrone, 17 ß –estradiol, testosterone and androstenedione) occur naturally (Natural hormones) [1-3].
Pharmaceuticals are an important group of potential EDCs which has recently attracted much attention of the international scientific community. They are emerging environmental contaminants, extensively and increasingly being used in human and veterinary medicine [4-5].
Wastewater is major contributors of pharmaceuticals in the environment. Due to their high consumption, pharmaceuticals along with their metabolites are continuously introduced to sewage waters, mainly through excreta, disposal of unused or expired drugs or directly from pharmaceutical discharges. The occurrence of pharmaceuticals and their metabolites and transformation products in the wastewater is becoming a matter of concern .
Based on all of the data reviewed on the toxicity of endocrine disrupting chemicals including pharmaceuticals residue and hormones and the effects that could occur to humans at very low levels which may result in adverse impact on human health, the pharmaceuticals residue and hormones in the effluent wastewaters from hospitals, influent and effluent wastewater treatment and effluent wastewater form pharmaceutical companies. Especially in the central part of Jordan (Amman district) should be studied.
Aim of the present work.
The main objective of this project is to monitor the pharmaceuticals residue (acids, bases and neutral drugs) and hormones in aqueous environmental samples (wastewaters). This objective will be reached through:
1- Measuring the concentrations of pharmaceuticals of various therapeutic
classes and hormones by using liquid chromatography electrospray tandem mass (LC-ES/MS/MS) or gas chromatography/mass spectrometry (GC/MS)
in the wastewater collected from different place located in the central of Jordan (Amman).
2- Compared to areas of study with each other and see which areas is more
Literature Review (selected).
Prasse et al (2010) developed a new analytical method for the determination of nine antiviral drugs (acyclovir, abacavir, lamivudine, nevirapine oseltamivir, penciclovir, ribavirin, stavudine, zidovudine) and one active metabolite (oseltamivir carboxylate) in raw and treated wastewater as well as in surface water using LC/ESI tandem MS detection. They found all antiviral drugs, except ribavirin, were detected in raw wastewater. A signiﬁcant reduction in concentrations was observed for acyclovir, lamivudine, and abacavir in treated wastewater indicating a substantial removal, while nevirapine, zidovudine and oseltamivir were found in similar concentrations in raw and treated wastewater. Concentrations in river waters were in the lower ng/ L range, with a maximum of 190 and 170 ng /L for acyclovir and zidovudine, respectively in the Hessian Ried. Gros et al (2006) described a method for the simultaneous determination of 29 multi-class pharmaceuticals using off line solid phase extraction (SPE) followed by liquid chromatography–triple quadrupole mass spectrometry (LC–MS–MS).the samples were collected from a WWTP located in Rubi (Barcelona, Spain), which receives urban, domestic and industrial wastewaters. they found Anti inﬂammatories and analgesics, lipid regulators, β-blockers and some antibiotics were the major groups detected in WWTP and among them acetaminophen, ketoprofen,
sulfamethoxazole and trimetroprim were the most abundant, with concentrations in high ng/L or low g/L levels. Maximum concentrations were detected for acetaminophen (paracetamol), with average concentration of 10 g/L in WWTP inﬂuent and 2.1 g/L in efﬂuent and for antimicrobial trimethoprim (1.1 and 0.29 g/L in WWTP inﬂuents and efﬂuents, respectively). Other compounds frequently detected in WWTP samples were carbamazepine and ranitidine, with average concentrations of 400ng/L for carbamezapine in both inﬂuent and efﬂuent samples (no elimination) and 188 and 135 ng/L for ranitidine in inﬂuent and efﬂuent, respectively. Gomez et al (2006) studied a selection of 16 pharmaceuticals: the anti-epileptic carbamazepine, seven analgesic/anti-inﬂammatory drugs (mefenamic acid, indomethacine, ibuprofen, naproxen, diclofenac, ketorolac and acetaminophen), the analgesic opiate codeine, two antidepressants (ﬂuoxetine and paroxetine), β -
blockers (atenolol and propranolol), antibiotic (trimethoprim, metronidazole, and erythromycin) and the anti-ulcer ranitidine in hospital efﬂuent wastewaters the samples were collected from the main sewer of a private health care centre, it is located in Almeria, a province in the southeast of Spain on the Mediterranean coast. They found antidepressants paroxetine and ﬂuoxetine were not detected and the two anti inﬂammatories, mefenamic acid and indomethacine, were non- detectable too. Carbamazepine, trimethoprim and erythromycin were detected in the lowest concentrations in the discharge being in the 10–70ng/L range. Concentrations of the other pharmaceuticals were in the g/L range in most of the cases. Ibuprofen and atenolol were detected eventually in the hospital efﬂuents with a very high concentration, more than 100 g/L, and the anti inﬂammatories acetaminophen and ketorolac, the antibiotic metronidazole and the anti- hypertensive propanolol were present in the samples at relative high concentration of around 10 g/L. Samples of inﬂuent and efﬂuent from 18 sewage treatment plants (STPs) in 14 municipalities in Canada were analyzed from metcalfe et al (2003). Several neutral and acidic drugs were detected in efﬂuents, including analgesic/anti-inﬂammatory agents, lipid regulators, and an antiepileptic drug, carbamazepine. Analgesic/anti- inﬂammatory drugs such as ibuprofen and naproxen, as well as the metabolite of acetylsalicyclic acid, salicylic acid, were often detected in final efﬂuents at μg/L concentrations. The acidic lipid regulator, cloﬁbric acid, and the analgesic/anti- inﬂammatory drug diclofenac were not detected in any final efﬂuent samples. the lipid regulators bezaﬁbrate and gemﬁbrozil were detected in some samples of inﬂuent and efﬂuent. The chemotherapy drugs ifosfamide and cyclophosphamide and the anti-inﬂam- matory phenazone were not detected in inﬂuent or efﬂuent samples, but the vasodilator drug pentoxyfylline was detected at ng/L concentrations in some final efﬂuents. Ternes (2001) reported, Recently several methods have been developed for the determination of drugs and their metabolites in the lower ng/l range using solid phase extraction (SPE), derivatization, detection and confirmation by gas chromatography/mass spectrometry (GC/ MS) and GC/MS/MS or LC-electrospray tandem MS (LC-ES/MS/MS). He found In 40 German rivers and streams 31 pharmaceuticals and five metabolites were quantified in at least one sample. The highest median values were found for bezafibrate with 0.35 μg/L and carbamazepine with 0.25 μg/L.
Research Methodology & Tools
1- Ordering / Buying required chemicals, standards and material for this
2- Sampling from more than one place of the effluent wastewaters from
hospitals, influent and effluent wastewater treatment and effluent wastewater form pharmaceutical companies in Jordan.
3- Samples will be homogenized well and will store at 4oC. 4- Separation and clean-up of pharmaceuticals residue and hormones in
wastewater samples by using solid-phase extraction method.
5- Quantification using (LC/MS,MS) and ( GC/MS) 6- Interpretation of results. 7- Calculating the concentration of pharmaceuticals residue and hormones of
8- Assessment of the of pharmaceuticals residue and hormones levels in all
1. SD. Richardson. Global Nest J. 2005, 7, 43 –60. 2. MJ. Nieuwenh uijsen. Global Nest J. 2005, 7,128– 144. 3. P.A. zejewski, B. Kasprzyk-Hordern, J. Nawrocki. Global Nest J. 2005, 7,
4. CG. Daughton, TH.A.Ternes. Environ Health Perspect. 1999, 107,907 –938 5. TH.A.Ternes. Water Res. 1998, 32, 3245 – 3260. 6. M.J.M.Bueno, A.Aguera, M.J.Go´mez, M.D.Hernando, J.F.Garci´a-Reyes
and A.R.Ferna´ndez-Alba. Application of Liquid Chromatography/ Quadrupole-Linear Ion Trap Mass Spectrometry and Time-of-Flight Mass Spectrometry to the Determination of Pharmaceuticals and Related Contaminants in Wastewater. Analytical Chemistry. 2007, 79, 24.
7. D.Löffler, J. Römbke, M.Meller and TH.A.Ternes. Environmental Fate of
Pharmaceuticals in Water/Sediment Systems.German Federal Institute of Hydrology, 2005.
8. D.Fatta, A.Nikolaou, A.Achilleos, S.Meric. Analytical methods for tracing
pharmaceutical residues in water and wastewater. Trends in Analytical Chemistry. 2007, 26, 6.
9. O. A. H. Jones, N. Voulvoulis, and J. N. Lester. Human Pharmaceuticals in
Wastewater Treatment Processes. Critical Reviews in Environmental Science and Technology. 2005, 35,401–427.
10. M. Petrovi´c, M. D. Hernando, M. S.D´iaz-Cruz, D.Barcel´o. Liquid
pharmaceutical residues in environmental samples: a review. Journal of Chromatography A.2005, 1067, 1–14
11. C.Prasse, M.P. Schlüsener, R.Schulz, and TH.A. Ternes. Antiviral Drugs in
Wastewater and Surface Waters: A New Pharmaceutical Class of Environmental Relevance?. Environ. Sci. Technol. 2010, 44, 1728–1735.
12. M.Gros, M.Petrovi´c, D.Barcel´o. Development of a multi-residue analytical
methodology based on liquid chromatography–tandem mass spectrometry (LC–MS/MS) for screening and trace level determination of pharmaceuticals in surface and wastewaters. Talanta. 2006, 70, 678–690.
13. Sh.Yang, J. Cha and K.Carlson. Quantitative determination of trace
concentrations of tetracycline and sulfonamide antibiotics in surface water using solid-phase extraction and liquid chromatography/ ion trap tandem mass spectrometry. Rapid Commun. Mass Spectrom. 2004, 18, 2131–2145.
14. Th.A.Ternes. Analytical methods for the determination of pharmaceuticals
in aqueous environmental samples. Trends in analytical chemistry. 2001, 20, 8.
pharmaceuticals in wastewater and rivers by liquid chromatography– electrospray tandem mass spectrometry. Journal of Chromatography A.2001, 983, 175-185.
16. S.Terzic, I.Senta, M. Ahel, M.Gros, M. Petrovic, D.Barcelo, J.Müller,Th.
Knepper,I.Martí, F.Ventura, P. Jovancic, D.Jabucar. Occurrence and fate of emerging wastewater contaminants in western balkan region. Science the total environment. 2008, 399, 66-77.
17. A.Nikolaou, S.Meric, D.Fatta. Occurrence patterns of pharmaceuticals in
water and wastewater environments. Anal Bioanal Chem. 2007, 387, 1225– 1234.
18. E.Vulliet, C.Cren-Olive, M.Florence, G.Loustalot. Occurrence of
pharmaceuticals and hormones in drinking water treated from surface waters. Environ Chem Lett. 2009.
19. A.Nikolaou,S.Meric, D.Fatta. Occurrence patterns of pharmaceuticals in
water and wastewater environments. Anal Bioanal Chem .2007, 387,1225– 1234.
Responsabile UOS Anestesia e Analgesia Ostetrico-Ginecologica UOC Anestesia e Rianimazione per il Dipartimento Materno Infantile NAUSEA E IL VOMITO NEL POST-OPERATORIO La nausea e il vomito nel post-operatorio (PONV) hanno un’'incidenza che varia tra il 20% e il 30% in rapporto a fattori di pertinenza chirurgica e propri del paziente. Sebbene la profilassi routinaria sembrerebbe appropriat
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care practices based upon the available medical literature and clinical expertise at the time of development. They should not be considered to be accepted protocol or policy, nor are intended to replace